Regional variation in supply and use of psychiatric services in three Canadian provinces

Objective — To examine the patterns in the supply and use of psychiatric services in 3 Canadian provinces: British Columbia, Manitoba, and Ontario.

Methods — We conducted a repeated cross-sectional analysis spanning fiscal years 2012/13 to 2021/22, using patient- and psychiatrist-level data aggregated into administrative health regions. Descriptive statistics and linear regression were used to assess patterns and relationships between the per capita number of psychiatrists (“supply”) and measures of use of psychiatric services (“utilization”), including any psychiatrist contact, psychiatric consultation (1–2 visits with the same psychiatrist), and ongoing psychiatric care (3 or more visits with the same psychiatrist).

Results — The number of psychiatrists per capita remained stable within the 3 provinces during the study period. In 2021/22, Vancouver had the highest number in British Columbia (45 psychiatrists per 100,000 individuals), compared to 14 per 100,000 in lower-supply regions. Toronto had the highest number in Ontario (38 per 100,000), compared to 9 in lower supply regions. Winnipeg had the highest number in Manitoba (25 per 100,000), compared to 7 in the lower supply regions. In 2021/22, the per capita number of psychiatrists was moderately correlated with any psychiatrist contact (R2 = 0.290) and ongoing psychiatric care (R2 = 0.411), but weakly correlated with psychiatric consultation (R2 = 0.005). The relationship between supply and utilization diminishes with higher levels of regional supply.

Conclusions — Psychiatrists were unevenly distributed within and across provinces. While more psychiatrists are needed, the moderate and diminishing relationships between their numbers and utilization suggest that increasing this number alone is unlikely to fully address unmet needs for mental healthcare. Strategies to improve access will need to directly target uneven distributions. Further research is needed to understand the factors influencing psychiatrists’ practice choices and ways to better support them in increasing their access to care.