Introduction: As reported by the Canadian Institute for Health Information, the rate of child and youth emergency department (ED) visits for mental health complaints increased by 50% between 2007 and 2015. Improving care for these patients has been identified as a major priority of Alberta Health Services As part of a multi-phased approach to improving care, the Emergency and the Addiction and Mental Health Strategic Clinical Networks undertook an analysis of administrative data to define incidence in Alberta and changing trends. Methods: The data analyzed included 5 different clinical information systems encompassing the 17 highest volume hospitals in Alberta, from April 2013 to March 2016. Patient encounters were included if the patient was under 25 years of age at the time of visit, and if the encounter included a CEDIS Presenting Complaint and/or an ICD-10 Primary Diagnosis relating to Addiction and/or Mental Health (AMH). A total of 54,810 patient encounters were included. Data was analyzed using descriptive statistics. Sub-group analysis was undertaken based upon age, presenting complaint, and primary diagnosis. Results: The incidence of children and youth presenting to an ED with an AMH complaint and an AMH primary diagnosis increased 22% and 7%, respectively, from 2013/14 to 2015/16. Admissions of patients were constant throughout this period. The largest increase in ED visits occurred among children aged 7-10, with a 60% increase in visits defined by presenting complaint and a 21% increase in primary diagnosis. The second largest increase was in young adults aged 18-21 with a 26% increase defined by presenting complaint, and a 12% increase in primary diagnosis. Analyzed by age group, the largest increase in primary diagnosis between 2013/14 and 2015/16 was seen in Depression/Suicidal/Self Harm with a 667% increase among ages 0-6, and a 79% increase among ages 7-10. The second highest increase was for Anxiety/Situational Crisis with a 223% increase among ages 0-6, and 74% among children aged 7-10. Conclusion: Within Alberta there has been a substantial increase in the incidence of child and youth visits to the ED for issues of mental health and addictions. It is clear is that these changing trends are placing an increased burden on our healthcare system and necessitate strategic planning to ensure the health and wellness of our patients.

Introduction: The Canadian Institute for Health Information reports the rate of child and youth emergency department (ED) visits for mental health complaints increased by 50% between 2007 and 2015. Improving care for these patients is a major priority of Alberta Health Services (AHS). As part of a multi-phased approach to improving care, the Emergency and the Addiction and Mental Health Strategic Clinical Networks (SCNs) surveyed youth who had presented to an ED for mental health or substance use concerns and their families/caregivers. Methods: The online survey contained closed- and open-ended questions on reasons for ED visits, expectations about and experiences during their visits, and areas for improvement. An ethics approved survey was conducted for 4 weeks. Participants were recruited across the province using an extensive array of social media platforms. For each survey, we randomly selected a sample of open-ended responses to thematically analyze to the point of informational redundancy. Results: The Youth survey received 992 responses and the Family survey received 553. A small number of overarching themes emerged. For both surveys, the major themes were 1) Wait times and access: participants were disappointed with lengthy wait times and services in the community. Youth said this made them question their decision to seek help and left them feeling hopeless. 2) Care provider training: participants were unhappy with the quality of care provided (e.g., lack of compassion, minimizing symptoms). They felt better training would improve care and attitudes towards mental health patients. 3) Environment: participants were uncomfortable with the lack of privacy for discussing sensitive topics; youth also requested items such as pens/paper and phone chargers to make the stay more comfortable and provide distractions. An additional theme emerged in the Youth survey regarding family involvement; participants wanted to decide how much/what information is shared with their families. Youth noted they were less likely to be honest with family present. Communication and navigation were mentioned frequently in the Family survey; participants noted the complexity of the mental health care system and felt frustrated by the lack of information to help them access additional resources. Conclusion: There are a number of areas in need of improvement to provide high-quality, patient-centred care to youth with mental health or substance use concerns that present to the Emergency Department. Phase II of this project will involve a review of the themes and determine priorities and strategies to address the themes that could be implemented into the workflow.