A father calls to schedule an appointment for his teenage daughter who has been talking about wanting to die. The scheduler tells him the next available appointment is in four months. He explains that this is urgent, that his daughter is in crisis, and is told that if it is an emergency he should take her to the emergency room, but for an appointment, the next available is in four months. He hangs up not knowing what to do in the months between now and then, whether to watch his daughter constantly, whether to quit his job to stay home with her, whether to take her to an emergency room that will see her once and release her. A young man experiencing his first episode of psychosis waits weeks for psychiatric assessment while his symptoms worsen and his family watches helplessly. By the time he is seen, what might have been addressed with early intervention has progressed to hospitalization. A woman finally decides to seek help for the depression she has carried for years, an act of courage that took everything she had, and learns that the wait for a therapist is eight months. The courage that brought her to the phone dissipates over the months of waiting, and by the time her appointment comes she has retreated back into survival mode and does not go. Wait times in mental health are not simply inconvenience but active harm, periods during which conditions worsen, crises escalate, lives fall apart, and people give up on help that might have made a difference if it had been available when they needed it. Why wait times persist and what would actually reduce them shapes the experience of everyone trying to access mental health care.
The Case for Wait Time Reduction as Priority
Advocates for prioritizing wait time reduction argue that long waits undermine the entire mental health system and that addressing wait times should be the central focus. From this view, access means nothing without timeliness.
Mental health conditions do not wait. Unlike many physical health conditions where waiting may be inconvenient but not catastrophic, mental health conditions often worsen without intervention. Waiting for mental health care is not neutral; it is often harmful. Timely access must be the goal.
Long wait times deter help-seeking. When people hear that waits are months long, many do not bother trying to access services at all. The reported wait times represent only those who persist through the system; they miss those who never enter because they know what awaits them.
Wait times for mental health exceed those for many physical health conditions, revealing that mental health is not truly treated as equivalent. If cancer treatment had eight-month waits, there would be outrage. Mental health waits of similar length are accepted as normal. This acceptance reflects stigma and deprioritization.
From this perspective, reducing wait times requires: substantial capacity increase through workforce expansion and new service models; wait time standards for mental health comparable to physical health; measurement and public reporting of wait times; and recognition that wait time reduction must be explicit priority, not assumed byproduct of general improvement.
The Case for Focus Beyond Wait Times
Others argue that focusing on wait times alone may miss more important questions about what people are waiting for and whether it helps. From this view, reducing wait times for ineffective services is not improvement.
Wait times are symptom, not cause. Long waits reflect inadequate capacity, which reflects inadequate funding, which reflects political choices. Focusing on wait times without addressing underlying capacity and funding issues addresses symptoms while cause persists.
Reducing wait times by providing less intensive services may not improve outcomes. Brief interventions that can be provided quickly may be less effective than longer engagements that require waiting. What people receive matters as much as how quickly they receive it.
Wait time focus may prioritize those who can navigate systems over those with greatest need. People who can persist through waits, make repeated calls, and advocate for themselves will benefit from wait time reduction. Those with more severe conditions who cannot navigate may still be excluded.
From this perspective, improving mental health access requires: adequate capacity to provide appropriate care, not just reduced waits; attention to who is and is not accessing services; quality of care alongside timeliness; and systems that prioritize based on need rather than who can wait longest.
The Measurement Challenge
Measuring mental health wait times is more complex than it might appear.
From one view, standardized wait time measurement would enable accountability. If waits were measured consistently and reported publicly, pressure for improvement would follow. What gets measured gets managed. Mental health wait times should be measured like surgical wait times.
From another view, mental health wait times are harder to define than surgical waits. When does the wait start—from first call, from referral, from assessment? What counts as receiving care—first appointment, ongoing treatment? Simple metrics may miss important variation. Measurement must be thoughtful to be meaningful.
How wait times are measured shapes what counts as progress.
The Triage Question
When capacity is limited, some form of prioritization is necessary, but how to triage fairly is contested.
From one perspective, acuity-based triage ensures those with most urgent needs are seen first. Someone in acute crisis should not wait behind someone with less urgent concerns. Triage based on clinical severity is appropriate.
From another perspective, triage based on severity may mean those with moderate symptoms wait indefinitely while their conditions worsen. By the time they reach acuity threshold, prevention has failed. Systems should serve across the severity spectrum, not just the most acute.
How triage operates when demand exceeds supply shapes who gets served and who waits.
The Stepped Care Model
Stepped care provides lower-intensity services first and moves people to higher intensity as needed.
From one view, stepped care efficiently matches intervention to need. Not everyone needs intensive therapy. Providing what is likely to help and stepping up only if needed serves more people with available resources. Stepped care can reduce waits while maintaining effectiveness.
