Access to mental health and addiction services for youth and their families in Ontario: perspectives of parents, youth, and service providers

BACKGROUND

Canadian youth (aged 16-24) have the highest rates of mental health and addiction concerns across all age groups and the most unmet health care needs. There are many structural barriers that contribute to the unmet mental health care needs of youth including lack of available and appropriate services, high costs, long wait times, fragmented and siloed services, lack of smooth transition between child and adult services, stigma, racism, and discrimination, as well as lack of culturally appropriate treatments. Levesque et al. (2013) developed a framework to better understand health care access and this framework conceptualizes accessibility across five dimensions: (1) approachability, (2) availability, (3) affordability, (4) appropriateness, and (5) acceptability. The purpose of this study was to explore access to addiction and mental health services for youth in Ontario, Canada from the perspectives of youth, parents, and service providers.

METHODS

This qualitative study was a university-community partnership exploring the experiences of youth with mental health concerns and their families from the perspectives of youth, caregivers, and service providers. We conducted semi-structured interviews and used thematic analysis to analyze data.

RESULTS

The study involved 25 participants (n = 11 parents, n = 4 youth, n = 10 service providers). We identified six themes related to structural barriers impacting access to youth mental health and services: (1) "The biggest barrier in accessing mental health support is where to look," (2) "There's always going to be a waitlist," (3) "I have to have money to be healthy," (4) "They weren't really listening to my issues," (5) "Having more of a welcoming and inclusive system," and (6) "Health laws aren't doing what they need to do."

CONCLUSION

Our study identified five structural barriers that map onto the Levesque et al. healthcare access conceptual framework and a sixth structural barrier that is not adequately captured by this model which focuses on policies, procedures, and laws. The findings have implications for policies and service provisions, and underline the urgent need for a mental health strategy that will increase access to care, improve mental health in youth, decrease burden on parents, and reduce inequities in mental health policies and services.

Inequities in the delivery of mental health care: a grounded theory study of the policy context of primary care

BACKGROUND

Strengthening capacity for mental health in primary care improves health outcomes by providing timely access to coordinated and integrated mental health care. The successful integration of mental health in primary care is highly dependent on the foundation of the surrounding policy context. In Ontario, Canada, policy reforms in the early 2000's led to the implementation of a new interprofessional team-model of primary care called Family Health Teams. It is unclear the extent to which the policy context in Ontario influenced the integration of mental health care in Family Health Teams emerging from this period of policy reform. The research question guiding this study was: what were key features of Ontario's policy context that influenced FHTs capacity to provide mental health services for mood and anxiety disorders?

METHODS

A qualitative study informed by constructivist grounded theory. Individual interviews were conducted with executive directors, family physicians, nurse practitioners, nurses, and the range of professionals who provide mental health services in interprofessional primary care teams; community mental health providers; and provincial policy and decision makers. We used an inductive approach to data analysis. The electronic data management programme NVivo11 helped organise the data analysis process.

RESULTS

We conducted 96 interviews with 82 participants. With respect to the contextual factors considered to be important features of Ontario's policy context that influenced primary care teams' capacity to provide mental health services, we identified four key themes: i) lack of strategic direction for mental health, ii) inadequate resourcing for mental health care, iii) rivalry and envy, and, iv) variations across primary care models.

CONCLUSIONS

As the first point of contact for individuals experiencing mental health difficulties, primary care plays an important role in addressing population mental health care needs. In Ontario, the successful integration of mental health in primary care has been hindered by the lack of strategic direction, and inconsistent resourcing for mental health care. Achieving health equity may be stunted by the structural variations for mental health care across Family Health Teams and across primary care models in Ontario.

Making it real: the institutionalization of collaboration through formal structure

Collaboration has achieved widespread acceptance as an indispensable element of healthcare delivery in recent decades, despite modest evidence for its impact on healthcare outcomes. Attempts to understand this seeming paradox have been based mostly in functionalist or conflict-theoretical approaches. Currently lacking, however, is an articulation of how collaborative ideals are embedded in broadly shared beliefs about what healthcare is and how it operates. In this article, we examine how language used in the CanMEDS competency framework and in two guides for Family Health Teams construct idealized versions of rational, autonomous physicians and primary care organizations, respectively. Informed by phenomenological sociology and neo-institutional theory, we characterize these documents as elements of formal structure, the putative "blueprints" for healthcare planning and activity. Drawing on this analysis, we argue that these documents and "collaborative" formal structures in general, not only function as tools to make healthcare more collaborative, but also create an appearance of "real" collaboration, independently of the realities of practice. We argue that they thus instill confidence that the current healthcare system functions according to deep-seated societal values of justice and progress. We conclude by emphasizing the potentially distorting influence of this on efforts to understand and improve healthcare.

An Exploration of the Methods of Communication between Policy Makers and Providers that Help Facilitate Implementation of Primary Health Care Reforms

Policy reforms targeting organizational structure, expansion of interprofessional teams, inclusion of collaborative practices, and shifting provider remuneration models have resulted with substantial change for providers and leaders with primary health care settings in Canada, USA, and elsewhere. Discourse analysis provides a theoretical lens that can help build an understanding about the implications of different modes of communication on the implementation of new policy initiatives like new models of primary health care. This study applies discourse analysis to determine the modes of communication that were used to relay policy expectations underpinning a newly emerging interprofessional model of primary health care. We conducted a secondary analysis of a qualitative study conducted between 2010 and 2011 with primary health care leaders and policy informants during a period of health care reform in Canada. In-depth semi-structured interviews were conducted with seven key policy informants (PIs) and 29 primary health care leaders (physicians, executive directors, and non-physician clinical leaders). Discourse analysis is useful in the investigation of the meanings of health, health policy, and health care settings.

An Examination of the Holism Paradigm: A View of Social Work

This article examines the holism paradigm, implications on social work practice in healthcare, and how social work practice can help promote the value of social justice. Examining the holistic health paradigm fosters a critical reflection that assists to better understand beliefs and assumptions that guide social work practice, thus leading to critical action.