Accessibility to facilities in Ontario that treat and diagnose Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and Obsessive Compulsive Disorder (OCD) in children and youth, measured by road-distance or travel time.
This measure was calculated using the service-specific methodology for CARI+, as described in the overall methodology publication (link). This measure was adapted to calculate accessibility to facilities in Ontario that treat and diagnose ADHD, ASD, and OCD in children and youth. It was achieved by measuring distance or travel time from population-weighted DA centroids to the closest facility location.
Lists of facilities were obtained from the ConnexOntario Health Services Information Database. Hospital based clinics were included in the list.
Interpretation
The continuous index can be used within statistical modelling as a measure of access, while the categorical scores can be mapped to show areas with higher or lower access. The latter can also be included in statistical modelling as a categorical or ordinal measure. The purpose of the analysis is to understand the measure of accessibility for mental health facilities depending on a population’s geographic location, as indicated by travel time and distance. This can be interpreted as a relative measure of spatial access between small geographic areas (DAs) to clinic locations.
There are two key aspects of child and youth mental health, early identification and treatment. Early identification is necessary to prevent mental health concerns from becoming more deeply embedded in their psychological development as they are susceptible due to the brain’s high plasticity during childhood. Treatment is also required to prevent symptoms, with an early diagnosis supporting more targeted and specialized therapies that improve long-term outcomes. As such, access to mental health facilities offering diagnosis and treatment services is vital for maintaining an environment that favours positive developmental trajectories and improved long-term well-being.
The analysis highlights communities with limited geographic access to mental health facilities. The nature of Ontario’s population distribution relative to its geographic size, results in a substantial clustering of mental health resources being located in southern Ontario. These patterns are compounded by inequities in rural transportation options, challenges with rural healthcare staffing, and often limited access to other social services in rural communities. These factors limit residents of smaller communities in their freedom to choose or switch between services to find the best fit, further impacting children and youth.
In recent years, new services have been added across the province, increasing Ontario’s mental health service capacity (Government of Ontario, 2024; 2nd source). However, the demand for diagnosis and treatment services has also increased over this time period (Government of Ontario, 2024; 2nd source).
The prevalence of ADHD, and ASD in children and youth, reported from 2019 and 2024 was determined using Statistic Canada from the Canadian Health Survey on Children and Youth. There is no disaggregated data on ADHD, ASD, and OCD rates for sub-provincial geographies such as Health Regions, resulting in few detailed Canadian prevalence estimates, with information on treatment availability also limited.
The CARI+ score and/or classification can be used as a covariate alongside other individual and area-based measures such as demographics (e.g., race, gender, age) and socioeconomic factors (e.g., income, education) in a study on rates of access to mental health services in rural Canada. Specifically, in rural contexts, the data can be used to assess the relationship between clinic accessibility and the degree of social or economic marginalization, using measures such as the Ontario Marginalization Index (Public Health Ontario, 2023).
Future goals include using the spatial framework to guide policy decision making based on mental health service coverage and accessibility restraints. It can additionally be used by researchers to identify geographic disparities in accessing mental health facilities, assessing inequities in access, determining patterns relating to the concentration of mental health services, and analyzing accessibility in relation to specific neuropsychiatric disorders (ADHD, ASD, and OCD).
Definitions and Caveats
Facility: facilities in Ontario available on ConnexOntario Health Services Information Database, that treat and diagnose Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and Obsessive Compulsive Disorder (OCD) in children and youth. Includes hospital based clinics.
Mental health: can be interpreted as a multidimensional construct that encapsulates behaviour regulation, cognition, emotional well-being, and social connectedness.
Access
2021 census population counts for DAs and CSDs were used, alongside the road networks available in 2024. List of facilities were obtained on September 25, 2025, the same year the data was analyzed. The frequency of updates is as needed.
Calculation Year: Access scores will vary for other years as service locations open or close over time and as the underlying population distribution changes. Differences will also occur across census periods and may vary in between them as well.
Selected References
- Government of Ontario. (2024, October 7). Ontario Expanding Access to Mental Health Services. Ontario Newsroom. https://news.ontario.ca/en/release/1005133/ontario-expanding-access-to-mental-health-services
- Public Health Ontario. (2023, September 28). Ontario Marginalization Index (ON-Marg). https://www.publichealthontario.ca/en/Data-and-Analysis/Health-Equity/Ontario-Marginalization-Index