Universal Coverage Doesn't Ensure People Will Seek Treatment

Even though universal health insurance is available in Canada, many Canadians still seem reluctant to seek mental health services, according to a study in the September Canadian Journal of Psychiatry.

The lead researcher was Helen-Maria Vasiliadis, Ph.D., a Canadian Institutes of Health Research postdoctoral fellow at the Harvard School of Public Health.

Canada's first national survey on mental health and well-being was conducted in 2002 and included detailed questions about service use. It was called the Statistics Canada Canadian Community Health Survey: Mental Health and Well-Being. Vasiliadis and colleagues have now analyzed service-use data from that survey.

Most Canadians with a mental disorder, including dependence on illicit drugs, did not seek help for it during the year preceding the survey, Vasiliadis and coworkers found.

Only 34 percent of respondents with depression reported past-year use of professional mental health services. The corresponding percentages were 42 percent for mania, 38 percent for panic disorder, 29 percent for social anxiety, and 29 percent for agoraphobia, and 37 percent for drug dependence.

Women, single persons, and divorced individuals were more likely to seek help for a mental disorder than were men and individuals with partners. People with less education and people born outside of Canada were found to take less advantage of mental health services than individuals with more education and born within Canada.

Even after adjusting for variables such as preferring to manage a mental health problem on one's own; not believing that mental health services will help, or having a language problem, ethnic status remained a significant predictor of nonuse of mental health services.

“This finding may in part be explained by different definitions of a mental health problem in each ethnic group,” Vasiliadis said in an interview. “Different ethnicities may have different thresholds of a perceived mental health need and therefore consult or seek services when there is a significant problem... .The perceived need for care is an important driver of service use. One must also keep in mind that important barriers to mental health service use include education (people with lower education levels consult clinicians less often) and gender (males seek consultation significantly less often) as part of cultural barriers.”

On the whole, Vasiliadis and her colleagues were not surprised by their finding that many Canadians are reluctant to seek mental health care. And the major reason, she believes, is Canadians' attitudes toward mental health services. “Most people think that the problem will go away, or that they can manage on their own,” she said.

Nonetheless, a lack of access to services may partially explain why many Canadians do not seek mental health care, she suggested.

While there is coverage for seeing a psychiatrist, she pointed out, other mental health services, such as psychotherapy sessions with a psychologist or other nomedical mental health professional, are either paid for out of pocket or covered by employee benefit programs. “Further, not all Canadians are covered by prescription insurance plans,” she said. “There is therefore a measurable out-of-pocket cost in Canada for effective mental health therapy.”

The study was funded by the Canadian Institute for Health Research.

“Service Use for Mental Health Reasons: Cross-Provincial Differences in Rates, Determinants, and Equity of Access” is posted at<www.cpa-apc.org/Publications/CJP/current/cjp-sept-05-vasiliadis-7.pdf>.▪