In support of A Common Statement of Principles on Shared Health Priorities, CIHI is working closely with federal, provincial and territorial governments to develop a set of common indicators focused on measuring pan-Canadian access to mental health and addictions services and to home and community care.
As part of this process, CIHI reached out to Canadians to learn about their understanding of “access to services” and what meaningful measures of access would look like to them. Through focus groups, an online survey and key informant interviews, the voice of the public — including people with lived experience — became a significant contributor to the Shared Health Priorities work and indicator selection process.
What Canadians had to say
Members of the public who participated in the consultations identified wait times and availability of appropriate services as clear priorities for both mental health and addictions services and home and community care. In particular, their comments zeroed in on the importance of
- Shorter wait times
- The availability of appropriate services
- Improved patient experience
- Support in navigating the health system
Participants noted that they felt they did not have a sufficient understanding of how either sector worked, what services were available and how to access those services. For mental health and addictions, in particular, participants also identified prevention and promotion as an important priority.
“The way our system is set up is detrimental to people who suffer from mental illness and are high-functioning. … People who are high-functioning fall through the cracks. The only way to get help is to check yourself into a hospital.”
“There are just not enough resources or spaces for people.”
“There is confusion as to where to go. … You don’t know where to start.”
Participants believe the patient should receive the right service at the right time.
Canadians struggle to obtain home and community care services
“You can have all these programs, but if you don’t have a way to get there, or someone’s not getting it to you quickly enough, then your needs aren’t being met, you’re still sick or getting worse. It’s not a good situation.”
“My brother came back from the hospital and no one mentioned home care. He was lost in the shuffle with all the red tape. Home care is only provided on an urgent need basis.”
Timely access is important to the Canadian public and to system managers because it reflects care experiences and health system responsiveness.
“It’s more favourable when you get home care versus hospital care. It seems today that when you go to the hospital for an operation, once complete you want to go home and you can convalesce a lot better. It’s kind of a neat system. It’s just that there is not enough emphasis on home care.”
Patients often wait to be discharged from the hospital because the right home care services are not available. Participants said that they have had good experiences with home and community care, but that access is encumbered by long wait times and a complicated process.
Canadians deserve access to mental health and addictions services when they need them
“Why do you have to wait until you are completely incapacitated before you can see someone and get help?”
Canadians said that mental health and addictions services are good for those in the system, but a person needs to be in crisis before they can get access. Repeated visits to emergency departments, urgent care centres or hospitals can mean people are having difficulty accessing the services and support they need in the community. From a patient perspective, this can be due to a lack of awareness or a lack of availability of community-based services, and it can result in an absence of continuity of care, poor experiences of care and poorer outcomes.
Participants also noted that mental health should be on par with physical health. They said that people want regular access to mental health services and should not have to justify their need or receive help only in a crisis.
“Everyone has a health care provider and they should also have a mental health provider.”
“It is important to connect mental health care to community care and social care if someone needs them all, because they need all 3 to have life satisfaction. We need the interaction of siloed sectors — the social and the medical — to have life satisfaction despite mental illness.”
Canadians want more effective preventive care for mental health and addiction
“For some, you have to be your own advocate — some people don’t have the energy to navigate the system and they fall through the cracks. They don’t have the support to get things done. If you are depressed, how are you supposed to do that if you are non-functioning?”
Canadians said that mental health and addictions prevention and promotion is important because it would minimize strain on the system, reduce stigma and better inform the public of what is available and how to support individuals with mental health and addictions issues. In particular, participants noted that patients often need to be in crisis to be seen and that it is difficult to access preventive care.
“There are free services but not everyone knows about them — people are not accessing them or they are afraid to access them. We need public education.”