(SMH3a) Mental Health and Social Context I
Tuesday Jun 18 9:00 am to 10:30 am (Eastern Daylight Time)
Trottier Building - ENGTR 1080
Session Code: SMH3a
Session Format: Présentations
Session Language: Anglais
Research Cluster Affiliation: Sociology of Mental Health
Session Categories: Séances Sur Place
This session focuses on the impact of social context on mental health outcomes, including changes over the life course. We define social context broadly, ranging from financial and economic context to neighbourhood residence, country of origin, workplaces, or social and demographic contexts including institutions of family, gender, race, and ethnicity. The papers in this session will emphasize patterns of differential vulnerability by individuals' social position within those contexts, including age and socioeconomic status, for example. Tags: Égalité et Inégalité, Santé et soin
Organizers: Ruth Repchuck, McMaster University, Jinette Comeau, King's University College at Western University; Chair: Jinette Comeau, King's University College at Western University
Presentations
Jinny Menon, MacEwan University; Vera Caine, University of Victoria
A narrative inquiry into the experiences of children and youth waiting for mental health services.
Worldwide, mental health and addiction challenges are the leading cause of disability among young people. Despite the grave impacts of mental health problems, approximately only 1 in 5 individuals receive the services and support needed to help manage these challenges. Youth have the most unmet mental health care needs in Canada with more than 75% not receiving the type of specialized mental health services needed. The critical need for improved youth mental health services in Canada has been exacerbated and exposed by the COVID-19 pandemic. This is particularly evident for youth who face structural vulnerabilities including Indigenous youth, Black youth, 2SLGBTQ+ youth, as well as immigrant youth. This research explores the experiences of vulnerable youth and their families waiting for formalized mental health services and exposes the wider impacts of the pandemic on youth mental health. Using narrative inquiry, a qualitative methodology, we explored the experiences of youth who are structurally vulnerable on waiting lists for formalized mental health services over several months. Alongside participants, we co-composed narratives of their individual and contextualizing narratives to demonstrate the complexities of youths' lives and the strategies used to navigate barriers and build or create supports.Our findings highlight the layered and isolating experience of waiting for multiple services, the impact of waiting on youth and parent identities, and an exploration into the innovative resources, strategies and supports these youth and families used to cope while waiting for formalized mental health treatment. In this presentation, we focus on findings that describe both common and unique experiences of youth who are structurally vulnerable and/or their families while they wait for mental health services. Interactions within schools and emergency departments related to mental health concerns are specifically discussed, as well as the experiences of 2SLGBTQ+ and racialized youth navigating access to care and waiting for service. Innovative and novel approaches, resources and supports utilized and/or created by youth and their families while waiting for formalized mental health service will also be addressed.
Non-presenting authors: Margot Jackson, MacEwan University; Holly Symonds-Brown, MacEwan University; Kristopher Wells, MacEwan University; Tracy Palmquist, MacEwan University
Nicole Andrejek, CAMH; Zoe Lea, CAMH
Mental illness in the perinatal period is common but often treatable through access to mental healthcare services, particularly psychotherapy (talk therapy). However, there are numerous service gaps and barriers to care that impede perinatal individuals from accessing mental healthcare, especially the increasingly limited access to specialist psychotherapy providers (SPPS). Due to the finite nature of the perinatal period, prompt access to mental healthcare services is essential. Further, evidence suggests that lack of access to mental health treatment during the perinatal period has an extensive reach, impacting the individual, their family, and their community beyond the length of the perinatal period. One proposed solution is “tasks-sharing,” in which “non-specialist psychotherapy providers” (NSPPS), such as peers or people with lived experience, are trained and supervised to deliver brief, structured forms of psychotherapy. In order to effectively implement a task-sharing model to reduce burdens on SPPS and improve access to care, it is necessary to explore the perspectives of both relevant stakeholders and NSPPS with experience delivering psychotherapy. Through this approach, we can produce strategic facilitators to minimize barriers to implementing NSPP-delivered psychotherapy. The leveraging of NSPPS to deliver brief psychotherapy to perinatal individuals seeks to bridge the gap in the increasingly burdened SPPS within the Canadian and American healthcare systems. For this study, we collected qualitative data from prominent stakeholders (n=31), which was comprised of key decision-makers, advocates, and mental healthcare