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Barriers to care for mental health conditions in Canada [1]
['Monnica T. Williams', 'School Of Psychology', 'University Of Ottawa', 'Ottawa', 'Ontario', 'Dept Of Cellular', 'Molecular Medicine', 'Muna Osman', 'Aidan Kaplan', 'Sonya C. Faber']
Date: 2024-09
A recent scoping review identified a range of patient and clinician related challenges, which include system capacity, need for continued training, and complexity across different services, settings, and providers [ 6 ]. Issues related to the availability and complexity of mental health care was reported in most of the included studies, along with issues of capacity, education, training, fragmented services and limited resources [ 6 ]. To build on this literature, the purpose of this study is to examine the mental health conditions Canadians experience the most difficulties in accessing care and disparities in these experiences among individuals with diverse identities and backgrounds.
Canadian health care system is federally funded to provide necessary coverage of hospital and physician services, and this system is managed, organized, and delivered differently across individual provinces and territories. Existing health and social policy gaps span the range of mental health care including promotion, prevention resources, as well as intensive specialized services [ 3 ]. Additionally, longstanding gaps in health insurance coverage and employment-based health benefits creates inequities and contributes to growing rates of unmet mental health care needs suggesting this is a dominant reality for many Canadians [ 4 ]. Policy and funding gaps exacerbate a two-tier system of public and private access to care [ 4 ], and these gaps were intensified by the COVID-19 pandemic. Notably, almost 70% of Canadians experienced adverse effects from the pandemic, while by the end of 2020, 40% reported experiencing mental distress in the previous month [ 5 ] (Statistics Canada, 2021).
Canada, like many countries around the globe, has ongoing challenges in the provision and availability of mental health services. Not only do Canadians lack adequate access to mental health care, the amount of care needed is actually increasing. Each year one in five Canadians require treatment for mental illness. About half of Canadians will be diagnosed with a mental illness by the age of 40 years [ 1 ]. In 2017, 5.3 million Canadians reported needing mental health services, half (3 million) had their needs fully met; from the remaining half, 1.2 million had their needs partially met, and 1.7 million had their needs entirely unmet [ 2 ]. The most commonly reported reasons for experiencing unmet or partially met mental health needs were: lack of time, lack of financial means, and a limited information or knowledge.
Mental health conditions in Canada
The most concerning mental health conditions can be broadly divided into four areas: mood disorders, anxiety disorders, schizophrenia spectrum disorders, and substance use disorders. The prevalence of these conditions often varies by generation and cultural background. However, the lack of data collection by ethnic and racial groupings in Canada hinders our understanding of racial differences.
Anxiety disorders. In a lifetime, 4.6% or 2.5 million Canadians suffer from an anxiety disorder. A national survey in July 2020 found one in seven Canadians (13.6%) were at risk of clinically significant levels of generalized anxiety disorders [7] which was further exacerbated by the COVID pandemic. Although prevalence of anxiety disorders in women was higher than men (17.2% vs. 9.9%), a dose-response relationship with COVID-19 misinformation exposure was only observed among men [7], underscoring the need for improved public health information access. A community survey on mental health in 2012 found that 2.6%, or about 1,000,000 Canadians over the age of 15 reported experiencing “symptoms consistent with generalized anxiety disorder” [8]. The 12-month prevalence of GAD was 3.2% in women and 2.0% in men [9].
Obsessive-compulsive disorder. A study of 25,097 Canadians found an obsessive compulsive disorder (OCD) diagnosis in 0.93% of the population [10]. Additionally, those with OCD were younger (M age = 37.35), than the control group (M age = 45.73) and were less likely to hold a job and had lower incomes than those without OCD [10]. These patterns highlight the impact of mental health experiences on socio-economic challenges.
Posttraumatic stress disorder. In 2021, Statistics Canada found that 8% of Canadians “met the criteria for probable PTSD”, whereas only 5% were diagnosed by a health professional, highlighting the lack of clinicians available to diagnose and treat individuals with this condition [11]. Women reported experiencing PTSD (10%) at rates almost twice as high as men (6%). Furthermore, individuals aged 18–24 years old reported having more PTSD symptoms (13%) than those 65+ years old (3%) and only 7% of these individuals identified as visible minorities [11]. Additionally, only half of those who suffer from PTSD (55%) sought external support, and of that, 82% “had trouble accessing the health care services they needed” [11, 12].
