Editor’s note: None of the past participants interviewed for this article were the author’s own patients. Each volunteered to share their experiences for the purposes of this piece.
By Joanna Cheek
Despite an escalating mental health crisis, many seats remain empty in new doctor-run mental health groups across the province.
In a time of such scarcity of access to mental health treatments, our team of family doctors and psychiatrists came together to bridge the gaping hole in services that British Columbians face when experiencing mental health challenges. But despite the measured effectiveness of our new mental health service, doctors are cancelling groups because of low referrals.
The problem? Not enough people know about it.
Prior to the pandemic, mental health conditions were the leading cause of disability in Canada, with one in five Canadians experiencing a mental health condition each year, and one in two Canadians affected by the age of 40 years, according to the Mental Health Commission of Canada.
Then Covid turned Canada’s long-standing mental health crisis into a catastrophe—coined the “echo pandemic” by the Canadian Mental Health Association (CMHA)—with over a third of Canadians reporting worsening mental health. Canadians reported counseling as their highest mental health care need, though it was the least likely to be met, reported the CMHA and Stats Canada.
With the costs of mental health services being a major barrier outside of the public health system, family physicians were left managing upwards of 80 per cent of people’s mental health care needs, the CMHA reported. A 2021 Canadian study showed that anxiety became the number-one reason for visits to family physicians, with anxiety and depression accounting for over 90 per cent of all virtual doctor visits in at least one region.
But the shortage of family physicians also reached a crisis point. A 2022 Angus Reid poll showed that nearly 60 per cent of British Columbians found it difficult to access a doctor or had no access at all, leaving people with mental health symptoms few publicly-funded options for treatment.
While we’ve been advocating for the government to publicly fund more non-physician mental health workers, we couldn’t wait for the slow process of systemic change. We needed to adapt how we offered our own services.
So, we decided to show it with our own feet: mental health treatment is important enough that doctors will use their limited resources to fill the gaps until more mental health services are created. One of our highest values as Canadians is health care for all, regardless of one’s ability to pay. Mental health cannot be excluded from this.
In 2015, we came together to create the Cognitive Behavioral Skills group program to offer equitable, accessible, and timely evidence-based mental health treatments for early intervention on a large scale. With startup funding from the Shared Care Committee (a partnership with the Doctors of BC and Ministry of Health) and the Victoria Division of Family Practice, we launched a collaborative project to see patients more efficiently in MSP-funded groups of 15 people.
Still, seeking help isn’t easy. Most people find the stigma of mental health challenges to be more debilitating than the symptoms of the conditions themselves. Stigma silences, and silence builds walls between us; rather than our shared vulnerabilities bringing us together, we often suffer alone.
The purpose of the group format is not simply to cut costs (although the numbers speak proudly: each person gets 12 hours of physician time in a group at the same cost to the system as four 20-minute counseling visits with their family doctors). Rather, the group itself is therapeutic.
“There’s so much stigma surrounding mental illness,” said a past participant (all names have been withheld to protect their privacy). “I still find it nerve-wracking to tell someone I have mental health issues because it’s a gamble: are they going to ‘get it’ or not? At CBT Skills, we all ‘get it’ because we’re all there for the same reasons.”
Another past participant agreed, stating, “To hear that other people in the group could identify with the things that I considered particularly damaged about myself really helped lessen my feeling of failure. For the first time in over a decade, I didn’t feel so alone.”
These groups empower patients with an eight-week curriculum of the best evidence-based strategies, drawing from CBT, dialectical behavioral therapy (DBT), acceptance-based therapy (ACT), and mindfulness to self-manage mental health symptoms.
Family physician Dr. Oona Hayes had been supporting her patients’ mental health individually in her clinic. However, at times she felt they needed something more.
“I found it hard because some patients needed much more background information and understanding about the way the mind works,” she said. “Also, I see so many people who struggle with their mental health that I felt I was always repeating myself. When I was approached about this project, I was excited about the opportunity to more efficiently teach skills around how to manage our inner experiences and live a fulfilling life.”
Our continuous evaluations show that participant wellness scores improve on par with medications and individual CBT therapy—both considered gold-standard treatments for depression and anxiety.
Because of its local success, the Shared Care Committee funded the provincial spread of the project in 2020 to train over 100 doctors across the province, allowing us to offer these groups both in-person and virtually. This expansion also allowed us to offer affinity groups for participants who feel more comfortable in groups with shared experiences, such as those specific to age or gender, and other lived experiences including 2SLGBTQIA+ people, people of colour, cancer survivors, pregnant people, and new parents.
While the program is offered in English at this time, handouts have been translated to multiple languages, and new physician facilitators are being trained to offer groups in a variety of languages.
The program offers a range of additional groups, all available to participants through one referral by a primary care provider. Once a participant completes the foundational CBT course, they are then offered “level 2” groups such as CBT for insomnia, mindfulness, and boosters (including self-compassion, values, cognitive change, and skills for avoidance, perfectionism, and procrastination).
There’s also a Raising Resilient Kids group that teaches parents and caregivers skills from child development, mindfulness, attachment, and reflective parenting, and an ADHD Skills for Success group offering adults strategies to help manage their symptoms of ADHD.
“Honestly, I have been so happy with what this group has done for me that I talk about it all the time,” said a past participant. “I have talked to my family, friends, and staff about various aspects of it, because I feel that the information taught in this course can be beneficial for anyone, not just those suffering with anxiety and depression. It really changed my life. I feel so much more confident in my ability to deal with any obstacles that come my way.”
Another said: “I left the last session feeling proud of myself and feeling empowered. I wish everyone fighting anxiety and depression could be offered these classes.”
We do, too. With 397 different groups offered by physicians across the province this year, new participants can start attending with little or no wait time.
Dr. Joanna Cheek, is a psychiatrist and clinical associate professor at the University of British Columbia’s Faculty of Medicine.