Income-based inequities in access to mental health services in Canada.

Objectives: While mental health services provided by general practitioners and psychiatrists can be billed to public health insurance programs in Canada, services provided by psychologists, social workers and other non-physician providers cannot. This study assesses the extent to which access to mental health services varies by income after first taking into account the higher concentration of mental health needs at lower income levels.

Method: Data from the Canadian Community Health Survey 2013-2014 are used to calculate need-standardized concentration indices for access to mental health services.

Results: More pro-rich utilization of mental health services provided by non-physicians and more equitable utilization of physician services is found for psychologists and general practitioners, but not for social workers, nurses and psychiatrists. Unmet need for healthcare for mental health problems is found to be more pro-poor than unmet need for physical health problems.

Conclusion: By standardizing for inequitable distribution of mental health need, this study provides strong evidence that income-based inequity in access to mental health services is an issue under Canada's two-tier system, particularly with regard to general practitioners and psychologists. For other types of providers, the results suggest that inequities in service utilization vary not just by Medicare coverage but also by service settings and target populations. Despite these variations, greater inequities in unmet need for mental health care than for physical health care suggest that inequity is the dominant reality for Canadians. The results provide a baseline that could be used to assess the equity impacts of policy reforms.