INTERLAKE RHA COMMUNITY HEALTH ASSESSMENT Mental Health Services Needs Survey: Expanded Report September 2010

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INTERLAKE COMMUNITY HEALTH ASSESSMENT MENTAL HEALTH SERVICES NEEDS SURVEY REPORT

Acknowledgements

• Thanks to Dr. Melissa Tiessen, Assistant Professor & Clinical Psychologist, and Dr. Andrea Lee, Psychology Resident both with the Rural & Northern Psychology Programme, Dept. of Clinical Health Psychology, Faculty of Medicine at the University of Manitoba for their contributions to this project. Special thanks to Dr. Lee and for her work on the preparation of this report.

• Thanks to Tannis Erickson, Interlake RHA Health Systems Analysis Manager, for all her support and assistance throughout the various stages of this project.

• Thanks to Sherry MacVicar, Anxiety Disorders Association of Manitoba, and Bev King, Mood Disorders Association of Manitoba for their input on the survey questions.

• Thanks to Brian Yuzdepski and Kim Canvin, Canadian Mental Health Association (Interlake Region), for making themselves available to assist participants complete the survey

• Thanks to the Rural & Northern Psychology Programme, Dept. of Clinical Health Psychology, Faculty of Medicine at the University of Manitoba for their financial support of this project.

• Most of all, thank you to the residents of the Interlake who took the time to complete this survey.

For more information contact: Dr. Karen Dyck IRHA Consulting Psychologist & Associate Professor Interlake Regional Health Authority/University of Manitoba (204) 785-4886 kdyck@irha.mb.ca

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Introduction The Canadian Mental Health Association defines mental health as “a balance in all aspects of one’s life: social, physical, spiritual, economic, and mental” (www.cmha.ca/bins/print_page.asp?cid=2&lang=1). Mental health is a key component in everyone’s overall health and well-being and influences one’s ability to enjoy life and respond effectively to challenges. Genetics (family history of mental health difficulties), biology, personality traits, physical illness, and environmental factors (e.g., stress) can all impact our mental health and cause us to experience mental health difficulties. In fact, many adults have periods in their lives when they experience mental health difficulties, which may or may not develop into a mental illness. Mental illnesses are characterized by changes in thinking, mood, and/or behavior that cause significant distress or interfere with an individual’s day to day functioning. It has been estimated that at least 1 in 5 Canadians will develop a mental illness (e.g., depression, anxiety disorder, eating disorder, etc.) at some time in their lives (www.cmha.ca/bins/print_page.asp?cid=3&lang=1). Data from the Interlake region has been largely consistent with this. Data from 2005/2006 indicated that 22% of Interlake residents had been diagnosed with 1 or more of the following mental illnesses: depression, anxiety disorder, substance abuse, schizophrenia and/or personality disorder (Interlake RHA Community Health Assessment Report, 2010). This figure likely underestimates the true scope of the problem as many individuals experiencing mental health difficulties do not seek help. Mental illnesses affect Canadians from all occupations, educational levels, income levels, and cultures. Mental illness will likely affect each of us at some point in our lifetime, whether it be our own, or that of a family member, friend, or colleague. The Mental Health Services Needs Survey was part of the broader Interlake Regional Health Authority’s Community Health Assessment and was developed to learn more about the mental health needs of adults living in the Interlake region. This survey included questions about adults’ experiences with and opinions about mental health difficulties and mental health resources. In keeping with the Interlake Regional Health Authority’s commitment to overall health and well-being the findings from this survey will be used to inform the ongoing development of regional mental health services.

Distribution of Survey The survey was sent out as unaddressed ad mail to a random sample of 5,000 Interlake households on October 5, 2009. The adult of the household was asked to complete the survey. If there was more than one adult living in the home on a full-time basis participants were asked to decide which adult was best suited to complete the survey. Participation in the survey was completely voluntary. In order to ensure anonymity and confidentiality, adults who chose to complete the survey were instructed not to put any identifying information on the survey.

Reporting of Results

In addition to the general results of the Mental Health Services Needs Survey, results were also divided by district (North East, North West, South East, and South West) and age (18-44, 45-54, 55-64, and 65+) in order to determine whether or not there were meaningful differences specific to these variables. Due to few respondents in the age groups younger than 45, these respondents were combined to form the 18-44 age category. The method used to examine differences between groups consisted of statistical analyses that help determine whether any observed differences reflect actual population differences or are due to chance factors. Gender, marital status, and education were

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controlled for in each of these analyses. By doing this we eliminate group differences attributable to these factors. For the district comparisons, age was also controlled for and for the age comparisons district was controlled. Controlling these variables allows us to answer the following questions: 1) Are there district differences after adjusting for differences in gender, age, education, and marital status? and 2) Are there age differences after adjusting for differences in gender, education, marital status, and district? It is important to determine true differences in order for program planning to be meaningful. Specific survey questions that potentially speak to program planning in the region were the focus of these additional analyses.

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Highlights 16% (792) of the 5,000 households surveyed responded, with a good representation from each

of the four districts in the region.

Most respondents were female (68%), married (66%), and between the ages of 45-64 (56%). The largest percentage of respondents reported having a high school education (28%), followed by college diploma (19%), trade school, technical or vocational diploma/certificate (15%), undergraduate degree (14%), and some high school (13%).

Feeling tired and nervous were the two most commonly reported stress symptoms experienced over the past 30 days; 1% reported feeling hopeless, depressed, worthless, or that everything was an effort “all of the time” during the past 30 days.

21% reported having a concern about their own mental health, 53% had concerns about another person’s mental health, 2% had concerns about their own and another person’s mental health during their lifetime. These respondents indicated that books, medication, one-on-one counselling, and websites were their primary means of coping with these concerns.

