Is Psychotherapy Covered by OHIP?

Ontario’s healthcare system can be very confusing. Canada offers free healthcare, but it does not cover everything.

Ontario’s provincial plan, the Ontario Health Insurance Plan (OHIP) does not cover many medications, glasses, and visits to the dentist, for example. These are usually paid through private or work insurance, or out-of-pocket.

Likewise, not all mental health services are OHIP-covered. While mental health is becoming more of a priority in Ontario, only some therapy-related services are publicly funded. Deciding to get therapy is hard, figuring out which services public healthcare covers should not be another headache.

So, is therapy covered by OHIP? The short (and annoying) answer is: sometimes.

The answer depends on the type of professional you are seeing, the service they are providing, and where they work.

As a therapist who’s been in the mental health field for years, I know that many people are confused about whether therapy is OHIP-covered. I’ve had conversations with people who assume that because therapy is a healthcare service, it must be covered by OHIP. Others assume that because a particular professional is not covered in private practice, they have no publicly funded options at all. Neither is quite right.

In this article I cover the following:

• Mental health services not covered by OHIP
• Mental health services covered by OHIP or publicly funded programs
• Where you can find publicly funded mental health services
• What to consider when choosing between public and private therapy
• Whether OHIP-covered services are right for you

Mental Health Services Not Covered by OHIP

Most therapy services are not covered by OHIP. 

Private offices are the most common therapeutic practices. If a therapist works for a private practice, they will usually only accept private insurance or out-of-pocket payments. This includes most psychologists, psychotherapists, and social workers.

This means that you can walk into a private therapy practice and see a fully qualified mental health professional, but OHIP will not necessarily pay for your appointment.

The prices and services offered by private offices range widely. Some therapists charge more than others, some offer sliding scale fees, some specialize in particular concerns or types of therapy, and some offer short-term therapy while others work with clients for years.

It is worth checking your work or private insurance before assuming that you have to pay the entire cost yourself. Depending on your plan, you may have coverage for psychologists, psychotherapists, social workers, or other mental health professionals.

This is something I encourage people to check before ruling out private therapy altogether. Sometimes people have mental health coverage through work and do not realize how much they actually have available.

Mental Health Services Covered by OHIP

There are a few different ways you may be able to access mental health services through Ontario’s public healthcare system.

These include:

• Psychiatrists
• Physicians who provide psychotherapy
• Mental health professionals working in publicly funded programs and institutions

The important distinction is that not every mental health professional is directly covered by OHIP in the same way. Physician services are generally covered when they are medically necessary, while other mental health services may be available through publicly funded programs.

Psychiatrists

Psychiatrists are medical doctors who specialize in mental health. Medically necessary physician services provided by psychiatrists are covered by OHIP.

They can assess mental health concerns, diagnose mental illnesses, prescribe medication, and provide ongoing medical care.

Seeing a psychiatrist does not necessarily mean that you will receive regular talk therapy. Many psychiatrists focus primarily on assessment, diagnosis, and medication management. Some may have shorter follow-up appointments to monitor how someone is doing with their treatment or medication. In some cases, psychiatrists will work alongside a therapist who provides the talk therapy component of treatment.

It is also important to separate the cost of seeing a psychiatrist from the cost of any medication they may prescribe.

OHIP coverage for physician services does not mean that every prescription medication is automatically covered. Prescription drug coverage is provided through different provincial programs depending on your age and circumstances. For example, OHIP+ covers eligible prescription drugs for people who are 24 and under and do not have private coverage, while the Ontario Drug Benefit program covers eligible people who are 65 and older and other qualifying groups.

If you are between 25 and 64, you may still qualify for prescription drug coverage through programs such as the Trillium Drug Program or other eligibility categories.

Physicians

Some medical doctors have training in psychotherapy. These physicians may offer psychotherapy services that are covered by OHIP when the service meets OHIP requirements.

This can be a useful option for someone who wants therapy but also wants to receive care from a medical doctor. However, not every physician who offers psychotherapy has the same level of psychotherapy training.

It is important to note that medical doctors are not regulated by the College of Registered Psychotherapists of Ontario. This means that while they may use the title ‘psychotherapist’, their psychotherapy training can vary.

This does not mean that a physician who practices psychotherapy is unqualified. It simply means that it can be helpful to understand their specific training and experience. If you opt for a physician who practices psychotherapy, consider asking them:

• How much experience they have practicing therapy
• What psychotherapy training they have completed
• Whether they have any formal certifications
• What types of mental health concerns they typically work with

These questions can give you a better idea of their background and whether their experience matches what you are looking for.

