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Emergency department as a first contact for mental health problems in children and youth

Gill PJ, Saunders N, Gandhi S, Gonzalez A, Kurdyak P, Vigod S, Guttmann A. J Am Acad Child Adolesc Psychiatry. 2017; 56(6):475-82.e4. Epub 2017 Apr 3.


Objective — To characterize youth who use the emergency department (ED) as a “first contact” for mental health (MH) problems.

Method — Population-based cross-sectional cohort study using linked health and demographic administrative datasets of youth ages 10-24 years with an incident MH ED visit from April 1, 2010 to March 31, 2014 in Ontario, Canada. We modeled the association of demographic, clinical, and health service use characteristics with having no prior outpatient MH care in the preceding 2-year period (“first contact”) using modified Poisson models.

Results — Among 118,851 youth with an incident mental health ED visit, 14.0% were admitted. Over half (53.5%) had no prior outpatient MH care, and this was associated with younger age (14-17 vs 22-24 years old: risk ratio [RR] 1.09, 95% CI 1.07-1.10), rural residence (RR 1.16, 95% CI 1.14-1.18), lowest vs highest income quintile (RR 1.04, 95% CI 1.03-1.06), and refugee immigrants (RR 1.17, 95% CI 1.13-1.21) and other immigrants (RR 1.10, 95% CI 1.08-1.13) vs non-immigrants. The 5.1% of the cohort without a usual provider of primary care had the highest risk of first contact (RR 1.78, 95% CI 1.77-1.80). A history of low acuity ED use and those whose primary care physicians were in the lowest tertile for mental health visit volumes were associated with higher risk.

Conclusion — Over half of youth requiring ED care have not previously sought outpatient MH care. Associations with multiple markers of primary care access characteristics suggest timely primary care could prevent some of these visits.

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Keywords: Mental health Emergency department visits Primary care/clinical practice

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