Mental health is a tricky thing. We all have rough patches in life when everything feels off balance. But at what point should you reach out for professional help? And what options even exist?
If you live in Ontario, you’ve probably heard of OHIP – the Ontario Health Insurance Plan. It covers doctor’s visits, hospital stays, and some prescription drugs. But does it cover that form of help so many of us desperately need these days? What about therapy and counselling?
Talk therapy comes in many shapes and sizes. Your stereotypical counsellor is listening to you vent on a leather couch. But you’ve also got more modern options like cognitive behavioural therapy, which teaches you new thought patterns. Or group counselling sessions where you realize you’re not alone.
The big question is, will it be covered if you’re an Ontario resident looking to try one of these psychotherapy approaches to improve your mental health?
Unfortunately, as with most aspects of healthcare, the answer is…complicated. While OHIP does cover some mental health services, it doesn’t include everything.
This article will explain exactly what types of therapy and which mental health professionals are covered. We’ll also explore options if you need help but don’t qualify for public funding. Our goal is to clarify this confusing topic so you can make the best choices for your mental health!
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Types of Mental Health Professionals
When it comes to mental health care, there are many letters after people’s names. And each combination unlocks something different in terms of OHIP coverage. Let’s break down the most common providers of talk therapy and counselling:
Psychiatrists
These are medical doctors who specialize in mental health after finishing med school. Psychiatrists can prescribe medication and diagnose illnesses like depression or bipolar disorder. They often work alongside therapists for a comprehensive treatment approach.
The excellent news is that OHIP covers psychiatry appointments. The bad news is that they focus on meds, not talk therapy.
Psychologists
After completing a PhD in psychology, these providers are experts in human thoughts, feelings and behaviours. Psychologists can not prescribe medication. Their focus is evaluating mental health concerns and providing different forms of counselling and therapy.
Their services are likely covered if they work in hospitals or public clinics. In private practice, you’ll be paying out-of-pocket.
Psychotherapists
Psychotherapists have training in psychotherapy approaches like CBT, EMDR, DBT, Lifespan Integration, Internal Family Systems, Gottman Method and psychoanalysis. They have master’s degrees and are registered with Ontario’s College of Registered Psychotherapists.
Like psychologists, office visits are only covered if they work in a public setting.
Social Workers
These providers have master’s degrees in social work (MSW) and broad education in mental health, relationships, and community services. Social workers serve all ages and backgrounds and provide counselling plus practical support.
Their services through hospitals, clinics, schools and agencies are OHIP-eligible. Private practice therapy is not covered.
Family Doctors
Some family doctors and nurse practitioners offer mental health counselling as part of primary care. They can refer patients to psychiatrists or prescribe medications. Their medical background gives a unique perspective.
Counselling from a family doctor or nurse is covered by OHIP. However, their time is limited, so they may only do brief sessions or medication management.
I hope this breakdown gives insight into the key players in talk therapy and how OHIP factors in! Let me know if you need any clarification at all.
Settings of Care
Alright, we’ve covered the different mental health professionals. Let’s talk about where they practice because that also affects OHIP coverage.
There are two main categories when it comes to therapy settings:
Publicly-Funded
These are government or community-funded organizations like:
- Hospitals – Psychiatrists and other providers offer counseling here
- Community health centers – Offer mental health and addiction services
- Family health teams – Doctors, nurses, therapists under one roof
- Schools and universities – Counsellors for students
- Shelters and residential programs – Support vulnerable groups
The critical thing these settings have in common is that they receive public funding from the government. That means their services, like psychotherapy and counselling, are covered under provincial health insurance.
So, if you can find a therapist who practices in one of these public settings, your appointments will be included in your OHIP coverage.
Private Practice
On the other hand, you have private practice clinics and offices. These include:
- Individual or group practices
- Private psychology, therapy and counselling centers
They operate as independent businesses without government funding. So, visits to providers in private practice will not be covered by OHIP.
You’ll be paying session fees out-of-pocket or submitting claims to private insurance.
The setting truly makes a difference when it comes to coverage. I’d suggest asking any potential therapist whether they are publicly or privately funded. This will give you clarity on what to expect cost-wise from working together.
Types of Therapies
Now that we’ve covered the providers and places let’s get into the good stuff – what treatment will you receive?
There are two main branches when it comes to therapy:
Medication-Based
Psychiatrists primarily offer this. It involves prescribing medications like antidepressants, antipsychotics, or mood stabilizers to improve mental health concerns like depression, anxiety, OCD and more.
These medication management appointments are covered under OHIP. But the prescriptions themselves may not be – it depends if you have additional coverage.
Talk Therapy/Psychotherapy
This encompasses meeting regularly with a provider to discuss your emotions, experiences, relationships and patterns of thinking or behaviour. There are lots of modalities:
- Cognitive behavioural therapy – Identify unhelpful thought and behaviour cycles
- Psychoanalysis – Analyze how past events impact you now
- Group therapy – Share experiences and insights with others
- Art therapy, play therapy – Get creative in healing
- And many more therapy modalities!
What’s covered depends on the provider and setting – psychiatrists and publicly-funded options are OHIP-eligible. Private practice therapists are not.
