Service Use for Mental Health Reasons: Cross-Provincial Differences in Rates, Determinants, and Equity of Access

Abstract

Objectives: In 2002, Canada undertook its first national survey on mental health and well-being, including detailed questioning on service use. Mental disorders may affect more than 1 person in 5, according to past regional and less comprehensive mental health surveys in Canada, and most do not seek help. Individual determinants play a role in health resource use for mental health (MH) reasons. This study aimed to provide prevalence rates of health care service use for MH reasons by province and according to service type and to examine determinants of MH service use in Canada and across provinces. Methods:We assessed the prevalence rate (95% confidence interval [CI]) of past-year health service use for MH reasons, and we assessed potential determinants cross-sectionally, using data collected from the Statistics Canada Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). We estimated models of resource use with logistic regression (using odds ratios and 95%CIs). Results:The prevalence of health service use for MH reasons in Canada was 9.5% (95%CI, 9.1% to 10.0%). The highest rates, on average, were observed in Nova Scotia (11.3%; 95%CI, 9.6% to 13.0%) and British Columbia (11.3%; 95%CI, 10.1% to 12.6%). The lowest rates were observed in Newfoundland and Labrador (6.7%; 95%CI, 5.3% to 8.0%) and Prince Edward Island (7.5%; 95%CI, 5.8% to 9.3%). In Canada, the general medical system was the most used for MH reasons (5.4%; 95%CI, 5.1% to 5.8%) and the voluntary network sector was the least used (1.9%; 95%CI, 1.7% to 2.1%). No difference was observed in the rate of service use between specialty MH (3.5%; 95%CI, 3.2% to 3.8%) and other professional providers (4.0%; 95%CI, 3.7% to 4.3%). In multivariate analyses, after adjusting for age and sex, the presence of a mental disorder was a consistent predictor of health service use for MH across the provinces. Conclusions:There is up to a twofold difference in the type of service used for MH reasons across provinces. The primary care general medical system is the most widely used service for MH. Need remains the strongest predictor of use, especially when a mental disorder is present. Barriers to access, such as income, were not identified in all provinces. Different sociodemographic variables played a role in service seeking within each province. This suggests different attitudes toward common mental disorders and toward care seeking among the provinces. Clinical Implications· Need is the strongest predictor of help seeking for MH reasons. · Different sociodemographic determinants seem to play a role in health service use among the provinces. Limitations· The cross-sectional study design precludes examination of whether needs were met. · The lifetime trajectory of service use and the sequence of shared mental health care cannot be established. · We did not assess the perceived need for individual care in terms of preferred types of interventions or expert assessment of need for care and services in this large community survey.

Use of medication and psychological counselling among Canadians with mood and/or anxiety disorders

“…35 Furthermore, a Canadian study that examined barriers to mental health care using data from the Canadian Community Health Survey concluded that "despite universal health insurance, there are significant inequi ties in access to mental health care for low-income Canadians." 36 been shown to exist 35,37 and results from our study might well reflect real regional differences. However, given the many nested factors that may contribute to our observations, we refrain from drawing any specific inferences from these findings.…”

Recours aux médicaments et aux consultations psychologiques chez les Canadiens atteints d’un trouble de l’humeur et/ou d’anxiété

“…On sait qu'il existe des différences dans l'utilisation des services de santé mentale d'une province à l'autre 35,37 , et les résultats de notre étude pourraient donc refléter de réelles différences régionales. Toutefois, étant donné les nombreux facteurs sous jacents susceptibles d'avoir pu contribuer à ces observations, nous préférons nous abs tenir d'en tirer des conclusions précises.…”

Trouble panique avec agoraphobie et trouble d’anxiété sociale : recours aux pairs-aidants et accès au traitement

“…Young (2001) rapporte que seulement 19 % des personnes qui ont consulté des services de première ligne ont reçu des soins adé-quats, contre 90 % qui ont consulté un spécialiste en santé mentale. Or, les médecins généralistes sont les plus consultés par les personnes souffrant de troubles anxieux (Vasiliadis et al, 2005 ;Wang et al, 2005) ; puisque ces dernières consultent davantage les services de soins primaires, il importe dès lors d'améliorer l'arrimage entre les différents services. C'est d'ailleurs un des objectifs du Plan d'action en santé mentale du Québec où l'on favorise le traitement des troubles modérés de santé mentale en première ligne, visant ainsi une évaluation et un traitement rapide, tant au plan médical que psychosocial (MSSS, 2005).…”

“…Ces dernières ont en effet tendance à consulter peu ou à attendre très longtemps avant de le faire, en raison des comportements d'évitement présents chez elles. De tous les troubles transitoires modérés de santé mentale, ces problèmes ont d'ailleurs les taux de consultation les plus bas (Kessler et al, 1999 ;Vasiliadis et al, 2005 ;Wang et al, 2005). Il importe donc d'améliorer l'accès au traitement pour ces personnes (Olfson et al, 1998 ;Perreault et al, 2004).…”