The Epidemiology of the Barriers to Accessing Mental Health and Addiction Services (MHAS) among Children and Adolescents Who Contacted the Central Intake Program during the COVID-19 pandemic

Abstract

Background: In 2017, only half of the children in Nova Scotia (NS) received the essential mental health care they needed. This low service utilization, coupled with the higher prevalence of mental health issues in NS compared to the national level in Canada, underscores a need to study the barriers to mental health care for children residing in NS. This study aimed to estimate the prevalence of the barriers to Mental Health and Addiction Services (MHAS) and to examine their relationships with sociodemographic and clinical factors. Methods: This cross-sectional study used a subset of the central intake data for children aged 18 years or younger who contacted the MHAS central intake between 2020 and 2021 (n = 7,184). The prevalence of reporting any barriers, including acceptability, accessibility, and availability barrier types, was estimated as the proportion of participants who reported at least one barrier or a specific barrier type. A trend analysis for prevalence was conducted using the Cochran–Armitage test. The associations between the reported barriers and sociodemographic and clinical factors were examined using logistic regression. Results: The prevalence of reporting any barriers was estimated to be 5.96% [95% CI: 5.42%, 6.53%] among children aged 18 or younger who contacted the central intake services between 2020 and 2021. The most common barriers were related to accessibility, followed by acceptability and availability. Except for accessibility barriers, all barriers showed a decreasing trend over time. Participants who were older, had no access to employee assistance program / private insurance, were self-referred, resided in the Western zone of NS, or had suicide risk were more likely to report any barriers. Conclusion: The main barriers limiting children's access to MHAS in NS were accessibility and acceptability barriers. The proportions of the reported barriers appeared to be decreasing over time. Health care providers and policymakers may consider integrating these results to develop strategies that address barriers to mental health care for children. Addressing these barriers is essential to improve service access and enhance the mental health of children.