Barriers to access to mental health services for ethnic seniors: the Toronto study.
OBJECTIVE
To identify and describe barriers to access to mental health services encountered by ethnoracial seniors.


METHODS
A multiracial, multicultural, and multidisciplinary team including a community workgroup worked in partnership with seniors, families, and service providers in urban Toronto Chinese and Tamil communities to develop a broad, stratified sample of participants and to guide the study. This participatory, action-research project used qualitative methodology based on grounded theory to generate areas of inquiry. Each of 17 focus groups applied the same semistructured format and sequence of inquiry.


RESULTS
Key barriers to adequate care include inadequate numbers of trained and acceptable mental health workers, especially psychiatrists; limited awareness of mental disorders among all participants: limited understanding and capacity to negotiate the current system because of systemic barriers and lack of information; disturbance of family support structures; decline in individual self-worth; reliance on ethnospecific social agencies that are not designed or funded for formal mental health care; lack of services that combine ethnoracial, geriatric, and psychiatric care; inadequacy and unacceptability of interpreter services; reluctance of seniors and families to acknowledge mental health problems for fear of rejection and stigma; lack of appropriate professional responses; and inappropriate referral patterns.


CONCLUSIONS
There is a clear need for more mental health workers from ethnic backgrounds, especially appropriately trained psychiatrists, and for upgrading the mental health service capacity of frontline agencies through training and core funding. Active community education programs are necessary to counter stigma and improve knowledge of mental disorders and available services. Mainstream services require acceptable and appropriate entry points. Mental health services need to be flexible enough to serve changing populations and to include services specific to ethnic groups, such as providing comprehensive care for seniors.
Sadavoy
Joel
J
Mount Sinai Hospital, Toronto, Ontario. jsadavoy@utoronto.ca
Meier
Rosemary
R
Ong
Amoy Yuk Mui
AY
D000368:Aged; D044466:Asian People / Q000523:psychology*; D002681:China / Q000208:ethnology; D004641:Emigration and Immigration; D005008:Ethnopsychology; D005260:Female; D017144:Focus Groups; D005852:Geriatric Psychiatry / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000208:ethnology* / Q000628:therapy; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009864:Ontario; D010348:Patient Care Team / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013188:Sri Lanka / Q000208:ethnology; D014505:Urban Population / Q000706:statistics & numerical data*