A new Canadian study finds that young refugees and immigrants may face barriers to accessing mental health services through primary care.
The study, published in CMAJ (Canadian Medical Association Journal), looked at the emergency department (ED) visits of adolescents and young adults (ages 10- 24) in Ontario for mental health issues or self-inflicted harm.
According to the findings, there were 118,851 youth who visited an emergency department with a mental health concern during the five-year study period (2010-2014).Of these, 1.8 percent (2,194) were refugees and 5.6 percent (6,680) were non-refugee immigrants.
For many of these young people, their ED visit was their first physician contact for mental health services. Rather than presenting first to primary care, 61.3 percent of refugee youth, 57.6 percent of non-refugee immigrants and 51.3 percent of non-immigrant youth came to the ED 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. The findings are important as having a family doctor who practices as part of a team (versus a walk-in clinic model of care) is 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 from the department of pediatrics at The Hospital for Sick Children (SickKids) and International Credential Evaluation Service (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 results demonstrate the importance of understanding what barriers and enabling factors influence the use of mental health services and access to care. The authors say that efforts should focus on reducing stigma and identifying mental health problems early, before a crisis occurs.
“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,” write the authors in CMAJ.