experts from across Canada and the U.S. on their perspectives of the barriers and facilitators to leveraging task-sharing with NSPPS to increase access to psychotherapy. In addition, we simultaneously examined provider-facing barriers and facilitators of task-sharing. Specifically, we interviewed NSPPS (n=15) who participated in the scaling up for maternal mental healthcare by increasing access to treatment (summit [1]) trial, which is a clinical trial aimed at increasing access to mental health treatment among perinatal women with symptoms of depression and anxiety in Canada and the United States. A central way that summit aims to increase access for perinatal individuals is by using a task-sharing model in which NSPPS are trained to deliver a brief, evidence-based psychotherapy called “behavioural activation (BA).” Through a thematic analysis of both qualitative datasets, we explore the policy-facing and provider-facing barriers and facilitators to the implementation of NSPP-delivered task-sharing to improve access to care. Stakeholder interviews highlighted two primary policy-facing barriers to implementation: (1) pushback from SPPS and their regulatory associations and colleges and (2) financial barriers. To facilitate implementation, stakeholders proposed forming a strategic business plan and creating multiple-targeted messaging approaches to get buy-in from SPPS, associated regulatory bodies, and clinical partners, such as hospitals that could house the implementation of an NSPP-delivered psychotherapy program, political leaders, and insurance groups. In addition, based on our interviews with NSPPS, barriers they encountered include (1) scheduling due to work-family conflict and (2) having to learn new socio-emotional and delivery skills to effectively administer psychotherapy. Perceived facilitators for NSPPS to deliver psychotherapy to perinatal individuals included (1) sufficient training; (2) ongoing supervision by experienced SPPS; and (3) a brief, structured psychotherapy modality to ensure NSPPS can efficiently learn and implement treatment to perinatal individuals as new providers. Although it is important to understand barriers from a sociological perspective, it is necessary to work towards actionable solutions to reduce mental health service gaps for vulnerable and underserved populations. Our findings suggest that, from a policy standpoint, a multi-pronged strategic approach working at the level of governing associations (ie. Psychotherapy regulatory bodies and insurance groups), institutional structures (ie. Hospitals), and political engagement (ie. Policy makers) will be pivotal in informing task-sharing policy development and implementation. From an NSPP standpoint, implementation will require effective task-sharing and collaboration with SPPS to provide sufficient training and supervision. We propose evidence-based solutions to improve access to mental health care for perinatal individuals while simultaneously reducing the existing burden placed on SPPS who are currently solely serving this population within the current Canadian and American healthcare structures.
Non-presenting authors: Daisy Singla, University of Toronto; Nour Schoueri-Mychasiw, Mount Sinai Hospital
Ukeme Eka, Memorial University
Mental health problems are increasingly recognized as a global public health concern (Rehm and Shield, 2019). Immigrants arrive from diverse source countries and settle in different communities. As the source countries have shifted from Europe to Asia, Africa, Latin America, and the Caribbean, understanding how these individuals and their families utilize mental health services has become more critical. As immigrants are prone to higher levels of stress than the general population (Chiu et al., 2018), exploring their use of mental health services is essential. For instance, compared to the larger Canadian population, immigrants are more likely to report poorer self-rated mental health (Kitchen, Williams, and Gallina, 2015), low mental health care utilization (Chen and Kazanjian, 2005; Fenta et al., 2006), and a lower sense of belonging to their local community (Kitchen et al., 2015). African immigrants face considerable challenges (i.e., cultural, economic, social, and political) with the potential to affect their resettlement, acculturation, healthcare needs, and service use patterns (Bacon et al., 2010; Müller and Koch, 2011; Son, 2013). Understanding the influence of cultural and socioeconomic determinants on health and perceived health is essential to understanding the health-seeking behaviour of immigrants in Canada (Cheng and Goodman, 2015). Many studies on mental health use among immigrants homogenously, lumped several ethnicities into a single category (Chen and Kazanjian, 2005; Durbin et al., 2015; Fenta et al., 2006; Kirmayer et al., 2011; Whitley et al., 2017), despite coming from different regions around the world, and encountering unique pre-immigration experiences (i.e., economic, cultural, political, and social) and diverse post-migration experiences, such as resettlement (Kirmayer et al., 201l; Muller and Koch, 2011; Son, 2013). Thus, generalizing immigrant experiences may not account for the diversity among immigrant populations or accurately represent the factors driving the need for services and the use of services (Gushulak et