Mental health service use and associated predisposing, enabling and need factors in community living adults and older adults across Canada.

OBJECTIVES: Using Andersen's model of health care seeking behavior, we examined the predisposing, enabling, and need factors associated with mental health service use (MHSU) during the first wave of the COVID-19 pandemic across Canada. METHODS: The sample included n = 45,542 participants in the 5 established regional cohorts of the Canadian Partnership for Tomorrow's Health (CanPath) and who responded to the CanPath COVID-19 health survey (May-December 2020), with complete data on MHSU. Multivariable logistic regression analyses were carried out to study MHSU as a function of predisposing, enabling, and need factors. Analyses were stratified by regional cohort. RESULTS: Among the need factors, individuals reporting moderate/severe symptoms of depression and anxiety and poorer self-rated mental health were more likely to report MHSU. Among the enabling factors, receipt of informational/financial/practical support was associated with increased MHSU. While income was not consistently associated with MHSU, reported decrease in income was marginally associated with reduced MHSU. Among the predisposing factors, identifying as female or other gender minority was associated with increased MHSU, as was the presence of past-year cannabis use. In contrast, older age and alcohol consumption were associated with reduced MHSU. CONCLUSION: Need factors were consistently associated with MHSU. Although income inequities in MHSU were not observed, changes such as reduced income during the pandemic may lead to barriers in accessing mental health services. Future research should focus on better identifying contextual enabling factors and policies that overcome financial barriers to MHSU.

Out from the shadows: What health leaders should do to advance the mental health and substance use health workforce.

The mental health and substance use health (MHSUH) impacts of the COVID-19 pandemic are proving to be significant, complex, and long-lasting. The MHSUH workforce-including psychologists, social workers, psychotherapists, addiction counsellors, and peer support workers as well as psychiatrists, family physicians, and nurses-is the backbone of the response. As health leaders consider how to address long-standing and emerging health workforce challenges, there is an opportunity to move the MHSUH workforce out from the shadows through full inclusion in health workforce planning in Canada. After first examining the roots and consequences of the long-standing exclusion of the MHSUH workforce, this paper presents findings from a recent study showing how the pandemic has compounded MHSUH workforce capacity issues. Priorities for MHSUH workforce action by health leaders include closing regulation gaps, engaging the public and private sectors in coordinated planning, and accelerating data collection through a central health workforce registry.

The impact of COVID-19 on the mental health and substance use health (MHSUH) workforce in Canada: a mixed methods study.

BACKGROUND: The increased need for mental health and substance use health (MHSUH) services during the COVID-19 pandemic underscores the need to better understand workforce capacity. This study aimed to examine the pandemic's impact on the capacity of MHSUH service providers and to understand reasons contributing to changes in availability or ability to provide services. METHODS: We conducted a mixed method study including a pan-Canadian survey of 2177 providers of MHSUH services and semi-structured interviews with 13 key informants. Survey participants answered questions about how the pandemic had changed their capacity to provide services, reasons for changes in capacity, and how their practice had during the pandemic. Thematic analysis of key informant interviews was conducted to gain a deeper understanding of the impact of the pandemic on the MHSUH workforce. RESULTS: Analyses of the survey data indicated that the pandemic has had diverse effects on the capacity of MHSUH workers to provide services: 43% indicated decreased, 24% indicated no change, and 33% indicated increased capacity. Logistic regression analyses showed that privately funded participants had 3.2 times greater odds of increased capacity (B = 1.17, p < 0.001), and participants receiving funding from a mix of public and private sources had 2.4 times greater odds of increased capacity (B = 0.88, p < 0.001) compared to publicly funded participants. Top reasons for decreases included lockdown measures and clients lacking access or comfort with virtual care. Top reasons for increases included using virtual care and more people having problems relevant to the participant's skills. Three themes were constructed from thematic analysis of key informant interviews: the differential impact of public health measures, long-term effects of pandemic work conditions, and critical gaps in MHSUH workforce data. CONCLUSIONS: The COVID-19 pandemic has had a substantial impact on the capacity of the MHSUH workforce to provide services. Findings indicate the importance of increasing and harmonizing funding for MHSUH services across the public and private sectors, developing standardized datasets describing the MHSUH workforce, and prioritizing equity across the spectrum of MHSUH services.

Service-level barriers to and facilitators of access to services for the treatment of alcohol use disorder and problematic alcohol use: protocol for a scoping review.

