Mental Health and Access to Care Survey (MHACS)

Detailed information for 2022

The Mental Health and Access to Care Survey (MHACS) collects information about the mental health status of Canadians, as well as their access to and need for services and supports, whether formal or informal. This survey also intends to assess the impact of the COVID-19 pandemic on population health as well as evaluate changes in patterns of mental health, service use and functioning in the last ten years.

Data release - September 22, 2023

• Questionnaire(s) and reporting guide(s)
• Description
• Data sources and methodology
• Data accuracy

Description

The objectives of the Mental Health and Access to Care Survey (MHACS) are:

(1) To assess the mental health status of Canadians on both illness and positive mental health continuums through selected mental and substance disorders, mental health problems, and well-being;
(2) To assess the impact of the COVID-19 pandemic on population health by evaluating changes in patterns of mental health, service use and functioning since the 2012 Canadian Community Health Survey;
(3) To assess timely, adequate, and appropriate access to and utilization of formal and informal mental health services and supports as well as perceived needs;
(4) To assess functioning, ability and disability in relation to mental health and illness; and
(5) To examine links between mental health and social, demographic, geographic, and economic variables or characteristics (covariates) including health behaviours, health conditions, and childhood experiences.

The data collected from the survey could be used by Statistics Canada, Health Canada, the Public Health Agency of Canada, federal and provincial departments, the Mental Health Commission of Canada, the Institut de la statistique du Québec, as well as universities, pharmaceutical companies, and mental health services and support providers to fill data gaps in understanding mental health. Policy makers and researchers will use this information to develop policies and programs that properly meet the mental health needs of Canada's population. The media's use of this information will help raise general awareness about mental health, an issue of concern to all.

Reference period: Varies according to the question (for example: "over the last 12 months", "over the last 6 months", "during the last week", etc.)

Subjects

• Health
• Health care services
• Lifestyle and social conditions
• Mental health and well-being
• Prevention and detection of disease

Data sources and methodology

Target population

The Mental Health and Access to Care Survey (MHACS) covers the population 15 years of age and over as of March 1, 2022 living in the ten provinces. Excluded from the survey's coverage are: persons living on reserves and other Aboriginal settlements, full-time members of the Canadian Forces, and persons living in collective dwellings, such as institutional residences.

Instrument design

This survey is a repeat of the 2012 Canadian Community Health Survey on Mental Health (CCHS-Mental Health). In contrast to the 2002 and 2012 iterations of the CCHS-Mental Health, which were administered in-person, the 2022 MHACS is administered by computer-assisted telephone interviews (CATI) due to the COVID-19 pandemic. The survey has been shortened to reduce response burden. Additionally, content has been updated to reflect the novel objective of evaluating change in mental health status and service use before and during the COVID-19 pandemic.

The CCHS-Mental Health questionnaire was developed by Statistics Canada in collaboration with stakeholders from Health Canada and the Public Health Agency of Canada, the Provincial Health Ministries, an expert advisory group consisting of specialists from Health Canada, the Public Health Agency of Canada, the Mental Health Commission of Canada, and academic experts.
Content was chosen using the following criteria:
- Data gaps identified by stakeholder consultations
- Significant number of people affected by the targeted issue
- Significant impact on family, community, and health care costs
- Issues identified as priority for the support/development of programs and policy, surveillance requirements and/or research
- Comparability with previous cycle of CCHS-Mental Health

Because the majority of content was previously administered in 2012, qualitative testing of new content was not undertaken. However, for the 2012 iteration of the CCHS-Mental Health in collaboration with Statistics Canada's Questionnaire Design Resource Centre, the questionnaire was subjected to two phases of qualitative testing, which took place in March and July of 2010 and consisted of one-on-one interviews. The objective was to evaluate respondent reactions to and understanding of the survey, as well as their willingness to respond to the questions. The qualitative testing was also used to obtain time estimates for the various sections of the questionnaire.

A pilot survey was conducted in April 2011. The pilot survey for the CCHS-Mental Health tested survey content, methodology, computer applications, interviewer procedures, reference material and data processing techniques in preparation for the main survey collection.

Sampling

This is a sample survey with a cross-sectional design.

Sample Size and Allocation

Based on the methodological assumptions of the survey (such as the targeted response rate), it was determined that a sample size of 40,000 was sufficient to produce reliable estimates at the national level. The target population was stratified by age group (15-24, 25-44, 45-64, and 65+), by gender (Female, Male) and by population group (South Asian, Black, Chinese, Filipino, and Other) to ensure a representative sample.

