Mental health policy and service delivery in Canada: Issues in policy reform, access to care, and use of mental health providers

This thesis presents the results of three research studies in mental health policy making and service delivery in Canada. The topic of each paper was selected for its current policy relevance. The first paper investigates how the policy legacies associated with the introduction of psychiatric asylums in 1850 in Upper Canada and the subsequent introduction of public insurance coverage for hospital and physician services in the late 1950s and early 1960s have affected subsequent efforts to reform mental health service delivery toward an integrated system with a stronger emphasis on community-based care in Ontario. Implications of policy legacies for achieving reform through the policy window currently afforded by mental health system transformation in Ontario are discussed. The second paper examines proposed models of interdisciplinary collaboration among family physicians, psychiatrists, social workers, psychologists and nurses and develops a conceptual framework which captures the many contextual factors that affect the successful implementation of such models. The relevance to developing multidisciplinary Family Health Teams in Ontario is discussed. The third paper examines role of supplemental insurance coverage in accessing mental health care in Canada using a recent national survey. The findings suggest no strong evidence of an important role for supplemental insurance coverage using these data. The findings of the three studies together advance our understanding of how to improve access to mental health services in Canada through policy reform geared to promoting greater efficiency in use of existing mental health providers.