Perceived Unmet Need for Mental Health Care for Canadians With Co-occurring Mental and Substance Use Disorders

Mar 1, 2008Psychiatric services (Washington, D.C.)

Unmet mental health care needs reported by Canadians with both mental health and substance use problems

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Abstract

22% of individuals with a disorder reported a 12-month unmet need for mental health care.

The odds of unmet need for care were 3.25 times higher among individuals with co-occurring mental and substance use disorders compared to those with only one disorder.
Commonly cited reasons for unmet need included a preference for self-managing symptoms and procrastination in seeking care.
The perceived unmet need for care was less influenced by previous contact with the health care system and more by overall distress and severity of problems.
Factors such as stigma, motivation, and satisfaction with past services may impact perceptions of unmet need and help-seeking behaviors.

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OBJECTIVE: Previous analyses demonstrated an elevated occurrence of perceived unmet need for mental health care among persons with co-occurring mental and substance use disorders in comparison with those with either disorder. This study built on previous work to examine these associations and underlying reasons in more detail.

METHODS: Secondary data analyses were performed on a subset of respondents to the 2002 Canadian Community Health Survey (unweighted N=4,052). Diagnostic algorithms classified respondents by past-year substance dependence and selected mood and anxiety disorders. Logistic regressions examined the associations between diagnoses and unmet need in the previous year, accounting for recent service use and potential predisposing, enabling, and need factors often associated with help seeking. Self-reported reasons underlying unmet need were also tabulated across diagnostic groups.

RESULTS: Of persons with a disorder, 22% reported a 12-month unmet need for care. With controls for service use and other potential confounders, the odds of unmet need were significantly elevated among persons with co-occurring disorders (adjusted odds ratio=3.25; 95% confidence interval=1.96-5.37). Most commonly, the underlying reason involved a preference to self-manage symptoms or not getting around to seeking care, with some variation by diagnosis.

CONCLUSIONS: The findings highlight potential problems for individuals with mental and substance use disorders in accessing services. The elevated occurrence of perceived unmet need appeared to be relatively less affected by contact with the health care system than by generalized distress and problem severity. Issues such as stigma, motivation, and satisfaction with past services may influence help-seeking patterns and perceptions of unmet need and should be examined in future work.

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Perceived Unmet Need for Mental Health Care for Canadians With Co-occurring Mental and Substance Use Disorders

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