Coalesce Research Group Journal of Addiction, Psychiatry and Mental Health Research Article 2021: Volume 1, Issue 1 Impact of Access to Mental Health Care in Ontario: A GIS- based Study Rosina Mete1* and Yonghong Tong2 1Leadership and Policy, Independent Researcher and Consultant, Canada 2Department of Computer & Information Sciences, College of Art and Sciences, Niagara University, USA Received Date: 05-05-2021 Published Date: 01-06-2021 Abstract Introduction The following article examines the state of universal mental The impact of mental illness on society is greater health care within Ontario. The article provides information than many people realize [1]. In Ontario, “the burden of depression alone is more than the combined burden of lung, regarding access to universally funded mental health care, colorectal, breast and prostate cancers” [2]. The definition of burden is explained as “YERF, or years equivalent of reduced examining repeated emergency room visits for the most functioning” [2]. The province of Ontario faces numerous specifically family physicians and psychiatrists, while common mental health concerns in the province, anxiety challenges when it comes to the treatment of mental illness, and depression. The study utilizes statistics and geographic including access to care. Due to the universally funded information system (GIS) software to visually display health care model, individuals with mental illness often the geographic trends of publicly funded mental health utilize emergency departments for treatment. The following care in Canada’s most populated province. The Canadian research study aims to provide a visual representation and Community Health Survey (CCHS) of 2012 provides data analysis of availability of psychiatric care and emergency regarding Ontario's population, mental health diagnoses, and room visits within the province of Ontario. access to universal mental health care via family doctors and Literature Review psychiatrists. Emergency room visits for repeated mental health concerns for six Local Health Integration Networks Background: Health Care in Canada (LHIN)s are outlined within the province. The results yielded The concept of universal health care is synonymous that mental health diagnoses and access to emergency care with Canada in that certain procedures and treatments are are increasing while the rates of psychiatry availability covered for legal residents. The Canada Health Act is a federal are decreasing per population. The article provides visual piece of legislation which allocates funding to provinces and representations via maps to assist with the determination territories for health care. The provinces and territories of funding and program development for mental health care must pay for all medically necessary treatments provided in Ontario. Additionally, mental health care via provincially funded psychotherapy is recommended to alleviate the burden on emergency room care. Corresponding author: Rosina Mete, Leadership and Keywords: Emergency Department; Mental Illness; Policy, Independent Researcher and Consultant, Canada Ontario; Psychiatrist E-mail: [email protected] Citation: Mete R and Tong Y. Impact of Access to Mental Health Care in Ontario: A GIS-based Study. 2021;1: 1-8. 01 within a hospital and/or by physicians. Each province and and social disorders. Individuals within a lower SES reported territory determine the definition of medically necessary higher rates of addictions and psychotic disorders. Some treatment since there is no set definition [3]. of the barriers to care identified by Steele et al. [9] include communication issues between patient and provider as According to the Mental Health Commission of Canada, well as stigma surrounding mental illness. Therefore, one “one in five Canadians are affected, either directly or may deduce that universal psychiatric care is not equally indirectly, by mental illness” [2]. Ontario, the most populated distributed within Ontario. province of Canada with roughly 13.6 million residents, will be examined within the following study [5]. In Canada, many mental health agencies and crisis intervention departments are normally available during Ontario, Health Care and Access to Psychiatric the day or early evening. Consequently, the Emergency Services Department may be the only resource open for mental In 2006, Ontario established the Local Health System health services. In a five-year study of Ontario individuals Integration Act which created organizations to organize, with mental health or substance use issues, Graham et al. plan, and provide strategic directions for health care [10] determined these people were more likely to visit the providers in Ontario. The non-profit organizations, or Local emergency department more than once when compared Health Integration Networks (LHINs) are associated with a to others without those issues. A report by Health Quality specific geographic area within the province. There are 14 Ontario found that “one-third of emergency department LHINs in Ontario [5,6]. visits for a mental illness or addiction are by people who have never been assessed and treated for these issues before The LHIN within each geographic area provides funding by a physician” [11]. to health care facilities such as hospitals, many psychiatric facilities, long-term care homes, Community Care Access Mood and Anxiety Disorders Centres, community health centres, and community mental The most common mental health diagnoses in Canada are health and addiction agencies. Each LHIN determines an mood and anxiety disorders [12]. This trend is also evident Integrated Health Service Plan (IHSP) which outlines its within the province of Ontario which is represented within priorities within a three-year period. The priorities include the geographic analysis found in results [12,13]. The 11th ideas which often correlate with patient-centered care [6]. A edition of the International Classification of Diseases (ICD) study by Martin & Hirdes [5] examined seven LHINs which defines anxiety disorders as “excessive fear and anxiety identified mental health as a priority within 2007-2010. and related behavioral disturbances” with symptom Their research found that individuals within the geographic intensity that impacts functioning in different areas such as LHIN area that prioritized mental health were more likely personal life, family, social, or work [14]. The ICD-11 notes to have accessed a psychiatrist, occupational therapist, or that “fear and anxiety are closely related phenomena; fear dietitian than those in non-priority LHIN areas. Additionally, represents a reaction to perceived imminent threat in the individuals within the highlighted LHINs also had exposure present, whereas anxiety is more future-oriented, referring to different types of therapy [5]. Therefore, the strategic to perceived anticipated threat” [14]. Examples of anxiety direction of the LHIN may impact the availability of mental disorders include generalized anxiety disorder (GAD), panic health services. disorder, and social anxiety disorder. To explain the publicly funded health care model in Ontario, Alternatively, mood disorders are “defined according to family physicians are often an individual’s first encounter particular types of mood episodes and their pattern over regarding their mental health. Research identified family time. The primary types of mood episodes are Depressive physicians spending “a substantial portion of their time episode, Manic episode, Mixed episode, and Hypomanic (26-50%) addressing mental health issues” [7]. However, episode” [14]. Examples of mood disorders include bipolar “in Ontario, psychiatrists are the only mental health disorder, dysthymic disorder, and single episode depression. professionals whose services are eligible for reimbursement Depressive disorders are within mood disorders and by the publicly funded health insurance program” [8]. Access are categorized by “depressive mood (e.g., sad, irritable, to a psychiatrist in Ontario normally requires a doctor’s empty) or loss of pleasure accompanied by other cognitive, referral or a hospital visit [9]. A federal survey of family behavioral, or neurovegetative symptoms that significantly physicians regarding access to psychiatrists yielded negative affect the individual’s ability to function” [14]. results, with a rating of poor as the most frequent response [8]. The Canadian Psychiatric Association “recommends a GIS and Mental Health supply of 15 psychiatrists per 100,000 residents…however, At present, many studies investigating mental health and rural Ontario has identified a psychiatrist shortage for the utilizing geographic information systems (GIS) provide past two decades” [8]. information on “sense of community” and emotional Unfortunately, it appears that, in Ontario, there is a wellbeing within specific regions [15,16]. There are studies discrepancy in availability to psychiatrist among specific examining access to care within identified LHINs, including populations. Kurdyak et al. [8] found that individuals within access to rehabilitative services and cardiac care [17,18]. One a higher socio-economic status (SES) and without prior study specifically identified transportation routes within psychiatric admissions were more likely to see a psychiatrist the Champlain LHIN in relation to hospital and acute care more than twice or on a semi-regular basis. Similarly, Steele facilities. In regards to mental health, the Ontario Ministry of et al. [9] found that individuals