What you need to know about psychiatric services

Even in this age of information, I still frequently meet people who are unaware that psychiatric services are fully covered under our provincial health care system.

I am often asked by patients how much my services will cost and even meet some who delay seeking treatment after being misinformed by a health care provider about whether psychiatric services will be covered.

All visits to a psychiatrist are paid for by your regular MSP coverage.

Services from psychologists, social workers and other counsellors are not covered unless they work for a mental health centre, hospital or sometimes a public school board. If you have extended health coverage through your employer or other insurance, these services may be covered in your plan.

Through the course of my daily conversations with people, I also meet many who do not understand that a psychiatrist is a medical doctor. All psychiatrists have gone to medical school and taken the same basic medical training as your family doctor or any other specialist. It is after medical school that each kind of specialist takes extra training during a residency to specialize in a chosen area – whether it is surgery, radiology or psychiatry.

You must get a referral from a primary care physician to see any medical specialist – including a psychiatrist. This is how our health care system is set up and is required in order for the government to pay the specialist for his or her services. Referrals also have to be renewed every six months even if you have continued to see the psychiatrist on a regular basis.

There is no limit to the number of visits you can have during the year. However, the physician may impose a limit due to availability.

Due to physician shortages, there is usually a wait for service. At the same time, those with urgent need are usually given priority and may be seen surprisingly quickly.

Some psychiatrists specialize in certain age groups or conditions. For example, child psychiatrists usually only see those under the age of 17 and geriatric psychiatrists may only see people above some arbitrary age such as 75 years of age. The lower age limit for geriatric psychiatrists tends to be getting older as the population ages. General psychiatrists may see people of all ages. All psychiatrists educated in Canada have training for all age groups.

The vast majority of mental health care is provided by non-psychiatrists simply because the demand far exceeds what can be provided by the available number of psychiatrists. However, there are certain situations when a psychiatrist should be consulted.

Those with serious mental illness such as bipolar disorder or schizophrenia should almost always be followed by a psychiatrist although a family doctor should also be involved in managing other health problems. Mental illness is associated with poor physical health and shortened life-expectancy. If the individual is being seen infrequently by the psychiatrist, the family doctor may also be providing important psychiatric care under the direction of the psychiatrist.

Those with serious impairment of function and certainly anyone who is off work for psychiatric reasons for more than a month should be referred to a psychiatrist. Anyone who is suicidal or psychotic should be referred and most family doctors will not want to manage someone alone in these circumstances.

If you think you need to see a psychiatrist and it has not been recommended or suggested, you are within your rights to ask for a referral. Your primary care physician will consider the request and discuss your options with you.


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