People seeking help with their mental and emotional health are often understandably confused about where they should go. Psychologists? Social Workers? Psychotherapists? Counsellors? Psychiatrists? What’s the difference? What’s covered by Ontario Health Insurance Plan (OHIP)? What’s free? What do I actually need and want? Here I try to explain how it works in Ontario. Or at least how I understand it. I’m happy to be further informed if you know more/different from what is below.
The system is complicated and dare I say it, underfunded, but there are good resources out there. So here goes…
What’s the difference between a Psychotherapist, a Counsellor, a Social Worker, a Psychiatrist and a Psychologist in Ontario?
Generally speaking, the difference is in training and approach to mental wellness. Some of these practitioners will work in community-based agencies, some in private practices.
|Title||Training||Regulating Body||Typical skill area/orientation|
|Psychologist||PhD or other Doctoral level degree (often research-based)||College of Psychologists of Ontario
||Psychologists can do more assessment (e.g. they can diagnose mental illnesses). Psychologists can work in agencies or in research environments, or in private practice. The therapy-focused work they do is similar to that of Psychotherapists.
|Psychotherapist||Masters level (MA – Masters of Arts, MSW – Masters Social Work, MEd. – Master of Education) usually.||College of Psychotherapists of Ontario (formed in 2015).
||Psychotherapists and Counsellors can either work in private practice or in agency settings.
|Counsellor||none specified though often counsellors have an Masters degree||Counselling is not a regulated profession in Ontario, so there’s no regulating body.
|Counselling is now a more general term applicable to many areas, e.g. volunteer post-partum counselling, credit counselling etc. Counselling used to be ubiquitous with psychotherapy but since the College of Psychotherapists came into effect it has changed.
|Psychiatrist||MD (Medical Doc) with specialisation in mental health||College of Physicians and Surgeons of Ontario||Psychiatrists are part of the medical system and covered by OHIP.
You need a referral from a GP to see a Psychiatrist typically. The Psychiatrist could be linked to the Doctors office (as in the case of the Hamilton Family Health Team approach) or through a department at St Josephs or another hospital.
Typically psychiatrists use diagnosis and medication when treating mental health challenges.
|Coach||May have a coaching certificate||None as such. Similar to counsellors (above).||
|MD Psychotherapist||A Medical Doctor (MD) degree plus additional training in psychotherapy||College of Physicians and Surgeons||
|Social Worker||BSW – Bachelor of Social Work, or a MSW -Masters of Social Work||Ontario College of Social Workers and Social Service Workers
||Can work in a private practice, an agency, a hospital, and other settings. Varied roles including psychotherapy, case management, resource finding, advocacy.
|Art Therapist||Registered Art Therapist (ATR). Masters-level degree.||Not a regulated profession in Ontario. Many are members of the College of Psychotherapists.||Art therapists can work in private practice and in agencies. Many work with children and many offer services in group format.
What’s the difference between psychotherapy and counselling?
Generally speaking counselling is more skills-based and short-term. Psychotherapy is more in depth, looking at the family in which you grew up, and bringing in the unconscious. In psychotherapy the relationship between the client and counsellor is particularly important, providing the basis for healing. That said the terms have (until recently in Ontario) been used fairly interchangeably, the difference resting in individual practioners.
In Ontario there is now a College of Psychotherapy, so anyone practicing the “act of psychotherapy” now needs to be a member of that college. Members of that college are now called Registered Psychotherapists. (I’m one of those).
What is covered under my extended health insurance?
Insurance plans differ a lot… even if you have the same provider as your neighbour, your employer has it’s own arrangement with the insurer. So check your coverage with your employer.
- how much is covered
- what providers (see above list) are covered
- when your coverage roles over each year
Since the College of Psychotherapists (my governing body) is new and the system is changing, it is also worth directly asking your employer if Psychotherapists are now covered. It’s only if there is demand from employees to the employers that insurance companies will start to cover RP’s services.
It’s often “Psychological Services” that are covered, which typically means Psychologists. Now, some Psychotherapists receive supervision through a Psychologist and can therefore bill through them. This is what I do to make my services more accessible. Talk to me if you are interested.
So if I’m struggling with my mood or mental wellness, and want professional help, who do I contact?
Good question.Your doctor may be the best point of initial contact if you are struggling. Doctors may prescribe medication (anti-depressants, anti-anxiety meds). They also ideally have the skills and sometimes time to listen to your concerns and refer you on as needed. Some doctors offices give access to Mental Health Counsellors (see below e.g. HFHT). There are also hospital or community-based support groups your doctor can refer you to.
Alternatively you can either pay out of pocket (see above fee estimates) or pay upfront and have your fees reimbursed by your extended medical insurance to access private psychotherapy. Either ask around to find a personal referral to a Psychotherapist, Social Worker or Counsellor in your community or check the searchable listing at Psychology Today.
Or if you can’t pay regularly (at least for 6-10 sessions) keep reading…
Where can I get free counselling?
If you are in Hamilton (Ontario) and want to talk to someone and you can’t afford the fees or don’t have extended benefits, here are some ideas:
- If your doctor is with the Hamilton Family Health Team (HFHT) or the McMaster Family Health Team you may be able to access counselling through the Mental Health worker at your doctors office. Both teams offer psycho-educational group support as well. Enquire at your doctors’ office.
- Call Coast Mental Health for support and/or local resources.
- Catholic Family Service provides walk-in counselling (fees based on income) and short term therapy ($90/hour) as well as other mental health and wellness programming.
- If you think you may “qualify” for some Mental Health services at St Joes there can be group or individual counselling available (many groups require a referral from your doctor)
- The Women’s Centre at Interval House offers some counselling and programming for women.
- Try accessing resources linked to your need (e.g. addiction, trauma, post-partum etc) or your sexual identity or culture or religious affiliation (e.g. queer, Muslim etc) and tap in to local supports that way.
- The Red Book lists all sorts of community supports that may be appropriate to your needs.
(I will keep building this resource list as I learn more, so feel free to email me with your ideas.)