TY - JOUR
KW - Grounded theory
KW - Humans
KW - Mental Health
KW - Ontario
KW - policy
KW - Primary Health Care
KW - Qualitative Research
KW - Equity
KW - mental health care
KW - primary care
KW - qualitative
AU - R. Ashcroft
AU - M. Menear
AU - J. Silveira
AU - S. Dahrouge
AU - M. Emode
AU - J. Booton
AU - K. Mckenzie
A1 - 
AB - BACKGROUND: Strengthening capacity for mental health in primary care improves health outcomes by providing timely access to coordinated and integrated mental health care. The successful integration of mental health in primary care is highly dependent on the foundation of the surrounding policy context. In Ontario, Canada, policy reforms in the early 2000's led to the implementation of a new interprofessional team-model of primary care called Family Health Teams. It is unclear the extent to which the policy context in Ontario influenced the integration of mental health care in Family Health Teams emerging from this period of policy reform. The research question guiding this study was: what were key features of Ontario's policy context that influenced FHTs capacity to provide mental health services for mood and anxiety disorders? METHODS: A qualitative study informed by constructivist grounded theory. Individual interviews were conducted with executive directors, family physicians, nurse practitioners, nurses, and the range of professionals who provide mental health services in interprofessional primary care teams; community mental health providers; and provincial policy and decision makers. We used an inductive approach to data analysis. The electronic data management programme NVivo11 helped organise the data analysis process. RESULTS: We conducted 96 interviews with 82 participants. With respect to the contextual factors considered to be important features of Ontario's policy context that influenced primary care teams' capacity to provide mental health services, we identified four key themes: i) lack of strategic direction for mental health, ii) inadequate resourcing for mental health care, iii) rivalry and envy, and, iv) variations across primary care models. CONCLUSIONS: As the first point of contact for individuals experiencing mental health difficulties, primary care plays an important role in addressing population mental health care needs. In Ontario, the successful integration of mental health in primary care has been hindered by the lack of strategic direction, and inconsistent resourcing for mental health care. Achieving health equity may be stunted by the structural variations for mental health care across Family Health Teams and across primary care models in Ontario.
AD - Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario, M5S 1V4, Canada. rachelle.ashcroft@utoronto.ca.; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada.; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.; Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.; School of Population and Public Health, University of British Columbia, Vancouver, Canada.; Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario, M5S 1V4, Canada.; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.; Wellesley Institute, Toronto, Ontario, Canada.
BT - International journal for equity in health
C5 - Education & Workforce
CP - 1
DO - 10.1186/s12939-021-01492-5
IS - 1
JF - International journal for equity in health
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Strengthening capacity for mental health in primary care improves health outcomes by providing timely access to coordinated and integrated mental health care. The successful integration of mental health in primary care is highly dependent on the foundation of the surrounding policy context. In Ontario, Canada, policy reforms in the early 2000's led to the implementation of a new interprofessional team-model of primary care called Family Health Teams. It is unclear the extent to which the policy context in Ontario influenced the integration of mental health care in Family Health Teams emerging from this period of policy reform. The research question guiding this study was: what were key features of Ontario's policy context that influenced FHTs capacity to provide mental health services for mood and anxiety disorders? METHODS: A qualitative study informed by constructivist grounded theory. Individual interviews were conducted with executive directors, family physicians, nurse practitioners, nurses, and the range of professionals who provide mental health services in interprofessional primary care teams; community mental health providers; and provincial policy and decision makers. We used an inductive approach to data analysis. The electronic data management programme NVivo11 helped organise the data analysis process. RESULTS: We conducted 96 interviews with 82 participants. With respect to the contextual factors considered to be important features of Ontario's policy context that influenced primary care teams' capacity to provide mental health services, we identified four key themes: i) lack of strategic direction for mental health, ii) inadequate resourcing for mental health care, iii) rivalry and envy, and, iv) variations across primary care models. CONCLUSIONS: As the first point of contact for individuals experiencing mental health difficulties, primary care plays an important role in addressing population mental health care needs. In Ontario, the successful integration of mental health in primary care has been hindered by the lack of strategic direction, and inconsistent resourcing for mental health care. Achieving health equity may be stunted by the structural variations for mental health care across Family Health Teams and across primary care models in Ontario.
PY - 2021
SN - 1475-9276; 1475-9276
SP - 144
T1 - Inequities in the delivery of mental health care: A grounded theory study of the policy context of primary care
T2 - International journal for equity in health
TI - Inequities in the delivery of mental health care: A grounded theory study of the policy context of primary care
U1 - Education & Workforce
U2 - 34147097
U3 - 10.1186/s12939-021-01492-5
VL - 20
VO - 1475-9276; 1475-9276
Y1 - 2021
Y2 - Jun 19
ER -