Psychotherapy in Alberta: Favorable Returns on Investment Resulting from Integrating Psychological Care into Primary Care Networks

Abstract

Untreated mental illness costs Alberta’s healthcare system an annual $2.3 billion in excess costs. These costs occur because many mentally ill patients are not properly treated. Rather than being treated in preventative methods, patients find themselves in more expensive hospital-delivered acute care. This issue is relevant in today’s policy realm because it represents a unique opportunity for the province of Alberta to realize large cost-savings, and to avoid hundreds of millions of dollars in excess costs to the provincial healthcare system. The relevant literature, family physician opinions, and various case studies illustrate how providing psychological care in an integrated manner is the most promising means of delivering a new program. Integrating such treatment into primary care facilities results in higher patient satisfaction, greater follow-up rates, superior patient recovery, and less mortality. Costs and cost-savings were determined for three different scenarios. Each scenario represents a unique way of delivering PCN-integrated psychological treatment. Scenario 1 offers internet-delivered therapy to all patients. Scenario 2 offers face-to-face therapy to all patients. Scenario 3 combines the two scenarios and offers a mixed model of internet-delivered psychotherapy for mildly mentally ill patients and face-to-face therapy for seriously mentally ill patients. Upon conducting the economic analysis, the Dunning Funnel, ROI and cost-savings estimates, and ease of project implementation were used to choose one recommendation: Scenario 2 was chosen. Scenario 2 offers returns on investment of approximately 434 per cent, and cost-savings of approximately $415,794,000. Costs for the Scenario are estimated at $77,455,521. Before Scenario 2 is fully scaled-up across the province, it is recommended that first it is implemented as a local pilot project – implemented in one PCN rather than in all of Alberta’s 42 PCNs. This will allow for more viable implementation and superior mitigation of financial risk. Furthermore, it will allow for shortcomings of the program to be solved before the project is fully scaled to the provincial level. Consultation plays an important role in this proposed integrated psychological care program. All directly involved healthcare practitioners, including: family physicians, psychiatrists, psychologists, social workers, and nurses, must all be heavily consulted. This must be done in order to gain valuable insight into how best to offer such a proposed program, as well as in order to gain the support of these powerful players in the healthcare community. Communication will play an important role during the implementation stage. A Director of Communications will need to effectively navigate and manage the media in regards to the implementation of Scenario 2. Eventually, funds may be reallocated from existing healthcare departments (such as the Emergency Department and inpatient services) to further finance the ongoing operations of Scenario 2. Better treatment of mental illness in Alberta represents a unique opportunity to save the province money – on the scale of hundreds of millions of annual dollars. All moral reasons for providing care to the ill aside, the financial savings from investing in mental health are the ultimate findings of this report.