Inequities in the delivery of mental health care: a grounded theory study of the policy context of primary care

Abstract

Background Strengthening capacity for mental health in primary care improves health outcomes by providing timely access to coordinated and integrated mental health care. The successful integration of mental health in primary care is highly dependent on the foundation of the surrounding policy context. In Ontario, Canada, policy reforms in the early 2000’s led to the implementation of a new interprofessional team-model of primary care called Family Health Teams. It is unclear the extent to which the policy context in Ontario influenced the integration of mental health care in Family Health Teams emerging from this period of policy reform. The research question guiding this study was: what were key features of Ontario’s policy context that influenced FHTs capacity to provide mental health services for mood and anxiety disorders? Methods A qualitative study informed by constructivist grounded theory. Individual interviews were conducted with executive directors, family physicians, nurse practitioners, nurses, and the range of professionals who provide mental health services in interprofessional primary care teams; community mental health providers; and provincial policy and decision makers. We used an inductive approach to data analysis. The electronic data management programme NVivo11 helped organise the data analysis process. Results We conducted 96 interviews with 82 participants. With respect to the contextual factors considered to be important features of Ontario’s policy context that influenced primary care teams’ capacity to provide mental health services, we identified four key themes: i) lack of strategic direction for mental health, ii) inadequate resourcing for mental health care, iii) rivalry and envy, and, iv) variations across primary care models. Conclusions As the first point of contact for individuals experiencing mental health difficulties, primary care plays an important role in addressing population mental health care needs. In Ontario, the successful integration of mental health in primary care has been hindered by the lack of strategic direction, and inconsistent resourcing for mental health care. Achieving health equity may be stunted by the structural variations for mental health care across Family Health Teams and across primary care models in Ontario.

Navigating inequities in the delivery of youth mental health care during the COVID-19 pandemic: perspectives of youth, families, and service providers

“…A third finding showed that there were inadequate and inequitable mental health services for youth and their families. Participants described disparities linked to economic resources, racism, discrimination, and disability (i.e., mental illness, addictions, and neurodevelopmental disorders) and these disparities need to be addressed in part through improved access to mental health care (Ashcroft et al, 2021 ). This study showed that this was not the case for participants in this study, who noted that even though mental health needs increased, access to mental health services decreased.…”

“…Studies show higher rates of mental health concerns since the start of the pandemic among sexual and gender minority youth (Hawke et al, 2021a;Jones et al, 2021), youth with disabilities (Arim et al, 2020), and Black, Indigenous, and People of Colour (BIPOC) populations (Castro-Ramirez et al, 2021). There has also been reduced access to services (Fegert et al, 2020;Hawke et al, 2020) and widened inequities in the delivery of mental health care (Ashcroft et al, 2021) since the start of the pandemic. The pandemic has exposed and exacerbated mental health inequities in youth defined by the WHO as "avoidable and unfair differences in health status between groups of people or communities" (WHO, 2021).…”

Artificial intelligence and health equity in primary care: A qualitative study with key stakeholders

“…Finally, the results were compiled as a narrative, building on the final iteration of the themes and the joining theory, and compared to preceding scholarship. A graphical logic model serves to visualize the theory (Figure 2), which has been used in studies with similar methodology [30][31][32] .…”

The Delivery of Patient Care in Ontario’s Family Health Teams during the First Wave of the COVID-19 Pandemic

“…The implementation of FHTs was intended to expand access to comprehensive healthcare services, particularly for the prevention, treatment and management of chronic conditions ( Hutchison et al 2011 ). FHTs vary in terms of organizational size, composition of types and numbers of providers ( Ashcroft et al 2021b ; Rudoler et al 2019 ). There is also variation in the types and numbers of services offered by family physicians and other interprofessional providers across FHTs ( Hutchison and Glazier 2013 ).…”