al., 2011; Kirmayer et al., 201l). Applying the Immigrant Health Services Utilization framework by Yang and Hwang’s (2016), we explored the factors that facilitate or impede African immigrants use of mental health services in St. John’s, Newfoundland and Labrador. Between June and December 2020, a cross-sectional mental health service questionnaire was developed and administered utilizing the Qualtrics survey system to survey 272 immigrants of African descent. The framework explores disparities in the utilization of mental health services by immigrants in relation to four broad categories: predisposing factors, including immigrants social and demographic characteristics (age, marital status, gender, etc.); enabling factors, including financial and human resources, immigrant networks; need for care factors such as immigrants self-reported health status; macrostructural and contextual conditions (e.g., policy, politico-economic factors). Complementary log–log regression models were used to examine factors influencing immigrants’ decision to seek mental health services considering Yang and Hwang’s framework. Overall, 11.4% of African immigrants self-reported they used mental health services in the past 12 months preceding the survey, while 88.6% indicated they had not used mental health services. Macrostructural and contextual factors, namely respondents self-rated perception of the provincial healthcare system and experiences with discrimination and racism, were statistically associated with mental service health use. For instance, immigrants with negative perception perceptions and ratings of the provincial healthcare system were 75% less likely to use mental health services. Also, those with experiences of discrimination and racism were about two times more likely to seek mental health services. Other factors, including African immigrants’ sense of belonging and access to social support, were important correlates of mental health services use. Respondents with a strong sense of belonging to their countries of birth were 77% less likely to use, while those with strong social support were about 2 times more likely to use. Our findings underscore the importance of emphasizing structural/contextual factors to improving mental health utilization among African immigrants in St. John’s, NL. Improving access to care and promoting immigrant-friendly healthcare policies that emphasize diversity and inclusion may help their use of mental health services.
Non-presenting author: Eric Tenkorang, Memorial University
Izumi Niki, University of Toronto; Alexa Carson, University of Toronto; Pelin Gul, University of Toronto
Nearly one million people in Canada are projected to be living with dementia by 2030 (Alzheimer Society 2023). Most of the current studies on dementia focus on medical or nursing issues such as diagnosis, prevention or intervention. Caring for a person with dementia, however, is social and familial as much as it is medical. Drawing on existing care literature based on the critical feminist perspective (Armstrong 2023; Funk and Kobayashi 2009), this research examines how family caregivers' stress and care responsibilities transform over the course of caring for an older person with dementia, and how individual and structural factors influence the decision to seek professional caring assistance. Dementia has profound impacts not only on the individual diagnosed but also on the lives of the people around them (La Fontaine and Oyebode 2014, Duggleby, Schroeder and Nekolaichuk 2013; Pointon 2011; Le Navenec, Lynne and Vonhof 1996). The vast majority of persons with dementia receive informal care, typically from family members; family caregivers of a person with dementia often experience high emotional distress (Law Commission of Ontario 2016; Papastavrou, Kalokerinou, Papacostas, Tsangari and Sourtzi 2007; Wimo and Winblad 2001). To investigate in-depth family care experiences and care arrangements in the Canadian context, our research team conducted semi-structured interviews (from February to June 2023) with 57 family members caring for older adults living in community settings (i.e. their own home or family member's home) and institutional settings (i.e. supportive housing, long-term care home) across Canada. Analysis of their narratives revealed important findings on their care responsibilities and decision-making processes. Dementia is a highly individualized disease, and the progression of symptoms varies considerably. Accordingly, older people's individualized care needs also change. Thus, family caregivers' care responsibilities and tasks are not static but transformed throughout the caregiving process, and definitions of 'good care' vary extensively among research participants. Older people's traits (personalities, preferences, and life patterns) and dementia symptoms (behaviours such as wandering or forgetfulness) are critical factors in determining the family's care tasks. Carers of individuals with dementia grapple with admitting their loved ones into a long-term care facility (LTCH). This is often a difficult decision. The negative image of LTCHs leads many people to avoid admitting older adults to a facility, especially in the wake of the pandemic. Nonetheless, carers also understand that institutions can provide a safer space for older people with dementia. Previous