Canadian Women’s Access to Mental Health Care Uneven

Just over half of adolescent girls and young women aged 15-29 years with mental health or substance use disorder accessed formal healthcare support in 2022, according to a study by Statistics Canada.

Some sociodemographic groups within this population were more likely to seek support than others, and some derived more benefit from the support than others. Cost and lack of awareness about where to seek information were among the barriers that prevented many patients from seeking care.

“In recent years, the prevalence of mental health disorders has increased among youth in Canada, and this is particularly true of girls and young women,” study author Kristyn Frank, PhD, a senior researcher at Statistics Canada in Ottawa, told Medscape Medical News.

The study was published on May 21 in Statistics Canada’s Health Reports.

Sociodemographic Differences

“Previous research has shown that girls and women have been more likely to report worsened mental health, especially since the COVID-19 pandemic, as compared with boys and men. This piqued our interest in examining their experiences accessing and receiving mental health services, as well their reasons for not accessing this type of care,” Frank said.

The investigators used data collected from March to July 2022 during the Mental Health and Access to Care Survey. The survey was conducted online via an electronic questionnaire, and a trained interviewer guided each respondent over the telephone.

Of the 1254 girls and young women aged 15-29 years, about 4 in 10 (38.5%) met the criteria for at least one mental health or substance use disorder (ie, major depressive episode, generalized anxiety disorder, bipolar disorder, social phobia, and alcohol or substance use disorder). “This [prevalence] is higher than for the general Canadian population during the same period,” noted Frank.

Of the participants who met criteria for at least one mental health or substance use disorder, 54.6% reported that they had accessed formal health services, which included talking to a psychiatrist, family doctor, psychologist, nurse, or social worker, as well as being hospitalized or accessing online therapy.

Most who sought support consulted with a family doctor or general practitioner (63.2%), a social worker or counselor (41.1%), a psychologist (33.4%), a psychiatrist (26.8%), or a nurse (13.2%).

Lesbian and bisexual girls and young women who met the criteria for a mental health disorder were more likely to access healthcare services (69.6%) than their heterosexual peers (46.7%). They were also more likely to receive counseling or therapy (odds ratio, 2.19) or medication (odds ratio, 3.65) because of problems with their emotions, mental health, or substance use.

The main reasons for not accessing information on mental health services among those who needed it were unawareness of how or where to seek information (46.3%), being too busy (33.9%), affordability (31.6%), and preference for self-management (29.4%). Slightly more than one quarter (26.7%) said that help was not readily available, and 24% said that they had no confidence in the healthcare system. Cost was another factor: About 2 in 10 respondents said they did not seek information because their insurance wouldn’t cover it (although access to information is generally free).

The most common reasons for not accessing counseling or therapy were a preference for self-management (39.2%), therapy being unaffordable (37.2%), unawareness of where to get help (36.2%), and being too busy (33.9%).

“We hope these results can contribute to a better understanding of the use of mental health and substance use health supports among this group in Canada and of where improvements could be made,” Frank said.

Many Barriers to Care

There are many barriers to care, especially in the younger population, Srividya Iyer, MD, professor of psychiatry at McGill University and researcher at Douglas Research Centre in Montreal, told Medscape Medical News.

“There are the individual barriers, like knowing when to seek help, or thinking you can rely on yourself, or fear of stigma about seeking help, or even having had a previous negative experience in the past around seeking help,” Iyer said.

“We tend to think the awareness and stigma barriers are the predominant ones, but there are also many systemic barriers,” she said. These barriers include long waitlists, complicated referral procedures, the costs involved with accessing services, and geographic distances (because many services are in urban areas).

“When it comes to young people, we have set up our services in a way that does not mirror the realities they face. They are very siloed. For example, a service might treat depression, but not if the person is also using cannabis. This becomes problematic because we are organizing services according to diagnoses, but, particularly among young people, it is often unclear what they are. We really need to have a much more holistic way of organizing services,” Iyer said.

In 2014, Iyer started ACCESS Open Minds to address gaps in the mental health care system, especially for Indigenous, remote, and underserved communities. “We need services catering to a range of mental health presentations, instead of filing them by diagnoses that can often change for young people.” She also called for services that help patients with work, school, and housing: “Services that we could offer under the same roof that might make it a bit more engaging for young people.”

Shortening wait times, educating more mental health counselors, and creating youth-friendly walk-in facilities in community settings can make accessing supportive care more accessible for younger people, Iyer advised.

She also stressed that the first point of contact for evaluation for mental health support does not need to be a psychiatrist. Requiring the first point of contact to be a psychiatrist “causes a bottleneck because we don’t have as many specialists. We have shown it is possible to train a range of mental health workers, including social workers, nurses, occupational therapists, psychologists, and counselors. We need to see young people right away and in a friendly way, meeting them at home or in a coffee shop, providing a safe, engaging, and rapid evaluation of their needs,” Iyer said.

“The goal is to increase young people’s awareness of when to seek help, where to go, and how to get help, but you also want to give them a friendly face. Make it simple for them. They don’t need to fill out forms. They can call or walk in. We need the message to be simple.”

The study was conducted by Statistics Canada. Frank and Iyer reported having no relevant financial relationships.