Do Investments in Mental Health Systems Result in Greater Use of Mental Health Services? National Trends in Mental Health Service Use (MHSU) in the Canadian Military and Comparable Canadian Civilians, 2002-2013

Abstract

Background: Mental disorders constitute a significant public health problem worldwide. Ensuring that those who need mental health services access them in an appropriate and timely manner is thus an important public health priority. We used data from 4 cross-sectional, nationally representative population health surveys that employed nearly identical methods to compare MHSU trends in the Canadian military versus comparable civilians.

Method: The surveys were all conducted by Statistics Canada, approximately a decade apart (Military-2002, Military-2013, Civilian-2002, and Civilian-2012). The sample size for the pooled data across the surveys was 35,984. Comparisons across the 4 surveys were adjusted for differences in need in the 2 populations at the 2 time points.

Results: Our findings suggested that first, in the Canadian military, there was a clear and consistent pattern of improvement (i.e., increase) in MHSU over the past decade across a variety of provider types. The magnitudes of the changes were large, representing an absolute increase of 7.15% in those seeking any professional care, corresponding to an 84% relative increase. Second, in comparable Canadian civilians, MHSU remained either unchanged or increased only slightly. Third, the increases in MHSU over time were consistently greater in the military than in the comparable civilian sample.

Conclusions: Our findings point to advantages with respect to MHSU of the military mental health system over the civilian system in Canada; these advantages have widened substantially over time. These findings speak strongly to the potential impact of analogous changes in other health systems, both military and civilian.

Keywords: access to mental health care; mental health services; military.

Figure 1.

Adjusted prevalence of past-year MHSU by provider category, calculated using iterative proportional fitting weights. The error bars were calculated as prevalence point estimate ± 1 standard error of the prevalence point estimate. The adjusted prevalence rates for Mil-2002, Civ-2012, and Civ-2002 surveys were calculated using weights to approximate the population of Mil-2013 survey. The following variables were included in calculating iterative proportional fitting weights: age, sex, education, marital status, family income, ethnicity/cultural origin, self-reported mental health status, self-reported physical health, past 12-month major depressive episode, past 12-month suicide ideation, and attempt.