INTRODUCTION: Prior to the COVID-19 pandemic, substance use health services for treatment of alcohol use disorder and problematic alcohol use (AUD/PAU) were fragmented and challenging to access. The pandemic magnified system weaknesses, often resulting in disruptions of treatment as alcohol use during the pandemic rose. When treatment services were available, utilisation was often low for various reasons. Virtual care was implemented to offset the drop in in-person care, however accessibility was not universal. Identification of the characteristics of treatment services for AUD/PAU that impact accessibility, as perceived by the individuals accessing or providing the services, will provide insights to enable improved access. We will perform a scoping review that will identify characteristics of services for treatment of AUD/PAU that have been identified as barriers to or facilitators of service access from the perspectives of these groups. METHODS AND ANALYSIS: We will follow scoping review methodological guidance from the Joanna Briggs Institute. Using the OVID platform, we will search Ovid MEDLINE including Epub Ahead of Print and In-Process and Other Non-Indexed Citations, Embase Classic+Embase, APA PsychInfo, Cochrane Register of Controlled Trials, the Cochrane Database of Systematic Reviews and CINAHL (Ebsco Platform). Multiple reviewers will screen citations. We will seek studies reporting data collected from individuals with AUD/PAU or providers of treatment for AUD/PAU on service-level factors affecting access to care. We will map barriers to and facilitators of access to AUD/PAU treatment services identified in the relevant studies, stratified by service type and key measures of inequity across service users. ETHICS AND DISSEMINATION: This research will enhance awareness of existing evidence regarding barriers to and facilitators of access to services for the treatment of alcohol use disorder and problematic alcohol use. Findings will be disseminated through publications, conference presentations and a stakeholder meeting. As this is a scoping review of published literature, no ethics approval was required.

Enhancing the capacity of the mental health and substance use health workforce to meet population needs: insights from a facilitated virtual policy dialogue.

BACKGROUND: Timely knowledge mobilization has become increasingly critical during the COVID-19 pandemic and complicated by the need to establish or maintain lines of communication between researchers and decision-makers virtually. Our recent pan-Canadian research study on the mental health and substance use health (MHSUH) workforce during the pandemic identified key policy barriers impacting this essential workforce. To bridge the evidence-policy gap in addressing these barriers, we held a facilitated virtual policy dialogue. This paper discusses the insights generated at this virtual policy dialogue and highlights how this integrated knowledge mobilization strategy can help drive evidence-based policy in an increasingly digital world. METHODS: We held a 3-hour virtual policy dialogue with 46 stakeholders and policy decision-makers as the final phase in our year-long mixed-methods research study. The event was part of our integrated knowledge mobilization strategy and was designed to generate stakeholder-driven policy implications and priority actions based on our research findings. The data collected from the virtual policy dialogue included transcripts from the small-group breakout rooms and main sessions, reflective field notes and the final report from the external facilitator. Coded data were thematically analysed to inform our understanding of the prioritization of the policy implications and action items. RESULTS: Facilitated virtual policy dialogues generate rich qualitative insights that guide community-informed knowledge mobilization strategies and promote evidence-informed policy. Our policy dialogue identified actionable policy recommendations with equity as a cross-cutting theme. Adapting policy dialogues to virtual formats and including technology-assisted facilitation can offer advantages for equitable stakeholder participation, allow for deeper analysis and help build consensus regarding evidence-based policy priorities. CONCLUSIONS: Our facilitated virtual policy dialogue was a key knowledge mobilization strategy for our research on the capacity of the Canadian MHSUH workforce to respond to the COVID-19 pandemic. Our policy dialogue allowed us to engage a diverse group of MHSUH workforce stakeholders in a meaningful action-oriented way, provided an avenue to get feedback on our research findings, and generated prioritized action items that incorporated the knowledge and experience of these MHSUH workforce stakeholders.

Centering equity and lived experience: implementing a community-based research grant on cannabis and mental health.

BACKGROUND: Mental health research in Canada is not only underfunded but there remains an inequitable distribution of funding to address unmet needs especially in clinical and applied research. In 2018, the legalization of cannabis for non-medical use in Canada sparked the need to examine the relationship between cannabis use and mental health. The federal government allocated $10 M over 5 years to the Mental Health Commission of Canada (MHCC), a pan-Canadian health organization funded at arm's length by the federal government. METHODS: In 2020, the MHCC implemented an innovative community-based research (CBR) program to investigate this relationship among priority populations including people who use cannabis and live with mental illness, First Nations, Inuit and Métis, two-spirit, lesbian, gay, bisexual, trans and/or queer (2SLGBTQ+) individuals, and racialized populations. Extensive consultations, a scoping review and an environmental scan set the research agenda. Key program components included a review committee with representation from diverse priority populations, extensive proposal-writing support for applicants, and capacity bridging workshops for the 14 funded projects. RESULTS: Of the 14 funded research projects, 6 focus on and are led by Indigenous communities, 5 focus on other equity-seeking populations, and 9 explore the perceived patterns, influence and effects of use including benefits and harms. Lessons learned include the importance of a health equity lens and diverse sources of knowledge setting the CBR research agenda. In addition to capacity bridging that promote equitable roles among knowledge co-producers as well as the critical role of organizational support in increasing research productivity, especially in the area of mental health and cannabis use where there is a need for more applied research. CONCLUSION: Centering equity and lived and living experience strengthened the rationale for investments and ensured user-led evidence generation and utilization - a key public health gain. Organizational support for proposal development and capacity bridging yields significant value that can be replicated in future CBR initiatives.