Keith Bundock isn’t sure when his life started falling apart.

He might’ve been 35, or maybe 40. During that time, his marriage was breaking down and his church was closing up. His support network was suddenly gone, and he was having odd, unsettling feelings of fogginess and confusion.

Even stranger, though, was that Bundock often didn’t feel much at all.

It wasn’t until a suicide attempt left him in a psychiatric ward that the east-end resident learned what was really going on: He was coping with severe chronic depression.

“Looking back, I can see little flashes of it throughout life — I didn’t understand it,” Bundock, now 53, recalls. “I didn’t associate what I was feeling with a mental illness.”

Once Bundock was diagnosed, he faced a new challenge: To get the treatment he needed, he had to navigate Ontario’s complex mental health care system.

With long wait times and an array of services available from different types of care providers, figuring out where to turn — and where to start — can be tricky when it comes to mental health care, experts say. There’s also a cost element, and determining how to pay for care is often another challenge for people coping with mental health issues, says the Canadian Mental Health Association.

Indeed, people often don’t know how to navigate Ontario’s “bewildering” mental health care system, says psychiatrist Dr. David S. Goldbloom, senior medical adviser at the Centre for Addiction and Mental Health. “And it’s probably a misnomer to call it a system, because that would suggest an organization of networks, and that’s not the case.”

Bundock agrees.

“Entry into the system can be, at best, a bit of a shock,” he says recalling his experience. “It’s not smooth and it’s not clear … we don’t know what our own needs are when we enter.”

For Bundock, being put into contact with a social worker at CMHA was a huge help.

“She was able to walk with me and explore things and was one of those people that would bring things to me that I didn’t know were out there,” he said.

The social worker helped Bundock access disability support as he underwent treatment with a physician.

“It took several years before I could get by without medication,” he says. “I learned the signs of what was leading me to depression.”

That support from his social worker was integral as Bundock began to rebuild his life. He moved into a rooming house and eventually took out a student loan to obtain a culinary degree from George Brown College.

He’s now working full-time running a food program, and volunteers at CMHA — his way of giving back to the organization that helped him stay afloat during one of the darkest times of his life.

“I volunteer to help people who are in the same place I was,” he says.

HOW TO GET HELP

Family doctor: A majority of people connect with mental health services through their family doctor but there are other ways to get mental health care.

“Family physicians are a common door 60 per cent of the time for people appearing with mental health issues,” says Steve Lurie, executive director with the Toronto branch of the Canadian Mental Health Association.

OHIP covers any care provided by a family physician. If the family doctor is part of a family health team, working alongside psychiatrists, social workers or other professionals, any services provided by professionals on the team would also be covered, Lurie adds.

“Family health teams and community health centres are based on rostering patients in a given area, so once you qualify to be served by that family health team ... you shouldn’t face waits,” Lurie says.

Specialists:

If your family doctor isn’t on a health team, or you need specialized mental health care beyond what they can provide, you might need your doctor to refer you to a psychiatrist. Or, if you can afford it, you can go through a private clinician like a psychologist or therapist.

Psychiatrists are medical doctors who can prescribe medication, and their services are covered by OHIP. A referral is required from your family physician, and Lurie says there may be significant wait times.

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Psychologists aren’t physicians and can’t prescribe medication, so they aren’t covered by OHIP. But they are registered health professionals, and private health insurance often covers at least a portion of their services.

There are also counsellors and therapists, who may have a background in social work. Again, they can’t provide medication, and people pay for their services out-of-pocket.

When it comes to services that aren’t covered by OHIP, Goldbloom says there is a “huge spectrum of costs,” since clinicians may have a sliding scale.

“Some people may get charged $10 an hour for counselling, because that’s all they can afford, while other people may be paying $300 an hour,” says Goldbloom. “For many people, costs of $100 an hour or more are simply unaffordable.”

Hospital:

Going through a hospital is another way to access care, if you can’t get it through a family doctor and don’t have benefits to pay for private treatment, Goldbloom says.

Every hospital has a psychiatry department, and it’s not exclusively for hospitalized patients; outpatient services are also typically covered by the umbrella funding of hospitals.

Lurie says you can call an ambulance to take you to the hospital if you’re having a severe mental health crisis, but he recommends contacting a specialized mental health crisis centre, like Toronto’s Gerstein Crisis Centre, instead.

Community organizations:

There are also free community resources available to help people navigate the mental health system and find affordable care.

“These are complex systems, and so having somebody to navigate and to advocate is always a help,” says Goldbloom.

Connex Ontario operates three help lines that provide health services information for people experiencing problems with drugs or alcohol, mental illness, or gambling.

There are also mental health organizations — such as the Canadian Mental Health Association, Mood Disorders Association of Ontario, and Schizophrenia Society of Ontario — that direct people to the right path for treatment.

How to access affordable mental health care in Ontario

Talk to your doctor about what you’re experiencing — and they can either treat you directly or get you a referral to a psychiatrist, both of which are covered by OHIP.

Go through your workplace employee assistance program if you have one. Check what types of counselling or other services are covered by your benefits plan. This could get faster access to services.

There is a community organization for just about any mental health issue in Ontario. These are all resources for finding affordable care. More broadly, there is a mental health helpline available through Connex Ontario (1-866-531-2600), and various services are provided by the Toronto branch of the Canadian Mental Health Association.