There needs to be more access to counsellors, psychologists, and other therapists, particularly for patients who do not have the financial means. They provide essential services that the medical system (i.e., family doctors and psychiatrists) cannot offer. Full coverage is a bigger issue, but there are areas we can target now.
Expanding DBT
In particular, focused investment to improve access to dialectical behaviour therapy (DBT) groups would be invaluable. In DBT groups, patients typically attend weekly two-hour sessions for around 26 weeks and learn a wide variety of distress tolerance skills.
These skills help prevent stressors from escalating to the point they result in a crisis presentation to PES. DBT is the most effective treatment for many personality disorders (unfortunately named and oft-stigmatized). The ER or PES may defuse an acute crisis but is the wrong place to treat the underlying problem.
In Victoria, affordable DBT is scarce, usually only available through a group at USTAT. However, with limited capacity and wait times that have escalated from weeks to many months, that’s no longer a viable option for the majority of people who would benefit.
Making it Happen
Expanding DBT groups would require funding for several therapists. Each full-time therapist hired could handle several DBT groups in parallel. While this would divert resources from individual private-pay therapy available in the community, it would provide a much-needed treatment option and keep many people out of PES. Much more could be offered, but it’s a start.
Ideally, access to DBT groups would be similar to BCalm or CBT Skills groups (both run primarily by family doctors, not mental health), needing only a doctor’s referral. Both of these provide a great service accessible to many. Neither require dedicated funding, but are facilitated by doctors who bill group medical visits through MSP. However, that wouldn’t work for DBT, which would require hiring specifically-trained therapists; very few doctors have that training and are in very short supply as it is.
As with the above groups, expanded access to DBT groups doesn’t have to happen through VIHA. Issue an RFP and let private counsellors or counselling groups provide this service.
Related: see all Victoria posts here
