More than 53 per cent of children and youth who present at an Ontario emergency room for mental health needs have not received any previous outpatient mental health care, according to a new study from the Institute for Clinical Evaluative Sciences (ICES), The Hospital for Sick Children (SickKids) and Centre for Addiction and Mental Health (CAMH).

The study, published in the journal American Academy of Child and Adolescent Psychiatry, looked at the records for nearly 120,000 Ontario youths aged 10 to 24 who made a first visit to an emergency department (ED) for mental health care from 2010 to 2014.

“Emergency services are important for managing acute mental health crises, but for most mental health disorders, primary care would be the most appropriate venue for treatment and referral to specialized services. The high proportion of youth who have not been previously assessed for mental health problems can pose particular challenges in terms of ensuring appropriate follow up,” says Dr. Astrid Guttmann, senior author on the study, chief science officer at ICES and staff paediatrician and senior associate scientist at SickKids.

The study is the first to evaluate children and youth who first present to the ED with any mental health–related condition. The study showed there was a diverse range of mental health diagnoses for the children and youth who presented at an ED for mental health needs, but 81 per cent of visits were due to anxiety, adjustment, mood/affective disorders and substance–related disorders. These first contact visits were more likely to happen after–hours (later than 4 p.m. on weekdays, and on weekends or holidays).

The study also found that children and youth with no previous mental health care before the ED had an average of 4.2 primary care visits compared to 10.4 visits over the same time period from 2010 to 2014, seen in those who had been treated for mental health care before presenting to the ED.

The researchers identified several risk factors that increased the likelihood of first contact mental health ED visits:

• Youth living in rural regions
• Youth not rostered to a primary care provider or with no primary care in the previous two years
• Youth from the most deprived neighbourhoods
• Refugees and non–refugee immigrant youth, compared to non–immigrant youth

The study also found that those youth whose primary care physicians saw more patients for mental health problems were less likely to have had a first contact emergency department visit.

“Our study suggests that we need to improve access to appropriate primary care for mental health needs and referral to specialized services to prevent these first contact emergency department visits,” says co–author said Dr. Paul Kurdyak, co–author, ICES scientist and Chief, Division of General and Health Systems Psychiatry, at CAMH.

“Emergency department as a first contact for mental health problems in children and youth,” was published in the Journal of the American Academy of Child and Adolescent Psychiatry.