Making mental health and substance use services accessible in the community

I have lived with mental illness for over 30 years. Nobody really knows how to help unless there is a medication that works. There is also stigma, especially in the workplace — a lot of people with lived experience don’t talk about it and try to take care of themselves in silence. — Anonymous Patient Partner, British Columbia

The devastating impact of mental health and substance use issues has led the federal, provincial and territorial governments to make access to timely services for them one of their shared health priorities. The indicators to measure progress in this area are

• Wait Times for Community Mental Health Counselling
• Youth Age 12 to 25 Who Accessed Integrated Youth Services for Mental Health, Substance Use and Well-Being SupportFootnotei

Counselling from a mental health professional, especially when provided early, can improve long-term mental health and keep people from being hospitalized.Reference6 If counselling is not available when needed, often because of long waits, symptoms can worsen and people may be less likely to show up to their first appointment.Reference6 Reference7

Note
* This does not include people who paid for their own care or paid using private insurance, or people who accessed such services without scheduling them in advance (e.g., at a walk-in clinic). 1 in 10 people waited 143 days or more.
Sources
Provincial and territorial data collection systems, 2023–2024.

Median wait times (the time it takes for half of those waiting for counselling to receive it) for community mental health counselling varied by several factors, including

• Age: Children and youth waited 2 days less than adults.
• Sex/gender: Females waited 2 days longer than males.
• Format: People waited 8 days less for virtual counselling than for in-person treatment (based on data from Newfoundland and Labrador, Nova Scotia, New Brunswick, Manitoba, Alberta and the Northwest Territories).

Wait times for mental health services are influenced by workforce availability, patient demand, urgency of need and client preferences, among other factors. In recent years, many jurisdictions have introduced a “stepped care” approach to mental health or substance use counselling. In this model of care, patients start with effective but less-resource-intensive treatments such as counselling on a walk-in or short-term basis. Depending on an individual’s need, they may be moved to more resource-intensive or specialized care. Overall, structuring care in this way can improve timely access to care. While programs such as walk-in counselling are not included in this indicator, the availability of these services may help shorten the wait for mental health counselling appointments in the community. 

Funding for mental health and addictions care has multiplied in recent years. We’ve implemented new programs like Open Access, where anyone can come in for counselling any time. Our biggest barrier is staffing — there’s money to deliver great services, but we can’t always recruit or retain the service providers we need to deliver them. — Debbra Cyr-Lebel, Director, Adult Addictions and Mental Health Services, Department of Health, New Brunswick

Despite the importance of early intervention for young people with mental health and substance use issues, too few support services are designed for their specific needs. Existing services are often scattered across unconnected organizations and providers, and long waits are common.Reference5 Access to care can become even more challenging when youth reach 18 and must navigate the switch to adult services.

Integrated Youth Services (IYS) is a model of care that several provinces and territories have launched to address these challenges.Reference8 Working with community partners, IYS sites link youth-focused services under one roof to offer care for mental health and substance use issues, as well as primary care, social services (such as employment and education support) and culturally specific services. 

It can be incredibly frustrating jumping from service to service… [it] can demotivate you from seeking the help you need. But with IYS, all resources are in one place… [you] don’t need to repeat yourself 10 times before you get the help that you need. — Anonymous, IYS Youth Advisor

Young people don’t need a referral to use IYS — they can just walk in to an IYS site. In some cases, virtual services are also available. To ensure that the services offered are relevant to the community they serve, staff at IYS sites engage with youth clients and their families to co-design programs to meet the needs of each community. 

Data from Newfoundland and Labrador, Ontario, Manitoba and British Columbia shows that in 2022–2023, there were 164,819 visits to IYS sites. On average, clients visited 5 times over the course of the year.Referenceii

Sources
Provincial and territorial IYS networks, 2024.

Further, in Newfoundland and Labrador, Ontario and British Columbia, the use of IYS services was highest among 17- and 18-year-olds, suggesting that these services are particularly important for young people who would otherwise be transferring to adult services. Data collection is important for measuring access to IYS. More data will become available as more IYS sites start to collect standardized data.

IYS is one of several models of mental health and substance use services for young people. Additional information on access to child and youth mental health and substance use services is also available using CIHI’s Early Intervention for Mental Health and Substance Use Among Children and Youth indicator.Reference9 

• Wait Times for Community Mental Health Counselling, 2023–2024 — Data Tables
• Youth Age 12 to 25 Who Accessed Integrated Youth Services for Mental Health, Substance Use and Well-Being Support, 2022–2023 — Data Tables
• Mental health and substance use
• Mental disorders and access to mental health care, Statistics Canada