Respondents indicated they would be most likely to seek advice about a mental health concern from their spouse/partner or their family doctor. Although there were some age and district differences, family doctor was consistently rated as the health care provider respondents from whom they would most likely seek advice.

Respondents indicated they would be most likely to use medication, one-on-one counselling,

and books to cope with a mental health difficulty. Although there were some age related differences, all groups (regardless of district or age) rated these as the resources they would be most likely to access.

20% - 31% of total respondents indicated that they would be “somewhat” to “very” likely to use internet discussion groups, in-person groups, or telephone counselling. Respondents aged 65 and older rated their likelihood of using internet discussion groups and telephone counselling as significantly lower than the other age groups.

41% - 53% of the total respondents indicated they were “somewhat” to “very” likely to use telehealth services to access various mental health services if they were unavailable in their community. There were no significant differences related to age or district.

27% would consider attending a mental health group, 54% were unsure, 17% would not. There were no significant differences related to age or district.

“Wanting to manage the problem on my own” (55%) and “thinking the problem is not bad enough to get help” (48%) were the top two reasons respondents thought they would not seek any help for a mental health concern. Although some age and district related differences were detected, these were the most frequently identified barriers for all groups (regardless of age or

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district). Cost (35%), “worry about what others think” (28%) and “worry about others finding out” (23%) were also endorsed by a number of respondents. Age and district related differences were found for the latter two barriers.

61% anticipated that their worries over privacy or confidentiality would make it difficult for them to attend group.

Knowing how confidentiality applied in a group (63%), being able to meet the group leader beforehand (60%), having a health care provider recommend the group (59%) and being able to attend an information session about the group beforehand (57%) were the most commonly endorsed factors that would make it more likely for respondents to attend a mental health group. Although some age and district related differences were found, these were rated as the factors that would most positively influence group attendance regardless of age and district.

Being able to call the service provider directly (65%), knowing the service provider has a degree/diploma in a mental health field (62%), having the provider located in their community (57%), and having prior positive contact with the provider (54%) were the most commonly identified factors that would make it more likely for respondents to seek any help for a mental health concern. Although some district differences were detected all groups, regardless of district or age, identified being able to call the service provider directly as a factor that would increase their likelihood of accessing services.

The findings from this survey will be used to inform the ongoing development of regional

mental health services.

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Results

The Respondents Seven hundred and ninety two (approximately 16% response rate) adults completed the survey, 20% from the North East region, 23% North West, 23% South East, and 24% South West. Sixty-eight percent were female and 30% male. Most were married (66%) and between the ages 45-64 (56%). More people were working full-time (29%) than part-time (11%), but most respondents were retired (31%). The following is a breakdown of the ages of the sample:

AGE

The majority of respondents reported obtaining a high school education or higher, with the specific breakdown as follows:

EDUCATION

0

5

10

15

20

25

30

18-24 25-34 35-44 45-54 55-64 65-74 75-84 Over 84

14

11

2927

20

6

1

13%

27%34%

14%

5%7%

some high school

high school

diploma or certificate

undergrad degree

grad degree

unknown

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Respondents’ Mental Health Concerns & Stress Related Symptoms Twenty-one percent of respondents reported having concerns about their own mental health at some point during their lifetime, 53% had concerns about another person’s mental health, 2% had concerns about their own and another person’s, and 24% have never had a mental health concern. When asked about their own stress related symptoms during the past 30 days, respondents were most likely to report feeling tired and nervous to varying degrees. Also noteworthy was the fact that 1% of respondents reported feeling hopeless, depressed, worthless, or that everything was an effort “all of the time” during the past 30 days. The following chart illustrates the symptoms of stress included in the survey:

SYMPTOMS OF STRESS

How Respondents Cope with Mental Health Concerns As indicated on the following page, respondents who reported a concern about their own and/or another person’s mental health reported using books, medication, one-on-one counseling, and websites as their primary means of coping.

4 1 0 1 1 0 1 0 1 10

1020304050607080

% o

f sam

ple

None of the time

A little of the time

Some of the time

Most of the time

All of the time

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FORMS OF HELP USED DURING ONE’S LIFETIME

Thirty-three percent of these respondents indicated they had spoken to a service provider over the telephone about their own or someone else’s mental health concern, whereas 36% had not. The types of service providers contacted over the telephone were as follows:

TYPE OF PROVIDER CONTACTED BY TELEPHONE FOR MENTAL HEALTH CONCERN

Likelihood of Respondents Seeking Various Forms of Help All respondents (regardless of whether or not they indicated they had a concern about their own or another person’s mental health) were asked to indicate how likely they would be to access various

25

17

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8

3

21 20

8

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21

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5

14 139

0

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20

25

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e

Self

Other

0

5

10

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20

2520

12

8 97

117

47 7

18

710

7 8

13

9

57 6%

of s

ampl

e

Self

Other

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types of help if they were to be concerned about a mental health issue. This information can help us to develop and implement mental health services that are not only address the needs of individuals who have already experienced mental health concerns but also the needs of individuals who may be affected by a mental health concern at some future point. Likelihood of Respondents Talking to Particular People for Advice Respondents reported that they would be “very likely” to seek advice about a mental health concern from their spouse (39%) and family doctor (35%). Seventeen percent of respondents indicated they would be “very likely” to seek advice from someone with a diploma/degree in the mental health field and 14% of respondents indicated they would be “very likely” to seek advice from someone from a mental health organization who had personal or family experience coping with the problem him/herself. In contrast, many respondents indicated that they would be “very unlikely” to seek advice from a spiritual/religious advisor, someone from a phone-in counsellor or health line, or from someone at a school/work based counselling centre.

