Contact with Mental Health Provider

Sex and Gender-based Analysis of this topic

Definition

Until recently, the mental health of Canadians was mainly monitored through hospitalization and mortality data. In order to capture data on care that occurs outside hospital settings, as well as data from individuals who suffer from mental illness but do not die as a consequence, Statistics Canada, and the Canadian Institute for Health Information (CIHI) implemented a new cycle of the Canadian Community Health Survey (CCHS) in 2002. The CCHS measures contact with mental health services for problems concerning emotions, mental health, or use of alcohol and drugs, unmet mental health needs, and barriers due to accessibility, acceptability (stigma issues), and availability [1]. Evaluated together, these issues illustrate and contextualize Canadians’ contact with mental health professionals. Data from that survey indicate that just over 10% of Canadians aged 15 and older reported symptoms of alcohol or illicit drug dependence or one of the five mental disorders (major depression, mania, panic disorder, social phobia, and agoraphobia) covered by the survey in the last 12 months [1]. During that time, only 38.5% of those affected saw or talked to a healthcare professional [2]. 

When Canadians do seek assistance for mental health concerns, the most widely consulted sources in descending order are: general practitioners, social workers/counselors/psychotherapists, psychiatrists, psychologists, and self-help groups [2]. According to Dr. Kirby, Chair of the Mental Health Commission of Canada, a lack of mental health service providers in Canada is creating serious challenges for those that need the services [3]. 

 
 
Sex Issues

Hospitalization and mortality data show that while men are more likely than women to be diagnosed with some mental health problems, such as substance use, overall mental illness rates are higher among women in all age categories. (4) This indicates a significant need for women to have access to mental health services. Women are especially at risk for depression and anxiety-related disorders [4-5], which account for over 90% of mental health disorders measured by the CCHS [1]. The rate of depression in women is estimated to be 2 to 3 times higher than in men [6], not including depression in the post-partum period, which affects 50-80% of women to some degree [7]. Despite this prevalence, CCHS data indicate that women have higher unmet mental health and addiction needs than men [1]. 

 
 
Gender Issues

Women are more likely than men to seek help for mental health problems [2]; yet, women report higher levels of barriers to mental health services due to accessibility, acceptability, and availability issues [8], many of which have gendered components. Mental health services are only partially covered by Medicare (typically only psychiatric) so individuals with greater financial resources have access to a greater number and range of services [9]. As women are more likely than men to have a low socioeconomic status, women may have restricted access to care. This effect is compounded as employed women are more likely to be part-time or low wage workers who are ineligible for employee assistance programs and extended health coverage [9]. 

Women are also more likely to report high levels of time stress due to household labour, caregiving, and increasingly higher numbers of women in the workforce [10], which combined may represent a barrier to accessing mental health services. These barriers to mental health services exist even though women are more likely to have a regular physician [11] indicating the depth of the accessibility, acceptability, and availability issues.

 
 
Diversity

Teenagers and young adults report suffering from the higher rates of mental disorders than any other group [1]. However, this group is also the least likely to access help from mental health services. One quarter of those aged 15-24 report contact with a mental health professional in the past year, while 45% of those aged 25-64 report accessing mental health services in the past year [1]. Sex-disaggregated analysis is currently not available for this group, representing a knowledge gap that should be addressed.

Aboriginal people are significantly more likely than non-Aboriginal Canadians to commit suicide and struggle with addiction [12]. For Aboriginal communities, the provision of mental health services is typically insured through a combination of provincial funding and the Non-Insured Health Benefits Program. Providing these benefits is challenging due to wide geographic dispersal of the population, particularly for rural and remote Aboriginal communities. Problems have been reported concerning gaps in coverage, inadequate or unstable services, a lack of culturally relevant services, and a lack of provincial/federal coordination that have resulted in significant barriers for Aboriginal people attempting to access mental health services [12].

 
 
Critique

Our capacity to understand the mental health of Canadians has been greatly expanded by the data collected by the new cycle of the Canadian Community Health Survey. These data, along with qualitative research [12] on the same topic are helping to shape future investigations of the barriers facing specific at-risk populations such as women, youth and Aboriginal individuals. It is imperative to continue with this work, especially as women report more unmet mental health needs and are therefore bearing the larger burden of lack of access. Additionally, the CCHS does not include individuals residing in institutions and/or homeless shelters, both of which are populations that have historically experienced high rates of mental health issues and significant barriers in accessing mental health services. The subpopulation of women and children in shelters who are fleeing violence deserve particular attention due to the connections between mental health, addiction, and violence against women. (For more information on this topic, see the Violence indicators on this website.)

 
 
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