What do these results mean for residents of Vancouver? Unfortunately, while mental health is becoming less stigmatized in popular conversation, there is still a great deal of work to be done to ameliorate accessibility. A 2011 study focusing on psychiatrists found that only 6 of the 297 listed in a medical directory accepted referrals from a general practitioner and provided an appointment within 4.5 weeks (Martinuk, 2019). Of the 230 doctors who could be contacted in that study, 70% refused to accept new referrals while the remaining refused to commit to any timeframe in which they could begin to see a new patient (Martinuk, 2019). According to Martinuk (2019), not much has changed in the intervening eight years as patients in Vancouver still face wait times of months to years to see a psychiatrist and many are now being offered group therapy sessions led by a nurse instead. Given that psychiatrists are so difficult to come by in Vancouver, it is a reasonable assumption that the services listed in this analysis are acting as the primary means of mental health care for some individuals and are thus likely to be overburdened. Long wait times also plague mental health services at post-secondary institutions as a 2019 Globe and Mail report details. Students, particularly those at UBC, at routinely referred to off-campus counselling services due to long wait times and overburdened campus resources and this can only add to the overall lack of accessibility of mental health care services within Vancouver (Gibson, 2019).
While the results of this analysis are influence by an assumed capacity for each mental health care site, reports of long wait times due to a lack of available services by Gibson (2019) and Martinuk (2019) show that accessibility is heavily lacking.
Future areas of analysis
Given the nature of the 2SFCA analysis, this analysis could easily be expanded to a wider geographic area such as entire health authorities, multiple cities or regions such as Vancouver Island, Metro Vancouver, or regions of BC. This kind of analysis could also easily be modified to find the accessibility scores for other medical professionals or non-medical resources such as food banks. Because one of the strengths of the 2SFCA analysis is its identification of underserved areas, it could also be used by municipalities to identify areas for new community programs or services.
For this analysis specifically, the next step would be to correct the site capacity values to be better representative of available services. Another important step would be to search further for available no-cost mental health care sites that are not managed by any of the health authorities used in this paper. In my research to locate mental health care sites, there were many resources available just for children and adolescents under the age of 19 so another useful analysis would be to examine the accessibility of these sites using DA population data for age 15 and under (Stats Canada groups age 15-64 together as adults so getting population data for ages 0-18 is likely more difficult). Several mental health services are also restricted by gender so further analysis to see if there are more services for one gender or another and also calculating their accessibility scores would be interesting. Lastly, as the census is carried out, it would be useful to redo this analysis with the most up-to-date population data.
Limitations
As mentioned, this study focused only on the city of Vancouver. Vancouver has 996 DAs and including those for Richmond, Burnaby, New Westminster, and UBC resulted in nearly 1700 DAs. The large number of DAs causes the network analysis to be very time consuming. With only the 996 DAs, the polygon building phase of one network analysis distance ran for nearly 40 minutes. As four distance thresholds were calculated, this resulted in nearly 3 hours just spent creating polygons and does not include the time ArcMap uses to locate all areas. Time constraints and access to a computer that can be left to allow ArcMap to process without interruption forced me to narrow the scope of this project to a manageable size.
Several assumptions were made about the mental health service sites. First, the capacity was assumed to be 250 because this data was not otherwise available. Second, only services accessible at no cost for individuals with a BC CareCard were included therefore psychiatrists, psychologists, and paid counselling services were excluded. Lastly, in-patient services were excluded as these services typically require referral by a general practitioner or mental health care professional.
Conclusion
While conversations about and around mental health care have become much more open, this has not translated to more accessible mental health care. With one tenth of Canadians experience mental health issues in their adult lifetimes, there is a significant need to provide better access so that a greater number of Canadians have the ability to seek mental health care. The results of this analysis show that the majority of Vancouver lacks access to mental health care services and that even within DAs that do have some access, it is very limited. Accessibility is best within 500 m of the sites in this report but at that level accessibility is scored at a maximum of 0.3 services per catchment area. By the largest catchment of 5 km, this accessibility score drops to 0.017 services per catchment area. Ultimately, after completing the road network analysis showing that a large proportion of Vancouver was within 5 km of a mental health care site, it was unexpected to see that so few DAs in Vancouver can expect any level of accessibility. It will be important going forward for more mental health services to be made available to improve accessibility scores across the city.