research has shown that people with high emotional distress are more likely to admit an older person to the institutional setting (Gaugler, Yu, Krichbaum and Wyman 2009). Along with intensified care needs due to dementia, external factors like the availability (or more likely lack) of resources (i.e. paid services and other family members) and regional characteristics impact the decision for institutional admission. Not only the care needs and preferences of the person but also the socio-economic status significantly affect their choice. Family members continue to provide care for older adults with dementia post-admission, but they experience less stress. Their care tasks are more attentive to individualized physical care and social and emotional support, which is often believed to be lacking in the institutional setting. While our study confirms existing literature on unpaid work provided by family caregivers in institutional settings, we also show that family caregivers can focus more on improving the quality of life for seniors with reduced stress when daily worries about essential care provision are alleviated through professional support. In this way, institutionalization reduces caregiver stress because caregivers lack the support and services that could alleviate their daily worries in a community setting. Our study on family caregiving experiences for people with dementia suggests the need for micro-level analysis as well as meso (institutional) and macro (provincial and national level policies) level examination. Caring for older adults is a continuous daily activity, and caregivers often make their decisions at a micro level. Nonetheless, their experiences and decision-making occur in a context with limited options and inadequate meso- and macro-level supports. Within that context, our findings indicate that institutionalization has benefits for informal caregivers who are otherwise overburdened. Services and resources in the community could also provide remedies and enable people with dementia to continue to live in their own homes. Moreover, a system that relies on family care to ensure the quality of care in the institutional setting is both unsustainable and destined to reproduce social inequalities.
Non-presenting author: Ito Peng, University of Toronto
Katie Aubrecht, St. Francis Xavier University
Cognitive Ableism in Supportive Community Care for People with Dementia
Access to quality care at home for people with dementia is a health system challenge, a social problem and human rights issue. In the context of population aging and against the backdrop of a health system in crisis, direct funding has been offered as a policy solution and pandemic recovery measure. However, evidence suggests that people living with dementia who do not have legal decision-making capacity experience distinct barriers to accessing and using direct payment programs to their full health-promoting potential. Historically, guardianship, conservatorship and mental health laws have allowed for decisions to be made on behalf of people with dementia by guardians, trustees, or caretakers. Canada ratified the Convention on the Rights of Persons with Disabilities (CRPD), which views the ability to exercise legal capacity as a universal human right that applies to all persons, regardless of physical or mental disability. Under Article 12 of the CRPD, States parties are to “reaffirm that persons with disabilities have the right to recognition everywhere as persons before the law”. According to Article 12 (3), persons with disabilities have the right to continue to exercise their legal capacity, including making their own decisions, even if they require a certain degree of support to do so. In ratifying the CRPD, Canada acknowledged that his could be interpreted as requiring the elimination of substitute decision-making and included a reservation to continue to use substitute decision-making in situations it deemed appropriate. This presentation shares an interpretive sociological analysis of cognitive ableism as it was made to appear in academic literature and policy documents that were reviewed as part an applied health research study on equity in directly funded dementia care in Nova Scotia, Canada. Nova Scotia’s Supportive Care Program provides direct funding to socially and clinically vulnerable community dwelling older adults living with dementia who have substitute decision makers. Using a critical disability studies perspective, we traced a relationship between equity and cognitive ableism, where barriers to accessing, using and benefiting from directly funded community care were more often associated with clinical assessment procedures and protocols, such the Instrumental Activities of Daily Life Assessment, and information, assistance with interpretation, and decision support tools. We propose that the promise in direct funding may only be fully realized if there are also changes in how people are assessed and greater awareness and responsiveness to the decision-making support needs of people living with dementia. As and if Canada moves away from substitute decision-making significant changes in continuing care and the health system more broadly will also be required.
Non-presenting authors: Christine Kelly, University of Manitoba; Shala Koncton, Dalhousie University