LIKELIHOOD OF TALKING TO PARTICULAR PEOPLE FOR ADVICE

District Differences Similar to the overall sample, all districts rated family doctors, counsellors with a mental health degree/diploma, and someone from a mental health organization who has had personal or family experience as the health care providers they would be most likely to speak with. However, residents in the North East district, on average, rated their likelihood of speaking to a family doctor about mental health concerns as lower than residents in the South East district. Residents in the North West district, on average, rated their likelihood of speaking to someone from a mental health organization as lower than residents of the South East district.

718 17 11

31 30 276 13 132

4 99

7 149

78 1214

919 26

1617

12

2123 20

96

9 127

6

615

17 1539

7

1421 6

7

535

17 14

0102030405060708090

5 - Very Likely

4

3 - Somewhat Likely

2

1 - Not at all likely

%of

sam

ple

11

LIKELIHOOD OF TALKING TO VARIOUS PEOPLE FOR HELP BY DISTRICT North East North West South East South West Phone-In Counselling/Health Line 2.247 1.887 2.152 1.902

School/Work Based Counselling Centre 2.123 1.773 1.946 1.873

Family Doctor **3.215 3.368 **3.833 3.616 Diploma/Degree in Mental Health 2.937 2.783 3.037 2.862

Mental Health Organization with Personal Experience 2.651 **2.320 **2.992 2.749

Not at all likely = 0; Somewhat likely = 2; Very likely = 4 **Indicates values that are significantly different from one another Age-Related Differences All ages rated family doctors, counsellors with a mental health degree/diploma, and someone from a mental health organization as health care providers they would be most likely to speak with. However, individuals in the youngest age category (18-44) rated their likelihood of speaking to a family doctor as lower than the 55-64 and 65+ groups, and the 45-54 group rated their likelihood lower than the 65+ group. Not surprisingly, individuals 65 years and older rated their likelihood of using school or work based counselling services as lower than individuals 45 – 64.

LIKELIHOOD OF TALKING TO VARIOUS PEOPLE FOR HELP BY AGE 18 - 44 45 - 54 55 - 64 65+ Phone-In Counselling/Health Line 1.872 2.283 2.153 1.870

School/Work Based Counselling Centre1 1.833 **2.125 **2.220 **1.524

Family Doctor2 **3.076 **3.345 **3.645 **3.874 Diploma/Degree in Mental Health 2.972 2.823 3.059 2.774

Mental Health Organization with Personal Experience 2.846 2.648 2.736 2.501

Not at all likely = 0; Somewhat likely = 2; Very likely = 4 1 45-54 and 55-64 > 65+ 2

18-44 < 55-64 and 65+; 45-54 < 65+

Likelihood of Respondents Using Various Types of Assistance Respondents were also asked to rate the likelihood of using particular types of assistance for mental health concerns. Consistent with forms of help used by individuals who had experienced mental health concerns, the overall sample of respondents indicated they would be “very likely” to use medication (26% from a family doctor, 21% from a psychiatrist), one-on-one counselling (26%), and a book (19%):

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LIKELIHOOD OF USING VARIOUS TYPES OF ASSISTANCE FOR MENTAL HEALTH CONCERNS

As illustrated above, a large portion of respondents thought they would be “not at all likely” to use computer-based treatment (62%), internet discussion group (61%), in-person groups (50%- 55%), or telephone counselling (43%). However, the fact that 20% - 31% (depending upon the type of service) of respondents indicated they were “somewhat likely” to “very likely” to use internet discussion groups, in-person groups, and telephone counselling suggests a number of Interlake residents may be open to these options. District Differences Consistent with findings from the overall sample, all districts identified medication (from family doctor or psychiatrist), one-on-one counselling, and books as the resources they were most apt to use. As shown on the following page, there were no district differences regarding likelihood of using various types of assistance.

266162

515250

5543

2122

27

1010

151617

1616

1766

10

2812

101614

1613

192222

17

114

35684

91919

18

195233

23

326

2621

0 20 40 60 80 100 120

BookInternet discussion group

Computer-based treatment1 education meeting for 2 hrs, 20-30 ppl

2-4 education meetings for 2 hrs, 20-30 ppl8-12 education meetings for 2 hrs, 4-8 ppl

One 6 hr education meeting, 20-30 pplTelephone counseling sessions

One-on-One counseling sessionsMedication from family doctor

Medication from Psychiatrist

1 - Not at all likely 2 3 - Somewhat Likely 4 5 - Very Likely% of sample

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LIKELIHOOD OF USING VARIOUS RESOURCES BY DISTRICT North East North West South East South West

Book 2.027 2.055 1.937 2.114

Internet Discussion Group .862 .736 .904 .780

Computer-Based Tx Program .655 .547 .663 .605

2 hr Ed Mtg (20-30 pple) .803 .743 1.104 1.075

2-4, 2 hr Ed Mtg (20-30 pple) .894 .854 1.008 .954

8-12, 2 hr Ed Mtg (4-8 pple) 1.102 .872 1.085 1.016

6 hr Ed Mtg (20-30 pple) .852 .614 .972 .852 Series of Telephone Meetings with a Counsellor 1.137 1.175 1.329 1.103

Series of One-on-One Meetings with a Counsellor 2.466 2.212 2.477 2.567

Medication from Family Doctor 2.386 2.241 2.538 2.670

Medication from Psychiatrist 2.321 2.024 2.190 2.315 Not at all likely = 0; Somewhat likely = 2; Very likely = 4 Age-Related Differences Regardless of age, medication (from family doctor or psychiatrist), one-on-one counselling, and books were rated as the resources individuals were most apt to use. However, respondents aged 65 and over rated their likelihood of taking a medication recommended by a family doctor as higher than those under 55. Respondents in the youngest age group (18-44) and the oldest age group (65+) were both less likely to engage in face-to-face meetings with a counsellor as compared to respondents between the ages of 55-64. Not surprisingly, respondents aged 65 and older were less likely than the younger age groups to use an internet discussion group and 18-44 year olds were more likely to use this resource than the 55-64 year olds. A similar finding was obtained for computer based treatment program (i.e., 65+ were less likely than respondents under 55 to use this resource). The only age differences with educational meetings appeared to be that respondents aged 55-64 were more likely to attend one 2 hour educational meeting with 20-30 people than respondents between the ages of 45-54. With regards to telephone meetings with a counsellor, respondents aged 65 and over were the least likely group to use this resource.

