Mental Health Care In Canada Research Articles

Perspectives on Cultural Competency and Black Canadians’ Access to Mental Health Care in Canada: A Thematic Analysis

Perspectives on Cultural Competency and Black Canadians’ Access to Mental Health Care in Canada: A Thematic Analysis

Barriers to Mental Health care in Canada Identified by Healthcare Providers: A Scoping Review.

The mental health treatment gap remains wide across the world despite mental illness being a significant cause of disability globally. Both end-user and healthcare provider perspectives are critical to understanding barriers to mental healthcare and developing interventions. However, the views of providers are relatively understudied. In this review, we synthesized findings from current literature regarding providers' perspectives on barriers to mental healthcare in Canada. We searched Medline, PsycINFO, Embase, and CINAHL for eligible Canadian studies published since 2000. Analysis and quality assessment were conducted on the included studies. Of 4,773 reports screened, 29 moderate-high quality studies were reviewed. Five themes of barriers emerged: health systems availability and complexity (reported in 72% of the studies), work conditions (55%), training/education (52%), patient accessibility (41%), and identity-based sensitivity (17%). Common barriers included lack of resources, fragmented services, and gaps in continuing education. Interestingly, clinicians often cited confusion in determining the ideal service for patients due to an overwhelming number of potential services without clear descriptions. These five domains of barriers present a synthesized review of areas of improvement for mental healthcare spanning both patients and clinicians. Canadian mental health systems face a need to improve capacity, clinician training, and in particular service navigability and collaboration.

The Business of Art Therapy: Exploring Art Therapists’ Professional Sustainability in Canada Through Extrinsic Factors and Systems of Influence (Le marché de l’art-thérapie : exploration de la durabilité professionnelle des art-thérapeutes au Canada au travers des facteurs extrinsèques et des systèmes d’influence)

This integrative literature review explores Canadian art therapists’ difficulties of finding and maintaining sustainable employment. When conceiving of what contributes to maintaining sustainable employment, the intersection of art therapist, art therapy culture, and business skills were considered. The goal of this literature review was to understand potential challenges that new and current art therapists may find by collating literature into main key categories that explore extrinsic systems of influence. In this study, extrinsic systems of influence are described as influences outside of an art therapist that contribute to a Canadian art therapist’s experiences of achieving sustainable employment. The literature was categorized into the following extrinsic experiences: gender, social action, activism, advocacy, feminism, psychology of identity and brand, and socialized health care. Two main conceptual recommendations were generated from the review. The first is that using a lens of the psychology of identity and brand can create a unified and inclusive art therapy identity in Canada. This lens can contribute to art therapists more concisely communicating a message of unique values, identity, and benefits. The second finding is that establishing provincial psychotherapy/counseling therapist regulatory colleges will bring recognition and inclusion in healthcare funding in the future. The implication of these two recommendations for future study is to evaluate and assess art therapists’ value offering messaging and employment in mental health care in Canada.

Advancing Collaborative Mental Health Care in Canada’s Primary Care Settings: A National Quality Framework with Recommended Measures

