Electronic Thesis and Dissertation Repository


Doctor of Philosophy




Dr. Graham Reid


Transitioning youth from Children’s Mental Health (CMH) services to adult care poses a major challenge for our mental health and health care systems. This dissertation used a mixed-methods approach to explore the challenges of caring for youth with ongoing mental health problems into young adulthood. A Grounded Theory qualitative study consisted of interviews with youth (i.e., ages 12 to 15) treated in CMH, their parents, CMH providers, and family physicians. Using administrative health record and CMH data in the province of Ontario, a complementary quantitative study examined the likelihood of receiving mental health services within the medical sector after the age of transfer (18 years old).

In Chapter 2, perceptions from youth and their parents revealed that common CMH disorders were viewed as long-lasting, but not necessarily persistent problems over time. Parents feared their children would disengage from needed mental health services after CMH treatment. Chapters 3 and 4 shed light on provider perspectives, specifically those of CMH providers and family physicians. The consensus view of participating youth, parents, CMH providers, and family physicians themselves was that family physicians were “out of the loop” or not involved with a youth’s mental health care.

Chapter 5 presents the first longitudinal, case-control study in Canada to focus on the problem of transition to mental health adult care. Two key findings were: (1) youth treated in CMH were more likely than the general population to have a mental health visit in the medical system during and after CMH treatment; (2) most factors that significantly predicted having a mental health related visit in the medical system after age 18 were related to prior service utilization in either CMH or the medical system. Overall, youth treated in CMH continued to receive mental health services in the medical sector as young adults.

The combined findings presented across this dissertation revealed two common themes. First, the ongoing mental health needs of some children and youth are unlikely to be met within the CMH system. Second, there is uncertainty about the role of family physicians in caring for youth who are treated in CMH. Implications for policy and practice are discussed.