Zully Samji has overcome a lot in his 47 years.

Abused as a child and plagued since adolescence by depression and anxiety, Samji has waded through a swamp of mental illnesses and addiction.

He says he has been diagnosed with bipolar disorder, borderline personality disorder, anxiety disorder and an eating disorder. He has fought alcohol, cocaine and crack habits, and is in recovery.

After three decades of mental health treatment, he has made some breakthroughs. But he says he still cannot find timely, affordable therapy.

“My experience in the mental health system — I have two ways of feeling about it,” says Samji. “I’ve felt supported at times and very marginalized at times as well.”

Samji is one of thousands of Ontarians caught between long wait times for publicly funded therapists and high costs for quick access to private ones.

The result is a two-tier mental health system, says Dr. Sylvain Roy, president of the Ontario Psychological Association.

“If you have money and can pay for services … you can see a psychologist overnight almost,” Roy says. “But if you don’t, you’re stuck on wait lists.”

Read part 1 of this series:Patients suffer over gap between physical and mental health care

In the summer, Samji wrapped up a 12-week course of OHIP-covered cognitive behavioural therapy, in which patients learn to modify their behaviour by challenging their troubling or irrational thoughts.

In October, he was referred to a new psychiatrist in North York.

Samji is now on a waiting list. He will not see this psychiatrist until May 2017, at which point his therapy will have been halted for more than eight months.

The most likely destinations for people seeking therapy are psychiatrists and psychologists.

Both are qualified to diagnose mental health conditions and provide talk therapy. The primary difference between the two professions is that psychiatrists are physicians. They can prescribe medication and, critically, their services are covered by OHIP.

There is, however, a major backlog of patients waiting to see psychiatrists.

The Ontario Ministry of Health and Long-Term Care does not currently track therapy wait times. But anecdotal evidence from patients, advocates and care providers suggests it can take weeks, months or even years to see a psychiatrist.

In 2014, the Ministry committed $2.75 million over three years to help the Centre for Addiction and Mental Health in Toronto, and three other psychiatric hospitals in Ontario, track wait times, find gaps in service and build frameworks for reporting and accountability.

The province is now working to create a standard definition of “wait times,” says Ontario Ministry of Health and Long-Term Care spokesperson David Jensen.

“Once a standardized definition for wait times is in place, wait time information will be collected, monitored and publicly reported for both in-patient and out-patient programs,” Jensen says.

Access to psychologists in private practice can be much quicker than access to psychiatrists. But psychologists, for the most part, are not covered by OHIP, and their fees can be prohibitively high for many patients.

The Ontario Psychological Association recommends its members charge $225 per session in private practice.

Roy says that amount reflects psychologist fees in the United States and the costs of office rent, staff salaries and other business overheads.

“Most psychologists that I know, especially who work with more vulnerable groups, tend to ask for $150, $160 per hour,” says Roy. “They want to have a fair rate.”

Many private psychologists will work pro bono or on a sliding scale for certain patients, says Roy, though it can be hard to find those less costly services.

A patient must find the psychologist they want to see, then contact them and ask for a discounted rate, which they may or may not provide.

“Ultimately the work is on the patient here to navigate the system, which adds to the complexity of the whole thing,” says Roy. “It’s a mess for everybody.”

Even reduced fees can be too pricey for some patients.

When Samji was working full-time, he found a therapist who charged $60 per session.

“Now I wouldn’t be able to afford it,” he says.

The Ontario government currently covers only minor subsidies for people trying to access private therapy.

People on provincial disability assistance or the Ontario Works financial and employment aid program can get coverage for the cost of their transportation to and from medical appointments, including therapy.

Jensen says Ontario has “committed to providing health benefits for children and youth in low-income families,” as part of its poverty reduction strategy. The province “will explore in consultation with key experts and stakeholders, long-term options to extend broader health benefits to all low-income Ontarians,” Jensen says, adding that the government will work with experts to determine what mental health services might be included in those benefits.

Many employer-provided healthcare plans offer some degree of coverage for therapy, says Dr. Karen Cohen, CEO of the Canadian Psychological Association.

“The challenge with those plans is that, often, the limits on the coverage are so low that it isn’t going to buy anyone a meaningful amount of treatment,” Cohen says.

Loading... Loading... Loading... Loading... Loading... Loading...

Dr. Kwame McKenzie, a psychiatrist who leads the Wellesley Institute think-tank on urban health, calls the situation “laughable.”

“They’ll give you $300 or $400, maybe they’ll give you $1,000. On the open market, $1,000 might get you five sessions, (but) if you need cognitive behavioural therapy, at minimum you’re going to be into eight to 12 sessions,” McKenzie says.

“It’s like they would cover cardiac surgery but you need a triple bypass and they’ll just do one of the arteries. It doesn’t make any sense.”

The CPA recommends that employers offer $3,000 to $3,500 of therapy coverage.

There are psychologists on salary at hospitals, whose services are free, but they’re plagued by the same long wait lists as psychiatrists, and their numbers are shrinking, says Cohen.

“When hospitals face their own public funding pressures, it impacts their own salary resources,” Cohen says. “More psychologists now, when they leave school and go into practice, they’re going into private practice, (not) public practice. And the minute you put it in the private sector it’s not funded.”

The backlog of patients waiting for affordable therapy could be alleviated with better oversight and organization in the mental health care system, says Dr. Vicky Stergiopoulos, physician-in-chief at the Centre for Addiction and Mental Health.

“(In Canada) in general, there is a little bit of inertia across the system,” says Stergiopoulos, who is also a faculty member at University of Toronto psychiatry department.

“There isn’t enough attention to flow, to really moving people on, graduating patients to other levels of care, to less care, or different types of care over time.”

She also stresses that psychiatrists and psychologists are not the only professionals capable of delivering effective treatment.

There is a wide range of professionals who cost far less than psychologists and can be valuable members of a mental health care team, Stergiopoulos says, offering social workers and nurses as examples.

“I think they should be available through either primary care services or general hospitals or specialty hospitals,” adds Stergiopoulos.

“It would be a wise investment to increase the number of inter-professional staff that deliver (mental health) intervention.”

Across Ontario, counselors with master’s degrees in social work or psychology provide free or low-cost therapy at “community-based” mental health organizations.

They are funded primarily by the Ministry of Health and Long-Term Care, which also helps fund a helpline and website called ConnexOntario to help direct people to mental health and addiction services in their area.

Gail Czukar who, as CEO of Addictions and Mental Health Ontario, represents over 220 of those organizations, says they are less costly than putting more psychiatrists or doctors of psychology on the payroll.

But community-based mental health resources have wait lists too.

“If somebody calls and they say, ‘Well it’ll be a month before you can see anybody,’ people get discouraged and that’s when they go and look for a private therapist at much greater cost,” Czukar says.

Increased government funding could help the organizations expand their services, she adds.

Czukar, McKenzie, Roy and others continue to call for greater commitment to, and spending on, mental health by governments.

“There needs to be a public ownership of mental health,” Roy says. “The Ministry of Health in every Canadian jurisdiction has to own up to the fact that mental health is a health condition.”

Note – January 11, 2016: This article was edited from a previous version.