Challenges Facing Canadian Psychiatry

Workforce Shortages and Access Barriers

The American Academy of Child and Adolescent Psychiatry notes that there is a significant dearth of child and adolescent psychiatrists, with limited therapy services, substance use treatment services, and home-based services due to a lack of providers 1
Among children experiencing poverty who need mental health care, less than 15% receive services, and even fewer complete treatment, according to the American Academy of Pediatrics 2
Cross-discipline training gaps prevent behavioral health and primary care physicians from effectively integrating their respective specialties, as reported by the American College of Physicians 3, 4
Educational inequities create downstream effects in training programs, leading to a behavioral health workforce that may not be culturally or linguistically appropriate for the populations being served, according to the American Academy of Child and Adolescent Psychiatry 1
Minoritized researchers face persistent funding disparities and barriers rooted in structural racism, limiting the diversity of the psychiatric workforce and research that addresses health disparities, as noted by the American Psychiatric Association 5, 6

The number of inpatient psychiatric beds sharply declined from 525,000 in 1970 to 212,000 in 2002, with community-based services insufficient to replace lost capacity, according to the American College of Physicians 8, 4
General hospital emergency departments, prisons, and jails have become de facto care settings for patients with serious mental health needs, facilities that often lack resources and clinicians with appropriate training, as reported by the American College of Physicians 3, 8
Intensive community-based services are underfunded nationally, resulting in overdependence on acute levels of care, according to the American Academy of Child and Adolescent Psychiatry 1
Inadequate skills for integrated practices and reluctance to change practice patterns represent major workforce challenges related to integration, as noted by the American College of Physicians 3, 4

Child and adolescent psychiatrists working in high-shortage areas can experience themselves as "lone providers" and must actively seek out resources in the community and advocate at state and local levels for funding and infrastructure changes, according to the American Academy of Child and Adolescent Psychiatry 1
Providers must recognize their own culture and class-related biases, as research shows providers presented with clients described as having lower socioeconomic status are less inclined to work with them, as reported by the American Academy of Pediatrics 2
Expanding roles and opportunities for community health workers in mental health services can simultaneously diversify the workforce and address service delivery gaps, according to the American Academy of Child and Adolescent Psychiatry 10
States must establish credentialing processes for family peer support providers to expand the lay health workforce and improve access to services, as noted by the American Academy of Child and Adolescent Psychiatry 10
Policy changes such as reevaluation of strict medical necessity rules to permit longer inpatient stays and broadening federal payment for high-quality inpatient psychiatric care may be necessary to increase capacity, according to the American College of Physicians 8, 4