Limited Access to Services

Everyone who shared their experiences reported challenges when interacting with healthcare services. The most common challenge faced was accessing care. This challenge showed up in seven different ways.

Denial of care/ Lack of requested services

  • Those of us who are Indigenous and have non-insured health benefits often encounter providers who are unfamiliar with this coverage. This can make it difficult to find practitioners we can access.
    • “A lot of different healthcare places have outright refused to accept me as a patient because I have status coverage. When I was looking for a dentist, I had to go to 12 different places.”
  • Challenges also come from being denied care or discharged before we receive the care that we are seeking.
    • “I went to the hospital because I got drugged and I was coherent enough to take myself there. They just tested me for STIs and then they gave me a blanket, a sandwich, and told me to leave while I was still having trouble walking and my vision was still blurry.”
    • It’s hard to find healthcare for those of us who are in active addiction or in recovery. Hospitals and clinics usually decline my friends. Because of this, a lot of my friends have passed away because they were declined care, just because they were judged for being in active addiction or because they were homeless.”
    • I was turned away from the ER multiple times due to my borderline personality disorder diagnosis, and at other times I was discharged while still suicidal.”

Limited practitioners and services

  • We often have limited choices if we are seeking care in rural settings and/or specialized healthcare.
    • “The closest hospital that can care for my type of needs, is 4 cities away. None of the emergency hospitals can care for me because they’re not specialized. They have to send me back to my clinic. If I have an emergency, no one in my city can see me.
    • “Especially when it gets more specialized in healthcare, we don’t have those options of who to see. A lot of it would be figuring out how to get through it and then have that community support before and after.”
  • For mental healthcare, limited emergency services and age limitations further restrict our options.
    • “I really dislike when people pose the psych ward as the only safe place you can go when you’re suicidal. It actually isn’t that safe in terms of the trauma that I incurred from the nurses and doctors. But there aren’t many other options out there.”
    • “Seventeen- and eighteen-year old’s in Vancouver are completely left behind in our current mental health inpatient system. The emergency psychiatric inpatient services are only for people aged 16 and under. Adult psychiatric facilities are technically supposed to be 19+. Because of this gap, I was put in an adult facility when I was still a minor.”

Limited practitioner hours

  • Our options for services are further limited if we have scheduling conflicts. We may not want to go to emergency services to avoid overburdening hospitals or long wait times. However, few alternatives exist.
    • “Most healthcare people only work their 9-5s. What this means is that people who have very full schedules, school, work, sex workers who work primarily at night and have to sleep during the day, night shift people in general- we can’t access healthcare unless we go to the hospital.”
    • “I don’t drive and I’m a working mom, so a lot of the time, it’s hard to go get my child from daycare and go to the clinic because their hours are all the same as my work hours. If we really need it, we go to emergency.”
    • “It sucks because who wants to go to emergency? You’re there for hours. It’s at a point where we don’t really go unless we have to. Which isn’t a good way to be either. We shouldn’t have to wait for it to get extreme just to access care.”

Difficulty finding safer practitioners

  • For many of us, it can be hard to find safer and affirming practitioners who understand our intersectional identities.
    • “It’s especially hard if there isn’t a database of practitioners who are safe for queer people and when practitioners aren’t clear about their values. Sometimes practitioners will write that they’re queer-friendly. But what do they actually mean by that?”
    • “Finding validating and genuine practitioners, who you can talk to about systemic things is hard. People don’t know who to go to.”
  • Family doctors are often a primary point of care. However, finding a supportive and available family doctor can be particularly challenging.
    • “Family doctors are especially hard to find because you need them for so many things and they have so much institutional power.”
    • “Finding a family doctor is really hard, especially one that isn’t harmful.”
  • Uncertainty about safety can prevent us from sharing openly with our practitioners.
    • “People hold back from their practitioners because they don’t know if the practitioners are willing to talk about systemic things.”

Financial limitations

  • Those of us who can locate practitioners may not be able to afford treatment. Financial barriers can come from public health (e.g., prescriptions) and paramedical services. (e.g., physiotherapy, acupuncture).
    • “Not having access to funds to pay for prescribed medications is an issue. I have clients who were put on samples of pretty intense psychiatric medication. And then that’s it. That’s all that the doctor gave them. It can be really scary and harmful.”
  • When we are unsure if services and practitioners meet our needs, consultation fees create additional challenges.
    • “A Google search doesn’t help that much. It actually takes a consultation. But most people don’t do free consultations, so that costs money on top of not knowing what that service does. That leads to confusion and an unwillingness to go.”

Lack of accessible information

  • When information is not easily accessible, it takes additional time and resources to navigate healthcare systems and services. Searching for information is challenging, especially when we are in crisis and need imminent care.
    • “Healthcare provider websites are so inaccessible, complicated, and difficult to look at. A lot of it is not accessible for those of us who are autistic or dyslexic. We can’t even look at the things we need to see, so we need to call. But some of us have phone anxiety so we can’t call. Or we can’t email them because they don’t list their emails. And if we live far away, then we can’t ask our questions in person.”
    • “There are so many steps someone has to go through to find programs, to figure out if they’re eligible and able to afford it and how to initiate care. It’s even harder to find out what participants’ experiences have been, the program offerings, expectations for participant commitment, and what people can do if their boundaries or rights have been crossed while receiving services. Finding this information can take many hours and several data sources. People in crisis often do not have the capacity to do this research.”
    • “It’s challenging when we don’t know about resources or how to navigate the healthcare system, like if we’re just handed a pamphlet. It’s so overwhelming, especially if you’re in a crisis.”
  • The challenges of inaccessible information connect to discussions around funding and support for providers.
    • “It’s tough because part of me has these expectations for a GP or a nurse, while also understanding that there’s not enough staff and funding. It’s not actually that simple and there are a lot of reasons why people are rushing through things and handing people pamphlets. It would take time and they probably don’t have the staff and resources to do that.”