Refugee and immigrant youth are more likely to end up in the emergency room during a mental health crisis than their Canadian-born peers, a new medical study shows.

Newcomers did not seek early help from primary care doctors likely due to barriers in accessing and using outpatient mental health services, said researchers from the Institute for Clinical Evaluative Sciences (ICES) and the Hospital for Sick Children.

“Efforts are needed to reduce stigma and identify mental health problems early, before crises, among immigrant populations,” said the study published in the Canadian Medical Association Journal Tuesday.

Based on health and demographic data, researchers looked at emergency department visits for mental health issues by youth between the ages of 10 and 24 years in Ontario.

They identified a total of 118,851 young people who visited an ER with a mental health concern between 2010 and 2014, including 1.8 per cent or 2,194 refugees and 5.6 per cent or 6,680 non-refugee immigrants. The rest were Canadian.

“Most major mental illnesses have an age of onset in adolescence and young adulthood with about 20 per cent of youth experiencing mental illness. Our findings suggest that there are important subgroups of immigrant and refugee children who face barriers in accessing outpatient mental health care,” said study co-author Dr. Astrid Guttmann, chief science officer at ICES and staff pediatrician at Sick Kids.

“Interventions to improve access to the mental health system should consider the needs of specific immigrant populations.”

The gaps between immigrant and non-immigrant youth can be attributed to differences in culture, language proficiency, ability to navigate health services and even referral biases by health care providers, said the report.

While the majority of youth sought help for mental health issues at an emergency department first, the rate was higher for newcomers. The study found 61.3 per cent of refugee youth, 57.6 per cent of non-refugee immigrants and 51.3 per cent of Canadian youth went to an ER first.

Report lead author Dr. Natasha Saunders, a pediatrician at Sick Kids and adjunct scientist at ICES, said the differences are both statistically and clinically significant.

“Emergency services are important for managing acute mental health crises, but for most mental health disorders, primary care would be the most appropriate place for treatment and referral to specialized services,” she explained

“The high proportion of immigrant and refugee youth who have not been previously assessed for mental health problems suggests a need to understand specific cultural and other barriers and enabling factors related to the use of mental health services and access to care.”

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Among all immigrants, recent arrivals had the highest proportion (64.3 per cent) of first contact in the emergency department, as did non-refugee immigrants from East Asia (61.7 per cent) and refugees from Africa (65.4 per cent), Central America (64.6 per cent) and East Asia (62.5 per cent).

Those who live in low-income and rural areas and those without OHIP coverage also had higher rates of first contact for mental health in the ER, said the report.