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More than half of children and youth in ER for mental health needs have not had any previous mental health-related contact with the healthcare system


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 healthcare, 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 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 healthcare 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 healthcare before the ED had an average of 4.2 primary care visits compared to 10.4 visits over the same time period, seen in those who had been treated for mental healthcare 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.

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

“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.

Author block: Peter J Gill, Natasha Saunders, Sima Gandhi, Alejandro Gonzalez, Paul Kurdyak, Simone Vigod and Astrid Guttmann.

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 Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital and a world leading research centre in this field. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental illness and addiction. CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre. For more information, please visit camh.ca or follow @CAMHnews on Twitter.

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 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

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