Collaborative mental health care involves primary care providers and mental health specialists working together in structured ways to improve access to care, quality of care and outcomes. Collaborative mental health care is a proven approach to improve timely access to evidence-informed care, individual health outcomes, patient experience of care, equitable health care delivery and outcomes across populations, and cost-effectiveness of care. However, its implementation in Canadian primary care settings is variable and do not necessarily align with research evidence. This has led to a knowledge-to-practice gap regarding the comparative effectiveness of the different collaborative mental health care practices that teams and organizations may use to achieve desired outcomes. The Mental Health Commission of Canada (MHCC) and its partners are pleased to share a pan-Canadian evidence-based framework for planning and measuring quality collaborative care. The report, “Advancing Collaborative Mental Health Care in Canada’s Primary Care Settings: A National Quality Framework with Recommended Measures” is the result of a two-year project led by the Quality Improvement for Collaborative Care (QI4CC) research team and is based on extensive consultations with providers, planners, and people with lived experience. A qualitative study was used to explore the current state of collaborative care across Canada and determine how to define and measure its quality and the project team engaged a multi-stakeholder group throughout the entire project to get feedback on the research process and findings and to refine and finalize the framework. The resulting revised Quality Improvement for Collaborative Care (QI4CC) framework was developed to assist stakeholders in organizing and delivering primary care mental health and addictions services. The framework is intended to help leaders in practice and policy put in place needed supports and structures to achieve successful implementation of good practices in collaborative care as well as recommending quality measures to prioritize when evaluating collaborative care initiatives in primary care practices.
 Learning Objectives:
 1. Have a better understanding of collaborative mental health care in primary care settings
 2. Provide an overview of the Quality Improvement for Collaborative Care framework and the key components in delivery of effective collaborative mental health care 
 3. Identify recommended measures to evaluate and improve the quality of collaborative care in primary health settings
 4. Explore opportunities to apply the QI4CC framework for an international audience 
 Target Audience: health-care providers – especially those involved in delivering mental health care in primary care settings, administrative leaders of health services, policymakers, and champions of collaborative care in mental health and addictions services (includes people with lived and living experience)

Organizational and practitioner challenges to Black youth accessing mental health care in Canada: Problems and solutions.

Organizational and practitioner challenges to Black youth accessing mental health care in Canada: Problems and solutions.

E-Mental Health Services in Canada: Can They Close the Access Gap?

With significant unmet needs for mental healthcare in Canada, there is a growing interest in e-mental health (e-MH) services to meet gaps in access. While the policy window appears to be open, it is unclear how best to implement e-MH services due to health system barriers that create unmet needs in the first place. We explore the financing, organization and delivery of Canadian mental health services and discuss the promise of e-MH services for alleviating access barriers, highlighting increased policy attention during the COVID-19 pandemic. We consider how evidence-based e-MH services have successfully scaled in other publicly funded healthcare systems and note potential issues in the Canadian context.

Access to mental health care in Canada

There has been ongoing national discourse about barriers to mental health care services in Canada. The purpose of the study is to better understand these barriers, with a focus on Canadians of color. To that end, this study surveyed 1501 adults representative of the general population, collected by the Angus Reid Institute. Over half of the respondents had sought out mental health care and experienced barriers to access. People of color (visible minorities and Indigenous people) had more difficulty accessing care, as did younger adults and those with lower incomes. The most common difficulties were largely structural: long waitlists (62%), financial barriers (58%), lack of resources/professionals in the area (47%), difficulty finding specialists (41%), and difficulty accessing in-person care during the pandemic (34%). Many noted negative experiences with mental health professionals (35%). More English-speaking than French-speaking Canadians reported barriers to care overall. Race/ethnicity was related to difficulties when trying to access mental health care, as many could not find someone of the same group (25% of Black respondents), someone who spoke their preferred language (22% of South Asian respondents), or they had prior negative experiences (50% of Indigenous respondents). We discuss the implications of these findings, including the critical need to increase the supply and diversity of mental health providers across Canada. This study is one of the first to provide quantitative data on the perceived barriers faced by Canadians in accessing mental health care while exploring the role of language, race, and ethnicity as variables that may influence access.

