This past year alone marks the deaths by suicide of three students at the University of Toronto. Their aftermath opened a barrage of criticisms toward the administration for their lax services for at-risk youth. While alarm bells have been rung for increased mental health and substance use services across campus, systemic change has been slow to come.
Indeed, the issue of mental health accessibility for youth — on and off campus, throughout the province, and across the country — remains a pressing policy and health care concern affecting millions of Canadians.
Among the sobering statistics that shroud youth mental health are the following: some 12.6 per cent of people under 18 years of age in Canada experience mental health and substance use disorders, while Statistics Canada cites suicide as the second most common cause of death, after accidents, among youth aged 15 and over. Importantly, Indigenous youth are disproportionately affected by suicide and addiction, and little research thus far has focused on this issue.
Many youth facing mental health challenges avoid treatment
Who are ‘youth,’ anyway? The McCain Centre for Child, Youth & Family Mental Health at the Centre for Addiction and Mental Health (CAMH) roughly categorizes those ages 12–25 within this demographic, though CAMH more broadly includes those up to 29 years old in their definition.
Unquestioningly, this demographic is particularly susceptible to various mental health challenges as they pass through the hoops of development: commencing and finishing a university or college degree or vocational program, navigating the ebbs and flows of intimate relationships, and searching for employment.
Despite numerous treatment options available for youth, many still go untreated. Why is this? The reasons are plentiful: youth’s preference for self-managing, societal stigma, lack of assessments and screening, and even system fragmentation. With these barriers in mind, how can Canada’s health care system improve and cater diligently and efficaciously to youth across the country?
The solutions, too, are plentiful
When I asked Dr. Joanna Henderson, Director of the Margaret and Wallace McCain Centre for Child, Youth, and Family Mental Health at CAMH, and Associate Professor of Psychiatry at U of T, if mental health services for youth are adequate, or even optimal, her answer was a hard no.
Henderson has worked with many teams and professionals to increase mental health and substance use services for youth. She explained that good services involve “creating spaces for young people who can walk in without an appointment or referral, and access high quality mental health and substance use services as an entry point.”
Long wait times, however, are a ubiquitously understood concern across the health care continuum, leaving young people with few, and often inadequate, options to choose from. The trope of “service delayed, service denied” captures this concern.
“When young people have to wait for service, several things happen,” Henderson said. “One, the symptoms they were originally presenting for become exacerbated, so they get worse. Two, the impact on their functioning can have significant long-term consequences. And three, the overall [health] outcomes are poorer.”
“From a system perspective, that means our delays have increased the cost of providing care to young people.”
In Canada alone, the economic burden of mental illness is high, with an estimated 51 billion dollars spent per year. This includes “health care costs, lost productivity, and a reduction of various quality-of-life health indicators.”
To be clear, this also means that young people requiring mental health and substance use support resort to emergency rooms where they may be hastily ushered in and out, without receiving thorough long-term care.
So what do youth-friendly mental health and substance use services look like? Among the many salient features, they are inclusive, safe, confidential, bright, and comfortable. Equally as critical, however, is that they involve consulting with youth for their input.
“How is it that the whole commercial for-profit industry figures out how to sell their product or their service?” Henderson asked. “You engage with and learn from consumers. We fail to do that in mental health and in health largely.”
Solutions to increase accessibility of mental health services for youth
The research on this is clear. A cardinal rule for youth-friendly services involves youth actively engaging with the system — from policy development to the implementation of strategies and programs.
We know that youth-friendly services can benefit immeasurably by having youth co-design these spaces, but we also know that to do so, current systems that feature the old-fashioned clinical model of care, whereby one presents a set of symptoms and is discreetly greeted, treated, and discharged, ought to be neatly folded and set aside for more modern and progressive models.
An optimal system, therefore, requires a flexible model of care. For starters, it’s making programs visible to youth so that they know where they can go when they need help, and one they can choose to enter and leave as they wish, without the rigidity of a treatment timeline and discharge date.
This includes drop-in visits and telephone conversations, where hours of operation are accessible, such as during weekends and evenings when youth would not need to worry about missing school or work. Artistic and innovative approaches to treatment, emphasizing non-verbal methods of communication such as music and drama therapy, could also be more accessible to youth.
Additionally, youth-friendly mental health and substance use services ought to be accessible in communities where public transit exists. Costs, too, must be fair and inexpensive, as Hawke and colleagues note in their recently published paper on this topic: “Youth who cannot afford services will not likely access them.”
Inclusivity mandates changing outreach platforms and engaging with technology to relate to and connect with youth. Social media platforms are pertinent sites of connection, as are websites that are colourful, up-to-date, and practical.
Steering clear from “disease language,” Henderson remarks, can shift the conversation away from pathologizing and lead youth to feel genuinely heard and understood.
Given also the wide range of development during this period of one’s life, youth services ought to be comprehensive and individualistic. There is no one-size-fits-all model, and clumping youth together under a monolithic category fails to address the transient and not-so-transient challenges children and adults experience.
The solutions to providing youth-friendly services are exhaustive, albeit refreshingly so. It’s good to know that we matter, but it’s perhaps more important to know that the system, warts and all, is gradually shifting to welcome youth input.
This can be achieved by hiring caregivers whom young people can bond and relate to, and expanding our very conceptions of mental health and the unique pins and needles experienced by every young person.
If you or someone you know is in distress, you can call:
- Canada Suicide Prevention Service phone available 24/7 at 1-833-456-4566
- Good 2 Talk Student Helpline at 1-866-925-5454
- Ontario Mental Health Helpline at 1-866-531-2600
- Gerstein Centre Crisis Line at 416-929-5200
- U of T Health & Wellness Centre at 416-978-8030.
Warning signs of suicide include:
- Talking about wanting to die
- Looking for a way to kill oneself
- Talking about feeling hopeless or having no purpose
- Talking about feeling trapped or being in unbearable pain
- Talking about being a burden to others
- Increasing use of alcohol or drugs
- Acting anxious, agitated, or recklessly
- Sleeping too little or too much
- Withdrawing or feeling isolated
- Showing rage or talking about seeking revenge
- Displaying extreme mood swings
The more of these signs a person shows, the greater the risk. If you suspect someone you know may be contemplating suicide, you should talk to them, according to the Canadian Association for Suicide Prevention.