Nicole Kozloff1,2, Binu Jacob1,3, Aristotle Voineskos1,2, Paul Kurdyak1,2,3, Nicole Kozloff; 1Centre for Addiction and Mental Health, 2University of Toronto, 3Institute of Clinical and Evaluative Sciences
Given the importance of reducing barriers to treatment for young people with psychosis, we review recent population-level data on access to care and present findings on care received by youth first presenting to acute services for psychotic disorders. We identified youth aged 16-24 across Ontario, Canada with a first emergency department (ED) presentation for psychotic disorder between 2010 and 2013. Following discharge from the ED, we examined psychiatrist visits, mental health-related primary care visits, ED revisits, and psychiatric admissions over 1 year. We modelled time to outpatient psychiatry visit using Kaplan-Meier curves and predictors of care within 30 days and 1 year using Cox proportional hazard regression. 2875 youth had a first presentation to the ED over the study period and 812 (28.2%) were discharged to the community. Among discharges, 325 (40.0%) received no outpatient mental healthcare within 30 days; factors associated with psychiatric aftercare included neighbourhood income (highest vs. lowest income, HR = 1.48, 95% CI 1.05-2.09), rural residence (HR = 0.46, 95% CI 0.31-0.70), and recent mental healthcare (outpatient psychiatrist visit: HR = 1.89, 95% CI 1.50-2.37; psychiatric admission: HR = 0.71, 95% CI 0.52-0.98). One year following first ED visit for psychosis, 105 (12.9%) youth still had not received any outpatient mental healthcare, 416 (51.2%) had returned to the ED and 334 (41.1%) had a psychiatric admission. Many youth first presenting with psychotic disorders to acute services do not receive timely mental health follow-up. These findings may guide improvements in pathways to care for youth with psychosis.