Making the case for citizenship-oriented mental healthcare for youth in Canada

PurposeVarying stakeholders have highlighted how recovery-oriented mental health services such as youth mental health services have traditionally focused on supporting individual resources to promote recovery (e.g., agency) to the exclusion of addressing structural issues that influence recovery (e.g. poverty). One response to this criticism has been work helping people with mental health problems recover a sense of citizenship and sense of belonging in their communities. Work on citizenship has yet to influence youth mental healthcare in Canada’s provinces and territories. This paper aims to highlight ways that youth mental healthcare can better help youth recover a sense of citizenship.Design/methodology/approachThe arguments described in this paper were established through discussion and consensus among authors based on clinical experience in youth mental health and an understanding of Canada’s healthcare policy landscape, including current best practices as well as guidelines for recovery-oriented care by the Mental Health Commission of Canada.FindingsHere, this study proposes several recommendations that can help young with mental health problems recover their sense of citizenship at the social, systems and service levels. These include addressing the social determinants of health; developing a citizenship-based system of care; addressing identity-related disparities; employing youth community health workers within services; adapting and delivering citizenship-based interventions; and connecting youth in care to civic-oriented organizations.Originality/valueThis paper provides the first discussion of how the concept of citizenship can be applied to youth mental health in Canada in multiple ways. The authors hope that this work provides momentum for adopting policies and practices that can help youth in Canada recover a sense of citizenship following a mental health crisis.

Collaborative Mental Health Care in Canada: Challenges, Opportunities and New Directions.

Collaborative Mental Health Care in Canada: Challenges, Opportunities and New Directions.

The “loneliness epidemic”, intersecting risk factors and relations to mental health help-seeking: A population-based study during COVID-19 lockdown in Canada

BackgroundPandemic-induced social distancing and stay-at-home orders, while successful in decreasing the transmission of COVID-19, could exacerbate loneliness. Few studies have examined how pandemic-related social determinants intersect to shape pandemic loneliness and its relations to mental health care in Canada. MethodsA population-representative sample of 3772 adults from the Canadian Perspective Survey Series (CPSS-6; January 25 to 31, 2021) was analyzed. Gender-specific logistic regression was employed to investigate the association between three-item loneliness scale (UCLA-3) with socio-demographics, job precarity, health behaviours, social isolation indicators, and mental health help-seeking. Classification and Regression Tree (CART) modelling was used to identify intersecting risk factors and the most important predictor of severe loneliness (UCLA-3 score ≥ 7). ResultsThe estimated prevalence of severe loneliness was 34.7 % in Canada, with women significantly higher than men (38.1 % vs 31.3 %, p < 0.001). Pandemic loneliness were more prevalent in female (OR = 1.53, 99 % CI: 1.26–1.85), those who were younger (OR's range 1.42–3.00), women without college degree (OR = 1.44, 99 % CI: 1.01–2.04), those living alone (OR = 1.56, 99 % CI: 1.09–2.23), immigrant men (OR = 1.79, 99 % CI: 1.23–2.60), those with small network (OR's range: 1.73–3.26), those who were absent from work due to COVID-19 related reasons (OR = 2.11, 99 % CI: 1.04–4.28), past-month binge drinkers (OR's range: 1.39–1.70) and cannabis user (OR = 1.47, 99 % CI: 1.12–1.93). The CART algorithm identifies that immigrants who experienced pandemic-triggered job insecurity were the most-at-risk group of severely loneliness. Pandemic loneliness was positively associated with formal help-seeking from mental health professionals (OR = 1.71, 99 % CI: 1.21–2.41), informal help-seeking from social circle (OR = 1.51, 99 % CI: 1.17–1.95), and unmet mental health needs (OR = 1.78, 99 % CI: 1.29–2.49). LimitationsCross-sectional data prohibits causal inferences. ConclusionThe COVID-19 pandemic converges with loneliness epidemic in Canada. Prevention and intervention programs should target upstream social determinants of mental health, especially the intersection of migration status and COVID-19-related job precarity, to eliminate loneliness during the pandemic.

Developing, Implementing, and Evaluating an Artificial Intelligence-Guided Mental Health Resource Navigation Chatbot for Health Care Workers and Their Families During and Following the COVID-19 Pandemic: Protocol for a Cross-sectional Study.