Depression & suicide. In a 2020 survey, 15% of Canadians screened positive for MDD, with more women diagnosed (18%) than men (13%). The highest proportion of MDD diagnosis were among those aged 18–34 years (23%) [5]. Untreated, depression can progress to suicidal ideation. Daily, 11 people in Canada take their own life resulting in about 4,000 deaths per year [13]. In 2018, suicide was the leading cause of death for children aged 10 to 14, and after accidents, it remained as the second leading cause of death for people aged 15 to 24 [13]. Indigenous people, particularly youth, have significantly increased rates of suicide. First Nations youth between 15 to 24 years of age experience suicide rates about six-fold higher than other Canadians. Among Inuit youth, suicide rates are about 24 times higher than the national average [14].
Schizophrenia spectrum disorders. Canadians already living with serious mental illnesses, including psychotic disorders, were profoundly impacted by the COVID-19 pandemic. These vulnerable Canadians were not only at higher risk for contracting COVID-19, the social distancing protocols and disruptions in routine services created a higher risk for poor mental health outcomes [15]. Psychotic disorders including schizophrenia have been determined to affect up to 4% of the population [16]. This means that more than 1.5 million Canadians are directly affected. The onset of schizophrenia, which occurs in early adulthood or late adolescence, is particularly tragic as it negatively affects the life experiences of young Canadians during a time when they are embarking on an independent life [17]. Globally it is among the top 10 causes of disability-adjusted life-years [16], and the costs in Canada of schizophrenia per year has been estimated to reach up to $10 billion Canadian dollars, demonstrating the urgent need for better care in this area [17].
Substance use disorders. The prevalence of substance use disorder in Canada is at 1.78% representing over 650,000 Canadians [18], and each day, on average, 20 Canadians perish from the use of illicit substances [19]. Mortality caused by the use of alcohol, opiates and other substances can be grouped together as “deaths of despair” and are on the rise in Canada. Although opioid-related deaths have been highest in British Columbia, Alberta, Yukon, and the Northwest Territories, the crisis has touched all regions of Canada [19, 20]. In all, the economic cost of substance use in Canada per year is a staggering $40 billion, which includes criminal justice, lost productivity and healthcare costs [19, 21].
Eating disorders. The most common eating disorders include anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder. The lifetime prevalence of eating disorders is notably higher (8.4%) for women than men (2.2%), and this trend extends to the prevalence for anorexia nervosa at 1.4% for women and 0.2% for men as well as bulimia nervosa 1.9% for women and 0.6% for men, and finally, for binge eating disorder where women have a prevalence of 2.8% compared to men (1.0%) [22, 23]. Individuals with eating disorders may be undertreated due to avoidance behaviors as the stigma and self-stigma around eating disorders has been reported to obstruct help-seeking behavior [24]. Additionally, the COVID-19 pandemic has severed social connections exacerbating the negative impacts of eating disorders [24].
Attention deficit hyperactivity disorder. Attention Deficit Hyperactivity Disorder (ADHD) symptoms commonly arise in children between the ages of 3 and 5, remain throughout adolescence in 75% of cases, and persist in 50% throughout adulthood [25]. One study found that from 1999 to 2012, ADHD had risen in all provinces for both youth, aged between 1–17 and young adults aged between 18–24 [26]. The prevalence of ADHD in adults is 2.5%, and in youth, between 4%-7%, with a three-fold higher likelihood in boys of ADHD development than in girls [25]. Caregivers of children with ADHD were adversely affected due to restrictions of the pandemic, as they were unable to access services they required (therapeutic, educational or medical), which resulted in an increase and worsening of symptoms [26–28].
Dementia. Dementia, characterized by memory loss, judgement and reasoning problems, behavioral alterations, and mood and communication disturbances, is one of the more expensive mental health disorders costing Canada about 8.3 billion in 2011 [29]. The prevalence of dementia increases with age, with an overall prevalence of 2.0% for the general population [30, 31], however the national data found a prevalence rate of 7.1% for dementia in individuals over 65 years old [32], with women (8.3%) experiencing higher levels of dementia than men (5.6%) [33]. Pandemic restrictions, including enforced social isolation, had severely negative impacts on people living with dementia [34, 35].
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