From another view, stepped care may delay appropriate treatment for those who need intensive intervention from the start. Requiring people to fail at lower steps before accessing higher steps wastes time for those who need more. Some people can be appropriately matched to intensive care immediately.
Whether stepped care improves or delays access to appropriate care shapes service design.
The Single-Session Models
Single-session approaches provide one-time interventions that may help some people quickly.
From one perspective, single-session models can reduce waits by serving people quickly and efficiently. Research shows that single sessions help many people. Those who need more can be identified for further care. Single-session as first response may serve many while freeing capacity for those who need more.
From another perspective, single sessions may be inadequate for conditions that require ongoing care. Counting single sessions as successful service may inflate access statistics while providing minimal help. Single sessions should be option, not substitute for adequate capacity.
Whether single-session models improve access or provide inadequate care shapes their role.
The Digital and Virtual Options
Digital tools and virtual care may reduce waits for in-person services.
From one view, digital and virtual options expand capacity. Apps, online programs, and video therapy can serve people who might otherwise wait for in-person care. Not everyone needs in-person service. Virtual options reduce wait times while serving real needs.
From another view, digital options may be inadequate for many mental health needs. Not everyone can use digital tools effectively. Virtual care has limitations for some presentations. Substituting digital for in-person care may reduce apparent waits while reducing quality. Digital should complement, not replace, adequate in-person capacity.
Whether digital and virtual options truly expand access or offer inferior alternatives shapes investment.
The Workforce Bottleneck
Wait times often reflect workforce shortages that cannot be quickly addressed.
From one perspective, workforce development must be central priority. Training more mental health professionals, improving retention, and expanding scope of practice for existing professionals can expand capacity. Wait time reduction requires workforce investment.
From another perspective, workforce expansion takes years and may not keep pace with demand. Task-shifting to non-specialists, peer support, and technology may be necessary to address immediate needs. Waiting for workforce to expand means waiting too long.
How workforce constraints are addressed shapes long-term capacity and wait times.
The Private Option
Some people avoid public wait times by paying for private services.
From one view, private options provide immediate access for those who can afford them. Those who can pay should be able to access faster care. Private services reduce pressure on public system by serving those who can afford to pay.
From another view, private options create two-tier system where access depends on wealth. Those who cannot afford private care wait while those with money are seen immediately. This inequity is inconsistent with universal healthcare values.
Whether private options are acceptable escape valve or unacceptable inequity shapes mental health system design.
The Emergency Department Alternative
Some people in mental health need go to emergency departments because they cannot wait for outpatient services.
From one view, emergency department presentation for non-emergent mental health represents system failure. People who need outpatient care are using expensive emergency resources because outpatient care is unavailable. Reducing outpatient waits would reduce emergency department pressure.
From another view, emergency departments provide immediate access when nothing else is available. For someone who cannot wait months, emergency care is rational choice. Emergency access should not be restricted; outpatient access should be improved.
How emergency and outpatient mental health care relate shapes system pressures and patient choices.
The Children and Youth Wait Crisis
Wait times for children and youth mental health are often particularly long.
From one perspective, children and youth waits are especially harmful because development does not wait. Young people experiencing mental health problems while waiting for services may face lifelong consequences. Child and youth mental health waits should be prioritized for reduction.
From another perspective, adult mental health waits are equally harmful and should not be deprioritized for children. Both populations need reduced waits. Competition between populations for scarce resources does not serve anyone.
Whether child and youth waits deserve special prioritization shapes resource allocation.
The Canadian Context
Canada does not systematically measure or report mental health wait times as it does for some physical health conditions. Available data suggests waits of months for many mental health services. Provincial strategies often include wait time targets but implementation and measurement vary.
From one perspective, Canada should establish mental health wait time standards, measure consistently, and hold systems accountable for meeting targets.
From another perspective, standards without capacity investment set targets that cannot be met. Measurement and accountability must accompany resource investment.
How Canada approaches mental health wait times shapes access for millions.
The Question
If mental health conditions worsen during long waits for care, if people who need help give up before they can access it, if the courage to seek help dissipates during months of waiting, if wait times reveal that mental health is deprioritized compared to physical health - why do we accept wait times for mental health that would be unacceptable for other conditions? When someone waits months for mental health care that might have helped if provided immediately, who bears the cost of that delay? When we promise mental health support but cannot deliver it in time to matter, what have we actually promised? When reducing waits requires investment we are unwilling to make, what does our unwillingness reveal? And when someone in crisis is told that help is available in four months, what does "available" actually mean?