From data to decisions

Mental health encounters in primary care

Family physicians are the first point of contact for patients with mental health concerns.⁷ A 2021 study by Stephenson et al, using electronic medical record (EMR) data from Ontario, found that the most common reason for a visit was anxiety (6.5% prepandemic, the level rising to 9.2% at the onset of the COVID-19 pandemic).⁸ People with mental health challenges—whether those in emotional distress, or those with a diagnosis of serious mental illness—often struggle to have their issues identified and treated in primary care.⁵ This is particularly so for children, youth, and seniors seeking mental health care.⁹

High-quality primary care provides compassionate care for individuals across their lifespan and, when there is capacity, can identify and treat mental health conditions before serious adverse outcomes occur.¹⁰ The World Health Organization has identified that improving collaboration with specialist services within primary care is the optimal way to respond to the increasing demand for mental health services.¹¹

The growing need for mental health care is reinforced by information recently reported by CPCSSN, a national repository of primary care EMR data, which evaluated the proportion of primary care visits devoted to mental health.¹² The results of an interrupted time series analysis of CPCSSN data show that primary care visits for mental health increased by a statistically significant percentage, from 12.7% before the COVID-19 pandemic to 14.1% after the pandemic’s onset (slope of +0.0004/month, P<.0001) (Figure 1). This analysis did not include visits that were coded for physical health conditions but in which a proportion of the visit was spent managing psychosocial issues. A previous study estimated that as much as 70% of all visits to primary care include some form of psychosocial concerns.¹³

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Figure 1.

Interrupted time series: MH visit rates by age group.

CPCSSN data reveal the highest share of mental health visits were with young adult patients. More than 20% of the visits by patients aged 15 to 24, and more than 25% of those by patients aged 25 to 44, addressed mental health concerns. Among those aged 15 to 24, rates continued to rise in the postpandemic period (slope of +0.00101/month, P<.0001). These numbers underscore the urgent need to invest in resources and strengthen primary care capacity to maintain universal access.

Increasing community support

Expanding access to community mental health supports, such as therapies that are provided by allied health professionals connected to primary care provision, and ensuring insurance access might be the most effective and cost-efficient solutions to addressing the mental health needs of Canadians.¹⁴ Currently, integration varies across the country. In Ontario, family health teams and community health centres often include embedded mental health providers. But in many other jurisdictions, especially in fee-for-service or rural settings, these supports are limited or absent, leaving physicians to manage complex cases alone.

Given the shortage of providers, we must invest in building primary care teams. Fewer than half of family physicians are satisfied with the mental health care they provide,¹⁵ and only 23% feel prepared to manage severe conditions.¹⁶ We must support care delivery by trained interprofessional providers (eg, social workers, psychologists, counsellors, psychiatrists) to meet population needs. Access remains inconsistent due to fragmented funding, limited public insurance coverage for psychotherapy, and variable integration into provincial reforms.

To guide policy in a resource-constrained system, we must evaluate the cost-effectiveness and impact of delivery models. National data sources such as CPCSSN offer a unique opportunity for this type of evaluation by helping to identify which innovations expand access and deliver value.

Early interventions in mental health substantially improve outcomes.¹⁴ CPCSSN data show that a quarter of youth and young adult visits are for mental health. Are these patients receiving adequate care? Although the issue is complex, CPCSSN data can help answer this. A core component of care is the use of psychotropic medications, which has increased across all age groups since the COVID-19 pandemic (Figure 2).

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Figure 2.

Interrupted time series: Psychotropic medication prescribing rates by age group.

Although psychotropics offer evidence-based benefits, cost-effective approaches include psychotherapy in combination with other mental health services.¹⁴ Embedding social workers or psychologists within primary care teams improves outcomes and reduces emergency department visits, with some studies suggesting long-term cost-effectiveness.^17-20 These collaborative approaches enhance timely access, satisfaction, and continuity for patients. Yet only a minority of Canadians receive mental health care through primary care, revealing a persistent gap between policy and practice. Improvements that incorporate interdisciplinary care models are urgently needed. The impact of such innovations can be tracked and measured through CPCSSN and similar data.

While this commentary focuses on existing structures, Canadians without regular providers—the unattached population—face the greatest barriers. Team-based models that integrate mental health services can improve efficiency and scope, freeing system capacity and reducing wait times. CPCSSN can also support evaluation of expanded access strategies such as community hubs, centralized triage, or virtual supports. It is well positioned to assess which models improve access and equity.