BackgroundApproximately 1 in 3 Canadians will experience an addiction or mental health challenge at some point in their lifetime. Unfortunately, there are multiple barriers to accessing mental health care, including system fragmentation, episodic care, long wait times, and insufficient support for health system navigation. In addition, stigma may further reduce an individual’s likelihood of seeking support. Digital technologies present new and exciting opportunities to bridge significant gaps in mental health care service provision, reduce barriers pertaining to stigma, and improve health outcomes for patients and mental health system integration and efficiency. Chatbots (ie, software systems that use artificial intelligence to carry out conversations with people) may be explored to support those in need of information or access to services and present the opportunity to address gaps in traditional, fragmented, or episodic mental health system structures on demand with personalized attention. The recent COVID-19 pandemic has exacerbated even further the need for mental health support among Canadians and called attention to the inefficiencies of our system. As health care workers and their families are at an even greater risk of mental illness and psychological distress during the COVID-19 pandemic, this technology will be first piloted with the goal of supporting this vulnerable group.ObjectiveThis pilot study seeks to evaluate the effectiveness of the Mental Health Intelligent Information Resource Assistant in supporting health care workers and their families in the Canadian provinces of Alberta and Nova Scotia with the provision of appropriate information on mental health issues, services, and programs based on personalized needs.MethodsThe effectiveness of the technology will be assessed via voluntary follow-up surveys and an analysis of client interactions and engagement with the chatbot. Client satisfaction with the chatbot will also be assessed.ResultsThis project was initiated on April 1, 2021. Ethics approval was granted on August 12, 2021, by the University of Alberta Health Research Board (PRO00109148) and on April 21, 2022, by the Nova Scotia Health Authority Research Ethics Board (1027474). Data collection is anticipated to take place from May 2, 2022, to May 2, 2023. Publication of preliminary results will be sought in spring or summer 2022, with a more comprehensive evaluation completed by spring 2023 following the collection of a larger data set.ConclusionsOur findings can be incorporated into public policy and planning around mental health system navigation by Canadian mental health care providers—from large public health authorities to small community-based, not-for-profit organizations. This may serve to support the development of an additional touch point, or point of entry, for individuals to access the appropriate services or care when they need them, wherever they are.International Registered Report Identifier (IRRID)PRR1-10.2196/33717

One country, two education models: exploring the pedagogical approaches to training undergraduate nurses for mental health care in Canada

The training and registration of psychiatric/mental health nurses has a contested past in Canada. One of the consequences of the professional jostling between psychiatry and nursing for control over this area is the unusual circumstances of Canada having two education systems for this specialty. To understand why the schism has taken place and the impact it has had on psychiatric/mental health nursing, the authors have undertaken a critical review of the ontological and epistemological assumptions of these two pedagogical approaches. This review reveals that while the approaches share much in common, groups from both the east and the west receive different levels of mental health-related curriculum within their training. While it could be argued that psychiatric/mental health nursing practice is different enough to warrant its own framework for the preparation of specialist practitioners, there is no clear answer as to whether one of the current models should be implemented over the other. In this context, this paper argues that it is important that psychiatric nurses advocate for a future for the speciality in Canada.

A Scoping Review on Barriers to Mental Healthcare in Canada as Identified by Healthcare Providers

AimsMental illness is among the leading causes of disability globally, however the treatment gap is wide even for developed countries. The perspectives of patients and mental healthcare providers are critical to understanding barriers to adequate mental healthcare and developing scalable solutions that improve access and quality of services. However, the views of providers are relatively understudied, precipitating our review to collate and synthesize their perspectives on the barriers to mental healthcare in Canada.MethodsWe searched MEDLINE/PubMed and PsychINFO for studies with findings in Canada published in English from 2000–2021 with terms for mental health, psychiatry, barriers, and referrals. Included studies were evaluated with the National Institutes of Health Study Quality Assessment Tools and Critical Appraisal Skills Programme.Results631 papers were screened, finding 20 eligible studies, including 13 qualitative, one cross-sectional, one retrospective, and five mixed-methods studies. Through inductive content analysis, five themes of barriers emerged: (1) patient accessibility (19% of studies), (2) health systems availability and complexity (31%), (3) training/education (25%), (4) work conditions (21%), and (5) cultural sensitivity (4%). Among barriers discussed, common challenges included a lack of resources for both patients and providers, gaps in continuing education for primary care providers, and health systems challenges such as difficulty securing referrals, unclear intake criteria, and confusion due to overload of contacts.ConclusionHealth systems face a multi-faceted set of challenges to improving access to mental healthcare that will require solutions from various stakeholders. Understanding these barriers is critical in focusing initiatives to improve mental health care, both in Canada and in countries facing similar challenges.

