Understanding the Mental Healthcare Field and Coverage Options

Antidepressant Medication

In some circumstances, a doctor may prescribe antidepressant medications. Antidepressant medications are used to help relieve the distress of depression or anxiety and are sometimes also used to help with chronic pain. Antidepressants don’t work for everyone, and when they do work, they are most effective when combined with mental health therapy, physical activity, support from family or friends, and self-care (such as getting enough sleep). Antidepressants can take some time (weeks or months) to be fully effective. Early signs include improved sleep and energy, while mood improvement may take longer.  Many anti-depressant medications should not be stopped suddenly, but tapered off on the advice of a doctor.

Anti-anxiety Medications

Anti-anxiety medications can help reduce anxiety symptoms such as panic attacks. These medications can help reduce anxiety and make it easier to sleep, while they may also be used as a muscle relaxant or for treatment of seizures and alcohol withdrawal. The most common types of anti-anxiety medications, benzodiazepines, are also called minor tranquilizers or hypnotics.  For some people the effects of these medications can be achieved without drugs using other strategies. Exercise, meditation, and talking to a trusted friend, family member or therapist should all be tried first before using anti-anxiety medications. These medications are safe and effective when used appropriately but may also be abused and can be addictive. Therefore, they are usually used for short-term or occasional use only.

Below is a list of some of the different types of mental health therapies available.  For a more extensive list and further details, see https://www.psychologytoday.com/ca/types-of-therapy.  *Please note: The Arthritis Society cannot attest to the efficacy or validity of the many types of therapy available.  It is important to do your research before starting any new therapy.  Anyone providing mental health therapy should be using evidence-based practices of assessment and intervention, and applying them within their scope of professional practice

Talking therapies

Talking therapies can include various forms of counselling, psychological treatment and psychotherapy, amongst others.  They involve talking to a professional who is trained in helping you deal with your negative thoughts and emotions and who can help you make positive changes in your life.  Talking about your feelings can help you identify what’s bothering you and determine possible solutions.  Talking therapies provide people with an opportunity to examine how their thoughts and emotions can have an impact on their mood and behavior.  It can help reveal ongoing negative patterns and ways these patterns could be changed.  Gaining a better understanding of one’s thoughts and feelings through talk therapy can help individuals develop new ways of thinking and acting to make positive change, providing a greater sense of empowerment and confidence.   

Cognitive Behavioural Therapy (CBT)

Cognitive-behavioural therapy (CBT) is a practical, short-term form of psychotherapy. CBT helps people develop skills for becoming and staying healthy by developing a better awareness of the impact of our thoughts and behaviours on problems in day-to-day life. By helping people make sense of what is happening around them and adjusting problematic thinking patterns CBT can change a person’s perceptions of how they feel. CBT is usually time limited to 6-20 sessions and is goal-oriented.  There is some evidence to suggest that Cognitive Behavioural Therapy can be effective in helping to address chronic pain symptoms such as those experienced with arthritis.

Acceptance and Commitment Therapy (ACT)

Acceptance and commitment therapy (ACT) is a type of psychotherapy focused on action.  ACT involves learning to come to terms with our negative emotions and accept that these can be appropriate responses to circumstances and should not prevent us from moving on with our lives.  This type of therapy helps individuals accept the challenges they face and commit to making positive behavioural changes, despite their current situation or how they might feel about it.

Mindfulness is the practice of focusing awareness on what is happening in the present (including our thoughts and behaviours) in a non-judgmental way. This may sound simple, but in fact, most people find it challenging. Mindfulness meditation is a particular type of meditation which asks us to pay attention to our body and our sensory experiences, thoughts, and emotions, moment by moment. It helps us to remember to stay fully aware of only what is happening in the present, both internally and externally – with no bias and no judgement. Many resources, including books and videos, are available to help you with the practice of meditation. Many communities offer meditation or mindfulness classes through their school board continuing education programs or other organizations.

Progressive muscle relaxation (PMR) involves systematically tensing and then relaxing individual muscles. This technique can help you recognize in your daily life when certain muscles are tightened and can help develop your ability to consciously relax them. Over time this allows you to have better control over muscular pain. If you have heart health issues, check with your doctor before trying PMR. You can find an example of a PMR technique in our Mental Health online module.

