EXPANDING ACCESS TO PUBLICLY-FUNDED PSYCHOTHERAPY: A COMPARATIVE POLICY ANALYSIS IN ONTARIO AND BRITISH COLUMBIA

Abstract

In 2021, Ontario became the first province in Canada to adopt a provincial publicly funded psychotherapy program, after a three-year long pilot project (2017-2020). Meanwhile, more than a decade prior, in 2008, BC introduced a smaller-scale program, Bounce Back, but opted to not adopt a larger-scale provincial program. This dissertation investigates the development of publicly funded psychotherapy in Ontario and BC through a comparative policy analysis of mental health policy reform. Broadly, this dissertation asks: “Under what conditions do jurisdictions achieve mental health reform?” More specifically, it addresses two sub-questions: 1) What conditions allowed BC to adopt an early, low intensity program and then constrained it from adopting a larger-scale program? 2) What conditions limited early policy development in Ontario, but allowed for a more ambitious and larger-scale program more recently? This dissertation draws on four well-established theoretical frameworks in political science: ideas, institutions, policy learning, and the role of policy entrepreneurs, to analyze and explain Ontario and BC’s divergent reform trajectories. Empirically, the research draws on extensive qualitative methods, including documentary analysis and over 30 elite interviews with policymakers, healthcare leaders and providers. These interviews offer insider perspectives on the motivations, challenges, and strategic decisions behind the policy decisions each province made. The findings reveal key differences in the policy processes and contextual factors that led Ontario to adopt a UK-inspired provincial model through the Ontario Structured Psychotherapy Program, in contrast to BC’s decision to implement a smaller-scale, low-intensity program, Bounce Back.