Equity of virtual mental health care uptake for children and youth during the COVID-19 pandemic.

The COVID-19 pandemic has transformed the way health care is delivered. To reduce the risk of COVID-19 transmission through unnecessary in-person visits to health care facilities, many health care providers are offering virtual visits. This has been facilitated through the creation of telemedicine physician billing codes and increased availability of virtual health platforms. Virtual mental health care has been proposed as a strategy to address the longstanding and growing gap between patient need and available mental health care resources, especially in underserviced and rural areas. However, it remains underused by both patients and physicians. Currently, there is a critical knowledge gap regarding the uptake of virtual mental health care during the COVID-19 pandemic for children and youth previously receiving care and those who are accessing it for the first time. Virtual care may address significant barriers to care including geography, time, and cost, with the pandemic acting as a stimulus for uptake. However, this uptake may not be universal, with some populations (e.g. those with limited reliable internet and language proficiency, or low income) continuing to face barriers in access. As a result, a shift to virtual care with the pandemic may have further widened existing health inequities. Using the well-established linked administrative and health data systems in Ontario, we will compare in-person and virtual mental health care visits for children (<18 years) with ongoing and new mental health care needs before and after the onset of the COVID-19 pandemic. We will illuminate whether the pandemic has widened inequities in access to care for priority populations. Namely, young people from low income neighbourhoods, rural areas, and who are refugees. Given the shift to this modality will likely be lasting, our data will inform ways in which virtual mental health care can be implemented in a more equitable and systematic way to better match patient need.