Paying for Psychotherapy
Let’s get down to the nitty gritty – how do you pay for therapy if OHIP doesn’t cover everything? There are a few options:
A. Public Funding
This refers to coverage through government-funded programs like OHIP in Ontario.
What’s Covered:
- Appointments with psychiatrists
- Counselling from providers in public settings like hospitals, community health centers, schools, etc.
- Type: Mostly medication management and brief therapy sessions
To Access: Make sure you are an eligible OHIP member, then ask your family doctor for referrals or research public settings directly.
Considerations: OHIP covers the basics, but limited appointment times and long waitlists are expected.
B. Private Insurance
Private plans include benefits offered through:
- Employers
- Student health plans
- Individual private plans
What’s Covered:
- It varies, but many plans cover therapy costs by psychotherapists, social workers, etc.
- Type: Talk therapy, CBT, counselling, etc.
To Access: Determine your coverage, then find a provider who takes your insurance.
Considerations: It takes pressure off out-of-pocket costs, but coverage varies.
C. Out-of-Pocket
Paying session fees directly to private practitioners who don’t take insurance.
What’s Covered:
- Get the therapist and therapy type you want.
- Costs: $160-250 per session is average, but many offer sliding scale fees.
To Access: Research therapists in private practice and ask about their rates.
Considerations: Most flexible but most expensive. Look for sliding scale options.
There are pros and cons to each system. Knowing your options, you can find the right fit for your needs and budget! .
Accessing Care
Alright, you’ve decided you want to start therapy or counselling. How do you find and access care?
If you want to use your OHIP coverage, here are some steps:
- Get a referral to a psychiatrist or OHIP-covered therapist from your family doctor. This may involve a waitlist.
- Search for providers like social workers and psychotherapists who work in hospitals, community health centers, and family health teams in your area. Reach out to them directly about wait times and making an appointment.
- Ask your school if they have counsellors available for students. Same for your workplace’s employee assistance program.
- Have patience. Wait times in the public system vary but can stretch weeks or months. Persistence pays off.
If you’re looking to pay privately or use insurance coverage, you’ve got more flexibility:
- Search online directories to find local counsellors, psychologists, therapists, etc., in private practice. PsychologyToday is a good directory.
- Check with your insurance. Ask what mental health providers and services are covered in your plan. Then, find someone who takes your insurance.
- Ask providers about the cost. What is their full fee? Do they offer a sliding scale or reduced rate if paying out-of-pocket?
- Consider virtual sessions to expand your options. Many therapists offer online counselling via video chat.
- Prioritize your needs. Don’t settle – find a provider and approach that fits your budget, preferences and therapeutic goals.
Key Takeaways
We hope this article sheds light on the ins and outs of accessing mental health care through OHIP versus privately in Ontario.
The key takeaways:
- OHIP covers psychiatrist visits and some public clinic options.
- Most therapy and counselling require private payment or insurance.
- Know your options – public funding, private insurance, out-of-pocket.
- Ask providers upfront about payment methods to avoid surprise costs.
- Have patience, but don’t settle – find the right therapist and approach for your needs.
Prioritizing your mental health is brave. You deserve clarity on your care options and benefits. Now that you understand OHIP coverage and beyond, you can make informed choices to find the support you need.
Frequently Asked Questions (FAQs)
- Psychiatrists - As medical doctors, their appointments are covered.
- Social workers, psychotherapists, psychologists - If they work in public hospitals, clinics, health teams, etc. Not private practice.
- Family doctors and nurses - Brief talk therapy and counselling.
Unfortunately no. While their services would be covered if they worked in a public health setting, therapy from privately practicing clinicians is not covered by OHIP. You would need private insurance or pay out-of-pocket.
OHIP mainly covers brief, medication-focused talk therapy from psychiatrists. More in-depth modalities like CBT, DBT, psychoanalysis, etc., would only be covered if provided by certain practitioners in public settings. Private practice therapy is not eligible.
Private insurance benefits or paying out-of-pocket for personal practice therapy can significantly reduce wait times compared to public options. You can quickly start therapy with the provider of your choosing.
If the virtual therapy is provided by an OHIP-eligible practitioner like a psychiatrist or publicly-funded therapist, then yes. Purely private practice online counselling is not covered.
Look for therapists offering low-fee or sliding scale options. You can also inquire about pro bono spots at community clinics. Student therapists may offer reduced rates.
Know your coverage and payment options, research therapist specialties and compatibility, and ask providers upfront about costs - this will set you up for success!
If provided by a psychiatrist or eligible public practitioner, then yes. Purely private practice couples/family therapy is not covered.
Pareen Sehat MC, RCC
Pareen’s career began in Behaviour Therapy, this is where she developed a passion for Cognitive Behavioural Therapy approaches. Following a Bachelor of Arts with a major in Psychology she pursued a Master of Counselling. Pareen is a Registered Clinical Counsellor (RCC) with the BC Association of Clinical Counsellors. She specializes in CBT and Lifespan Integrations approaches to anxiety and trauma. She has been published on major online publications such as - Yahoo, MSN, AskMen, PsychCentral, Best Life Online, and more.
