First Nations, low income kids in Alta. turn to ERs for mental health care

TORONTO – Children and teens from First Nations communities and families on welfare were more likely to use hospital emergency departments for mental health crises than other kids their age, a new study reports.

The rates were highest among First Nations youth, followed fairly closely by children from families on welfare. Children from other low income families – those which qualified for a provincial government subsidy – were next.

Children whose families didn’t receive any government subsidies turned to emergency rooms for mental health care at the lowest rates of the four groups.

First Nations girls were about three times more likely to go to the emergency department for mental health care than girls from families didn’t receive government subsidies. And with First Nations boys, the rate was about four times higher, according to the study, published this week in the Canadian Medical Association Journal.

“We were expecting differences but we weren’t expecting to see such gaps,” said lead author Amanda Newton, an assistant professor of pediatrics at the University of Alberta.

Newton and her co-authors looked at records for emergency room use in Alberta hospitals only. She said it would be useful to see if similar patterns emerged in other jurisdictions, but her findings can’t be used to predict what is happening in other parts of the country.

The data are interesting and a possible sign of problems. But because of the type of study this is, Newton and her colleagues cannot say whether children from First Nations or welfare families have higher rates of mental health problems.

The children from families who aren’t of First Nations origin and don’t receive government subsidies may have mental health problems at the same rate as the other groups.

But they may be getting care elsewhere – through psychologists, psychiatrists or through mental health programs – and therefore may be less likely to get to the type of crisis that necessitates an emergency room visit. If Alberta kids and teens didn’t use the emergency department for mental health care, they would have been invisible to these researchers.

Nor can Newton and her colleagues say for sure that First Nations children and teens are showing up to emergency departments because they lack adequate mental health resources in their communities.

It could well be that there are services, but they aren’t effective, she said. Alternatively, there may be such a stigma about using such services in the community that First Nations kids avoid them, then turn to emergency departments when problems reach a head.

“We really need to use this study as a jumping off point to ask much more particular questions and not just assume that we need more services,” Newton said.

Children and teens who turned to the emergency department for mental health care suffered a spectrum of problems, from attempted suicides to accidents caused by drinking or drug use. But the majority of complaints were about anxiety and stress.

Still, the pattern with First Nations children was different from the others, the study said.

“We found that more First Nations children presented to emergency departments for disorders secondary to substance abuse and intentional self-harm than other children, and that, compared with other children, First Nations children returned more quickly to the emergency department and had a longer time before visiting a physician in the post-crisis period,” the study said.

In fact, the median time to a follow-up appointment with a doctor was 79 days for First Nations children and teens.

Newton and her colleagues started the work as part of a grant from the Canadian Institutes of Health Research to see how Alberta emergency departments were being used.

After poring over six years worth of data on Emerg visits, they noticed a high usage for mental health care among children and further that there appeared to be differences in usage rates that were gender and socio-economically based.

First Nations girls aged 15 to 17 had the highest rate of visits – 7,047 per 100,000 children – followed by First Nations boys – 5,787 visits per 100,000 children. The study said First Nations children make up about six per cent of all children under 18 in Alberta.

The lowest rates were found among boys (1,323 per 100,000) and girls (2,144 per 100,000) from families who didn’t receive any government subsidies.

Newton said it’s important to find out more about why children are turning to emergency departments for mental health care and what happens after they do.

“Because being in a crisis doesn’t feel good. Going into the emergency department and waiting for several hours to see someone for an assessment is probably not how families and kids want to spend their time,” she said.

“The emergency department is a critical piece in terms of access to services. But asking questions about what happens before and after are also equally critical.”