Frequent Emergency Room Visits for Help With Mental Health and Substance Use

This indicator gives the percentage of individuals who had 4 or more emergency room (ER) or urgent care centre (UCC) visits for help with mental health and substance use in a given year.

Lower rates are desirable.

Data updated:
Data availability: to (fiscal years)
Geographic coverage
Prince Edward Island, Nova Scotia, Quebec, Ontario, Saskatchewan, Alberta, British Columbia, Yukon
Reporting level
National, Province/Territory, Region
Calculation

(Total number of individuals who had at least 4 ER or UCC visits for mental health and substance use in a 1-year period ÷ Total number of individuals who had at least 1 ER or UCC visit for mental health and substance use in a 1-year period) × 100

Unit of analysis: Patient

Denominator

Total number of individuals who had at least 1 ER or UCC visit for mental health and substance use in a fiscal year. The most recent visit in a fiscal year is the index visit.

Numerator

Total number of individuals in the denominator who had at least 4 ER or UCC visits for mental health and substance use in a 365-day period. Each individual has a 12-month look-back period prior to their most recent visit in a given year. Therefore, data for 2 fiscal years is necessary to obtain the data for the numerator.

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The square marker with a dotted line (for the trend chart) and the hatch pattern (for the bar chart) indicate partial data coverage.

Both crude rate and risk-adjusted rate are calculated as a percentage. Please refer to Methodology tab for details.

The dash (—) indicates that no data is available. Select different parameters or reset the chart.

Data may not be available for all fiscal years for a selected reporting entity.

For Prince Edward Island, Nova Scotia, Saskatchewan and British Columbia, results are based on partial data coverage and should not be compared.

For Manitoba, results are not shown due to insufficient data coverage.

No results are available at this time for Newfoundland and Labrador, New Brunswick, the Northwest Territories and Nunavut.

Regional data is available only for 2020–2021 and onward.

Results for regions based on partial data coverage should not be compared.

Results from 2020–2021 onward should be interpreted in the context of the COVID-19 pandemic. To learn more, see the Impact of COVID-19 on Canada’s health care systems.

Sources

National Ambulatory Care Reporting System, Canadian Institute for Health Information.

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Notes

Both crude rate and risk-adjusted rate are calculated as a percentage. Please refer to the Methodology tab for details.

The dash (—) indicates that no data is available.

Breakdowns are available only at the Canada and province/territory levels.

Data may not be available for all fiscal years for a selected reporting entity.

For Prince Edward Island, Nova Scotia, Saskatchewan and British Columbia, results are based on partial data coverage and should not be compared.

For Manitoba, results are not shown due to insufficient data coverage.

No results are available at this time for Newfoundland and Labrador, New Brunswick, the Northwest Territories and Nunavut.

Regional data is available only for 2020–2021 and onward.

Results for regions based on partial data coverage should not be compared.

Results from 2020–2021 onward should be interpreted in the context of the COVID-19 pandemic. To learn more, see the Impact of COVID-19 on Canada’s health care systems.

Sources

National Ambulatory Care Reporting System, Canadian Institute for Health Information.

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Name

Frequent Emergency Room Visits for Help With Mental Health and Substance Use

Short/Other Names

Frequent Emergency Room Visits for Help With Mental Health and Substance Use

Description

Percentage of individuals who had 4 or more emergency room (ER) or urgent care centre (UCC) visits for help with mental health and substance use in a 365-day period among those who had at least 1 ER or UCC visit for mental health and substance use in a given year.

For details, please see the General Methodology Notes (PDF).

Rationale

Frequent visits to emergency departments or UCCs may be an indication that people are not getting access to the services or the support they need in the community for help with mental health and substance use.

  • This could suggest people had conditions that were inadequately managed in the community. It might also suggest they were unaware of services in their communities, had difficulty accessing them, or had negative experiences or outcomes with community care.
  • Frequent visits may strain already busy ERs.

A higher rate may signal challenges with access to community-based care or unmet needs.

Interpretation

Lower rates are desirable.

HSP Framework Dimension

Access to comprehensive, high-quality health services

Areas of Need

Getting Better

Targets/Benchmarks

Not applicable

Available Data Years

to

Geographic Coverage

  • Prince Edward Island
  • Nova Scotia
  • Quebec
  • Ontario
  • Saskatchewan
  • Alberta
  • British Columbia
  • Yukon

Reporting Level/Disaggregation

  • National
  • Province/Territory
  • Region
  • Age group
  • Recorded sex or gender
  • Neighbourhood income quintile
  • Urban versus rural/remote
  • Ambulatory care type

For more information, please refer to CIHI’s Equity stratifiers web page.

Indicator Results

Web Tool:
Your Health System: In Brief — Frequent Emergency Room Visits for Help With Mental Health and Substance Use

Update Frequency

Every year

Latest Results Update Date

Updates

Regional results are available for 2020–2021 onward.

Description

(Total number of individuals who had at least 4 ER or UCC visits for mental health and substance use in a 1-year period ÷ Total number of individuals who had at least 1 ER or UCC visit for mental health and substance use in a 1-year period) × 100

Unit of analysis: Patient

Type of Measurement

Percentage or proportion

Denominator

Description:

Total number of individuals who had at least 1 ER or UCC visit for mental health and substance use in a fiscal year. The most recent visit in a fiscal year is the index visit.

