Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Doctor of Philosophy

Program

Psychology

Supervisor

Reid, Graham J.

Abstract

Approximately one in five children in Ontario have a mental health disorder causing significant distress and/or impairment. Yet only a third of these children receive specialized mental health services. One of the barriers to accessing care is long waitlists. Mental health walk-in clinics (MHWCs) can help address this issue by providing immediate support and removing administrative hassles for families (e.g., phone calls, intakes). The current dissertation sought to better understand the availability, implementation, and use of MHWCs.

Study 1 explored the availability of MHWCs across Canada. A brief survey was distributed to child and youth mental health (CYMH) agencies. Many CYMH agencies (73% total sample; 69% random sample) reported using this service delivery model. Study 2 examined the implementation of MHWCs in Ontario. An in-depth survey was distributed to CYMH agencies in Ontario. MHWCs are being used to provide timely and accessible services, as well as to serve as a point of intake for 44% of agencies. MHWCs are provided in different locations (e.g., agencies, schools) using different modalities (e.g., consulting break) and approaches (e.g., solution focused therapy). Most agencies quickly adapted to COVID-19 restrictions by providing virtual MHWCs.

Studies 3 and 4 explored how families use MHWCs. Administrative data from two CYMH agencies in Ontario capturing a period of 3 to 6 years were extracted. Overall, 24% and 61% of families in Agency 1 and 2, respectively, used MHWCs at least once. About a third of families using MHWCs had 2 or more visits. Younger children, children in shared custody or under the guardianship of their birth/adoptive mother or father, and children that were not referred to other agency services had higher risk of a second MHWC visit. Over half of families use MHWCs alongside other agency services; most often, earlier in the service use trajectory. Older children, children in shared custody, and children who were referred to other agency services had higher odds of MHWC use before other services.

In summary, MHWCs were a common service delivery model in the CYMH agencies sampled in Ontario and in Canada. It is flexible, such that the implementation (e.g., modality, approach) can be tailored to fit the needs of an agency and community. MHWCs may be sufficient for 33-43% of families. Providing help in a MHWC visit without requiring a comprehensive intake or asking families to wait should enhance access for other families who require more intensive services. For other families (57-67%), MHWCs can help support them at the beginning of their service journey by providing initial support and linking them to other agency services.

Summary for Lay Audience

About one in five children in Ontario have a mental health disorder, but only a third of these children get mental health services. One of the barriers to accessing services is long waitlists. Mental health walk-in clinics (MHWCS) can help by providing immediate support and removing hassles for families, such as phone calls and waiting days to weeks to see a professional. The current dissertation sought to better understand the availability, implementation, and use of MHWCs.

Study 1 explored at the availability of MHWCs across Canada. Child and youth mental health (CYMH) agencies were contacted and asked to complete a short survey. Many CYMH agencies (73% overall) reported that they offer MHWCs. Study 2 examined how the MHWCs had been implemented by CYMH agencies in Ontario. MHWCs are being used to provide accessible services, as well as to serve as a point of intake (e.g., agency staff talk to families about their concerns so that they can guide them to the appropriate service) for 44% of agencies. MHWCs are provided in different ways, such as the locations used (e.g., agencies, schools). Most agencies quickly adapted to COVID-19 restrictions by providing virtual MHWCs.

Studies 3 and 4 explored how families use MHWCs. Electronic records from two CYMH agencies in Ontario were obtained. Overall, 24% and 61% of families in Agency 1 and 2, respectively, used MHWCs at least once. About a third of families using MHWCs had 2 or more visits. Younger children, children in shared custody or under the guardianship of their birth/adoptive mother or father, and children that were not referred to other agency services were more likely to have a second MHWC visit.

Furthermore, over half of families use MHWCs alongside other agency services (e.g., MHWCs and an anxiety group); most often, earlier in their service use journey. Older children, children in shared custody, and children who were referred to other agency services were more likely to use MHWCs before other services.

In summary, MHWCs were a common service delivery model in the CYMH agencies sampled in Ontario and in Canada. It is flexible so that the way it is set up can be tailored to fit the needs of an agency and community. MHWCs may be sufficient for 33-43% of families. For other families (57-67%), MHWCs can help support them at the beginning of their service journey by providing initial support and linking them to other agency services.

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