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Access to Primary Care Study

People living with serious mental health and/or substance use issues face unique barriers accessing primary care (health care provided by a medical professional that is a patient’s first point of entry into the medical system) and often end up as unattached patients. Unattached patients are people who do not have regular access to a primary care provider (i.e., a doctor, nurse, or nurse-practitioner). We want to learn about what happens when people with serious mental health and/or substance use issues go to the doctor or try to go to the doctor and don’t get the care they need. We also want to learn about positive primary care experiences. We want to know what has helped people with mental health and/ or substance use issues access medical care.
In addition to some members of the Re:searching for LGBTQ Health team, partners on this project include The Empowerment Council, Parkdale Activity & Recreation Centre, Scadding Court Community Centre,Sherbourne Health Centre, Somerset West Community Health Centre, The Ontario College of Family Physicians, Susan Pigott and Barney Savage from CAMH and Dr. Simone Vigod from Women’s College Hospital. These partners contribute diverse and valuable insights which will help us to use our results to improve access to primary care for people with mental health and substance use issues.​


Like all of our current projects, this is a community-based research (CBR) project. As such, we are concerned with asking questions that are important to people who are the focus of the research, in this case consumer/survivors, and including consumer/survivors in the design and development of the project.
We used both interviews and a short questionnaire to learn about people’s primary care experiences. In the interview we asked people who have experienced mental health and/or substance use issues to talk about their experiences seeking medical care. The questionnaire asked questions regarding one’s identity or background such as their age, gender, and ethnic or cultural background. We also interviewed service providers about what they think prevents people with mental health and/or substance use issues from accessing primary care and what supports them to access primary care.
We want to use the information gained from this project to provide ideas for programs and policies that will improve access to medical care for people with mental health and/or substance use issues.


• Principal Investigator: Dr. Lori Ross
• Co-Investigators: Dr. Simone Vigod (Women’s College Hospital), Barney Savage (CAMH), Jennifer Chambers (Empowerment Council), Jan Kasperski (Ontario College of Family Physicians)
• Project Coordinator: Jason Oliver
• Research Assistants: Myera Waese and Dean Spence


The Access to Primary Healthcare research team has developed  a one-page Recommendations document from our data. 


Empowerment and Advocacy for Clients

  • Support independent, client-directed advocacy where it already exists within the healthcare system.
  • Expand independent client advocacy for people living with mental health and/or substance use issues to the primary care sector
  • Provide resources to client-run advocacy organizations to develop a campaign to empower people living with serious mental health and/or substance use issues to be active partners in their own primary health care.

Service Provider Education

  • In partnership with clients, provide educational opportunities for primary care providers on the lived realities and self-identified needs of clients living with mental health and/or substance use issues.
  • Share information about how primary care providers can find information about local referral resources and education relevant to mental health and substance use issues.

Collaborative, Interdisciplinary Models of Care

  • Increase accessibility of collaborative and interdisciplinary models of primary health care, such as family health teams and community health centres, for people living with mental health and/or substance use issues.
  • Provide more access to free mental health and addictions therapy, counseling and supportive services.
  • Expand opportunities for physicians to network with and be mentored by mental health and/or substance use specialists.
  • Investigate the impacts of primary health care funding models on access and outcomes for clients with mental health and/or substance use issues.
  • Increase availability of case managers, system navigators, advocates, peer support workers, outreach workers or other intermediaries between clients living with mntal health and/or substance use issues and the healthcare system.
  • Explore strategies to improve communication between multiple health care providers working with an individual living with mental health and/or substance use issues. 

 KTE Projects

The Access to Primary Care team has produced a number of Knowledge Transfer and Exchange projects (updated October 2016):
• A Tip Sheet for clients to reiterate their rights when seeking primary care and to offer practical tips.
•​ Recommendations.
Videos of an educational intervention addressing values and attitudes of primary health care providers.
• A Community Report that summarizes study findings in accessible language.
• A Policy Report to use for dialogue with health care funders and other policy- makers.
A peer-reviewed publication in BMC Family Practice.
• A CAMH presentation in September 2013.

 Related Links


​​For other info and resources to address poverty-related barriers to primary care access, visit these websites:

Ontario College of Family Physicians Poverty Committee. Includes practical resources for physicians wishing to help their clients who are living in poverty, and also includes information about income supports for people living in poverty in Ontario.

Health Providers Against Poverty. Has additional info for health care providers.

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