Researching for LGBTQ Health

Access to primary care for people with serious mental health and/or substance use issues: A qualitative 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). In this study, we aimed 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.

In addition to some members of the Re:searching for LGBTQ2S+ Health team, partners on this project included 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 contributed diverse and valuable insights which helped us to identify the key factors that affect access to primary care for people with mental health and substance use issues.

Like many of our team's projects, this was 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 identified barriers and facilitators to primary care access operating at three levels: client-level factors (e.g., poverty), service-provider level factors (e.g., stigma and discrimination) and health system level factors (e.g., separation of services for physical and mental health). You can learn more about the study findings and read the study products at the project website.


  • 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

Funded by the Centre for Addiction & Mental Health Development and Dissemination Fund

Project Outcomes:

  • Final recommendations to increase primary care access for people living with mental health and substance use issues.
  • Tips for clients seeking primary healthcare to help them understand their rights.
  • An educational intervention addressing values and attitudes of primary health care providers. This intervention was delivered to nursing students at Toronto universities during the 2013-2014 academic year. View video.
  • A community report that summarizes study findings in accessible language.
  • A policy brief to use for dialogue with health care funders and other policy- makers.
  • An academic article summarizing our findings for primary health care providers