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LIKELIHOOD OF USING VARIOUS RESOURCES BY AGE 18 - 44 45 - 54 55 – 64 65+

Book 2.265 1.961 2.071 1.851

Internet Discussion Group1 **1.225 **1.046 **.771 **.291

Computer-Based Tx Program2 **.834 **.773 .586 **.306

2 hr Ed Mtg (20-30 pple) .790 **.708 **1.207 .972

2-4, 2 hr Ed Mtg (20-30 pple) .901 .710 1.037 1.042

8-12, 2 hr Ed Mtg (4-8 pple) .932 .924 1.138 1.063

6 hr Ed Mtg (20-30 pple) .664 .729 .991 .876 Series of Telephone Meetings with a Counselor3 **1.275 **1.392 **1.279 **.818

Series of One-on-One Meetings with a Counselor4 **2.285 2.370 **2.786 **2.247

Medication from Family Doctor5 **2.217 **2.239 2.492 **2.827

Medication from Psychiatrist 2.105 2.038 2.276 2.402 Not at all likely = 0; Somewhat likely = 2; Very likely = 4 **Indicates values are significantly different from one another 1 18-44 > 55-64; 65+ < than all other age groups 2 18-44 and 45-54 > 65+ 3 65+ < than all other age groups 4 18-44 and 65+ < 55-64 5

18-44 and 45-54 < 65+

Factors Affecting Help Seeking Behaviour All of the participants were asked questions aimed at identifying the reasons they would be unlikely to seek help as well as factors that might make it more or less likely for them to seek help for mental health concerns. Reasons One Would Be Unlikely to Seek Services Respondents indicated that the main reason they would not seek any help for mental health concerns is because they “would want to manage the problem on my own” (55%), with “thinking the problem is not bad enough to get help” as the second most frequent reason to not seek help (48%). A number of respondents also indicated that cost (35%), worry about what others think (28%), and worry about others finding out (23%) would be reasons for them not seeking help.

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REASONS ONE WOULD BE UNLIKELY TO SEEK HELP

Transportation did not appear to be a significant barrier for respondents (only 9% indicated that it would be). Indeed, most people indicated they would be willing to do some traveling for services:

MINUTES ONE WOULD TRAVEL BY CAR FOR SERVICES

District Differences Regardless of the district, wanting to manage the problem on their own and thinking the problem is not bad enough were the top two reasons given for not seeking help. District differences were identified for only 4 of the 13 reasons listed. The North East district was more likely to identify “want to manage problem on my own” as a reason that they would be unlikely to seek help as compared to South West or North West residents. Residents in the North East district were more likely than

5548

64

1728

2335

91515

116

0 10 20 30 40 50 60

Want to manage on ownProblem not bad enough

Think treatment won't helpThink nothing will helpNot know where to go

Worry what others thinkWorry others find out

CostTransport

Type of help unavailableWaitlist too long

Service not in my languageOther responsibilities to tend to

% of sample

11 11 12

23

6

34 34

46 46

2628 29

25

17

30

20 19

96

32

0

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30

35

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45

50

Limited appts with psychiatrist

Limited appts with psychologist

Weekly individual therapy

Weekly mental health group

meetings

Limited appts with medical

specialist

Would Not

Up to 30 min

31-60 min

More than 60 min

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residents in the South East district to endorse worries reflecting stigma, such as “worry what others will think” or “worry that others will find out.” Lastly, more respondents in the South East district than in the North West endorsed “type of help is unavailable” as a potential barrier for accessing mental health services.

REASONS UNLIKELY TO SEEK HELP (PERCENTAGE BY DISTRICT) North East North West South East South West

Want to manage on own1 **49.0 **63.7 55.2 **71.5

Problem not bad enough 59.0 56.5 49.8 53.7

Think treatment won’t help 11.9 3.7 10.1 5.2

Think nothing will help 9.1 2.7 5.5 3.6

Not know where to go 24.1 17.0 16.8 21.1

Worry what others think **44.0 36.7 **25.1 35.3

Worry others find out **33.8 30.6 **16.9 27.3

Cost 41.7 29.9 44.9 42.7

Transportation 7.2 14.0 9.0 8.3

Type of help unavailable 14.9 **23.4 **6.6 15.0

Waitlist too long 22.7 14.0 14.4 14.5

Service not in my language 0.1 0.3 1.6 0.5

Other responsibilities to tend to 17.2 24.2 18.1 16.3 Not at all likely = 0; Somewhat likely = 2; Very likely = 4 **Indicates values that are significantly different from one another 1

SW and NW < NE

Age Related Differences Regardless of age, wanting to manage the problem on their own and thinking the problem is not bad enough were the top two reasons given for not seeking help. However, respondents under 45 years of age were less likely than those 45 – 54 and 65+ to endorse “problem is not bad enough.” In terms of the other reasons, the 45-54 age group were more likely than the 65+ age group to endorse “think treatment won’t help” and the youngest age category (18-44) was more likely than either of these two age groups to endorse that they “think nothing will help.” Worries reflecting stigma, such as “worry what others will think” or “worry that others will find out” showed consistent age differences. Respondents aged 65 and over were less likely than all younger age groups to consider this an issue and those 55-64 were less likely than those 18-44 to worry what others will think. There were a variety of differences for reasons of a practical nature. Although only a small percentage of respondents from any age group identified transportation as a barrier, the youngest age group were more likely than those between the ages of 45 – 54 to identify this as a barrier to seeking help. Furthermore, the oldest age group (65+) was the least likely to consider “other responsibilities to

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tend to” a barrier and respondents within the youngest group were more likely to endorse this than those in the second oldest age category (55-64) and oldest (65+) categories.