Alberta’s Mental Health Review Panels: Accountable, Transparent Adjudication?

This article examines issues of accountability and transparency in Alberta’s Mental Health Review Panel process. A person who is involuntarily admitted to a mental health facility, or who is subject to a community treatment order (CTO), can appeal to the Review Panel to have their admission certificates or CTO cancelled. This process is intended to provide access to a decision-maker to review decisions that affect the liberty of those living with mental illness. Unfortunately, Alberta’s Mental Health Review Panels are not transparent or accountable decision-makers. The article begins with a brief outline explaining the delivery of mental health care in Canada, followed by a description of Canadian law on CTOs. The article then examines Alberta’s Mental Health Review Panels — first in terms of their role in relation to CTOs, followed by concerns about accountability and transparency in the Review Panel process. Finally, the article looks at legal and system reforms that will enhance the accountability of the process.

Perceptions of Educational Needs in an Era of Shifting Mental Health Care to Primary Care: Exploratory Pilot Study.

BackgroundThere is an unmet need for mental health care in Canada. Primary care providers such as general practitioners and family physicians are the essential part of mental health care services; however, mental health is often underestimated and underprioritized by family physicians. It is currently not known what is required to increase care providers’ willingness, comfort, and skills to adequately provide care to patients who present with mental health issues.ObjectiveThe aim of this study was to understand the need of caregivers (family members overseeing care of an individual with a mental health diagnosis) and family physicians regarding the care and medical management of individuals with mental health conditions.MethodsA needs assessment was designed to understand the educational needs of caregivers and family physicians regarding the provision of mental health care, specifically to seek advice on the format and delivery mode for an educational curriculum to be accessed by both stakeholder groups. Exploratory qualitative interviews were conducted, and data were collected and analyzed iteratively until thematic saturation was achieved.ResultsCaregivers of individuals with mental health conditions (n=24) and family physicians (n=10) were interviewed. Both the caregivers and the family physicians expressed dissatisfaction with the status quo regarding the provision of mental health care at the family physician’s office. They stated that there was a need for more educational materials as well as additional support. The caregivers expressed a general lack of confidence in family physicians to manage their son’s or daughter’s mental health condition, while family physicians sought more networking opportunities to improve and facilitate the provision of mental health care.ConclusionsRobust qualitative studies are necessary to identify the educational and medical management needs of caregivers and family physicians. Understanding each other’s perspectives is an essential first step to collaboratively designing, implementing, and subsequently evaluating community-based mental health care. Fortunately, there are initiatives underway to address these need areas (eg, websites such as the eMentalHealth, as well as the mentorship and collaborative care network), and information from this study can help inform the gaps in those existing initiatives.

"One Degree of Separation": A Mixed-Methods Evaluation of Canadian Mental Health Care User and Provider Experiences With Remote Care During COVID-19.

