By Samer Abughannam
Mental health. A term we now face on a daily basis. Mental health challenges are widespread across our country, affecting one in four to five of us. Facing a mental health challenge can interfere with our lives in many ways, compromising our ability to work, maintain relationships, care for our physical well-being, and much more. One in three Canadians reported to Ipsos that a mental health issue disrupted their lives in some way over the last year. The stress of our daily lives contributes to this - last year, almost half of the Canadian population felt stressed to the point where we felt like we could not cope with things (4th Annual Mental Health Checkup, 2018).
As you can imagine, this translates into major impacts on our society and the economy. According to a study prepared by RiskAnalytica on behalf of the Mental Health Commission of Canada, mental illness cost the Canadian economy near $50 billion in 2011 alone. This is not an issue that is disappearing over time. When we look at the root causes and trends in recent years, it's clear that this crisis is only getting worse.
Fortunately, in recent years we have seen increased awareness and reduced stigma towards mental health. However, that will only go so far. The much needed next step is to increase services and improve how they are provided.
The reality today is that many people are not receiving the care they need. I spent the majority of October & November of last year interviewing people to better understand why. I spoke with therapists, physicians, health system experts, and most importantly people who have sought help for themselves or their loved ones. Some recurring themes were:
1. Inadequacy of publicly funded/affordable options. While affordable or publicly funded options may be available, they are nowhere near adequate to meet our society’s needs. Waitlists of several months are not uncommon, and patient choice is very limited. Outside of the community setting or public system, psychotherapy is offered by regulated healthcare providers (Psychologists, Social Workers, Psychotherapists) in their private practice. Most employer benefit plans offer some level of coverage for psychotherapy, some more generous than others (kudos to employers like Manulife, Starbucks, and others who understand this gap and offer limits of $5K+/year for therapy). Finally, there is large variability in pricing, where sessions in Toronto can cost upwards of $225, creating confusion and uncertainty for those seeking care.
2. System fragmentation & inefficiency. Whether within the community or in private practice, the system is extremely fragmented. This fragmentation creates major access and navigation hurdles for the population. It also creates inefficiency in care delivery, at a time where we need every single bit of capacity we can use to meet the growing need.
3. Hassle & uncertainty in finding a therapist. From personal experiences and after interviewing many individuals on this topic, I learned that the process can be daunting and confusing for many. For those already suffering from mental health challenges, being faced with the additional problem of finding the right therapist can create a lot of uncertainty and anxiety. People spend days, and sometimes even weeks searching for a therapist while being overwhelmed with questions about credentials, what kind of therapy is best for them, what type of employer coverage they have, who is available, their work hours, and how much they charge. Even after finding a therapist and these questions are answered - it is not guaranteed that the therapist and patient will be the right fit. In this case, the patient must start at square one and face the daunting process again.
I must admit, when I started working on this project I had limited knowledge of how effective therapy can be, and what makes therapy successful. With the help of a trusted colleague, I was quickly pointed to this evidence:
- Psychotherapy works. Research has shown that 75-80% of people benefit from psychological treatment (see 2017 paper commissioned by the Mental Health Commission of Canada).
- Interpersonal factors are critical. Over 300 studies have shown the importance of interpersonal factors in driving positive outcomes in psychotherapy. This includes, among other factors: the patient-therapist alliance, collaboration, goal consensus, empathy, and cultural adaptation. Wamplod and Imel discuss this in detail in The Great Psychotherapy Debate.
So we have to ask ourselves, what can be done? How can we make sure those in need not only get treatment, but get the right treatment? It is from these questions that Layla was created, in an attempt to do our part in improving the situation. What if we could take the potentially weeks-long process of looking for a therapist, compress it into half an hour, reduce uncertainty while improving the chances of a strong patient-therapist fit prior to the first session? What if all this can be done in a way that helps clinicians grow their practice, work with clients that fit in their area of special interest, and reduce time spent on non-clinical work? What if we can create enough efficiencies to offer therapy at a below-market rate, and reduce the occurrence of poor client - care provider matches and unsatisfying client experiences? This is what we aspire to do.
I am very excited about Layla and the opportunity to empower others to take greater control of their mental health, bridging some of the gap between wanting care and getting it. We are still new, and we are learning. We have taken on an ambitious mission and I know we won’t be perfect. However, I am optimistic about the change that we can create and I look forward to collaborating with others to do so.