Immigrant, refugee youth most likely to visit the ED with a new mental health problem

October 09, 2018

Refugee and immigrant youth in Ontario may face barriers to accessing mental health services through primary care, say the authors of a study of emergency department visits published in CMAJ (Canadian Medical Association Journal).

The study looked at emergency department visits for mental health issues or self-inflicted harm 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% (2194) were refugees and 5.6% (6680) were non-refugee immigrants. For many of these youth, their emergency department visit was their first physician contact for mental health services. Rather than presenting first to primary care, 61.3% of refugee youth, 57.6% of non-refugee immigrants and 51.3% of non-immigrant youth presented to the emergency department with a mental health crisis.

Among immigrants, newcomers (fewer than five years in Canada) and refugees had the highest rates of first contact in the emergency department. Having a family doctor who practised as part of a team (versus a walk-in clinic model of care) was associated with better rates of receiving outpatient mental health care prior to presenting in crisis to the emergency department.

"Our study highlights that immigrants face barriers to using mental health services from a physician on an out-patient basis, but there is variability within immigrant groups by country and region of origin as well as by duration of residence in Canada," says Dr. Natasha Saunders, Department of Pediatrics, The Hospital for Sick Children (SickKids) and ICES.

"The results are consistent with those of other studies of adults that show immigrants and refugees may not have the same access to mental health services by physicians in the community compared with non-immigrants," she says.

"The findings suggest a need to understand the barriers and enabling factors that contribute to the use of mental health services and access to care, including focusing efforts to reduce stigma and identify mental health problems early, before crises. This is particularly important for refugee and newcomer youth and immigrants from Africa and Central America where we saw the highest rates of first contact in the emergency department," say the authors.

In a related commentary, Dr. David Cawthorpe, Alberta Children's Hospital Research Institute, University of Calgary, writes "What is clear from this study, however, is that first presentation with a mental health issue to the emergency department is common for all youth in Ontario, which signals general problems with access to appropriate mental health services in the province."

"There is no question that marginal groups may be overrepresented at the gateways to service, and it is necessary to understand and address the contributing factors. Nevertheless, failing to grasp the overarching issues, such as the lack of integration and organization of health and mental health services, will perpetuate current barriers to access and treatment. Youth mental health resources remain the orphan's orphan -- segregated and scarce -- and proven fledging innovations directed at shaping access to appropriate services require wider dissemination," he argues.

"Use of the emergency department as a first point of contact for mental health care by immigrant youth in Canada: a population-based study" is published October 9, 2018.

Canadian Medical Association Journal

Related Primary Care Articles from Brightsurf:

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

Continuity of English primary care has worsened with GP expansions
A new study published by the British Journal of General Practice has found that patients' abilities to see their preferred GP has fallen greater in English practices that have expanded, compared with those that stayed about the same size.

Primary care office-based vs telemedicine care visits during COVID-19 pandemic
This observational study quantified national changes in the volume, type and content of primary care delivered during the COVID-19 pandemic, especially with regard to office-based visits compared with telemedicine encounters.

Expenditures for primary care may affect how primary care is delivered
This study looks at trends in out-of-pocket and total visit expenditures for visits to primary care physicians.

Primary care clinicians drove increasing use of Medicare's chronic care management codes
To address the problem of care fragmentation for Medicare recipients with multiple chronic conditions, Medicare introduced Chronic Care Management (CCM) in 2015 to reimburse clinicians for care management and coordination.

Primary care at a crossroads: Experts call for change
Primary care providers have experienced a rise in responsibilities with little or no increase in the time they have to get it all done, or reduction in the number of patients assigned to them.

Primary care physicians during the COVID-19 epidemic
Scientists from the University of Geneva has analysed clinical data from more than 1,500 ambulatory patients tested for COVID-19.

The five phases of pandemic care for primary care
The authors present a roadmap for necessary primary care practice transformations to care for patients and communities during the COVID-19 pandemic.

Women almost twice as likely to choose primary care as men
Analysis of osteopathic medical school survey data reveals women are 1.75 times more likely to choose primary care than men, according to a study in The Journal of the American Osteopathic Association.

Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.

Read More: Primary Care News and Primary Care Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to