Increasing access and building equity into mental health services: an examination of the potential for change

Navigating inequities in the delivery of youth mental health care during the COVID-19 pandemic: perspectives of youth, families, and service providers

OBJECTIVES

There have been concerns about the adverse effects of the COVID-19 pandemic on Canadian youth (aged 16-24) as they have the highest rates of mental health concerns. The objectives of the present study were to explore the experiences of youth with mental health and/or addiction concerns and their families during the pandemic, and to examine how adequate and equitable mental health services have been for youth and families from the perspectives of youth, parents, and service providers.

METHODS

Using a descriptive qualitative research design and a university-community partnership, we conducted individual interviews with youth, parents, and service providers. The study involved a total of 25 participants (n=15 service users, n=10 service providers). Among the service users, 11 participants were parents and four were youth. We used thematic analysis to analyze interview data.

RESULTS

The thematic analysis identified three themes in the data: (1) youth mental health concerns have increased, whereas supports have decreased, (2) families end up being the treatment team with increased burden, little support, and lack of recognition, and (3) inadequate and inequitable mental health services for youth and families are amplified during the pandemic.

CONCLUSION

At a time when mental health needs were higher, the mental health care system offered less support to youth and their families. For a more equitable response to the pandemic, we need an accessible and integrated mental health care system that shows a commitment to addressing social determinants and reducing health disparities and inequities in access to mental health services.

The Traumatizing Impact of Racism in Canadians of Colour

Purpose of Review

While research has identified racial trauma in other contexts, it is often overlooked amongst Canadian society. Racial trauma occurs as a result of an event of racism or cumulative events over time whereby an individual experiences stress and consequent mental health sequelae. Given that the BIPOC (Black, Indigenous, and/or Person of Colour) population in Canada is increasing, it is imperative to identify racial discrimination and the subsequent stress and trauma associated with being racialized in Canada, which subjects BIPOC Canadians to various forms of racism, including microaggressions.

Recent Findings

This paper reviews the published literature on racism and racial discrimination that identifies or infers racial trauma as the source of the mental health implications for various groups (e.g., Indigenous people, Black Canadians, Asian Canadians, immigrants, and refugees). In addition, intersectionality of racialized persons is prominent to their psychological well-being as their psychosocial and socioeconomic position are complex. Therefore, this paper both provides insight into the Canadian experience as a person of colour and signifies the need for further research on racial trauma in a Canadian context.

Summary

Despite Canada’s emphasis on multiculturalism, racialized individuals are at risk for racial trauma due to prejudice and discrimination. The politicization of multiculturalism has permitted Canada to deny claims of racism, yet the historical basis of established institutions results in irrefutable systemic and systematic barriers for Canadian people of colour.

A protocol for a scoping review of equity measurement in mental health care for children and youth

BACKGROUND

Mental health (MH) problems are among the most important causes of morbidity and mortality for children and youth. Problems of lack of equity in child and youth MH services (CYMHS)-including, but not limited to, problems in inaccessibility and quality of services-are widespread. Characterizing the nature of equity in CYMHS is an ongoing challenge because the field lacks a consistent approach to conceptualizing equity. We will conduct a scoping review of how equity in MH services for children and youth has been defined, operationalized, and measured. Our objectives are to discover: (1) What conceptual definitions of equity are used by observational studies of CYMHS?; (2) What service characteristics of CYMHS care do indices of equity cover?; (3) What population dimensions have been used to operationalize equity?; (4) What statistical constructs have been used in indices that measure CYMHS equity?; and (5) What were the numerical values of those indices?

METHODS

The following databases will be searched: Medline, Embase, PsycINFO, Cochrane Controlled Register of Trials, CINAHL, EconLit, and Sociological Abstracts. Searches will be conducted from the date of inception to the end of the last full calendar year (December 2019). Studies will be included if they include an evaluation of a mental health service for children or youth (defined as those under 19 years of age) and which quantify variation in some aspect of child or youth mental health services (e.g., accessibility, volume, duration, or quality) as a function of socio-demographic and/or geographic variables. Study selection will occur over two stages. Stage one will select articles based on title and abstract using the liberal-accelerated method. Stage two will review the full texts of selected titles. Two reviewers will work independently on full-text reviewing, with each study screened twice using pre-specified eligibility criteria. One reviewer will chart study characteristics and indices to be verified by a second reviewer. Reviewers will resolve full-text screening and data extraction disagreements through discussion. Synthesis of the collected data will focus on compiling and mapping the types and characteristics of the indices used to evaluate MH services equity.

DISCUSSION

The planned, systematic scoping review will survey the literature regarding how equity in MH services for children and youth has been operationalized and help inform future studies of equity in CYMHS.

SYSTEMATIC REVIEW REGISTRATION

Open Science Foundation ID SYSR-D-19-00371, https://osf.io/58srv/ .

