Spatial accessibility to mental health care in the City of Toronto

Abstract

Mental illness refers to a wide range of disorders that affect mood, thinking and behaviour. One in five Canadians has mental health care needs, many of which are unmet (Smetanin et al., 2015). Within the City of Toronto, the provision of mental health care is delivered by over 100 public and private community service organisations and over 700 physicians with a psychiatric specialization - each providing community-based general or specialised care to residents in need. Research has shown that travel distance is an enabling factor of health service utilisation, thus equitable spatial access to services remains a key priority (Fleury et al., 2012). Using spatial quantitative methods, this study examines potential spatial accessibility to mental health services and specialist physicians within the City of Toronto, and levels of statistical association between access to care and prevalence of mental health crisis events. A wide range of datasets is analyzed including occurrence data for apprehensions under the Mental Health Act undertaken by the Toronto Police Service and the Canadian Marginalization Index. The enhanced two-step floating catchment area (E2SFCA) method is used to compute spatial accessibility to mental health services based four modes of transportation: driving, walking, cycling and public transit. Areas that are underserved by mental health specialists and mental health community services are identified and shown to have different income levels. This study provides spatial explicit patterns of accessibility to mental health services in Toronto, providing detailed data to inform planning and policy of mental health care delivery.