The impact of language-related immigration policies on immigrant mental health care utilization

Economic immigrants are selected into Canada using a point system, which accounts for immigrants' language proficiency, education, and experience. We examined the impact of three policy changes associated with increasingly strict language requirements on mental health care utilization of immigrants in Canada. Using administrative health care data from Ontario, Canada, covering 1997 to 2015, we employed a difference-in-differences approach to study the effects of language requirement-related policies on economic immigrants' (i.e., skilled workers) mental health care use, relative to several comparison groups not impacted by the policy, including immigrants from the Anglosphere (i.e., immigrants from countries that have English as an official language or national language) and non-points-based immigrants (i.e., immigrants in the family class). Following policy changes that coincided with periods of increased English proficiency as an entry requirement, we found that mental health care utilization (i.e., visits to general practitioners for mental health reasons and psychiatrists) decreased for economic immigrants from non-Anglosphere countries, compared to those from Anglosphere countries, but increased compared to non-points-based immigrants. Additionally, non-mental health care utilization increased for economic immigrants from non-Anglosphere countries, compared to those from Anglosphere countries and non-points-based immigrants, following the later policy changes. This study sheds light on the impact of immigration policies, namely language requirements, on health care utilization and provides a starting point to understanding potential barriers that immigrants may face in accessing mental health care in a host country.