Government-funded psychologists, psychotherapists, and social workers

Psychologists, psychotherapists, and social workers may provide mental health services through publicly funded programs and institutions.

This is an important distinction; a psychologist or psychotherapist working in a private practice is generally not covered by OHIP, while the same type of professional working within a publicly funded program may be available without an out-of-pocket fee.

Community Health Centres are one example. These organizations provide primary healthcare and other services, including support for people experiencing mental health concerns.

Other publicly funded mental health services can be found through hospitals, community organizations, schools, clinics, shelters, and other programs depending on your location and eligibility.

The exact services available can vary significantly depending on where you live. Some programs may offer individual counselling, while others offer group therapy, short-term counselling, drop-in therapy, crisis support, or specific programs for certain mental health concerns.

This is one of the reasons that finding “OHIP-covered therapy” is not always as simple as finding a therapist whose title is covered. You also need to find out what services are actually available, whether you meet the eligibility requirements, and how long you may have to wait.

If you need help finding the right support, A Complete Guide to Finding Low-Cost and Free Therapy in Toronto may help.

Are OHIP-Covered Services Right for You?

When deciding whether OHIP-covered services are right for you, there are multiple things to consider.

I want to start by emphasizing that neither publicly funded nor private services are inherently better than the other. The right option depends on what you need, how quickly you need it, what you can afford, and what type of therapy or mental health support you are looking for.

Wait times

Publicly funded mental health services can have waitlists, although wait times will vary depending on the program, location, and type of service.

You may find a program that sounds like a great fit, only to find out that there is a long waitlist. Or you may find a program that has availability, but does not offer the type of therapy you were hoping for.

If you are looking for help now or soon, it may be worth considering both publicly funded and private options depending on what is available to you.

This does not mean that you need to spend hundreds of dollars a week on therapy. There may be lower-cost private options, sliding scale therapists, workplace benefits, or insurance coverage available.

Budget

A benefit of publicly funded mental healthcare is that you may not have to pay out-of-pocket for the service. This is obviously a huge benefit.

Therapy can be expensive. If you are going once a week, the cost adds up quickly. If you are already struggling with your mental health, adding another significant monthly expense can feel impossible.

If cost is a consideration, you may want to look into publicly funded or lower-cost therapeutic services. You can also look into your work benefits or private insurance. Check exactly which mental health professionals your plan covers, how much it covers per year, and whether there are limits on how much you can claim per appointment.

This is worth doing before assuming that private therapy is completely inaccessible. At the same time, I do not want to minimize the financial reality here. Even with insurance, you may still have to pay part of the cost yourself, and many people do not have insurance at all. If that is you, looking for publicly funded services is completely reasonable.

What Services You Need

It can also help to think about what kind of support you are actually looking for.

Some people may be looking for medication or a psychiatric assessment, while others may be looking for talk therapy. You may also be looking for support with a specific mental health concern that’s only provided in certain settings. Support for eating disorders, for example, tends to be available in clinics. If you’re struggling with addiction, you may opt for a rehab. Help for psychosis is generally available in hospitals.

If you are not sure what type of support you need, that is okay too. A family doctor may be able to help you figure out what type of care would be appropriate. The goal is not to find the one “right” mental health professional. It is to understand what kind of support you are looking for and then find a service that can provide it.

Understanding Your Options

The healthcare system can make finding mental health support more complicated than it needs to be.

Psychiatrists and physicians can provide medically necessary services covered by OHIP, including physician psychotherapy in appropriate circumstances. Other mental health professionals may provide services through publicly funded programs and institutions rather than through OHIP directly.

Private practice therapy is generally not covered by OHIP, although your workplace or private insurance may cover some of the cost.

There is no single option that will work for everyone. What matters is understanding what is available to you, what type of support you are looking for, and what you are realistically able to access.

You can look into publicly funded services, check your insurance coverage, and ask potential providers about their fees, availability, training, and services before deciding what works best for you.

Accessing mental healthcare can take some research, but understanding how the different options work can make the process a little easier.

If you’re interested in working with a private therapist, reach out. You can find information on my cost of services here. I offer free consultation calls to see if we’re the right fit, and if not, I will try to refer you to the right service or therapist from my trusted network.