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Emergency department as first contact for mental health services more common for immigrant and refugee youth compared to those born in Canada


More immigrant and refugee children and youth who arrive at an Ontario emergency department for mental health needs have not received previous outpatient mental healthcare compared to their Canadian-born counterparts, according to a new study from the Institute for Clinical Evaluative Sciences (ICES) and The Hospital for Sick Children (SickKids).

Emergency department visits as a first point of contact for mental health conditions reflect poor access to timely mental healthcare that may be delivered in outpatient settings (by family doctors, pediatricians or psychiatrists). 

“Emergency services are important for managing acute mental health crises, but for most mental health disorders, primary care would be the most appropriate place for treatment and referral to specialized services. The high proportion of immigrant and refugee youth who have not been previously assessed for mental health problems suggests a need to understand specific cultural and other barriers and enabling factors related to the use of mental health services and access to care,” says lead author Dr. Natasha Saunders, staff physician in Paediatric Medicine and associate scientist at SickKids and adjunct scientist at ICES. 

In the study published today in CMAJ, researchers examined data representing emergency department visits for mental health issues by youth between the ages of 10 and 24 years in Ontario. There were 118 851 youth who visited an emergency department with a mental health concern during the five-year study period (2010-2014) of whom 1.8 per cent (2194) were refugees and 5.6 per cent (6680) were non-refugee immigrants. For a majority of all youth, their emergency department visit was their first physician contact for mental health physician services. Instead of presenting first to primary care, 61.3 per cent of refugee youth and 57.6 per cent of non-refugee immigrants versus 51.3 per cent of non-immigrant youth presented to the emergency department with a mental health concern.

“Most major mental illnesses have an age of onset in adolescence and young adulthood with about 20 per cent of youth experiencing mental illness. Our findings suggest that there are important subgroups of immigrant and refugee children who face barriers in accessing outpatient mental healthcare, who then rely on emergency departments to provide care and referral to services. Interventions to improve access to the mental health system should consider the needs of specific immigrant populations,” says Dr. Astrid Guttmann, senior author on the study, chief science officer at ICES and staff paediatrician and senior associate scientist at SickKids.

Compared with long-term immigrants, recent immigrants had a 10 per cent higher incidence of first contact for mental health in the emergency department. There was wide variability in first-contact emergency department visits by region and country of origin. Specifically, immigrants (both refugee and non-refugee immigrants combined) from Africa, Central America and South and East Asia were most likely to have their first contact for mental healthcare in the emergency department.

This research is an example of how SickKids and ICES are contributing to making Ontario Healthier, Wealthier and Smarter. 

“Use of the emergency department as a first point of contact for mental healthcare by immigrant youth in Canada: a population-based study,” was published today in CMAJ

Author block: Saunders N, Gill P, Holder L, Vigod S, Kurdyak P, Gandhi S, Guttmann A.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized child and family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is a founding member of Kids Health Alliance, a network of partners working to create a high quality, consistent and coordinated approach to pediatric healthcare that is centered around children, youth and their families. SickKids is proud of its vision for Healthier Children. A Better World. For more information, please visit www.sickkids.ca. Follow us on Twitter (@SickKidsNews) and Instagram (@SickKidsToronto).


Deborah Creatura
Media Advisor, ICES
[email protected]
(o) 416-480-4780 or (c) 647-406-5996

Jessamine Luck 
The Hospital for Sick Children (SickKids)
[email protected]
416-813-7654 ext 201436

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