The number of hours needed to start working as a psychologist seeing patients in Ontario could be slashed under proposed changes aimed at boosting the province's supply of the health professionals.
The College of Psychologists and Behaviour Analysts of Ontario (CPBAO), which regulates the professionals, says Ontario lags behind Alberta and Quebec in the availability of psychologists, leaving people to wait for care.
To address the gap, the college recommends Ontario "modernize" by cutting training hours to be licensed, ditching an oral exam and moving away from an ethics exam. Now, an advocacy group of psychologists is pushing back, warning people won't get the care they need ― and that the move could be riskier for vulnerable patients.
In October, the Canadian Institute for Health Information reported about one in 10 people waited four months or more for community mental health counselling between 2020 to 2024.
Ontario has about 1,600 mental health and substance use providers per 100,000 residents, fewer than many other provinces. Ontario's auditor general found intensive treatment for children and youth who experience impaired functioning because of their mental health problems was 105 days in 2023/24, up from 94 days the year before.
The need for specialized care comes as wait times for community mental health counselling can be longer for children and youth than adults.
Symptoms could go through the roofPsychologists diagnose and treat a wide range of patients and clients, including children, youth and adults with mild to very severe mental health issues and illnesses.
A psychologist licensed with less training might, for example, incorrectly diagnose a child with ADHD when they actually have PTSD and anxiety disorder, which can have similar symptoms to somebody who doesn't have experience distinguishing, said Dr. Jenn Bossio, a clinical and health psychologist in Kingston, Ont.
"If we incorrectly assume that somebody has ADHD and then that leads, let's say child getting prescribed a stimulant like an ADHD medication ... but they actually have PTSD and anxiety disorder, then it can make their symptoms go through the roof. It can make things much more dangerous."
Psychologists also point to the level of expertise they need to distinguish between memory loss from depression versus dementia that other mental health care providers don't assess.
When people deal with very severe mental health concerns, the risks are not insignificant and include higher risk of dying by suicide, prolonged or worsening disability, said Bossio, a spokesperson for the Psychology Advocacy Network.
Psychologists with a master's degree are effective, says Maryann Istiloglu. (Submitted by Maryann Istiloglu)'Unneccesary barriers'Removing unnecessary delays to get qualified professionals practising could help Ontarians of all ages have access to qualified, skilled, and competent psychological and behavioural care, the college says.
Tony DeBono, registrar and executive director of College of Psychologists and Behaviour Analysts of Ontario said currently, the province requires master’s-level graduates to complete four years of unevaluated supervised work experience, followed by a year of supervised practice before becoming a psychological associate. That's compared to one year of supervised practice in jurisdictions such as Alberta, Saskatchewan, Northwest Territories and the Yukon.
"This requirement creates unnecessary barriers, drives graduates out of Ontario, and conflicts with national labour mobility and free trade agreements," DeBono said.
Maryann Istiloglu, executive director at Ontario Association of Mental Health Professionals, supports the proposal for master's levels psychologists, which she called long overdue.
"I think it is the right step," Istiloglu said. "Psychologists who have a licence with the college are competent and are effective and really good in what they do."
Psychotherapy coverage and inequity concernsThe Mental Health Commission of Canada notes most people have to pay out-of-pocket for psychotherapy due to long waits for public services, while U.K. and Australia introduced country-wide programs that increased no- or low-cost access to psychotherapies for people living with mild to moderate depression and anxiety.
The Canadian Psychological Association has called for more workplace insurance coverage for psychologists. And a report by the Public Health Agency of Canada pointed to lack of public health insurance coverage for treatment of mental health conditions by non-physicians in all provinces and territories and access to employer-paid insurance as factors contributing to inequities.
The Canadian Psychological Association has said altering registration requirements for psychologists and psychological associates, including removing the doctoral standard it accredits, is not the way to go.
Lisa Votta-Bleeker, CEO of the Canadian Psychological Association, instead called for dialogue on investing in publicly funded institutions to address gaps in labour mobility and registration restrictions.
WATCH | Prescribing powers expand:Ontario is looking to expand what health-care professionals can do — from pharmacists prescribing more medications, to new roles for optometrists, psychologists and dental hygienists.Provincial health ministers discussed the ability of various health-care professionals, such as physicians, to work more easily in multiple provinces at their October meeting and closing news conference.
However, Ontario's health minister's office said the proposal to cut training hours was developed and put forward by the CPBAO.
"It is not the result of any government legislation, and we have no plans to make such a change," Ema Popovic, spokesperson for Ontario's health minister said. "The Scope of Practice consultations now underway apply to each regulated health profession at their current standards."
The college's consultations run until Dec. 9, with final consideration resting with the college’s board and Ontario's minister of health.