It's high time to simplify our mental health referral system

Referrals to specialists in Ontario have a myriad of issues, including the lack of tracking, the dependence on fax, and the multitude of referral forms and pathways that are obstacles to effective, efficient referrals. However, in the mental health referral system, an additional barrier presents itself, with hospital-based outpatient psychiatry departments limiting their services to patients from specific geographic areas. This is an absurdity, particularly in Toronto where living on the wrong side of the street may preclude certain patients from accessing services. In my own practice, I’ve had complex patients who receive multiple medical services (e.g., cardiology, endocrinology, respirology) at the hospital they deem to be their home facility, yet they are denied access to mental health services—at that same hospital—because of their address. My colleagues have experienced even more ludicrous situations where patients have been refused outpatient mental health care from nearby hospitals, as they fall into gray zones that these hospitals claim not to service. While there is the argument that mental health services are in short supply and geographic limitations are needed to best parcel out the available care, other medical services that have very limited capacity (e.g., neurosurgery or ophthalmology) have no such restrictions. Though these specialties may deny referrals as their waitlists are too long, they impose no geographic-based limitations on accepting patient referrals. Read: What's the does-response relationship between exercise and depression? Such geographic restrictions suggest that these practices contravene the Canada Health Act, which states that to satisfy the criterion of accessibility, the province “must provide for insured health services on uniform terms and conditions and on a basis that does not impede or preclude, either directly or indirectly whether by charges made to insured persons or otherwise.” The current practice of turning away patients based on where they live, does not appear to meet this standard and limits patients in where they can go for care. To address some of the issues with accessing mental health, the Ontario Government Select committee on Mental Health Additions released a report 12 years ago that was critical of mental health in Ontario. It stated: “there is..no single organization responsible for ensuring that mental health and addictions services and supports are delivered consistently and comprehensively across Ontario.” The committee also proposed that a new umbrella organization be created to ensure that a single body is responsible for designing, managing and coordinating Ontario’s mental health system. Not until 2020 was this organization—the Mental Health and Addictions Centre of Excellence— set up under Ontario Health and as of yet, there has been no attempt to address the plethora of mental health referral systems and lack of coordinated care. Concurrent with the COVID-19 pandemic, demand for mental health services is increasing. While addressing the systemic barriers to accessing mental health in Ontario will take years, streamlining the referral system by doing away with geographic restrictions would be one, relatively simple, step towards improving access to mental health care for Ontarians. Dr. Aaron Harris is a family physician in Toronto, Ontario. Read: The importance of trauma-informed medication education

It's high time to simplify our mental health referral system

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