Inclusions:

  1. Emergency Department* records (Amcare_Group_Code = ED)
  2. Recorded sex or gender coded as male or female 
  3. Records with valid age on the index visit
  4. Records with either/or
    1. Mental health and substance use as defined by ICD-10-CA codes in the main problem or other problem fields::
      1. Substance-related and addictive disorders: ICD-10-CA: F10–F19, F55, F63.0
      2. Schizophrenia and other psychotic disorders: ICD-10-CA: F20, F21, F22, F23, F24, F25, F28, F29
      3. Mood disorders: ICD-10-CA: F30, F31, F32, F33, F34, F38, F39, F53.0, F53.1
      4. Anxiety disorders: ICD-10-CA: F40, F41, F93.0, F93.1, F93.2, F94.0
      5. Selected disorders of personality and behaviour: ICD-10-CA: F60, F61, F62, F68 (excluding F68.1), F69
      6. Other disorders: ICD-10-CA: F42, F43, F44, F45, F48.0, F48.1, F48.8, F48.9, F50, F51, F52, F53.8, F53.9, F54, F59, F63 (excluding F63.0), F64, F65, F66, F68.1, F70–F73, F78, F79, F80–F84, F88, F89, F90, F91, F92, F93.3, F93.8, F93.9, F94.1, F94.2, F94.8, F94.9, F95, F98.0, F98.1, F98.2, F98.3, F98.4, F98.5, F98.8, F98.9, F99, O99.3
    2. An ED Discharge Diagnosis code as defined by the Canadian Emergency Department Diagnosis Shortlist (CED-DxS) version 2015, mental and behaviour disorders:
      1. Substance-related and addictive disorders: ICD-10-CA: F10.0, F10.3, F11.9, F12.9, F13.9, F14.9, F15.9, F16.9, F18.9, F19.9
      2. Schizophrenia and other psychotic disorders: ICD-10-CA: F20.9, F23.9
      3. Mood disorders: ICD-10-CA: F31.9, F32.9
      4. Anxiety disorders: ICD-10-CA: F41.9
      5. Selected disorders of personality and behaviour: ICD-10-CA: F60.9
      6. Other disorders: ICD-10-CA: F48.9, F50.9, F99

*Includes emergency department, UCC and emergency department mental health service visits.

Exclusions:

  1. Records with invalid health card number
  2. Records with an invalid code for province issuing health card number
  3. Records that are dead on arrival (Visit Disposition Code = 11, 71*)
  4. Scheduled ED visits (ED_visit_indicator = 0)
  5. Transfer to and from ED (Transfer from OR Transfer to Type = E)
  6. 2018–2019 data onward: Medical assistance in dying (MAID) (Visit Disposition Code = 73)

*2018–2019 data onward

Numerator

Description:

Total number of individuals in the denominator who had at least 4 ER or UCC visits for mental health and substance use in a 365-day period. Each individual has a 12-month look-back period prior to their most recent visit in a given year. Therefore, data for 2 fiscal years is necessary to obtain the data for the numerator.

Method of Adjustment

Logistic regression

Adjustment Applied

Covariates used in risk adjustment:

Age group, recorded sex or gender, mental illness category, left against medical advice, ambulatory care type and COVID-19 diagnosis

Geographic Assignment

Place of residence

Data Sources

  • NACRS

Caveats and Limitations

This indicator is a starting point to measure access to community-based mental health and substance use care.

  • Complete diagnoses in ERs are not always possible and tend to reflect symptoms or problems instead, which may lead to under-capture of conditions included in the indicator. In addition, capture of diagnoses depends on the level of detail submitted to the National Ambulatory Care Reporting System.
  • Results are based on all available data reported to CIHI. 4 jurisdictions (Quebec, Ontario, Alberta and Yukon) have complete ER data. For provinces that have partial data coverage (P.E.I., Nova Scotia, Saskatchewan and B.C.), repeat visits are likely underestimated because records cannot be linked across all hospitals. Therefore, results should not be compared. For Manitoba, results are not shown due to insufficient data coverage. No results are available at this time for Newfoundland and Labrador, New Brunswick, the Northwest Territories and Nunavut. Reporting for this indicator is expected to improve as more regions submit data and more diagnosis information becomes available.
  • Substance-related visits may be underestimated, as poisonings are not included in the indicator.
  • This indicator does not include dementia or problems related to brain injuries, such as concussion or stroke.

Trending Issues

Regional  and provincial trends (e.g., weakening, improving) may differ due to differences in data availability. For example, there may be 5 years of provincial results available but only 3 years of regional results.

Comments

This indicator belongs to the Shared Health Priorities portfolio measuring access to mental health and substance use services and to home and community care.

More information on this indicator is available in the 2019 companion report (PDF).

References

  1. Brennan JJ, Chan TC, Hsia RY, et al. Emergency department utilization among frequent users with psychiatric visits. Academic Emergency Medicine. September 2014.
  2. Brien S, Grenier L, Kapral ME, Kurdyak P, Vigod S; Health Quality Ontario, Institute for Clinical Evaluative Sciences. Taking Stock: A Report on the Quality of Mental Health and Addictions Services in Ontario (PDF). 2015.
  3. Canadian Institute for Health Information. Repeat Hospital Stays for Mental Illness. Accessed October 1, 2018.
  4. Chartier M, Bolton J, Mota N, et al. Mental Illness Among Adult Manitobans (PDF). 2018.
  5. Canadian Institutes of Health Research, Canadian Institute for Health Information. Dynamic Cohort of Complex, High System Users — 2011–2015 (PDF). 2017.
  6. LaCalle E, Rabin E. Frequent users of emergency departments: The myths, the data, and the policy implications. Annals Emergency Medicine. July 2010.
  7. MHASEF Research Team. Mental Health and Addictions System Performance in Ontario: A Baseline Scorecard (PDF). 2018.
  8. MHASEF Research Team. The Mental Health of Children and Youth in Ontario: 2017 Scorecard (PDF). 2017.
  9. Urbanoski K, Cheng J, Rehm J, Kurdyak P. Frequent use of emergency departments for mental and substance use disorders. Emergency Medicine Journal. April 2018.

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