Transforming Youth Mental Health

Emerging evidence shows that mental illness and substance use are widespread and impose a larger burden on society than cancer or other major disease areas.

In Canada, more than 70 per cent of people who develop a mental illness do so by the age of 25. Moreover, a wave of increased help-seeking behaviour has been washing over the mental healthcare system.

The Canadian Institute for Health Information reported emergency department visits by children and youth (5 to 24 years) for mental health or substance use treatment rose 75 per cent and hospitalizations jumped 56 per cent between 2007 and 2017. Furthermore, young people and their families report not being able to access the services they need in a timely fashion.

Many services for youth mental health in Canada have had several shortcomings:

• Long wait times
• Unclear pathways to care (where do I go for help?)
• Fragmented and siloed care – little communication and coordination between services in the system
• Limited meaningful engagement of youth and family carers
• Treatment is often neither youth-friendly nor culturally appropriate
• Service cliff at 18 (young people are forced to transition to the adult care system at age 18 when many youth are refused service)
• Inadequate and often inappropriate care
• Lack of measurement and evaluation to assess quality and outcomes of services

As an illustration, a typical community in Canada with a population of 30,000 might have between 15 to 25 different organizations that serve struggling youth. These organizations often do not work together and are funded through multiple, uncoordinated funding streams.

A young person seeking help in this community will likely experience confusion about where to get help, long wait times (up to 18 months), uncoordinated service from multiple providers and the need to find new service providers at age 18.

The system could be described as fragmented and inefficient, with poor coordination of care and large service gaps.

More facts

• The average duration of untreated mental illness has been estimated to be 1 to 2 years for psychosis, 6 to 8 years for mood disorders and 9-23 years for anxiety disorders (Wang et al 2005).
• By age 40, one in two Canadians will have experienced a mental illness (according to the Mental Health Commission of Canada).
• A large survey of Ontario university students showed that between 2013 and 2016, there was a 50 per cent increase in anxiety, a 47 per cent increase in depression, and an 86 per cent increase in substance use. Suicide attempts also rose 47 per cent during this period.

A once-in-a-lifetime opportunity to re-imagine how we serve youth is emerging due to the growing recognition of the inadequacy of services for youth combined with the rapidly growing demand for services. Moreover, Canadian governments are increasingly prioritizing youth mental health in terms of both policy reform and funding. Because of this and the work of many people and organizations, including the Graham Boeckh Foundation, a growing pan-Canadian and international movement is emerging to build easily accessible and integrated services where youth and families are at the centre of care. In Canada, we call this movement “Integrated Youth Services” (IYS) and several major projects are underway across the country focused on transforming services for youth aged 12 to 25.

The Foundation’s strategy has been to partner with mental health experts, various Canadian governments and other philanthropic organizations to build, evaluate and scale integrated systems of care for youth mental health. More precisely, the focus has been on partnering directly with Canadian provinces and territories, as they have authority over health and social services, to build models of care that can be scaled across their jurisdiction. These large, multi-million-dollar projects are building what has become known as Integrated Youth Services. They are building branded systems of care, in some cases with a focus on integrated service hubs, that provide easy access to a holistic suite of youth-appropriate and evidence-informed services. Overall, the Foundation sees IYS as a set of principles and methods that can be implemented through different models across jurisdictions and types of communities (more info on What is IYS page).

The Foundation is helping to build a dynamic pan-Canadian and international ecosystem for IYS, by supporting initiatives (research, innovation and quality improvement). In addition, the Foundation is fostering knowledge exchange and mobilization for IYS.

The Integrated Youth Services movement in Canada has been inspired by efforts in a number of other countries to transform youth mental health services. Notable examples from abroad include the following:

Australia has Headspace, a youth-friendly, one-stop-shop that provides mental and physical health, substance use and work supports. There are currently over 100 Headspace centres across Australia.

In France, les Maisons des Adolescents comprises over 100 access centres across the country that provide a variety of integrated mental health and related services.

Across Ireland, Jigsaw and other organizations provide rapid access to youth friendly services.

In New Zealand, a network of hubs called Youth One Stop Shops, provides rapid access to a comprehensive suite of mental health and related services.

Other countries are beginning to set up Integrated Youth Services initiatives. For example:

In the United States, there are plans to open three allcove centres to offer a range of services to youth experiencing mental, physical and emotional challenges in the state of California.