Barriers and Facilitators to Accessing Mental Healthcare in Canada for Black Youth: A Scoping Review

Abstract

There is evidence to suggest that Black children and youth in Canada face disproportionate challenges in accessing mental healthcare. Thus, the objective of this scoping review was to map current literature on the barriers and facilitators to care for Black youth in Canada. Both academic articles and gray literature published between January 2005 until May 2019 were reviewed. Six databases were searched for relevant academic articles: CINAHL, PsycINFO, PubMed, EBSCOhost, Social Science Citation Index, and Applied Social Sciences Index & Abstracts. Gray literature was sourced from community recommendations and Google. Thirty-three (33) sources met the inclusion criteria. Data were coded and analyzed using a thematic analysis framework. Barriers to care for Black youth were identified and occurred at multiple levels of society including systemic (i.e., wait times, poor access to practitioners, geographical challenges and financial barriers to care), practitioner-related (i.e., racism and discrimination from providers, the inability to provide culturally competent care and a lack of organizational support) and personal and community-related barriers (i.e., internalized stigma and stigma from community). Support from family and friends, as well as a good relationship with providers, were noted as facilitators. The findings of this review suggest that Black children and youth face many barriers to accessing the Canadian mental healthcare system despite its purported universality. An increase in funding, expansion of the universal healthcare system to include mental health, and concerted effort on delivering culturally competent care are requisite to facilitate access to care for this population. Further research should focus on Black youth, be rooted in community-based research, and explore intersecting identities in the context of mental illness.

Access to mental health for Black youths in Alberta

“…There is ample and growing evidence that Black youth in Canada are disproportion ately affected by challenges in accessing mental health services. 20 The results of our study confirm that a number of barri ers impede the access to mental health services by Black youth in Alberta.…”

“…16,17 In the United States, Black youth are less likely to utilize mental health ser vices than their White counterparts 18 despite being at a higher risk of diagnosed major depressive disorder and six times more likely to die by suicide as a result of their depression. 19,20 In 2016, there were approximately 1.2 mil lion Black people living in Canada, includ ing 198 610 youths aged 15 to 24 years. 21 Relative to the national average, a higher proportion of Black individuals live in lowincome environments, face lower lev els of employment, achieve lower levels of education and face a distinct wage gap.…”

“…2325 Past research into Black immigrants' and refugees' experiences with the Canadian health care system found that stigma, racism/discrimination, lack of knowledge regarding mental health, cost, lack of cul turally appropriate services and inaccessi bility posed major barriers to accessing health care. 20,26 Although the province of Alberta has the fastest growing population of Black Canadians, with 129 390 people, including 17 530 youths aged 15 to 24 years, 21 to our knowledge no research has consid ered the mental health of Black youth in Alberta.…”

Moving Towards Racial Equity in the Child and Youth Mental Health Sector in Ontario, Canada

“…What we know affirms that the Canadian health system does, in fact, discriminate. BIPOC youth in Canada face significantly more barriers to care (Fante-Coleman & Jackson-Best, 2020) and are more likely to mistrust the health system due to historical trauma, resulting in underutilization of health services and poorer health outcomes than their White counterparts (Li & Galea, 2020). In light of these existing barriers, there is widespread concern that COVID-19 has disproportionally impacted the mental health of BIPOC children and youth (Children's Hospital of Eastern Ontario, 2021;Mental Health Commission of Canada, 2020).…”

The Substance Abuse Program for African-Canadian and Caribbean Youth (SAPACCY): An Innovative Program Serving the Mental Health Needs of African, Caribbean, and Black Youth

“…Black people also have higher levels of psychological stress and lower levels of subjective well-being (Williams, Yu, Jackson & Anderson, 1997). Despite this need, Black youth in Canada have decreased access to mental healthcare and particularly lack culturally safe anti-racist mental healthcare (Fante-Coleman & Jackson-Best, 2020). It is as a result of the specific challenges facing Black youth that a program such as SAPACCY which specifically targets the mental health needs of Black youth was created, and remains vitally important to this day.…”