MH – Lesson 4 – Overcoming barriers to accessing professional mental health care

In recent years, virtual care has become a common way to access mental health care. Virtual mental health care is convenient and allows individuals to work directly with qualified mental health providers in the comfort and privacy of their homes (or other settings when privacy can be assured). This is often valued for people with arthritis who may face mobility challenges, live in remote areas, or are experiencing disease flares.

Through extensive work from Arthritis Consumer Experts and others in the community, we are learning who benefits most from virtual mental health and when it may not be a good fit. For instance, a 2021 Arthritis Consumer Experts’ national survey ^4,5 found that people living with arthritis who identified as Black, Indigenous and people of colour were:

• more likely to experience factors that made it difficult to use virtual care;
• more likely to not have access to virtual care services; and,
• less likely to be very satisfied with their virtual care experiences.

Many new technologies are available to help ensure remote care can be offered safely and effectively. Specialized virtual mental health solutions provide secure options for receiving care and are increasingly available through employers, community centres, federal and provincial health systems, and other local resources.

However, easier access to mental health care has also introduced new concerns. Since the onset of the COVID-19 pandemic, shortages in qualified mental health professionals have grown significantly in Canada. Virtual care made it easier for people without proper training to offer “health coaching” services. It is important to realize that the term “therapist” is not protected by law – anyone can call themselves a therapist.

There are several things you can do to ensure that any mental health provider you may choose to work with – virtually or in person – is appropriately trained and qualified. Qualified mental health professionals must be licensed by a regulatory board and remain “in good standing” in their province or state to practice independently. Look for credentials such as PhD or PsyD for psychologists, MSW for social workers or MA/MEd for counseling psychologists. Increasingly, individuals who are in training are becoming licensed, and are called “qualifying psychologists” or “licensed interns.” However, not all insurance will cover services provided by such trainees, so it is best to check first if you will be seeking reimbursement.

Individuals with deep clinical experience and assessment skills will have a terminal degree such as PhD, PsyD or DSW. Psychiatrists are medical doctors who have completed subspeciality training in psychiatry. However, given the worldwide workforce shortages, and trends over time for psychiatrists to work with more severe and complex mental illness (e.g., schizophrenia, bipolar disorder, severe depression), wait times to see a psychiatrist are often long. In Canada, generally to see a psychiatrist, you must be referred by a family doctor.

Many mental health professionals are well equipped to support individuals living with arthritis. Licensed Psychologists (PhD, PsyD with subspecialties in clinical, counseling, or health) can help people with arthritis by providing tools to manage stress, cope with chronic pain, and address emotional challenges like depression and anxiety, improving both mental well-being and overall quality of life. Social workers (MSWs) can help people with arthritis by offering emotional support, connecting them to community resources, and guiding them through practical and psychological challenges that affect their mental health and daily life. They are well positioned to help with crisis interventions and address social determinants of health such as housing, income and disability services.

Licensed counselors and psychotherapists (MA/Med) can provide guidance, education, and support; often, they may be in training for PhD/PsyD or work under the supervision of these individuals. You can verify that the license of any qualified mental health professional is active and unrestricted (i.e., no disciplinary actions or complaints pending) by checking the public online registers or calling the local licensing board.

Although members of the clergy are not typically licensed mental health professionals, there is a growing movement for some to receive additional specialized training to offer supportive counseling, particularly in areas related to grief, stress, and spiritual well-being. They can be valuable sources of emotional and spiritual support and often can help connect individuals with professionals who are trained and qualified to provide mental health services.

Another option is to use trusted directories such as Psychology Today (Canadian), the Counselling and Psychotherapy Association (CCPA), Canadian Professional Counsellors Association (CPCA) and Inclusive Therapists Canada – these groups are also available to connect people with appropriately qualified and licensed professionals. For low-cost or sliding-scale options check out the Affordable Therapy Network (ATN). Federal sources include Wellness Together and the Mental Health Commission of Canada. Indigenous Services Canada lists mental health programs and services for First Nations and Inuit communities. The Hope for Wellness Help Line offers free 24/7 support to all Indigenous peoples across Canada.

Licensed professionals generally offer both virtual and in-person services and are required to ensure that adequate safeguards are in place to ensure all virtual conversations are private and secure.