Teens heading to ER for mental health care called 'exceedingly frustrating'

Children and young people with mental disorders increasingly turned to emergency departments for care, a finding a psychiatrist worries reflects lack of treatments in the community. 

The rate of emergency department visits by young Canadians increased by 45 per cent from 2006 to 2014, according to Thursday's report from the Canadian Institute for Health Information.

Emergency visits for mental disorders increased from 946 per 100,000 to 1,371 per 100,000.

"The biggest concern from my perspective is the use of the emergency room as what seems to be the preferred place of treatment for young people with mental disorders," said Dr. Stan Kutcher, a psychiatry professor at Dalhousie University in Halifax.

"The kind of community-based, easily accessible treatments that we should be having are likely not there."

About eight per cent of Canadians aged 15 to 24 described their mental health as fair or poor to Statistics Canada. 

The increase in emergency visits was predominantly for anxiety disorder and mood disorders, which can be treated in the community, said Kutcher. He holds the Sun Life chair in adolescent mental health and reviewed CIHI's research as an expert adviser. 

Stark call to action

The researchers found about 39 per cent of children and youth who went to an emergency room for a mental disorder had three or more visits compared with 15 per cent who went to emergency for another reason. Kutcher considers the  repeat visits are another shout for better community care.

He highlighted two solutions that could dramatically cut down on emergency visits:

• Youth health centres in junior high and secondary schools to provide a full gamut of health care, including links to primary care as well as counsellors or psychologists, as in Nova Scotia. The model could also be used in rural areas. 
• Train primary health care providers such as family doctors how to diagnose and treat mental health disorders, a collaborative program Kutcher said has taken off successfully in British Columbia. 

"It's a pretty stark call to action," Kutcher said of the report. "I find this personally and professionally exceedingly frustrating. It's not like we don't have the data to show us what to do."

The report's authors also found one in 12 people aged 15 to 24 in Manitoba, Saskatchewan and British Columbia were dispensed a mood or anxiety or antipsychotic medication in 2013–2014.

Quetiapine was the most commonly prescribed antipsychotic drug. It was often dispensed at doses low enough to indicate treatment of conditions other than schizophrenia or bipolar disorders, such as a sleep aid, the researchers said.

"The increase in the use of quetiapine reported here is of some concern given the low dosages at which it is being dispensed, if it is being used as a sleep aid," the authors said. It wasn't possible to tell why the drugs were prescribed. 

Kutcher said it's reasonably appropriate to prescribe quetiapine for some kinds of aggression or in association with behavioural therapy in children with autism who are self-harming. But it's inappropriate to use as a sleep aid.

In contrast, Kutcher sees a "treatment gap" for selective serotonin reuptake inhibitors or SSRIs used to treat mood and anxiety disorders. The prevalence of medication use for the disorders was below the prevalence of mood and anxiety disorders in the population.

Counselling and psychotherapy services by physicians for those age 5 to 24 also increased by 10 per cent between 2007 and 2012, based on billing data.