Sample Design

The stratification of the population facilitated the oversampling of people identifying with population groups designated as visible minority (South Asian, Black, Chinese, Filipino) and ensured having enough respondents within specified age and gender groups. The purpose of this stratification was to collect data from a sufficient number of individuals to allow for relevant analyses at the level of these population subgroups. To help achieve precision targets for these subpopulations, the set of respondents to the 2021 Census long questionnaire was used as a sampling frame. This allowed the identification and selection of targeted individuals from these groups, which is much more efficient than selecting dwellings in the general population.

Data sources

Data collection for this reference period: 2022-03-17 to 2022-07-31

Responding to this survey is voluntary.

Data are collected using computer-assisted telephone interviewing (CATI).

View the Questionnaire(s) and reporting guide(s) .

Error detection

Electronic files containing the daily transmissions of completed respondent survey records were combined to create the "raw" survey file. A verification stage was performed to identify and eliminate potential duplicate, records that contained no data, as well as those that were determined to be out-of-scope.

After the verification stage, editing was performed to identify errors and modify affected data at the individual variable level. The first editing step was to identify inconsistencies and determine which items from the survey output needed to be kept on the survey master file. Subsequent to this, invalid characters were deleted and the remaining data items were formatted appropriately.

Imputation

This methodology type does not apply to this statistical program.

Estimation

In order for estimates produced from survey data to be representative of the covered population and not just the sample itself, users must incorporate the survey weights in their calculations. A survey weight is given to each respondent included in the final sample. This weight corresponds to the number of persons in the entire observed population that are represented by the respondent.

MHACS uses a frame based on Census 2021 long form respondents for its sample selection. From this frame, initial weights are calculated for each sampled person. These weights undergo several adjustments, including for non-response and outliers, to create the final weights. More details on the weighting steps can be found in the User Guide.

The sample design used for this survey was not self-weighting. That is to say, the sampling weights are not identical for all individuals in the sample. When producing simple estimates, including the production of ordinary statistical tables, users must apply the proper sampling weight.

Proportions and ratios are obtained in three steps. The numerator is computed by summing the final weights of responding records having one characteristic of interest. The denominator is computed by summing the final weights of responding records having a second characteristic of interest (valid skips and missing values should be excluded). The proportion or ratio is then computed by dividing the numerator by the denominator.

Due to the complex nature of the MHACS design, variance estimates are produced using bootstrap weights. A generalized version of the bootstrap resampling method has been implemented for the MHACS to properly incorporate variability coming from its own design as well as from that of the 2021 Census of Population. The use of generalized bootstrap methodology requires the use of a multiplicative factor to produce valid estimates of sampling error, such as variance, standard error or CV. Details on the bootstrap methodology and how to produce valid measures of variability can be found in the User Guide.

Quality evaluation

Throughout the collection process, control and monitoring procedures were put in place and corrective action was taken to minimize measurement errors. These procedures included response rate evaluation, reported and non-reported data evaluation, observation of interviews, improved collection tools for interviewers and others.

After the MHACS data were compiled, a variety of summary indicators calculated from the data were reviewed in terms of the accuracy, coherence and overall reasonableness.

Disclosure control

Statistics Canada is prohibited by law from releasing any information it collects which could identify any person, business, or organization, unless consent has been given by the respondent or as permitted by the Statistics Act. Various confidentiality rules are applied to all data that are released or published to prevent the publication or disclosure of any information deemed confidential. If necessary, data are suppressed to prevent direct or residual disclosure of identifiable data.

Revisions and seasonal adjustment

This methodology type does not apply to this survey.

Data accuracy

Survey errors come from a variety of different sources. One dimension of survey error is sampling error, which is defined as the error that arises because an estimate is based on a sample rather than the entire population.

Sampling error can be expressed through a confidence interval or coefficient of variation (CV), both of which can be produced using bootstrap weights. The CV magnitude will depend on the domain of interest and the prevalence of the characteristic. The MHACS User Guide describes approaches for estimating these measures of variability, including the incorporation of a specific adjustment due to the use of the generalized bootstrap method.

Non-sampling errors arise primarily from non-response, coverage, measurement and processing. In total, 39,485 of the selected units in MHACS were estimated to be in-scope for the survey, out of which a response was obtained for 9,861 individuals, resulting in a response rate of 25%. Non-response adjustments to the weights helped reduce the risk of estimate bias. It is expected that the population was well-covered, due to the high response rate to the 2021 Census. As noted in the Quality Evaluation section, procedures were put in place during collection to reduce the amount of measurement error. Thorough review and validation processes after collection served to identify and correct processing errors.