Virtual care expansion and physician follow-up among youth with first mental health contact through a hospital: population-based repeated cross-sectional study

Background — Timely follow-up is crucial for youth whose first mental health contact is through a hospital; virtual care could facilitate this.

Objective — This study aimed to examine the association between the significant expansion of virtual care in Ontario, Canada, and follow-up mental health care rates for these youths.

Methods — We conducted a population-based repeated cross-sectional study using linked health administrative databases. We identified first-contact emergency department (ED) visits or hospital admissions for self-harm, mood disorders, or psychosis from March 1, 2009, to February 29, 2024, among Ontario youth (aged 10-24 years). Virtual care was expanded in March 2020; we examined 2 expansion stages (temporary and permanent). Autoregressive integrated moving average analyses estimated level and slope changes (vs before virtual care) in age- and sex-standardized monthly rates of 7-day mental health follow-up. Subgroup analyses examined rurality and socioeconomic status.

Results — We identified 42,208 first-contact ED visits and 17,701 first-contact hospital admissions. Pre–virtual care mean follow-up rates were 17.64 (SD 2.97) per 100 first-contact ED visits and 21.90 (SD 5.05) per 100 first-contact hospital admissions. Temporary expansion was associated with immediate increases in follow-up that declined (level changes: 4.81, 95% CI 2.82-6.81 for ED visits and 7.51, 95% CI 4.41-10.60 for hospital admissions; slope changes: −0.31, 95% CI −0.42 to −0.21 for ED visits and −0.32, 95% CI −0.48 to −0.15 for hospital admissions). Permanent expansion was associated only with an immediate decrease in ED visit follow-up (level change: −3.81, 95% CI −6.70 to −0.92) that was significant in rural (−1.06, 95% CI −1.93 to −0.184) but not urban (0.44, 95% CI −0.179 to 1.06) areas; results were otherwise similar between subgroups.

Conclusions — Virtual care was not associated with sustained changes or equity improvements in mental health follow-up for high-acuity youth, representing a missed opportunity to extend physician reach and address barriers. Further research and quality improvement are needed.