Income-based inequities in access to mental health services in Canada

Abstract

Objectives While mental health services provided by general practitioners and psychiatrists can be billed to public health insurance programs in Canada, services provided by psychologists, social workers and other non-physician providers cannot. This study assesses the extent to which access to mental health services varies by income after first taking into account the higher concentration of mental health needs at lower income levels. Method Data from the Canadian Community Health Survey 2013-2014 are used to calculate need-standardized concentration indices for access to mental health services. Results More pro-rich utilization of mental health services provided by non-physicians and more equitable utilization of physician services is found for psychologists and general practitioners, but not for social workers, nurses and psychiatrists. Unmet need for healthcare for mental health problems is found to be more pro-poor than unmet need for physical health problems. Conclusion By standardizing for inequitable distribution of mental health need, this study provides strong evidence that incomebased inequity in access to mental health services is an issue under Canada's two-tier system, particularly with regard to general practitioners and psychologists. For other types of providers, the results suggest that inequities in service utilization vary not just by Medicare coverage but also by service settings and target populations. Despite these variations, greater inequities in unmet need for mental health care than for physical health care suggest that inequity is the dominant reality for Canadians. The results provide a baseline that could be used to assess the equity impacts of policy reforms.

Protective and Risk Factors for Medical and Nursing Staff Suffering From Psychological Symptoms During COVID-19

“…Medical staff with low income, medium-low income, and very low income levels were all susceptible to anxiety, staff with a mediumlow income level were also vulnerable to depression and sleep disorders. It has been reported that income level is related to mental health both in developed countries such as Canada (Bartram, 2019) and developing countries such as Turkey (Kose, 2020).…”

Odds of Anxiety and Depression Symptoms in School-Aged Children From Official Language Minority Communities

“…The difference in the number of immigrants between the two regions could explain why immigrants in the Fredericton area fared much better than the immigrants in the Madawaska region, as social psychology theories tend to agree that larger ingroups increase group identification and, in turn, the well-being of its members ( 42 ). Income-based inequities in access to mental health services may also be a root cause ( 43 ). Looking beyond the OLMCs, some general tendencies emerged for all New Brunswick youth, regardless of social group status.…”

Out from the shadows: What health leaders should do to advance the mental health and substance use health workforce

“…13,15,16 This two-tier system leaves the lowest income Canadians facing the greatest barriers in accessing MHSUH services as they are least likely to have access to benefits or to be able to afford to pay out-of-pocket. 17 This two-tier system also means that many providers in the MHSUH workforce work in the private sector and are paid through some combination of direct out-of-pocket payments, employment-based benefit programs, or by private employers such as bed-based addiction treatment centres.…”