An Analysis of Canadian Mental Health Services

• Author / Creator

  Wang, Jian

• Among the developed countries, the burden of mental disorders has become increasingly important. According to Statistics Canada (2013), one in five Canadians will experience a mental illness in their lifetime, though one-third of these individuals perceive their needs in mental health (MH) care to be partially met or not met at all. Canada has a universal healthcare system, where all provinces and territories provide universal coverage for medically necessary hospital and physician services that are free at the point of use. Despite the lifting of financial burden, many people with mental illness are not getting the healthcare they need. The purpose of this thesis is to better understand how Canadians seek MH services and to estimate the publicly-funded MH expenditures for Fiscal Year (FY) 2013, using the most available, publicly accessible database. In addition, the cost estimates for FY 2013 are compared to the results from a published report for FY 2003. The research questions include: a) What are the important factors associated with the demand behavior for MH services identified by the published empirical evidence from the literature? b) What are the directions and magnitudes of the associations between the key factors and the demand behavior for MH services, in terms of likelihood and frequency of MH visits? c) What is the public provincial spending for MH services as a proportion of the total public healthcare costs, for the most recent years that public data is available? d) How are resources allocated to MH services with respect to changes in the total healthcare costs in the preceding decade? e) What are the policy and practice implications? A three-part thesis, including a literature review, an economic model and a cost analysis were developed to examine the MH system in the Canadian provinces. Data for the economic modelling was obtained from the Canadian Community Health Survey, Mental Health Wellbeing, conducted by Statistics Canada (2012). The cost analysis was based on healthcare expenditures acquired from publicly-accessible databases, such as the Canadian Institute for Health Information and Intercontinental Marketing Services Health Canada. Factors associated with the demand for MH services were identified and interpreted. For the general population, indicators of MH needs, proxied by diagnoses and distress levels, independently and significantly increase the odds and frequency of visits to all MH services. Some sociodemographic factors (e.g., female gender) significantly increase the odds and number of MH visits, while other factors, (e.g., being a senior, immigration status, and being employed) significantly decrease the odds and number of MH visits and the likelihood of using prescribed psychotropic medication. In FY 2013, the total provincial public MH expenditures were estimated to be $6.75 billion; however, the proportion of total public national health spending allocated to MH programs and services decreased from 5.4% to 4.9% over the decade from FY 2003 to FY 2013. This thesis provides important information on the MH outcomes, MH service utilization, and resources being allocated to mental healthcare across the Canadian provinces to inform the development of MH programs and services that will address the needs of those in specific population subgroups. In addition, this three-part thesis identifies an information gap in the existing evidence from MH service research. The development of a longitudinal MH database and a standardized reporting system at the level of provincial governments is recommended for a more robust demand and cost assessment.

• Subjects / Keywords

  • mental health services
  • public expenditure
  • demand response

• Graduation date

  Spring 2018

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/R3D795R9P

• License

  Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.