Wealthier neighbourhoods had more access to virtual mental health services in the pandemic: study

It’s well understood that the pandemic worsened the mental health of Canadians across the country—but it’s wealthier neighbourhoods that received more access to virtual care options and services, according to a recent study.

Data has shown that the mental health of those who struggle with anxiety, depression, and psychological distress worsened as a result of the COVID-19 pandemic, with one in 10 Canadians polled by Canadian Association of Mental Health in July 2020 citing as such.

But the pandemic also impacted the delivery of mental health services, as in-person appointments were put on hold indefinitely, and virtual appointments were offered in their place, a recent report shows.

And according to a recent report from the Canadian Institute for Health Information, the virtual delivery of mental health services was more available for Canadians who lived in higher-income neighbourhoods.

WEALTHIER NEIGHBOURHOODS HAD MORE ACCESSS

New data on virtual mental health care from the Institute published in December showed that the mental health services increased overall across Canada, however the access to virtual services varied geographically and population-wise.

The report looked at trends of virtual mental health services across five Canadian provinces, Ontario, Manitoba, Saskatchewan, Alberta and British Columbia, between the timeframe of April 2019 and March 2021.

A visit with a family physician, pediatrician or psychiatrist, where the diagnosis on the claim is for anxiety or depression, were the classified forms of mental health services in the report.

While the offering of virtual care is a medium which can increase accessibility for patients, the report shows that accessibility was still granted more to some patients over others throughout the pandemic.

Despite an uptake of virtual mental health care by patients of all income levels, virtual care was more accessible to those in higher-income and more urban neighborhoods.

And while more services became available via family physicians, pediatricians, and psychiatrists, the report citing a 22 per cent, 39 per cent, and 16 per cent increase, respectively, between Jan. and March 2021 compared to the year prior, it also showed that there was a bigger income gap than other forms of virtual physician care based on income level of patients.

The difference in use ranged from seven per cent to 14 percent for mental health services for lower income and higher income patients, respectively, and a smaller gap was found of 3 per cent to 5 per range for all other services.

Having a lower income is also linked to poorer mental health outcomes, influenced by factors like increased stress, lack of access to basic needs like food, housing, opportunities, and mental health care overall, according to a report by Statistics Canada published last July. 

The geographic location of patients was also identified as a factor in higher uses of virtual health services, with patients living in urban areas reported as using more virtual mental health services.

The report found that 53 per cent of care was delivered to patients living in urban neighborhoods, compared to 47 per cent to those in rural or remote neighborhoods.

In terms of the reasons for this disparity, a report by the Ontario COVID-19 Science Advisory Table published in September outlined that those who are lower income face challenges like a lack of housing, privacy, digital literacy support and high-speed internet.

The Advisory Table states that these barriers can impede virtual mental health services. As well, because racialized people are more likely to face these issues due to the long-term harms of systemic racism, the lack of culturally-relevant mental health services would be a deterrent as well to accessing care, it explains.

AN INCREASE IN SERVICES SPARKED BY PANDEMIC

While the accessibility of virtual mental health care was found to be inequitable based on income levels, overall, as service needs increased during the pandemic, the number of services provided to diagnose anxiety and depression for Canadians rose as well.

In fact, there was a 15 per cent increase in physician service offerings for mental health between January and March 2021, reaching 502,007 services, as well as a reported 16 per cent increase in physician payments for mental health services.

In 2020-2021, virtual services accounted for 57 per cent of mental health services provided by physicians, a sizable jump from just four per cent in 2019 to 2020.

A noteworthy increase in payments for virtual mental health services by physicians was cited as well, from $29 million in 2019 to 2020 to $621 million in 2020 to 2021.

The report states that going forward, more work on the appropriateness of virtual care in relation to the health outcome of patients will help to guide decision-makers in the health care space as to how to best integrate virtual mental health care services into existing health care systems.