Inside London’s Mental Health System: Where Does It Go Wrong?

I’ve been navigating London, ON’s mental health system for five years.

I’ve switched therapists, psychiatrists, medications, and doctors, been tossed around by referrals, lain in hospital beds for days awaiting treatment, and seen some cold, condescending, uncaring, and overall, unhelpful practitioners. That’s not to say all mental health practitioners are bad. I’ve met a couple of very kind ones, but they were always an anomaly in my experience.

Unfortunately, my story isn’t unique, which is why I decided to speak to some Londoners between the ages of 18-24 years old who’ve accessed or attempted to access mental health services in the city. Over a series of three articles combining personal anecdotes, testimonials, opinions, and research, I’ll highlight their experiences. For their  privacy, interviewees will remain anonymous. This first installment will focus on the flaws of the mental health system from a Londoner’s perspective.

So, What Are The Flaws?

One of the more  noticeable shortcomings of London’s mental health system is its lack of accessibility. The issue of access breaks down into exorbitant costs and wait-times. The Ontario Health Insurance Plan (OHIP) covers mental health services provided by general practitioners, psychiatrists, and some services provided within government-funded institutions, such as hospitals. OHIP does not cover services provided by registered psychologists, social workers, and psychotherapists in private practice. It may seem like the easy answer would be to seek help from government-funded institutions, GPs, or psychiatrists. However, this isn’t always possible, nor is it the best option for people needing immediate or specialized support.

Inaccessibility: The High Costs of Getting Help

Before diving into that, though, let’s look at just how costly therapy can be, even with insurance or financial aid. An individual I spoke to opened up about this. She explained that her doctor had referred her to a psychologist while she waited to see a psychiatrist. This referral wasn’t exactly affordable because although her school offered $400 in insurance for therapy, each session was $180. In addition, the psychologist recommended they meet weekly to properly treat her, meaning insurance would cover only two weeks of treatment.

Another interviewee had a similar story. He explained that although his parents’ insurance covered therapy, he still couldn’t afford to go as often as he needed to (once a week).

I’m not covered by insurance, and so to see providers in private practice, my family has to pay out of pocket. I’ve seen practitioners charge $260 for almost two hour appointments, $140 for fifty minute appointments, and everything in between. The worst part is, I’m considered privileged in this case. My parents could afford for me to see practitioners in private practice. Not easily, and not weekly, but for several appointments. I’m lucky, but I still can’t afford regular appointments. As one participant said, “You either have the money to get the help you need, or you’re out of luck.”

Inaccessibility: Waiting Lists and Lack of Support

“So just see someone in a hospital or government-funded program,” you might say. I wish I could, but let’s talk about the absurd wait times. In 2018, I found myself in an emergency room for my mental health. I waited three days in the ER before I transferred to a different hospital for assessment. That is considered a short wait.

Once I was able to speak to a psychiatrist, they suggested a dialectical-behavioural therapy (DBT) program. They said it was vital I get proper support so I don’t end up back in the hospital. I asked to register for this program right away, and the staff informed me there was an 11 month wait list for it. Waiting lists were nothing new to me, and they’re still something I deal with now. Waiting at least half a year to get into a program or see a social worker is typical for many people. When you urgently need help, though, coping on your own for 11 months until there’s room is incredibly damaging.

One interviewee had a similar experience, waiting eight months for a DBT program. She added that the only reason her wait time was shorter than a year was because this was her 2nd time in the hospital. She explained that unless you’re in immediate crisis, you’re not seen as worthy of treatment. Other participants discussed their wait times being anywhere from a month to two years.

Having to wait for urgently needed help is harmful enough, but participants also talked about the lack of support available as they waited. An interviewee who waited five months for an intake appointment commented on feeling ignored. People knew they needed help, but nothing could be done, and no attempts were made to provide resources while they waited. Another interviewee also shared  a similar experience. She said the most difficult part of the process was that people knew she was unwell but left her to cope alone.

Uncaring Practitioners and Inadequate Services

“Either [mental health practitioners] don’t care or the system makes them not care,” one interviewee said to me near the end of our interview. Most participants acknowledged that it is often problems within the system which result in poor mental health care. Still, when a practitioner is condescending, rude, or apathetic, it harms the clients going to them. I’ve dealt with my share of practitioners infantilizing me or commenting, “I know it’s hard, but stop being anxious.”

Many of the individuals I interviewed felt discouraged from seeking help due to the way practitioners had treated them, the disregard the system had for them, or the stigma surrounding mental health. For example, one recalled a lack of any follow-up after an appointment with her school’s services where she admitted to feeling suicidal. The lack of support left her not wanting to seek help again. Another, who’d enlisted in the army at the time, recollected completing intake with a nurse who quipped, “I thought you army types were supposed to be tough.”

Interviewees expressed feeling lost in the system, not knowing where to go. One discussed a walk-in clinic advertised at her school. Supposedly, the guarantee was that students could see a counsellor on the same day they went. She went as soon as her classes were over, and the clinic told her she’d have to come wait in line the next day. Unable to book an appointment ahead of time, this would not be possible due to her class schedule. She also spoke of previous attempts to get help on-campus, to no avail, including when a student in her residence had passed away. She called the resources offered “symbolic” more than helpful.

One interviewee touched on a lack of survivor-centred approaches in the counselling he received for intimate-partner violence. Another commented on the impatience many counsellors overtly express during appointments, and many more participants spoke on how practitioners invalidated them, with one woman describing having to bring her parents to appointments for the counsellor to take her seriously.

What Does This Mean?

Altogether, it means that the mental health system is failing us. Every participant echoed that the system is underfunded, understaffed, and overwhelmingly in-demand. If the system does not undergo drastic change, it will continue to fail us. To end with a quotation from one individual, “we are actively harming our youth and children in this city by not giving them the help that they need. This will have consequences.”

This is Part One of a series by Teigan Elliott exploring the mental health system in London, Ontario. In Parts Two and Three, Teigan will investigate possible improvements to the system, as well as the unique experiences of queer and racialized individuals accessing mental health services.

Feature photo by Kristina Tripkovic.