Support groups are spaces where you can share experiences, learn from others and connect with people with similar experiences to yours. Some groups may be led by a mental health professional, while others might be a casual group of peers. Community health organizations may run support groups in your area, or you can look online. If seeking out a support group online, make sure it is a reputable group, ideally affiliated with a mental health organization. You can also learn about starting a support group on flourish.

Some community organizations, such as the Canadian Mental Health Association or your regional health centre/hospital, offer mental health services that are often freely available to local clients. To find out what is available, search “mental health services” on the internet and the name of your city, town or region to explore the options. There are also free online services available, such as Cognitive Behavioural Therapy programs or Mindfulness Meditation. Some of these are led by an instructor guiding the therapy or meditation through live or pre-recorded sessions, while others are self-led, providing prompts for you to follow You may need to register for a subscription to an online service to continue using it, while many provide some or all programs for ongoing free use.

Each province and territory has their own public health insurance plan which is supported by our taxes. When using public healthcare services, such as a hospital or medical clinic, you must show your health insurance card. All parts of Canada will provide free emergency medical services, even if you don’t have a government health card, but there may be restrictions depending on your immigration status. There is also an agreement between provinces and territories to use health services if you are not in your own region within Canada. Be sure to learn what your public health insurance covers, as each region may have different coverage of healthcare, and specifically mental healthcare. For instance, in many provinces, psychiatrists are covered by the provincial health insurance plan as long as a referral is made from your family doctor.

Private, or personal, health insurance plans provide additional coverage for health expenses and preventative care. In many regions, public health insurance may not cover prescription drugs, health practitioners such as counsellors or physiotherapists, and medical equipment. If you have private health insurance, it may cover these items in part or in full. Private health insurance may be available through an employer, a school, a family member’s employer, or another source. You can also purchase your own private health insurance. This insurance may include coverage of some types of mental healthcare.

An employee assistance program (EAP) is offered by some employers as a confidential, short-term counselling service for employees to help deal with life challenges. EAPs can offer help and suggestions with resolving difficulties in a person’s life, even if the source of the issues is not related to the workplace. Often, EAPs offer a range of services, usually connected with phone or internet-based access to mental health professionals, and referrals to other agencies or professionals as needed.

Individual, one-on-one or solo therapy involves only you and the therapist, which could be a psychologist, counsellor or psychotherapist. Individual therapy allows your therapist to build a relationship with you and understand – and address – your specific issues. This type of therapy is conducted in-person in a relaxing environment where only you and the therapist are in conversation. Through ongoing conversations, you and the therapist can address one or multiple issues, while the therapist may also call back to previous appointments and provide reminders on effective coping skills. In-person individual therapy can be more expensive than other delivery methods, but depending on the type of therapist, it may be covered by public or private insurance.

Group therapy involves one or more psychologists, counsellors, psychotherapists or others who lead a group of roughly five to 15 patients. Typically, groups meet for an hour or two each week. Some people attend individual therapy in addition to groups, while others participate in groups only. Group therapy may focus on a specific problem, or more generally focus on improving social skills or overcoming issues. Groups usually have a shared lived experience, allowing group members to serve as a support network that also holds you accountable. Group therapy may sometimes be available when one-to-one relationships are not feasible. In some cases, group therapy may be available at a lower cost than one-to-one therapy.

Mobile phone or tablet applications (apps) for mental health are often directly available for anyone to download. These apps might include monitoring symptoms, tracking treatment, or providing access to therapy and self care. It’s important to note than an app can offer incorrect or misleading information to patients, such as therapeutic treatments that may not be effective, or new interventions which are clinically unproven. Proceed with caution and look to mental health professionals for recommendations when seeking an app to use. These apps may be available for free, such as some daily meditation apps, or may have a cost associated with them.

Online or over the phone therapy, also known as virtual mental health or tele-mental health, is a growing field. A mental health professional provides consultation or counseling and support over the internet through email, video conferencing, online chat, or a phone call. Virtual mental health may be useful to individuals who cannot leave their home, who work unconventional hours, who are overseas or those who live in rural or remote areas. If using a video conference or online chat, check which platform is being used to ensure it is secure. Depending on the type of health professional, there may be a fee associated with this service, which may or may not be covered by public or private insurance.