A recent CIHI study found that the rate of hospitalizations and emergency department (ED) visits for mental health–related conditions has increased substantially since 2006.
Care for Children and Youth With Mental Disorders found that rates of ED visits for children and youth age 5 to 24 increased by 45% between 2006–2007 and 2013–2014. Similarly, rates of hospitalizations involving at least 1 overnight stay increased by 37% over the same time period.
What’s driving these numbers? Anxiety, mood and substance-related disorders were the leading causes of ED visits, while mood and other disorders — such as conduct and eating disorders — were among the most common diagnoses for inpatient hospitalizations.
For Kimberly Moran, president and CEO of Children’s Mental Health Ontario, there’s another consideration.
“I think what the numbers say to us is that the kids or children and youth are using emergency rooms and hospitals because they can’t connect with services in the community that they need,” she explains.
Moran not only sees this in her work but has personal experience with the system. When her daughter was 11, she started to show symptoms of depression. After ruling out a physical issue, they were referred to a community mental health service with a wait time of almost a year.
“Within two and a half months, she tried to take her life. She was 11, and she stopped eating and drinking,” says Moran. “We took her to emergency, so we were one of those families.”
Her daughter subsequently spent 2 weeks in inpatient care before she was moved to a residential centre for 6 months, followed by 18 months of day treatment.
The occurrence of mental disorders can having a lasting effect — among youth it can be associated with poor educational and employment outcomes.
“She’s 15 now and doing very well, but at school she’s trying to catch up on the enormous gap from being sick so long,” notes Moran. “For kids, losing 2 years of school is a big challenge — with potential implications for the rest of their lives.”
Multiple ED visits and repeat hospitalizations may also signal a gap in community care. CIHI’s study found that 39% of children and youth who visited an ED for a mental disorder had 3 or more visits, while 11% of those hospitalized had 3 or more inpatient stays.
“If you go to an ED for help for mental health issues, you may end up being released quickly because it’s not seen as an acute issue to be treated in the hospital,” explains Moran. However, without the appropriate capacity in the community, a child can end up back at the hospital.
Moran believes what’s needed is a larger conversation around creating a system of care for mental health similar to seniors care and chronic disease management.
“We have to have a talk about what kids and families need in terms of service. They need primary health care involved, and of course they need hospitals and pediatricians,” says Moran. “But much of the day-to-day treatment and management of these kids and supporting their families is in the community sector, and right now there is just insufficient capacity to do that.”