Acute and outpatient service utilisation prior to, during, and following enrolment in community-based mental health treatment among children and youth in Central Ontario: a proof of concept for cross-sectoral data linkage

Aim — Given the fragmentation of mental health and addictions (MHA) services for children and youth, comprehensive data on utilisation patterns are lacking. We sought to describe MHA-related service use across the community, acute and outpatient sectors.

Methods — We used linked health-administrative data sets to identify a cohort of individuals aged <18 who received MHA treatment in a large community organisation in Ontario, Canada between 1 April 2007 and 31 March 2012. We described their socio-demographic characteristics, examined their MHA-related concurrent service use in acute care and outpatient physician settings (primary care providers, paediatricians and psychiatrists), and compared service utilisation prior to, during and following enrolment using Poisson regressions.

Results — Among 7285 children and youth receiving community MHA treatment, there were 481 concurrent MHA-related emergency department visits, 173 hospitalisations and 12140 outpatient physician visits. The average age at enrolment was 10.5 years, and 64% of clients were enrolled for ≥3 months. MHA-related emergency department use significantly declined from 1 year prior, compared to 1 year following receipt of community MHA treatment (112 vs. 82 visits per 1000 person-years, P < 0.001), particularly in females, ages 10-14, those living in higher-income neighbourhoods and urban areas, and those with anxiety disorders. MHA hospitalisations also declined (45 vs. 32, P < 0.001), while outpatient physician visits increased (1750 vs. 1874, P < 0.001).

Conclusions — Our study suggests that community-based MHA treatment may be effective in diverting children and youth away from acute care and highlights the importance of data linkage as a means to better understand the complexity of cross-sectoral MHA service use.