Primary care is one of the most common ways people access mental health treatment in this country. When we are experiencing mild to moderate mental health issues, such as anxiety or depression, the family physician is often the first person we speak to.
In fact, an estimated three quarters of Canadians rely on their primary care provider – a family physician or nurse practitioner – to address their mental health needs, according to the Ontario Medical Association.
Given the rise in mental health cases, that is troubling on several fronts.
First, it is troubling given that so many people in this country lack access to a primary care provider. If you are racialized, if you do not speak English, if you experience poverty or if you live in a rural or remote community, you are far less likely to have a primary care provider. Who and where are these people turning to for help with their mental health?
Second, there are trickle-down impacts on the primary care providers who are deluged with patients who have mental health concerns. How are they meeting their patients’ needs, both for patients with and without mental health concerns? What is the impact on their practice? Are they less likely to take on more or new clients?
What is clear is that when it comes to patients with mental health concerns, the current health-care setup is not working. Waitlists are excessively long. People continue to live with untreated mental health struggles.
For certain segments of the population, that number is even higher. Our own polling from earlier this year suggested that two thirds – or 66 per cent – of women between the ages of 18 and 35 are living with a mental health condition.
The poll offered insights into treatment. A large majority of people said they would be more likely to access mental health supports if there was someone to help guide them.
Our organization sees this as both a problem and an opportunity.
There are more than 24,000 registered social workers in Ontario. They are the largest group of mental health providers in the province – and the country, for that matter. That means that while psychiatric care is laden with considerable waitlists, social workers are often more available. They are trained to address the underlying problems often associated with declining physical and mental health: poverty, education, housing instability, access to nutritious food and other factors known as “social determinants of health.”
Where there are social workers in primary health care teams, they provide individual and group counselling, conduct assessments, and provide system navigation by connecting patients to treatment, care or other limited resources. They are extremely useful additions to teams.
The issue is most family physicians – an estimated 70 per cent – are not enrolled in teams. As a result, there are relatively few social workers currently employed in primary care.
We want that to change.
We see two possible starting points. Government could increase the numbers of primary care teams, ensuring funding to hire enough social workers, or it could make it easier for family physicians and nurse practitioners to work collaboratively in a team. A dedicated referral and consult system, for example, would facilitate fast connections with available social workers in the area.
The impact would be swift and dramatic. More people would have access to mental health care; primary care providers would be able to take on more patients; and fewer people would be forced to wait for care.
This is a win for patients, a win for equity-deserving groups, a win for primary care providers and a win for society as a whole.
Rachelle Ashcroft, Shelley Allen, Zeenat Ahmad, Lee-Ann Boucher, Geneviève Côté, Lori Dunne, Candace Hind, Julia Henderson, Lauren Massey, Nathalie Mehrer, Beverley Jones, and Carolyn Voort contributed to this article.
A strong majority, or 82 per cent of respondents, say it is important for mental health providers to have a wide range of backgrounds and experiences, including diverse racial, ethnic and cultural backgrounds as well as diverse gender identities.
The lowest-income Ontarians are least likely, at 27 per cent, to have accessed mental health supports over the past year.
Half of Ontarians would be more likely to access mental health supports if they were covered by their employers’ benefits programs.
Among those who tried to access help but were unable to, waitlists were the No. 1 concern (60 per cent).
Three in five people, or 57 per cent, said they would turn to their family doctor if they were experiencing a mental health crisis.