Emergency Department as a First Contact for Mental Health Problems in Children and Youth

Objective: To characterize youth who use the emergency department (ED) as a "first contact" for mental health (MH) problems. Method: This was a population-based cross-sectional cohort study using linked health and demographic administrative datasets of youth 10 to 24 years of age 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. More than half (53:15%) had no prior outpatient MH care, and this was associated with younger age (14-17 versus 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 versus 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) versus nonimmigrants. 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 individuals whose primary care physicians were in the lowest tertile for mental health visit volumes were associated with higher risk. Conclusion: More than half of youth requiring ED care had not previously sought outpatient MH care. Associations with multiple markers of primary care access characteristics suggest that timely primary care could prevent some of these visits.