Use of the emergency department as a first point of contact for mental health care by immigrant youth in Canada: A population-based study

AUTHORS    Natasha Ruth Saunders, Peter Gill, Laura Holder, Simone Vigod, Paul Kurdyak, Sima Gandhi and Astrid Guttman

LOCATION   Ontario


Emergency department visits as a first point of contact for people with mental illness may reflect poor access to timely outpatient mental health care. This article sought to determine the extent to which immigrants use the emergency department as an entryway into mental health services. The objective was to determine whether immigration and immigration-related factors are associated with using the emergency department as an entryway into mental health services in Ontario, Canada. Findings show rates of first contact in the emergency department for youth mental health conditions in Ontario were highest among refugees and recent immigrants to Canada, with variability by sociodemographic and primary care factors.

How does this research apply to my work?

The findings suggest that immigrants face barriers using mental health services from a physician on an outpatient basis. Accordingly, the various barriers may contribute to variation in pathways for mental health support and suggests a need for education and training for early identification of mental illness among nonphysican support networks. In addition, interventions to improve access to the mental health system on an outpatient basis among young immigrant youth should consider the needs of specific immigration populations. 

What should I take away from this research?

  • Major mental illnesses begin in adolescence and young adulthood. Emergency departments play a critical role in crisis management; however, this may not be the ideal environment for youth to engage with the mental health system for the first time. Such visits are associated with worse outcomes including more severe disease at presentation, longer duration of untreated illness and higher future use of acute care services.
  • The important differences in outpatient delivery of mental health services between immigrants and non-immigrants may reflect differences in culture, language proficiency, health system navigation and referral biases by health care providers.
  • There are important country-specific variability in rates of emergency department first contact for mental health. This article identifies subpopulations in need of better access to outpatient mental health services.

What’s the next step?

Better understanding of the barriers and enabling factors that contribute to use of mental health services and access to care are needed, including focusing efforts to reduce stigma and identify mental health problems early, before crises, in particular among refugee and newcomer youth and immigrants from Africa and Central America

Read more here.

The Immigrant and Refugee Mental Health Project also had the opportunity to host a webinar with the primary author for this article. You can watch it here.

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