Triple Jeopardy: Complexities of Racism, Sexism, and Ageism on the Experiences of Mental Health Stigma Among Young Canadian Black Women of Caribbean Descent

This article explores how the intersection of race, gender, and age intertextually complicate and nuance the experience of mental health stigma among young Black women of Caribbean descent living in Canada. The Mental Health Commission of Canada acknowledged that mental health stigma continues to affect the help-seeking behavior of young adults. Some youth-serving agencies and many advocates within Black communities have become increasingly vocal about mental health stigma and the lackluster response to the needs of Black youth (e.g., no increase in funding for the Substance Abuse Program for African, Canadian, and Caribbean Youth-SAPACCY, since the program was established in the mid-1990s). The issue of mental health stigma within the African, Caribbean, and Black Canadian (ACB) communities is widely known and often discussed at public forums. Several recent mental health forums and mental health initiatives held in Toronto made it clear that mental health in Black communities is at a crisis point in the Greater Toronto Area (GTA) and possibly across Canada. Forum discussions also revealed that the issue is further compounded by the intersection of race, gender, and age. In addition, while research studies have also identified stigma as a barrier to accessing mental health services and/or supports, there is a paucity of research on how mental health stigma, when complicated by the experience of racism, sexism, and ageism, affects access to services among young Black women of Caribbean descent. This lack of research on Caribbean women's experience with mental illness limits insights into concepts, issues, and problems that directly impact broader issues related to mental health in Canada. This article engenders a discussion that strengthens the focus on mental health stigma campaigns and education on the mental health of young Black women in Canada. The lack of literature relating to this topic in the Canadian context, as previously noted, limits the extent to which this issue can be fully discussed within Canada. As such, insights into concepts and existing discussions on women's mental health throughout this paper will include references to literature from the U.S., U.K., and Australia, professional experiential knowledge, and personal insights from conversations with young Black women of Caribbean descent. The paper calls for more research on Caribbean women's mental health in Canada to provide better insights and understanding of the issue within a Canadian context.

Issues and Options for Improving Services for Diverse Populations

International migration has led to increasingly diverse populations in many high-income countries. With approximately 250,000 newcomers each year, it should be no surprise that developing services that meet the needs of immigrants, refugees, ethnocultural, and racialized populations (IRER) is a major priority in the Mental Health Strategy for Canada. The published Canadian literature on the mental health of diverse populations concludes that differences in the exposure to social risk factors lead to differences in rates of illness for some groups. Whether rates of illness are high or low in a particular group, however, problems in accessing services are ubiquitous. Improving the service response will require political will, leadership, strategic planning, and data, and must include people with lived experience and the populations at highest risk. This paper outlines the “Issues and Options” paper commissioned by the Mental Health Commission of Canada, which used a thorough literature review and a national consultation to develop a model for service development. A health equity approach that utilizes local-population-based planning and the evidence-based interventions that are available for diverse groups could improve services for IRER groups in Canada.

Rates of mental illness and suicidality in immigrant, refugee, ethnocultural, and racialized groups in Canada: a review of the literature

OBJECTIVE

Studies from around the world point to differences in the rates of mental illnesses between immigrant, refugee, ethnocultural, and racialized (IRER) groups and host populations. Risk of illness depends on social contexts; therefore, to offer the best information for people aiming to develop and offer equitable services, local information on rates of mental illness in different population groups is required.

METHODS

We performed a literature review of peer-reviewed journals and the grey literature between 1990 and 2009 using standard techniques and identified primary research reporting the rates of mental illness and suicidality in IRER groups in Canada.

RESULTS

Among the 229 papers we reviewed, 17 were included. Most papers reported rates for depression. There was no clear pattern, with different IRER groups and different age groups reporting either elevated or lower rates, compared with white Canadians. Refugee youth in Quebec have higher rates of numerous mental health problems and illnesses. When immigrant groups were considered as a whole, suicide rates were low but different national origin groups reported different trajectories in rates across the generations.

CONCLUSION

The literature on rates of mental illness and suicidality in IRER groups in Canada is diverse and not comprehensive. In addition, most research has been conducted in 3 provinces and, in particular, 3 major cities. The rates of mental illness seem to vary by national origin groups, age, and status in Canada. There is very little research on nonimmigrant, culturally diverse populations in Canada. This lack of information may undermine efforts to develop equitable mental health services for all Canadians.

Variation in health services utilization among ethnic populations

BACKGROUND

Although racial and ethnic disparities in health services utilization and outcomes have been extensively studied in several countries, this issue has received little attention in Canada. We therefore analyzed data from the 2001 Canadian Community Health Survey to compare the use of health services by members of visible minority groups and nonmembers (white people) in Canada.

METHODS

Logistic regression was used to compare physician contacts and hospital admissions during the 12 months before the survey and recent cancer screening tests. Explanatory variables recorded from the survey included visible minority status, sociodemographic factors and health measures.

RESULTS

Respondents included 7057 members of visible minorities and 114,255 white people for analysis. After adjustments for sociodemographic and health characteristics, we found that minority members were more likely than white people to have had contact with a general practitioner (adjusted odds ratio [OR] 1.28, 95% confidence interval [CI] 1.14-1.42), but not specialist physicians (OR 1.01, 95% CI 0.93-1.10). Members of visible minorities were less likely to have been admitted to hospital (OR 0.83, 95% CI 0.70- 0.98), tested for prostate-specific antigen (OR 0.64, 95% CI 0.52-0.79), administered a mammogram (OR 0.68, 95% CI 0.59-0.80) or given a Pap test (OR 0.47, 95% CI 0.39-0.56).

INTERPRETATION

Use of health services in Canada varies considerably by ethnicity according to type of service. Although there is no evidence that members of visible minorities use general physician and specialist services less often than white people, their utilization of hospital and cancer screening services is significantly less.