REASONS UNLIKELY TO SEEK HELP (PERCENTAGE BY AGE)

18 - 44 45 - 54 55 - 64 65+

Want to manage on own 66.1 61.3 57.8 53.8

Problem not bad enough1 **72.5 **50.4 55.1 **42.9

Think treatment won’t help 09.9 **12.6 06.8 **02.1

Think nothing will help2 **11.6 **04.1 04.7 **01.2

Not know where to go 20.5 23.6 15.9 19.3

Worry what others think3 **53.5 **39.9 **32.5 **17.9

Worry others find out4 **35.9 **38.5 **25.3 **10.9

Cost 45.4 38.4 36.0 39.3

Transportation **17.7 **06.5 08.0 07.1

Type of help unavailable 10.6 16.2 19.7 13.4

Waitlist too long 10.6 18.9 18.8 17.1

Service not in my language 00.4 01.6 00.0 00.4

Other responsibilities to tend to5 **32.9 **26.6 **16.5 **01.9 **Indicates values are significantly different from one another 1 18-44 > 45-54 and 65+ 2 18-44 > 45-54 and 65+ 3 18-44 > 55-64; 65+ less likely than all other age groups 4 65+ less likely than all other age groups 5

18-44> 55-64 and 65+; 65+ less likely than all other age groups

Factors Affecting Likelihood of Seeking Help As shown on the following page, factors that contribute to respondents being more likely to seek any type of help for mental health concerns include being able to call the service provider directly (65%), knowing the service provider has a diploma/degree in a mental health field (62%), having the provider located in their community (57%), and having a prior contact with the provider that was positive (54%).

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FACTORS AFFECTING LIKELIHOOD OF SEEKING HELP FOR MENTAL HEALTH DIFFICULTIES

District Differences Two of the 14 factors listed on the graph above were examined for district differences; “needing to be referred by a medical doctor” and “being able to call the service provider directly.” District differences were found for only the latter factor. Although “being able to call the service provider directly” appears important for all districts, residents in the South East and South West rated this as being a more important factor in their help seeking behaviour than residents in the North West district.

FACTORS AFFECTING LIKELIHOOD OF SEEKING HELP BY DISTRICT North East North West South East South West

Able to Call Provider Directly1 1.723 **1.582 **1.835 **1.774

MD referral required .859 1.035 1.062 1.064 Less likely = 0; Neither = 1; More likely = 2

**Indicates values are significantly different from one another 1

NW < SE and SW

Age-Related Differences Consistent with the overall sample, all ages identified being able to call the provider directly as being an important factor. As shown on the following page, age-related differences were found for only one of the two factors examined. The youngest age group rated “needing to be referred by a medical doctor” as a factor that would make them significantly less likely to seek help as compared to other age groups. A significant difference on this factor was also found between the 45 – 54 and 65+ groups.

5715

545

653434

151616

6238

4325

0 10 20 30 40 50 60 70

Provider in communityProvider outside community

Positive contact with providerNegative contact with provider

Able to call provider directlyReferred by medical doctor

Provider lives in regionProvider not live in region

Provider active in communityHave personal information about provider

Proivder has mental health educationProvider has personal experience

Service in general health centreService in community mental health centre

Neither

Less Likely

More Likely

% of sample

19

FACTORS AFFECTING LIKELIHOOD OF SEEKING HELP BY AGE 18 - 44 45 - 54 55 - 64 65+

Able to Call Provider Directly 1.722 1.655 1.811 1.713

MD referral required1 **.5560 **.984 **1.112 **1.314 Less likely = 0; Neither = 1; More likely = 2 **Indicates values are significantly different from one another 1

18-44 > than all other groups; 45-54 < than 65+

Experiences with & Opinions about Mental Health Groups Group based mental health services can be an extremely efficient and effective means of preventing and treating a variety of mental health concerns. The group format can be particularly helpful at providing a supportive environment that allows members to learn from and support one another and reduces their sense of isolation and concerns about stigma. Considering the numerous benefits of group programming, we were particularly interested in learning about respondents’ experience with and opinions about group based mental health services. Awareness of and Participation in Interlake Groups Of the total sample, 25% had previously participated in a group program for a mental health concern, whereas 73% had not. Of the respondents who participated in a group program, 30% found their experience in group “very helpful,” 25% found their group experience “somewhat helpful,” and only 8% found it “not at all helpful.” As indicated in the following graph, respondents were most familiar with groups offered in the Interlake region by Manitoba Schizophrenia Society, Mood Disorders Association of Manitoba, and Anxiety Disorders Association of Manitoba.

GROUPS IN INTERLAKE REGION ONE IS AWARE OF OR ATTENDED

Willingness to Attend Future Groups Respondents appeared somewhat receptive to future group experiences. Twenty-seven percent indicated that they would consider attending a mental health group, 54% were unsure, and 17% were not open to future group experiences.

