SPPA PhD Public Policy alumna Mary Bartram and SPPA Prof. Jennifer Stewart publish article Income-based inequities in access to psychotherapy and other mental health services in Canada and Australia in Health Policy.


This paper compares income-based inequities in access to psychotherapy and other mental health services in Canada and Australia, two federal parliamentary systems with sharply contrasting responses to high rates of unmet need. Income-based inequity is measured by need-standardized concentration indices, using comparable data from the Canadian Community Health Survey 2011–2012 and the Australian National Survey of Mental Health and Well-Being 2007. The results indicate that utilization of psychologist services is more concentrated at higher income levels (i.e. pro-rich) than the other provider groups in both countries, and may be more pro-rich in Canada than in Australia. While the distribution of unmet need for psychotherapy was expected (as a negative indicator of access) to be more concentrated at lower income levels (i.e. pro-poor) under Canada’s two-tier system, unmet need was not more equitable in Australia despite expanded public insurance coverage. As psychotherapy was made universally affordable for the first time in Australia in 2006, a possible backlog effect may have driven up both service utilization and unmet need, particularly among lower-income Australians. The impact of different Medicare co-payment policies also warrants further exploration.


Mary Bartram recently started a Postdoctoral Researcher position with McGill University’s Faculty of Law (as part of the Research Group on Health and Law) and the Institute for Health and Social Policy. As part of a broader grant on Harm Reduction as Public Policy, Mary will be studying the potential for harm reduction to act as a bridge between recovery models in the mental health and addictions sector. For more information, please contact Mary at mary.bartram@mcgill.ca