ObjectivesThe COVID-19 pandemic has contributed to a shift from in-person to remote mental health care. While remote care methods have long existed, their widespread use is unprecedented. There is little research about mental health care user and provider experiences with this transition, and no published studies to date have compared satisfaction between these groups.MethodsCanadian mental health care users (n = 332) and providers (n = 107) completed an online self-report survey from October 2020 to February 2021 hosted by the Canadian Biomarker Integration Network in Depression. Using a mixed-methods approach, participants were asked about their use of remote care, including satisfaction, barriers to use, helpful and unhelpful factors, and suggestions for improvement.ResultsOverall, 59% to 63% of health care users and 59% of health care providers were satisfied with remote care. Users reported the greatest satisfaction with the convenience of remote care, while providers were most satisfied with the speed of provision of care; all groups were least satisfied with therapeutic rapport. Health care providers were less satisfied with the user-friendliness of remote care (P < 0.001) than users, while health care users were less satisfied than providers with continuity of care (P < 0.001). The use of a video-based platform was associated with remote care satisfaction among health care users (P < 0.02), and qualitative responses support the importance of visual cues in maintaining therapeutic rapport remotely. The majority of users (55%) and providers (87%) reported a likelihood of using remote care after the pandemic.ConclusionsRemote mental health care is generally accepted by both users and providers, and the majority would consider using remote care following the pandemic. Suggestions for improvement include greater use of video, increased attention to body language and eye contact, consistency with in-person care, as well as increased provider training and administrative support.

Interpreting Irremediability When a Mental Health Disorder is the Sole-qualifying Medical Condition for MAiD

In this critical commentary, a set of ethical considerations of relevance to the (currently contested) interpretation of irremediability for medical assistance in dying (MAiD) in circumstances where the sole-underlying medical condition is a mental health disorder is explored and analyzed. Based on the application of an ethics lens, a practical description of irremediability is proposed for intended use as guidance by Canadian mental health care clinicians, MAiD assessors and providers, and provincial/territorial professional regulatory authorities.

Ketamine-Assisted and Culturally Attuned Trauma Informed Psychotherapy as Adjunct to Traditional Indigenous Healing: Effecting Cultural Collaboration in Canadian Mental Health Care.

Ketamine therapy with culturally attuned trauma-informed psychotherapy in a collaborative cross-cultural partnership may provide a critical step in the operationalization and optimization of treatment effectiveness in diverse populations and may provide a foundation for an improved quality of life for Indigenous people. Decolonizing Indigenous health and wellbeing is long overdue, requiring an equal partnership between government and Indigenous communities, built upon an aboriginal culture holistic foundation of balance of mind, body, social and spiritual realms, and within the context of historical and lived experiences of colonialism. Culturally attuned trauma-informed psychotherapy paired with ketamine—a fast-acting antidepressant that typically takes effect within 4 hours, even in cases of acute suicidality—may be uniquely qualified to integrate into an Indigenous based health system, since ketamine’s therapeutic effects engage multiple neuropsychological, physiological, biological, and behavioral systems damaged by intergenerational complex developmental trauma. Ketamine holds the potential to serve as a core treatment modality around which culturally engaged treatment approaches might be organized since its brief alteration of normal waking consciousness is already a familiar and intrinsic element of healing culture in many Indigenous societies. There is great need and desire in Indigenous communities for respectful and sacred partnership in fostering more effective mental health outcomes and improved quality of life.

The Quality Mental Health Care Network: A roadmap to improving quality mental healthcare in Canada.

Although there are numerous quality of care frameworks, little attention has been given to the essential concepts that encompass quality mental healthcare. HealthCareCAN and the Mental Health Commission of Canada co-lead the Quality Mental Health Care Network (QMHCN), which has developed a quality mental healthcare framework, building on existing provincial, national, and international frameworks. HealthCareCAN conducted an environmental scan, key informant interviews, and focus groups with individuals with lived experiences to develop the framework. This article outlines the findings from this scan, interviews and focus groups.

Invited commentary: ACCESS Open Minds/Esprits ouverts-A seismic shift in Canadian mental healthcare.

Invited commentary: ACCESS Open Minds/Esprits ouverts-A seismic shift in Canadian mental healthcare.