0 5 10 15 20 25

Stress Management & Relaxation Training

Changeways

Anxiety Disorders Association (Monthly)

Mood Disorders Association (Monthly)

Manitoba Schizophrenia Society (Monthly)

Anxiety Disorders Association (Weekly)

Working on Wellness

10

6

20

20

15

0

8

1

1

2

1

11

2

% of sample

Attended

Aware of

20

District Differences There were no district differences regarding respondents’ willingness to attend group. Age-Related Differences There were no age-related differences regarding respondents’ willingness to attend group. Group Topics of Interest Topics potentially covered in group format that were of most interest to respondents appeared to be stress management (39%), healthy relationships (33%), depression (31%), self-esteem (28%) and anxiety (27%):

GROUP TOPICS OF INTEREST

District Differences Consistent with the overall sample, respondents from all districts identified stress management and healthy relationships as the top two topics of interest. However, the North East district was more likely than the South East district to be interested in stress management. Although gambling did not appear to be a topic of great interest, respondents in the South West district were more likely than those in the North West district to be interested in this topic.

0 5 10 15 20 25 30 35 40

Healthy relationshipsParenting

Self-esteemAnger management

AssertivenessStress management

Drug/alcohol useGambling

DepressionAnxiety

SchizophreniaPain managementIllness adjustment

GriefCaring for elderly parent

Coping with family's mental illness

3312

2813

1839

93

3127

617

1616

1618

% of sample

21

TOPICS OF INTEREST BY DISTRICT North East North West South East South West

Healthy relationships 45.4 34.5 40.1 43.6

Parenting 13.6 16.7 14.7 13.8

Self-esteem 36.5 30.1 34.6 37.2

Anger management 22.1 12.1 12.5 11.5

Assertiveness 22.9 22.3 25.3 22.4

Stress management **55.5 40.4 **36.8 42.6

Drug/alcohol use 14.9 7.1 8.2 11.4

Gambling 1.7 **0.7 2.8 **7.2

Depression 40.1 29.4 28.6 38.0

Anxiety 37.5 26.6 31.0 32.0

Schizophrenia 9.6 4.9 4.6 7.9

Pain management 14.0 14.1 20.6 22.8

Chronic illness adjustment 13.8 18.9 20.2 18.4

Grief 19.0 22.9 14.9 19.4

Caring for an elderly parent 14.2 21.1 15.6 17.9 Coping with a family member’s mental illness 26.2 20.7 22.9 19.0

**Indicates values that are significantly different from one another Age-Related Differences Respondents aged 18 – 54 identified stress management and healthy relationships as the topics of greatest interest, whereas respondents aged 55 – 64 identified healthy relationships and self-esteem (closely followed by stress management). Respondents 65 years and older identified stress management and depression as the topics of greatest interest. Aside from the topic of chronic illness adjustment which was more likely to be of interest, those aged 65+ were consistently less likely to be interested in topics such as healthy relationships, parenting, self-esteem, anger management, assertiveness, stress management, anxiety, or caring for an elderly parent.

22

TOPICS OF INTEREST BY AGE 18 – 44 45 - 54 55 - 64 65+

Healthy relationships1 **.560 .387 **.436 **.266

Parenting2 **.405 .125 **.054 **.029

Self-esteem3 **.418 .333 **.402 **.235

Anger management4 **.260 .169 **.109 **.061

Assertiveness .264 .229 **.295 **.143

Stress management5 **.624 **.474 **.399 **.281

Drug/alcohol use .115 .119 .095 .088

Gambling .005 .049 .047 .018

Depression .362 .353 .357 .290

Anxiety6 **.376 **.384 .325 **.196

Schizophrenia .059 .075 .040 .096

Pain management7 **.077 **.228 **.266 **.131

Chronic illness adjustment8 **.059 .188 **.248 **.204

Grief .186 .198 .249 .130

Caring for an elderly parent .204 **.221 .182 **.087 Coping with a family member’s mental illness .262 .194 .239 .199

**Indicates values that are significantly different from one another 1 18-44 and 55-64 > 65+ 2 18-44 and 55-64 > 65+ 3 18-44 and 55-64 > 65+ 4 18-44 > 55-64 and 65+ 5 18-44 > 55-64 and 65+; 45-54 > 65+ 6 18-44 and 45-54 > 65+ 7 18-44 < 45-54 and 55-64; 55-64 > 65+ 8

18-44 < 55-64 and 65+

Preference for Group Length Respondents indicated that, if they were to attend group, they would prefer a 6-8 week long group (35%), followed by 3-5 weeks (31%), 1-2 weeks (11%), and 9-12 weeks (11%). Factors Affecting Likelihood of Attending Group It appears that confidentiality concerns are prevalent, with 61% anticipating that their worries over privacy or confidentiality would make it difficult for them to join a mental health group. Indeed, the majority of respondents (63%) indicated they would be more likely to attend a mental health group if they knew how confidentiality applies in the group. Other factors that increased the likelihood of respondents attending group included having a health care provider or friend recommend the group (59%, 51% respectively), being able to meet the group leader beforehand (60%), and being able to attend an information session about the group beforehand (57%).

23

FACTORS INFLUENCING LIKELIHOOD OF ATTENDING A MENTAL HEALTH GROUP

District Differences Regardless of the district, respondents identified meeting the group leader beforehand, knowing how confidentiality applies in group, ability to attend a pre-group information session, and having group recommended by a service provider as the top four factors increasing their likelihood of attending group. However, the South East and North East districts were more likely than the North West district to consider meeting the group leader beforehand as an important factor. The South East and South West districts were more likely than the North West district to consider attending a pre-group information session as important. With respect to location preferences, residents in the South East and South West districts rated their likelihood of attending group if it were offered in a community health centre or hospital, on average, as higher than those in the North West district. On average, residents in the North East district rated their likelihood of attending group at a mental health centre as lower than those in the South East district.

