Mental health and substance use health workforce needs policy attention

Mary Bartram and Kathleen Leslie

More than one in three Canadians report serious mental health concerns, and one in four report problematic substance use, according to the most recent data from the Mental Health Commission of Canada and the Canadian Centre on Substance Use and Addiction.  These are staggering numbers.

The impacts of the global pandemic on the mental health and substance use of the Canadian population are proving to be complex — and persistent. The mental health and substance use health workforce is the backbone of the critical response but is at risk of being overshadowed by the crisis in the broader health workforce.

Regulation of this field would help provide Canadians with more equitable access and enable needed critical workforce planning. The federal government has an important role streamlining this process in partnership with the provinces and territories — and in creating a new national health workforce registry, which would help the health system as a whole.

Mental health and substance use health counselling in some parts of Canada right now is a bit of a wild west. 

If you go to a regulated psychotherapist or counselling therapist in Nova Scotia, New Brunswick, Quebec, Ontario or PEI, you will know what kind of service to expect, who is providing it and what kind of accreditation they’ve received. You are also more likely to get these regulated services paid for by the province, or at least partially covered by your workplace benefits program if you are fortunate enough to have one.

But if you live elsewhere in Canada, many provinces and territories have yet to move forward with psychotherapy regulation. This means you won’t know what you’ve signed up for.

Some protections are in place through the voluntary certification and competency frameworks of provincial associations, but services from these providers may not qualify for public and private funding.  And from a health planning perspective, understanding the supply of these mental health and substance use providers is more difficult. 

In this way, the fragmented regulatory landscape for mental health and substance use health providers across Canada is undermining equitable access to services and inhibiting our capacity to undertake workforce planning.

Our current research, led by Athabasca University in collaboration with the University of Ottawa and the Mental Health Commission of Canada, is zeroing in on both key barriers and facilitators to these critical regulatory reforms. 

For example, progress in New Brunswick was helped by a unique approach. Since 1950, regulation for each new health profession in the province has been introduced through a private member’s bill rather than through the more complex public legislation used in other provinces.

In Alberta, proposed legislation to regulate the mental health and substance use workforce has been stalled since 2018 due to concerns about the impact on addiction counsellors and Indigenous practitioners, whose training and competencies draw more on lived experience and cultural knowledge.

We hear similar concerns from our partners in the peer support and addiction sectors, who have developed robust competency and certification frameworks but are wary of regulatory frameworks that privilege graduate-level professional education above other forms of lived knowledge and training.

In 2021, we held a virtual policy dialogue with diverse provider groups, frontline workers, and policy makers. Sixty participants from across the country met and identified a number of other key priorities that need immediate attention in this critical landscape. Firstly, they recommended better mental health and substance use workforce data collection.  They also recommend coordinated workforce planning that includes employment-based benefit programs and publicly-funded services.  They also stressed the need for increased diversity and cultural competence and access to regulation that recognizes lived experience and cultural knowledge.

So, what’s the solution?

Regulatory reform is needed urgently on two tracks. First, psychotherapy and counselling therapy should be regulated across the country as soon as possible.

Second, policy makers need to listen to the full range of providers to develop modern, flexible approaches to regulation and certification that work for the workforce as a whole.

A modern regulatory framework will be key for implementing federal commitments to develop mental health and substance use healthcare standards and ensure equitable access to high-quality services for all. 

Each province and territory could continue their own approach to workforce regulation. But there is also an opportunity for the federal government to spearhead a less fragmented approach by fully integrating flexible, modern workforce regulation into a new national health workforce registry.  This registry would facilitate robust workforce planning to help ensure the future workforce can meet the population’s needs. 

Regulation is a key priority for strengthening the capacity of the mental health and substance use health workforce. Next up, we need a broader health workforce strategy for Canada.

Mary Bartram is the Director of Policy at the Mental Health Commission of Canada.Kathleen Leslie is an Assistant Professor at Athabasca University.