Patients should not “face charges for medically necessary care when a service would otherwise be covered if provided by a physician,” federal Minister of Health Mark Holland recently stated in his letter to provincial and territorial Ministers of Health on the importance of upholding the Canada Health Act. Starting in April 2026, the federal government says it will deduct any dollar paid “wrongfully” by Canadians for “physician-equivalent services provided by regulated health professionals, such as nurse practitioners” from federal health transfers.
This is an important move to safeguard medicare in Canada. Unfortunately, mental health and substance use health professionals seem to have been completely overlooked in the warning. By omitting them, the federal Minister has missed a golden opportunity to require provinces and territories to address long-standing gaps and inequities in access to much needed healthcare.
Mental health and substance use health professionals are a critical component of our health system. Physicians started to be able to bill provincial medicare plans for psychotherapy, an important treatment method for mental health and substance use health, soon after the Medical Care Act was passed in 1966.
The same services should be covered so long as the healthcare providers are regulated by statute, as physicians are, which would include psychotherapy provided by psychologists, social workers, psychotherapists, counselling therapists and occupational therapists. Provincial regulation of these providers started in earnest in the 1960s, and is almost complete today as the remaining five provinces work to regulate psychotherapy and counselling therapy.
So why not include them in the letter?
While we are at it, why not consider expanding medicare coverage to include certified peer support workers, as has been done across the United States — as well as certified addiction counsellors?
Expanded medicare coverage would go a long way to address longstanding gaps and inequities in access to mental health and substance use health services, which date back to the original exclusion of mental hospitals from hospital insurance in 1957 that was further entrenched in the Canada Health Act in 1984.
Today, many people in Canada still do not have access to needed mental health and substance use health services, with the ongoing impacts of the pandemic, the overdose crisis and the toxic illegal drug supply amplifying the gap between the needs of the population and the capacity of health workers to respond. Targeted federal health transfers are helping but are still falling short.
For mental health and substance use health to reach full parity with physical health, it’s time for it to be included in medicare through explicit inclusion in the Canada Health Act.
We understand that such a policy change requires a significant transfer from the private to the public purse, just as with recent steps towards medicare coverage for dental services and pharmacare. However, the case for public investment is rock solid.
Mental health and substance use health are the foundation of economic productivity as well the cornerstone of our health and wellbeing, and mental health and substance use concerns are each estimated to cost the economy close to $50 billion dollars a year.
Our research team has just released Toward a Mental Health and Substance Use Health Workforce Strategy for Canada that draws on international best practices, the latest evidence, and advice from a diverse cross-section of experts from provider associations, the public and private sectors, and individuals with lived experience. It’s time Canada explicitly include mental health and substance use health in our public health insurance plans.
A first step is within reach. We urge the federal Minister of Health to clarify that psychotherapy provided by regulated mental health and substance use health professionals be added to an expanded interpretation of the Canada Health Act. In so doing, the federal government would recognize that mental health and substance use health professionals have been providing psychotherapy that is at least equivalent to — and in many cases better than — what is provided by less specialized primary care physicians.
The United States, the UK, Australia and New Zealand all have national strategies for the mental health and substance use health workforce. Expanded public insurance coverage for psychotherapy should be the first step in the implementation of a ground-breaking mental health and substance use health workforce strategy for Canada.
Photo courtesy of Mholland2014 – photos is taken by me and can also be seen at www.voteholland.ca, Public Domain, https://commons.wikimedia.org/w/index.php?curid=4789240