4418

4115

2031

3560

5759

5147

6340

3823

36

0 10 20 30 40 50 60 70

Offered in communityOffered outside communityAt community health centre

Offered in a schoolOffered in mental health centre

Offered in daytimeOffered in evening

Meet leader beforehandInformation session beforehand

Provider recommends itFriend recommends it

Knowing how past members rated itKnowing about confidentiality

Teaches skillsTeaches skills plus personal sharing

Personal sharing onlyCan bring loved one

% of sample

Neither

Less likely to attend

More likely to attend

24

FACTORS AFFECTING LIKELIHOOD OF ATTENDING GROUP BY DISTRICT North East North West South East South West Offered in Community Health Centre/Hospital1 1.321 **1.230 **1.492 **1.471

Offered in a School .766 .787 .912 .886

Offered in Mental Health Centre **.774 .912 **1.081 .945 Can Meet Group Leader Beforehand2 **1.683 **1.451 **1.738 1.670

Pre-Grp Info Session3 1.561 **1.483 **1.732 **1.691 Recommended by Service Provider 1.573 1.593 1.591 1.676

Know Past Members’ Evaluation 1.427 1.455 1.393 1.530 Know How Confidentiality Applies 1.590 1.667 1.729 1.795

Run Like a Classroom 1.223 1.205 1.258 1.229 Balanced Between Sharing and Learning Skills 1.271 1.140 **1.408 **1.097

Focused on Discussing Problems .936 .879 .766 .787

Able to Bring Family/Friend 1.130 1.318 1.318 1.295 Less likely = 0; Neither = 1; More likely = 2 **Indicates values are significantly different from one another

1 NW < than SE and SW 2 NE > NW; NW < SE and NE 3

NW < SE and SW

Age-Related Differences As shown on the following page, respondents, regardless of age, identified meeting the group leader beforehand, knowing how confidentiality applies in group, ability to attend a pre-group information session, and having group recommended by a service provider as the top four factors increasing their likelihood of attending group. Respondents aged 65+ were also more likely than those between ages 45-54 to consider service provider recommendation as an important factor. Respondents over age 55 were more likely to prefer a community health centre or hospital over the youngest age group. Furthermore, the youngest age group seemed to prefer bringing a friend or family member to group over those between ages 45-54. The structure of group did not appear to be of consistent concern across age groups.

25

FACTORS AFFECTING LIKELIHOOD OF ATTENDING GROUP BY AGE 18 - 44 45 - 54 55 - 64 65+ Offered in Community Health Centre/Hospital1 **1.179 1.349 **1.484 **1.466

Offered in a School .794 .882 .802 .862

Offered in Mental Health Centre .770 .873 1.048 .994 Can Meet Group Leader Beforehand 1.595 1.559 1.668 1.705

Pre-Grp Info Session 1.562 1.578 1.709 1.599 Recommended by Service Provider 1.602 **1.485 1.610 **1.724

Know Past Members’ Evaluation 1.519 1.371 1.381 1.532 Know How Confidentiality Applies 1.743 1.589 1.714 1.724

Run Like a Classroom 1.340 1.270 1.133 1.183 Balanced Between Sharing and Learning Skills 1.161 1.215 1.339 1.198

Focused on Discussing Problems .745 .829 .939 .854

Able to Bring Family/Friend **1.440 **1.139 1.183 1.304 Less likely = 0; Neither = 1; More likely = 2 **Indicates values are significantly different from one another

1

18-44 < 55-64 and 65+

Telehealth Services Speciality health services, including mental health services, are not always available close to where people live in rural and northern communities. Telehealth services offer one means of increasing rural residents’ access to mental health services without having to travel long distances. Telehealth is a two-way television link that lets two people who may be hundreds of miles away from each other talk to one another in real time. It’s like talking to a television except that you are looking at a real person and they can see and hear you as well. Given the potential this has to increase access to mental health services we were particularly interested in learning about respondents experiences with and opinions about telehealth services.

Past Experiences with Telehealth Services Of the total sample, 5% had used telehealth for a health care service other than mental health, and 2% had used telehealth mental health services. Of those who had used any type of telehealth services, 47% were “very satisfied,” 41% were “somewhat satisfied,” and 10% were “not at all satisfied” with the service.

26

District Differences The North West district was more likely than either the North East or South East districts to have used telehealth for a health care service other than mental health. There were no differences across districts for telehealth use for mental health services or satisfaction ratings.

PAST EXPERIENCES WITH TELEHEALTH (PERCENTAGE BY DISTRICT)

North East North West South East South West

Yes, for general health1 **4.6 **18.2 **2.9 2.0

Yes, for mental health 2.8 5.9 1.1 1.1

No2 **91.4 **74.8 **95.3 94.4 **Indicates values are significantly different from one another 1 NW > NE and SE 2

NW < NE and SE

SATISFACTION WITH TELEHEALTH BY DISTRICT North East North West South East South West

Average .849 1.606 1.650 1.290 Not at all satisfied = 0; Somewhat satisfied = 1; Very satisfied = 2 Age-Related Differences Respondents under age 45 were more likely than those 55 and over to have used telehealth for a health care service other than mental health. There were no differences for telehealth use for mental health services. There were also no differences for respondents’ ratings of their telehealth experiences.

