Access to mental health services for people with complex chronic conditions: A qualitative study

Abstract Background Mental health conditions are common among people living with complex chronic conditions (PLWCCC), yet recognition and treatment are low in medical settings. Methods To design appropriate mental health services for this population, a qualitative study was conducted to identify the factors affecting access to mental health care for PLWCCC. The study involved 13 PLWCCC enrolled in a heart failure management program, as well as 9 clinicians and researchers with expertise in mental health care and/or complex chronic conditions, recruited from a large academic hospital in Ontario, Canada between March 2021 and March 2022. Data collected from one-on-one semi-structured phone interviews were analyzed using inductive reflexive thematic analysis, and the resultant themes were mapped to the domains of Levesque’s patient-centred access to care framework. Results A total of 14 themes were identified, revealing barriers to mental health care at the system and patient levels. System-level barriers included health care system and service approachability (difficulties detecting mental health concerns; unpreparedness for referral conversations), availability and accommodation (available mental health services were limited; services were poorly timed; pathways to care were inconsistent), and affordability (limited human resources; lack of options for choice or finding fit; insufficiency of generic mental health services). Patient-level barriers included limitations in the ability to perceive mental health needs (low mental health literacy; denial, stoicism, and self-reliant coping methods), as well as seek (stigma), reach (inconvenience of in-person delivery), and pay (lack of full insurance coverage and high cost of psychological services) for mental health care hindered access. Conclusion Given the multi-level factors identified that hinder access to mental health care services for this population, service pathways should seek to enhance the approachability, availability, and appropriateness of mental health services and promote the ability of PLWCCC to perceive their mental health needs.