When an employee or dependent is facing a mental health challenge, the journey to treatment can be confusing. It can also be frustrating, as employees may submit claims for “counsellors” who are not eligible for coverage.

In a nutshell, core benefits plans (not counting wellness accounts) can only help foot the bill for health professionals who are registered with regulatory bodies (also referred to as colleges). Each province or territory has its own regulatory bodies for the various health professions, funded and governed by its respective government and legislation.

Psychiatry that is medically necessary is covered under the public system. However, as wait times for psychiatrists steadily grew—and are currently at one to two years—paramedical benefits under private plans have come to play an increasingly important role by providing coverage for one or more of the other registered providers: namely, psychologists, psychotherapists (which include clinical counsellors), professional counsellors, addiction counsellors and social workers.

Diana Garcia

Dr. Diana Garcia, CloudMD

“Many paramedical benefits added coverage for psychotherapists and social workers, in particular, during the pandemic,” notes Dr. Diana Garcia, chief psychologist at CloudMD Software & Services Inc., a preferred partner of Benefits Alliance.

A patient’s journey will often begin with the family physician, though an employee assistance program (EAP) can be an effective first responder. Given the low rates of treatment—the Centre for Addiction and Mental Health Services has calculated that only about third of people with mental health problems seek help—an EAP can be a vital, welcoming first point of entry for plan members.

While private plans may not cover all of possible registered mental healthcare providers, and some plans may require a referral from a physician, the pandemic has helped boost plan members’ awareness that their health benefits plan may be a reliable source of help. Here’s a breakdown of the similarities and differences between the registered providers, and why each can be important to meet the needs of plan members.

Psychiatrist

Psychiatrists qualify as licensed medical doctors in a four-year general medicine program, and then complete at least five more years of accredited training before the Royal College of Physicians and Surgeons of Canada (or, in Quebec, the Corporation professionnelle des médecins du Québec) certifies them as specialists.

As medical doctors, they can diagnose conditions and prescribe medications. Among mental health professionals, only psychologists share the authority to make a diagnosis. No other mental health specialist can prescribe medications.

Psychologist

Psychologists have extensive training – up to seven years on top of a four-year undergraduate degree. They will assess a patient, determine what difficulties are occurring, provide a diagnosis as appropriate, and then create and sometimes implement a treatment plan. Their psychological assessments offer valuable support to family doctors, most of whom aren’t trained in mental health diagnostics.

“Psychologists are best suited for more complex cases – so, more chronic, severe mental health concerns – than some of the other vocations,” says Garcia. “Their ability to assess and diagnose through the use of objective evidence-based measures allows for a comprehensive approach to treating complex cases, with a moderate to severe clinical presentation.”

Psychotherapist

Psychotherapists treat severe dysfunction related to long-term mental-health disorders. They have completed a recognized psychotherapy program at the master’s level and are registered by a regulatory body for psychotherapists.
Counselling by these professionals tends to focus on exploring and resolving problems, including employing talk therapy and treatment modalities such as cognitive behavioural therapy and dialectical behaviour therapy to address emotional difficulties.

“Psychotherapists require in-depth training and supervision which enables them to treat a variety of mental health concerns of a mild, moderate, and severe nature, based on their traiing and experience. As well, they are well versed in a variety of clinical interventions,” says Garcia.

Professional counsellor, addictions counsellor

Professional counsellors typically treat common mental health issues that are less severe and shorter in duration than those that require psychotherapeutic interventions. They treat such issues as personal growth, career development and emotional difficulties (e.g., in relationships).
Addiction counsellors are trained in all aspects of recovery from substance addictions or behaviour addictions: assessment, treatment, management and relapse prevention.

Social worker

A social worker may have an undergraduate or master’s degree in social work or an undergraduate degree in a different discipline plus a master’s degree in social work.

Historically, social workers responded to social issues such as racism, poverty or unemployment, with the goal of promoting social change and development. Today, many social workers provide therapy and counselling, working with individuals, families and communities to improve individual and collective well-being. They also often work in institutional settings such as schools and hospitals.

“Social workers fit well in the employee assistance program or student assistance program model, evaluating what someone needs and then helping direct them to different resources. Many have also pursued specialty training and supervision in clinical interventions in order to work in the more traditional therapy settings,” says Garcia.

More on coverage

Students in one of the regulated professions, generally supervised by a regulated professional, may be covered under a private health benefits plan. Otherwise, benefits plans tend not to cover services outside of these regulated professions. However, while providers such as youth service workers, autism support workers and financial counsellors may be unregulated, coverage could be made available through wellness accounts or government funding.

In the end, Garcia says connecting plan members and dependents to appropriate mental health care – including care beyond the first few sessions if needed – can lead to a decreased use of benefits, including disability benefits, and increased work productivity. She emphasizes that making these connections is an essential part of a preventative wellness plan.