PAST EXPERIENCES WITH TELEHEALTH (PERCENTAGE BY AGE) 18 - 44 45 - 54 55 - 64 65+

Yes, for general health1 **.138 .077 **.029 **.047

Yes, for mental health .034 .034 .041 .003

No .833 .865 .922 .923 **Indicates values are significantly different from one another 1

18-44 > 55-64 and 65+

SATISFACTION WITH TELEHEALTH BY AGE 18 - 44 45 - 54 55 - 64 65+

Average 1.193 1.235 1.651 1.685 Not at all satisfied = 0; Somewhat satisfied = 1; Very satisfied = 2

27

Likelihood of Using Telehealth Services If face-to-face services were not available to them, respondents indicated their likelihood of using telehealth to access a limited number of appointments with various specialists (psychiatrist, psychologist, medical specialist) as well as weekly individual therapy and weekly mental health group meetings to be as follows:

LIKELIHOOD OF USING TELEHEALTH IF SERVICES WERE NOT AVAILABLE

OTHERWISE

Between 30% and 37% of respondents indicated they would be “not at all likely” to use telehealth services to access various mental health services, whereas only 25% of respondents indicated this to be the case for appointments with medical specialists. The fact that 41% – 53% (depending upon the type of service) of respondents indicated they were “somewhat likely” to “very likely” to use telehealth mental health services suggests a number of Interlake residents may be open to this option. District Differences As shown on the following page, there were no district differences related to their likelihood of using telehealth for a limited number of appointments with a psychiatrist or psychologist, and weekly counselling or weekly mental health group meetings were examined.

32 31 30 3725

6 7 912

6

34 34 3027

33

8 9 97

12

11 10 12 7 15

0

10

20

30

40

50

60

70

80

90

100

Limited appts with psychiatrist

Limited appts with

psychologist

Weekly individual therapy

Weekly mental health group

meetings

Limited appts with medical

specialist

5 - Very Likely

4

3 - Somewhat Likely

2

1 - Not at all likely

28

LIKELIHOOD OF USING TELEHEALTH BY DISTRICT

North East North West South East South West Limited Number Appointments with Psychiatrist 1.475 1.502 1.691 1.368

Limited Number Appointments with a Psychologist 1.507 1.698 1.647 1.418

For Weekly Counselling 1.555 1.714 1.602 1.470

Weekly Mental Health Grp Mtgs 1.135 1.335 1.102 1.156 On a scale from 0 = Not at all likely to 4 = Very likely Age Differences There were no age differences related to respondents’ likelihood of using telehealth for a limited number of appointments with a psychiatrist or psychologist, and weekly counselling or weekly mental health group meetings.

LIKELIHOOD OF USING TELEHEALTH BY AGE

18 - 44 45 - 54 55 - 64 65+ Limited Number Appointments with Psychiatrist 1.523 1.614 1.506 1.406

Limited Number Appointments with Psychologist 1.744 1.556 1.620 1.378

Weekly Counselling 1.567 1.519 1.723 1.538

Weekly Mental Health Grp Mtgs 1.258 1.095 1.383 1.002 On a scale from 0 = Not at all likely to 4 = Very likely

Computer and Internet Access Computer/internet-based mental health treatment programs are becoming increasingly available and have been shown to be effective forms of therapy for many individuals. These programs offer additional means of increasing rural residents’ access to mental health services. As such, we were interested in exploring Interlake residents’ computer and internet access. Of the total sample, 79.9% indicated they had a home computer and 66% reported access to the internet at home. Of those with internet access, 50.6% reported having high speed internet, 31.7% reported having dial up, and the remainder did not respond. District Differences As shown on the following page, no district differences were found with respect to computer ownership or internet access. Respondents in the South East district were, however, more likely than those in the North West district to have access to high speed internet.

29

The Interlake RHA would like to

acknowledge the participants who took the time to respond to

this survey. Thank you.

ACCESS TO HOME COMPUTER & INTERNET (PERCENTAGE BY DISTRICT) North East North West South East South West

Home Computer 84.5 84.4 80.4 78.6

Internet (any type) 81.7 74.0 75.9 74.8

High Speed Internet 61.0 **57.3 **78.8 73.1 **Indicates values are significantly different from one another Age Differences Although the majority of all age groups reported having a home computer and internet access, fewer respondents aged 65 and over reported this to be true. There were no significant age differences related to access to high speed internet.

ACCESS TO HOME COMPUTER & INTERNET (PERCENTAGE BY AGE)

18 - 44 45 - 54 55 - 64 65+ Computer1 **97.1 **85.6 **83.8 **63.4 Internet (any type)2 **94.8 **79.9 **78.0 **56.0 High Speed Internet 78.7 64.4 63.7 62.4

**Indicates values are significantly different from one another 1 65+ < than all other age groups 2

65+ < than all other age groups; 55-65 < 18-44

Summary The purpose of the current survey was to gather information that could be used to guide the development of mental health resources in the Interlake Region. Findings from this survey must, however, be viewed cautiously due to the low response rate. As such, opinions of many Interlake residents are not reflected in the current information. With these considerations in mind, the current findings offer the largest source of information to date regarding preference for mental health services, barriers and facilitators to accessing mental health services, and openness to accessing services that may be unfamiliar to many people (e.g., computer based treatment, telehealth). District and age related differences offer more detailed information that can be useful in guiding resource development targeting particular regional districts and age groups. In order to supplement the information from this survey, an additional survey was sent out to various health care providers in the Interlake region (e.g., physicians, community mental health workers, paraprofessionals, nurses) asking for opinions about various mental health resources. Specifically, it asked health care providers the likelihood of recommending particular resources, barriers to making recommendations, factors that would influence a recommendation, and the opinions regarding perceived effectiveness of various mental health resources (see Interlake RHA Mental Health Services Needs: Provider Survey Report dated September 2010 for these results). Taken together, the information from these surveys can offer valuable direction into the development of regional mental health services.