Pandemic shows that privatizing mental health services has been a failure

February 08, 2021

Montréal – The APTS (Alliance du personnel professionnel et technique de la santé et des services sociaux) has sent the health and social services minister, Lionel Carmant, an advisory opinion in the context of consultations about the next interministerial action plan for mental health. The APTS document, which includes nine recommendations, highlights the fact that mental health services have been chronically underfunded, with consequences that have been revealed by the pandemic: Quebecers are forced to look to the private sector to get services within a reasonable length of time.

The APTS also provides a critical analysis of Québec’s program for mental disorders (Programme québécois pour les troubles mentaux), which the government is presenting as a comprehensive solution for every problem associated with the delivery of mental health care.

“Lack of funding, and lack of appropriate recognition for the professions that provide care, have seriously undermined the public system’s ability to provide Quebecers with mental health services,” says APTS president Andrée Poirier. “Mental health problems have gotten worse because we don’t have the personnel we need to deal with the pandemic. The government is now acting in panic mode – the new money they’re investing is welcome, but it’s also too late, and clearly insufficient. Today we’re paying the price for years of negligence. When you see 75% of new psychology graduates heading for private practice, you know it’s time to set a new course.”

Representing over 30,000 employees providing psychosocial services in the public sector (including some 1,700 psychologists), the APTS believes the solution is to be found in improved working conditions that will make it possible to attract and retain the personnel needed to provide all Quebecers with free, high-quality care. And in fact, both Minister Carmant and Premier Legault have both recognized that salary conditions in the public sector are not sufficient to counteract a shortage of psychologists that has been apparent for years in health and social services institutions.

“It’s all very well to turn to the private sector in desperation, but in doing so, the government has offered conditions that are basically a knife in the back for thousands of employees asserting their right to better pay and greater professional autonomy,” says Poirier. “It’s encouraging professionals and technicians to head for the private sector, making the public system even more fragile. It’s a vicious circle, and we have to break out of it.”

As the union representing psychologists, psychoeducators, social workers and other workers providing mental health services in the public health and social services system, the APTS finds it hard to understand why Minister Carmant did not see fit to invite it to the public consultations held in January, especially since these consultations dealt with themes the union has consistently been interested in: the needs of the health and social services system, the multidisciplinary approach, access to services, and management of waiting lists.

“How can the government improve mental health services if the people who actually provide these services on the ground are excluded from exchanges? How does it think it will find better ways of organizing services between employees, and focus on prevention, without the participation of their union representatives?” says the APTS president. “If the government really wants to be diligent and improve mental health services, it needs to take the hand we’re holding out and become aware of the scope of our expertise.”

Québec’s national centre of excellence in mental health

The APTS is appalled by the government’s decision to quietly put an end to the Centre national d’excellence en santé mentale (CNESM) while waiting lists are exploding. The CNESM’s autonomy and independence enabled it to suggest new ways of organizing mental health services. It also played a key role in supporting multidisciplinary teams on the ground. The way the government tried to camouflage its move raises questions about its true intentions.

“We’re facing a mental health crisis, and the government can’t think of anything better to do than deprive the public health system of a key resource,” says Poirier. “It should have done exactly the opposite – reinforce CNESM staffing and increase its status. In the middle of a public health crisis, the government would certainly never dismantle Québec’s national public health institute. So why is this acceptable when mental health is involved? The government must reverse its decision and maintain the Centre’s independence and autonomy.”

The APTS
The APTS (Alliance du personnel professionnel et technique de la santé et des services sociaux) represents a total of 60,000 members who play a key role in ensuring that health and social services institutions run smoothly. Our members provide a wide range of services for the population as a whole, including diagnostic, rehabilitation, nutrition, psychosocial intervention, clinical support, and prevention services.