Area-Level Variation in Children’s Unmet Need for Community-Based Mental Health Services: Findings from the 2014 Ontario Child Health Study


There is limited empirical evidence documenting the magnitude and correlates of area-level variability in unmet need for children’s mental health services. Research is needed that identifies area-level characteristics that can inform strategies for reducing unmet need in the population. The study purpose is to: (1) estimate area-level variation in children’s unmet need for mental health services (using Service Areas as defined by the Ontario Ministry of Children and Youth Services), and (2) identify area-level service arrangements, and geographic and population characteristics associated with unmet need. Using individual-level general population data, area-level government administrative data and Census data from Ontario, Canada, we use multilevel regression models to analyze unmet need for mental health services among children (level 1) nested within Service Areas (level 2). The study finds that 1.64% of the reliable variance in unmet need for mental health services is attributable to between-area differences. Across areas, we find that Service Areas with more agencies had a lower likelihood of unmet need for mental health services. Compared to other Service Areas, Toronto had much lower likelihood of unmet need compared to the rest of Ontario. Rural areas, areas with unsatisfactory public transport, and areas with higher levels of socio-economic disadvantage had a higher likelihood of unmet need for mental health services. These findings identify challenges in service provision that researchers, policymakers and administrators in children’s mental health services need to better understand. Policy implications and potential Service Area strategies that could address equitable access to mental health services are discussed.

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The authors would like to thank the Ontario Ministry of Children, Community and Social Services (formerly the Ministry of Children and Youth Services) for providing administrative data used in the analysis.


The 2014 Ontario Child Health Study was funded by research operating grant 125941 from the Canadian Institutes of Health Research (CIHR), Health Services Research Grant 8-42298 from the Ontario Ministry of Health and Long-Term Care (MOHLTC) and from funding from MOHLTC, the Ontario Ministry of Children and Youth Services and the Ontario Ministry of Education. Dr. Boyle was supported by CIHR Canada Research Chair in the Social Determinants of Child Health, Dr. Georgiades by the David R. (Dan) Offord Chair in Child Studies and Dr. Reid by the Children’s Health Foundation.

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Correspondence to Laura Duncan.

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Duncan, L., Georgiades, K., Reid, G.J. et al. Area-Level Variation in Children’s Unmet Need for Community-Based Mental Health Services: Findings from the 2014 Ontario Child Health Study. Adm Policy Ment Health 47, 665–679 (2020).

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  • Mental health
  • Services
  • Children and youth
  • Unmet need
  • Multilevel modelling
  • Area-level variation