Canadians short on access to care for mental health and substance use

Mental health and substance use issues often start during adolescence, and 70% of people living with a mental illness experience symptoms before the age of 18. It’s estimated that up to 20% of children and youth in Canada — approximately 1.2 million young people — are affected by a mental health disorder.Reference4 Meeting the mental health needs of children and youth builds a foundation for health and well-being throughout their lives.

Services for youth are often fragmented, which makes it hard to find the right care. Then, when people turn 18, they must switch to adult services. Not only does this mean starting the search for care again, but the available services aren’t tailored to youth, don’t necessarily meet their needs and may have long waits.

The integrated youth services approach was developed to address long-standing problems — limited, fragmented services and uneven quality of care — that keep youth (age 12 to 25) from getting the help they need. The goal is to make youth mental health and substance use services easier to find and use by bringing together all the types of supports young people may need in one place.

Many of the integrated youth services sites across the country are new or just getting started. A core component of integrated youth services is measurement-based care. Integrated youth services providers understand it is important to measure outcomes through shared data systems, common evaluation tools and research studies. While we don’t yet have enough information to report on this indicator, here is a glimpse at some of the benefits integrated youth services offer:

• They provide easily accessible, youth-friendly and inclusive services to help reach youth who traditionally face barriers to mental health and substance use care.
• They work with community partners to bring a range of community resources to youth, blending help for mental health and substance use with primary health care and social services such as employment, housing and education supports.
• They are planned together with youth and family members and guided by shared principles so they meet the specific needs of the youth and communities they serve.
• They have spread across the country to help vulnerable youth, with at least one site operating or starting up in most provinces and territories. Some are designed just for Indigenous communities and incorporate traditional Indigenous healing and cultural practices. There is still work to do to address some of the challenges in remote communities, such as limited human resources.
• They study the kinds of care offered and measure results so improvements can be based on evidence of what works, what doesn’t and what’s still needed but missing.

Notes
n/a: Not available.

Quebec is not participating in the joint reporting exercise stemming from A Common Statement of Principles on Shared Health Priorities. Therefore, results are not available for Quebec. Newfoundland and Labrador is currently undertaking planning related to this indicator. Data is not available at this time for the number of sites under development.

† Saskatchewan has a minimum of 3 sites in development.

‡ In Alberta, Kickstand is the initiative represented in pan-Canadian activities.

§ British Columbia has 14 active in-person sites and 1 active virtual site.

The type and number of integrated youth services sites shown is a snapshot of provincially/territorially funded integrated youth services delivery sites that were part of provincial/territorial or pan-Canadian networks at the time this report was prepared.

Source
Provincial/territorial and pan-Canadian representatives of integrated youth services networks, 2023.

A 2018 survey of Canadians age 12 and older found that just over 14% reported being diagnosed with a mood or anxiety disorder (not including Quebec). Among those people,

• Nearly 8% reported they’d needed mental health care in the past 12 months but had not received it
• Another almost 20% reported they’d received some mental health care in the past 12 months but that it had only partially met their needs

Taken together, this means more than one-quarter of Canadians (not including Quebec) with a diagnosed mood or anxiety disorder — more than 851,000 people — reported in 2018 at least some unmet mental health care needs in the past 12 months. People with mood or anxiety disorders were twice as likely to have their need for mental health care unmet as people with other mental health issues.Reference5 Without formal care for mental health problems, symptoms can get worse.

Source
Statistics Canada. Custom tabulation based on 2018 Canadian Community Health Survey — Annual Component (CCHS). 2023.

Notes
n/a: Not available.

Quebec is not participating in the joint reporting exercise stemming from A Common Statement of Principles on Shared Health Priorities. Therefore, results are not available for Quebec.

Percentage of Canadians age 12 and older who reported having a diagnosed mood or anxiety disorder and that their perceived needs for mental health care were not met in the last 12 months (not including Quebec).

Mental health care includes information, medication, counselling and other services.

