Brave New World

Integrated service hubs are an innovative approach to transforming youth mental health care in Canada.

Jessica’s mental health struggles started when she was 15 and accelerated when she left home at 18 to attend university in another province. She had the scholarships, grades, extracurriculars, and volunteer hours to attend one of Canada’s most prestigious post-secondary institutions. But once her studies began, the psychological cracks from her early adolescence began to widen. Unfortunately, although she was brave enough to ask for help, the resources available at the time were not well developed.

“I was sent (once) to see the campus psychiatrist. I still remember the shame I felt just going into the mental health building. In those days, it wasn’t part of the physical health services with doctors and physiotherapists — it was a separate building altogether. Anyone that saw you go in there would know that you were ‘crazy,’” she said. “He recommended a course of antidepressants and talk therapy, but I thought I knew better. Besides, I couldn’t access these things without my parents’ insurance plan, and that was a fate worse than death. I couldn’t let them (or myself) down by showing that type of weakness.”

As hard as it is to hear Jessica’s story, it is regrettably all-too common. Seventy per cent of persons living with a mental illness begin showing symptoms before age 18, and it affects some 1.2 million of children and youth.

Help wanted
Despite a growing awareness of the importance of mental health, and an increasing demand for care, youth ages 15 to 24 are highly vulnerable. It is still difficult for young people to get help, especially those who are marginalized or living in rural and remote areas. The statistics are sobering:

• Just 1 in 5 children in Canada receives appropriate mental health services.
• 39% of Ontario high-school students show a moderate-to-serious level of psychological distress (symptoms of anxiety and depression). A further 17% display a serious level of psychological distress.
• About 28,000 children and youth in Ontario are on waiting lists for mental health treatment (as of January 2020). This number has more than doubled since 2017.
• Average wait times in Ontario for children and youth: 67 days for counselling and therapy, 92 days for intensive treatment.
• Access to services in Ontario differs based on geography: in some areas, children and youth can access services almost immediately; in others, it can take up to 2.5 years.
• About 40% of parents say they wouldn’t tell anyone (including the family doctor) if their child was experiencing a mental health problem.

While affordability is a barrier to care for many people, other obstacles include not knowing where to go or how to access care. Stigma and negative perceptions about mental illness are also important factors, given that 60 per cent of those living with a mental health problem or illness won’t seek help for fear of being labelled.

The academic pressure cooker
It can be difficult at any age to recognize or accept that you might need help with your mental health. But for students it can bring unique and complex challenges. Transitioning to post-secondary studies coincides with other big life changes. It could be the first time they leave home and live as fully independent adults. On top of juggling relationships, finances, housekeeping, and staying healthy, students also need to manage their own learning.

They may also face a lot of pressure to perform, succeed, fit in, and compete for scholarships. Financial pressures. Family expectations. Academic pressures. It can all be overwhelming.

Such an intensification often brings mental health concerns to the surface — such as anxiety, depression, substance use, and eating disorders — and struggling with mental health makes things more difficult. It can affect your memory, concentration, energy levels, decision making, and motivation.

Yet, because students worry about what their professors or other students might think, many struggle in silence. Students often hesitate to admit they have test anxiety or need an accommodation based on the stigma associated with mental health problems. Studies in the U.S. show that just 20 to 40 per cent of students who experience a mental health problem seek treatment while enrolled in college.

For Jessica, when the stress and pressure of getting scholarships for graduate school brought on new difficulties that her medication could not control, she moved far away from family and friends to a place where she didn’t know anyone. “I didn’t know the system and was under immense pressure to perform, and that was when my mental health hit the breaking point,” she said.

Playing detective and jumping through hoops
The students who most need mental health care services are often the least likely to seek help and find it. For those who do get access, care usually comes with a limited number of hours, after which there’s no warm hand-off to services in the community. When Jessica sought help, she was offered a set number of appointments at the campus counselling centre. Only after several hospitalizations in the local psychiatric hospital did she receive regular mental health services. Jessica’s experience with seeking care in the community was like another ordeal.

“I had to travel all over the city to access services and had to tell my story repeatedly — recalling significant trauma, suffering, and abuse. Each time, I felt like I was experiencing it all over again. And with my muddled thoughts and poor memory, remembering what medications I was on, what changes were made to my dosages, what treatments I had tried — it was all just a blur. I carried around a binder to keep it straight. It was exhausting, and I felt that I simply couldn’t keep going on.”

 As Jessica’s experience shows, while navigating the labyrinth of health services is challenging at the best of times, when you’re not feeling well, doing so can become overwhelming. If you’re also facing other challenges, like housing, income pressures, or discrimination, it may feel almost impossible to cope.

Integrated services: An innovative approach
Over many years, young people have been facing limited access, fragmented services, and ineffective mental health care. But thankfully things are shifting. An innovative approach called Integrated Youth Services (IYS) is transforming the way youth-focused services for mental health, substance use, primary health care, and social services are delivered. With IYS sites in most provinces and one territory, people between 12 and 25 can now get the help they need, when they need it, in one youth-friendly location.

How is IYS changing outcomes for young people in Canada? We asked Dr. Karen Tee, Associate Executive Director of Foundry, a provincial network of integrated youth health and social service centres in British Columbia. “We know a quarter of youth in Canada are affected by mental health and/or substance use concerns, and believe Canadian youth deserve easy access to community supports for these concerns,” said Tee. “IYS initiatives are transforming the health care system by designing services in collaboration with young people, families, caregivers, and service providers to ensure it meets the needs of young people. Through Integrated Youth Services currently being offered across Canada, we are seeing health and wellness outcomes improving for young people and families and caregivers. We’re reaching more youth and families and caregivers in their own communities and as a result, they have easier access to resources and supports designed specifically for them to address concerns in all aspects of their lives.”   

What does the promise of integrated mental health care look like to people like Jessica?

“I think my story would have been significantly different — significantly improved — had there been IYS when I was younger. I would have had a single place to access mental and physical health care where stigma was reduced, where I wasn’t retraumatized in retelling my story, where I wouldn’t have to lug around a binder to access basic care. Young people need a team of people to relate to, not a network of clinics staffed by different clinicians each time you visit. Young people need a soft landing to independent health care because they are trying to figure out so many other things at that time in their lives. They aren’t just little adults. They are young people trying to navigate a million new, exciting, challenging things.”

Key findings about IYS

• 86% of youth would recommend youth hubs to other youth.
• 2 out of 3 parents of youth would recommend access hubs to them.
• 84% of youth said that a youth hub would be useful, especially their flexible hours, the ability to just walk in without an appointment, and having access to many different services in one location.
• 60% of youth could see themselves visiting a hub (75% among those with a diagnosed mental health issue).
• In the past two years, 57% of young people experienced a mental health issue, but fewer than 1 in 3 sought help.
• 31% of youth said they had a diagnosed or undiagnosed mental health condition.
• 27% of youth who had a mental health problem in the last two years said they weren’t sure where to get help. 40% were too shy or embarrassed to talk about their problem (higher among ages 18-25).

These findings are based on unpublished data from an online survey conducted by Bell through a third-party panel provider (Schlesinger Group) with Canadians from March 22 to April 7, 2022, and was statistically weighted to represent the Canadian general population for region, gender and age.