Is Therapy Covered by OHIP?

Ontario Health Insurance Plan (OHIP) is the publicly funded health insurance program in Ontario, Canada. It covers a wide range of medical services and treatments, including hospital stays, doctor visits, and certain (if not most) medical procedures. However, the extent to which psychotherapy services are covered by OHIP is limited and varies depending on the type of therapy and the individual's specific circumstances.

Let’s take a deeper look into what we mean.

Simply put, when it comes to therapy or counseling services, OHIP does not cover the cost of these services provided by the two most prevalent practitioners — psychologists or psychotherapists. This means that individuals seeking these services must pay for them out of pocket or seek coverage from a private insurance plan.

It is important to note that there are some limited services related to mental health that are covered by OHIP. For example, psychiatric services provided by a psychiatrist, such as the assessment and management of mental illness, may be covered by OHIP. However, these services are typically only covered when they are deemed medically necessary and are performed in a hospital setting. There are some limited exceptions, such as when psychotherapy is provided as part of a hospital stay, but this is not the norm.

In addition, some programs and services provided by community-based organizations, such as mental health clinics, may be funded by the government and provide services at no cost to individuals. However, these programs may have limited availability, long waitlists, and may not cover all types of therapy or counseling services.

The Waitlist Factor

In terms of waitlists, recent studies have found that the average wait time for children seeking community-funded treatment is 67 days for counselling and therapy and 92 days for intensive treatment. For adults, the average wait time is 118 days and can sometimes stretch to over a year in cases where specialized support is required.

The waitlists for OHIP-funded mental health services can vary depending on a number of factors, such as the availability of therapists, the severity of the patient's condition, and the funding provided by the government. To help address this issue, the government of Ontario has taken steps to improve access to mental health care, such as increasing funding for mental health services and providing support for the recruitment and retention of mental health professionals. However, it will likely take time for these efforts to have a significant impact on waitlists.

In terms of access to mental health services, a 2018 report from the Canadian Mental Health Association found that waitlists for mental health services in Ontario can be long, and that many people are unable to access the care they need.

With regard to the quality of care provided, a 2018 study from the Institute for Clinical Evaluative Sciences (ICES) found that the quality of mental health care in Ontario is generally good, with high levels of satisfaction reported among patients who received care.

However, these evaluations are just snapshots in time, and the quality of mental health care can vary greatly depending on a number of factors, such as the individual's needs and the availability of mental health services in their area.

OHIP & Access to Psychotherapy Services

With regard to therapy support provided by psychotherapists—or, talk therapy—most forms are not covered by OHIP. Some of the more popular forms of this include Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Narrative Therapy, Acceptance & Commitment Therapy, and various other couples and family approaches.

Because these are generally not covered when provided in a private practice setting, this means that individuals seeking these forms of therapy must pay for the services out of pocket or through private insurance. Some employers offer extended health insurance plans that cover therapy, and individuals may also be able to claim therapy expenses as a medical expense on their income tax return.

In our opinion, there would be several potential benefits to having OHIP cover psychotherapy. Some of these would include:

1. Increased access to care: If psychotherapy were covered by OHIP, it would become more accessible and affordable for individuals in Ontario who need it, reducing barriers to care and making it easier for people to receive the help they need.

2. Improved mental health outcomes: By providing access to psychotherapy, individuals would be better equipped to manage their mental health, reduce their symptoms, and improve their overall well-being. This can lead to improved mental health outcomes, and help prevent more serious and costly mental health problems in the future.

3. Reduced health care costs: By providing access to effective mental health treatments, OHIP could reduce the long-term costs associated with untreated mental health conditions, such as increased hospitalizations, disability claims, and lost productivity.

4. Improved quality of life: By receiving psychotherapy, individuals would be better able to manage their mental health and improve their quality of life. This can have a positive impact on their relationships, work, and overall functioning.

While implementing such a change would likely involve some upfront costs, it could lead to significant long-term benefits for individuals and society as a whole, and would undoubtedly alter the course of mental health treatment in Ontario.

Overall, while Ontario has made efforts to improve access to and the quality of mental health care, more work needs to be done to ensure that everyone has access to the care they need when they need it. One way to accomplish this would be by adding placing all mental health supports under the umbrella of OHIP and making it more affordable and accessible for the general public.