This indicator is based on those who reported being diagnosed with a mood or anxiety disorder. Provincial differences in the rate of diagnosis or in processes involved in receiving a diagnosis could affect the comparability of results between provinces.

The numbers in brackets show a range of possible values — the confidence interval — for the estimates from the survey data. This range accounts for the uncertainty of the estimates. For example, a province might have a wide range if there is a small number of survey responses and the results are less stable.

Source
Statistics Canada. Custom tabulation based on 2018 Canadian Community Health Survey — Annual Component (CCHS). 2023.
 

These results do not provide the full picture of unmet mental health needs. From more recent data we know that during the fall of 2020 — as the second wave of the COVID-19 pandemic spread across the country — almost 1 in 5 Canadians 12 and older reported needing mental health care in the last year. Of those people, nearly 1 in 2 felt their needs were unmet or only partially met. When Canadians who reported a need for mental health care were asked why it hadn’t been met, they gave reasons such as not knowing where to go or not having enough money to pay for care. 1 in 4 said they preferred to manage their needs themselves.Reference6

This data can’t tell us the impact of not having needs met or anything about people who didn’t look for mental health care. The COVID-19 pandemic increased mental health needs but also brought different ways of getting care, such as videoconferencing, phone calls, even texting, which might have made it easier for some people to find treatment and support.

It is very difficult across Canada to access psychological services, whether it’s psychologists, social workers or specialized educators. There are long waiting lists and given that many young people are experiencing an increase in distress and anxiety symptoms, it’s urgent that we focus our action on them. Parents want to know what they can do to help their kids.— Dr. Nicholas Chadi, pediatrician, Sainte-Justine University Hospital Centre, Quebec

Getting care quickly may prevent visits to emergency departments and hospital stays and can lead to better long-term mental health.

Note
This indicator measures the median number of days that clients waited for community mental health counselling and includes only publicly funded services that are scheduled in advance.

Sources
Provincial and territorial data collection systems, 2020.
 

Key questions as governments work to make high-quality mental health services more available include

• Are Canadians able to access the care they need?
• Are they getting care quickly enough?
• How do people feel about their experience getting care?

Notes
n/a: Not available.

No data is available at this time for Prince Edward Island, Quebec, Ontario and Nunavut.

— Alberta results are not shown due to incomplete data coverage but are included in the calculation of the Canada value.

Median number of days waited for community mental health counselling.

Includes only publicly funded services that are scheduled in advance.

For Nova Scotia, Manitoba, Saskatchewan, British Columbia and Yukon, results are based on partial data coverage.

Caution should be used when interpreting this data. The data comes from independent provincial and territorial systems, which have known variations in definitions.

Sources
Provincial and territorial data collection systems, 2020.
 

In some places, waits for mental health counselling services are longer for children and youth than for adults 18 and older. Children and youth make up about one-third of the total volume of referrals for mental health counselling.Reference7

We know there are differences in how provinces and territories deliver services, collect data and report it.  Many things affect how long a person waits for counselling, including

• What services are available, including differences between publicly funded and privately delivered services
• How easy it is to make their way through the system
• Community and cultural factors that affect the need for care 
• Realities such as income level, social and family support, education and where they live 
• Stigma, which can discourage people from asking for help
• How severe a person’s need is
• The availability or scheduling preferences of the person receiving services

Accessing mental health care takes a very long time, even when a youth is in crisis for months. About 5 months prior to being hospitalized the first time, my family doctor advised my parents to take me to hospital due to being in a mental health crisis. Even when a youth goes to the emergency department suicidal, you get sent back home without care and put on a wait-list.— Hannah, 19, Ontario

Better access to mental health and substance use care is important for millions of Canadians. While challenges are widespread across the country, information about who is affected, what services are available, and who is and is not getting support is unevenly gathered. If we are going to improve access to effective mental health and substance-use supports, we have to work on understanding the needs of different groups (such as by sex, income level, language and race). We have to understand the barriers that keep people from getting care and find out which ways of organizing and delivering care work best.

• Mental health and substance use at CIHI
• Wait Times for Community Mental Health Counselling indicator