A nationwide youth mental health service model that shifts care from hospitals and other institutional settings into community-based services can improve care and relieve pressure on the Canadian health system, new research showed.
Researchers found that compared with young people who received standard community mental health care, those who received care through an ACCESS Open Minds site saw greater reductions in hospital admissions; outpatient, specialist, and general practitioner visits; and admissions to public residential treatment facilities.
Published online on July 7 in The Lancet Psychiatry, the research also showed that during the study period, the ACCESS Open Minds program saved an average of $4355 per person annually, or almost $10 for every dollar invested.
“What we’re seeing, in the largest site in this network, is that [this model] delivers better care that is also in community settings and closer to where people live, as well as a return on investment,” said study author Jai Shah, MD, assistant professor in psychiatry at McGill University and co-director of the Prevention and Early Intervention Program for Psychosis in Montreal.
Reduction in Use of Intensive Services
Researchers reviewed medical records for about 1400 young people who received care through ACCESS Open Minds in Edmonton between 2016 and 2019, comparing them with records for more than 9000 similar youths who received standard community mental health services during the same period.
Compared with the standard care group, young people who were referred to ACCESS Open Minds faced more serious mental health challenges. Also, before entering the program, they required more of nearly every type of service.
Despite these differences, after entering the ACCESS Open Minds program, they saw greater reductions in the use of intensive services than did young people who received traditional care.
“The study illustrates how modest investments in rapid, accessible, and community-based mental health care for youth are associated with significant cost savings and reduce the use of some of the most expensive components of our mental health care system,” said Colin King, PhD, associate professor in applied psychology and director of the Mary J. Wright Child and Youth Development Clinic at Western University in London, Ontario.
Multiservice Mental Health Model
ACCESS Open Minds service sites across Canada provide culturally relevant mental health services, physical health and sexual services, traditional Indigenous support, and other social services for youth aged 11-25 years.
Youth in need can get help as soon as possible through walk-ins, phone calls, email, or social media. In addition, youth can continue to access care after age 18 years if needed.
“The research shows that having rapid access to care and direct connection to other appropriate services is appropriate for this developmental time period, when there’s a lot of age-related vulnerabilities,” said King.
This availability is particularly important because “we know that [wait times] can be quite long [in Canada], especially those for those youth who might require more specialized intensive supports,” he said.
The ACCESS Open Minds model tries to address some of the limitations of standard mental health care for youth by, for example, including family members and carers whenever feasible. “One of the things we know clearly is that when family members or carers are constructively involved, outcomes are better,” said Shah.
In addition, a key component of the model is the ACCESS clinician, “a skilled, youth-friendly, and knowledgeable person who not only does the assessment but also engages and guides a young person and their family to where they need to be,” said Shah.
Widening the Care Funnel
Researchers emphasized that the savings seen with the ACCESS Open Minds model — and with similar models — depend upon covering the cost of these community-based settings up front and ensuring that these services are also offered to young people with complex needs who might otherwise require emergency or hospital-based care.
Over the past few years, however, some mental health networks and sites have narrowed their focus to young people with milder symptoms, rather than including youth with greater mental health care needs, Shah pointed out. This trend partially results from the overwhelming number of referrals that sites face, he said.
In a 2025 study in Psychiatric Services, Shah’s colleagues examined youth mental health service models in Canada and other countries. They found that only a small number of models offered intensive or specialist services, and three models actively excluded young people with severe mental health needs.
“When networks narrow the focus to one group, they may do a disservice from a systems perspective,” said Shah. “By keeping the funnel wide open and including everyone, we’re able to deliver more care in a youth-friendly way at a net cost savings.”
The study was funded by the Canadian Institutes of Health Research and the Graham Boeckh Foundation. Shah and King reported no relevant financial relationships.
