Access to Mental Health Services: Precariously Employed Workers Experiencing Anxiety or Depression Encounter Barriers When Seeking Care

Background: This study synthesizes findings on precariously employed workers’ self-reported feelings of severe or extreme anxiety and depression, along with their experiences accessing mental health services. Methods: This mixed-methods research included surveys (N = 259) and interviews (N = 40) with precariously employed workers in Ontario, Canada, conducted from November 2020 to July 2021. Inclusion criteria included: (i) not being directly employed, being self-employed, or a gig worker; (ii) not working full-time; (iii) not holding a permanent or open-ended contract; (iv) performing informal work; or (v) being recently unemployed. Results: The adjusted, statistically significant odds of reporting severe or extreme anxiety or depression were higher among workers with greater precarity (2.28), self-employed workers with no employees (3.61), gig or platform workers (3.08), workers earning less than 60% of the median income (2.75), and those unsure whether their hours would vary in the next three months (2.59). The odds were lower (0.22) for workers with some or little income variation in the previous three months. Interview participants described chronic stress, worry, anxiety, depression, and overall negative wellbeing linked to their precarious employment. Despite an increased need for mental health services, participants reported similar difficulties accessing them. Interpretation: To improve access to mental health services, sustainable intersectoral solutions with demonstrated potential are required, including increasing social and health expenditures, revising labor market legislation, and reorganizing the delivery of employer-dependent health services. Recommendations are made for solutions at various levels, including those that could be adopted by medical practitioners.