Predictors of unmet need for medical care among justice-involved persons with mental illness.

Abstract

This cross-sectional study examined factors associated with unmet need for care from primary care physicians or from psychiatrists among clients enrolled in mental health court support programs in Toronto, Ontario. The sample included adults admitted to these programs during 2009 (N=994). Both measures of unmet need were determined by mental health court workers at program intake. Predictors included client predisposing, clinical, and enabling variables. Twelve percent had unmet need for care from primary care physicians and 34% from psychiatrists. Both measures of unmet need were associated with having an unknown diagnosis, having no income source or receiving welfare, homelessness, and not having a case manager. Unmet need for care from psychiatrists was associated with symptoms of serious mental illness and current hospitalization. Obtaining care from psychiatrists appears to be a particular challenge for justice-involved persons with mental illness. Policies and practices that improve access warrant more attention.