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Are Mental Health Services for Children Distributed According to Needs?
Results
Needs
Overall prevalence of at least 1 mental health disorder was, according to parent reports, 24% among children aged 6 to 8 years, 20% among those aged 9 to 11 years, and 18% in the group aged 12 to 14 years. The average CGAS score was similar across the 3 age groups (85 or 86). The proportion of parents who perceived that their child needed help was 12% among the youngest group, 13% among the middle group, and 16% in the oldest group.
There were no statistically significant differences at the 5% level among the 4 regions for any of the 3 need indicators. To get an idea about the size of variation across regions, the extremal quotient (EQ) (that is, the ratio of the highest to the lowest score) was calculated. For the prevalence of at least 1 mental health disorder, the EQ ranged from 1.5 for the group aged 6 to 8 years to 1.8 for the group aged 12 to 14 years. The CGAS scores were virtually identical across regions. For the perception of need for help, the EQ ranged from 1.6 for the group aged 9 to 11 years to 2 for the group aged 6 to 8 years (Figure 1).
Professional Resources
On average, the availability of professional resources within the school system varied considerably across the 4 selected types of professions, from 1.5 FTE special education teachers per 100 000 children to 89.9 FTE psychologists per 100 000 children in 1992–1993. Availability also varied across regions. There were 8.5 times more social workers and social help technicians in the metropolitan region than in the central west region. The metropolitan region had 3.7 times more psychoeducators than did the central east region. Conversely, there were 11.5 times more special education teachers in the latter region than in the former region. The EQ for psychologists was 1.6 (Figure 2).
Rates of physicians and nonphysicians per 100 000 population in the community ranged from 2.7 psychoeducators to 118 family physicians (Figure 3). Availability varied greatly across regions in 1992–1993. The variation was highest for psychiatrists: the metropolitan region had 5.7 times more psychiatrists than did the central west region. Although the distribution of family physicians was more equitable, still, those 2 regions differed by 41%. The EQ for the other professions was 3.2 for social workers, 4.3 for psychoeducators, and 4.6 for pediatricians (Figure 3).
Service Use
In 1992–1993, the number of services that physicians provided for mental health problems was estimated at 449 per 1000 children aged 6 to 8 years, 501 in the group aged 9 to 11 years, and 455 in the group aged 12 to 14 years. Variations among regions were important (Figure 4a). Depending on the age group, the number of services in the metropolitan region was 1.6 to 2.3 times that in the southeast region.
Hospitalization rates per 10 000 children were 3.7 in the youngest group, 4.6 in the middle group, and 12.8 in the oldest group. Again, regions differed (Figure 5a). For the 3 age groups, the EQ was 1.8, 2.3, and 1.4, respectively.
Evolution of Resources and Service Use
Data from 1997–1998 allow for an analysis of the regional variations found in 1992–1993. The overall availability of professionals within the school system varied as much across regions in 1997–1998 as it did 5 years before (Figure 2b). The ratio between the highest and the lowest score was even larger for special education teachers in the recent period (EQ = 23.9) but smaller for social workers and social help technicians (EQ = 2.3). For the number of professionals available in the community, the EQs were in the same range for the 2 periods, except for psychoeducators (Figure 3). For this group, the EQ had decreased from 4.3 in 1992–1993 to 2 in 1997–1998. For psychologists, whose regional data were unavailable for 1992–1993, the EQ for 1997–1998 was 1.9 (data not shown).
The regional variation in the use of physician services for mental health problems decreased from 1992–1993 to 1997–1998 for the group aged 6 to 8 years (EQ = 2.3 vs 1.6), stayed the same in the group aged 9 to 11 years (EQ = 1.9 vs 1.9), and decreased slightly in the group aged 12 to 14 years (1.6 vs 1.4) (Figure 4b). Variation in hospitalization rates across regions increased between the 2 study periods (Figure 5). The EQs for the 3 age groups in 1997–1998 were 4.1, 2.6, and 1.6.
Figure 1 Mental health needs of children according to parents,
by age group and regiona (Quebec, 1992–1993)
Figure 2 Number of selected professionals in the school system per 100 000 population,
aged 6 to 14 years by region (Quebec, 1992–1993, 1997–1998)
Figure 3 Number of health professionals per 100 000 population by region
(Quebec, 1992–1993, 1997–1998)
Figure 4 Rates of physician visits per 1000 population for mental health problems among children,
by age group and region (Quebec, 1992–1993, 1997–1998)
Figure 5 Hospitalization rates per 10 000 population for mental health problems among children,
by age group and region (Quebec, 1992–1993, 1997–1998)
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