Taking the Next Step Forward

Building a Responsive Mental Health and Addictions System for Emerging Adults

WHAT HAVE WE LEARNED?

CURRENTLY IN CANADA:

• Promising models and best practices for EA do exist in various provinces and regions.
• Some youth-specific strategies have been developed, but few provinces or territories have implemented evidence-based approaches to transitions management or EA clinical service delivery approaches.
• No national government leadership, strategy, or pan-Canadian policy guidance exists to support policy makers, planners, and service providers working to support EA in transition.
• No province or territory has fully implemented transitional protocols for EA.
• No policy requiring that health authorities and providers follow protocols currently exists.
• No province or territory is tracking youth across this transition.
• No province or territory has mandated, designated community- or hospital-based specialist clinical services for EA, beyond First Episode Psychosis programs.
• EA are not seen as a distinct population from the policy, planning, funding, and/or service delivery perspective.

In relation to EA and their needs, current research, policy, and programming demonstrate that:

• Up to 52 per cent of young people engaging in the transition process disengage at a time when serious mental health problems or illnesses are most likely to occur.
• Connections with peers and families have been shown to support motivation to engage with services.
• As the brain matures, risk-taking behaviour decreases, and reasoning and capacity to modulate emotions increases. These neurobiological developments peak in the mid-20s.
• A high proportion of EA with mental health issues also use substances.
• Continued engagement with EA is key to improving their mental health outcomes, and for the development of responsive program models.
• Without access to needed assessment and treatment services, health, social, and employment outcomes are compromised, especially for the most vulnerable EA.
• Policy and dedicated funding with a clear priority on EA is important.
• A collaborative, cross-ministry policy approach responding to young people with mental health and addiction issues who are involved, or may need to be involved, with multiple systems and sectors of care is necessary.
• High-profile national champions with political influence and academic and clinical credibility have an impact.
• National research and training initiatives will drive program development.
• There is a need for nationally funded, evidence-based practice and clinical guidelines, based on EA-specific research.
• Collaborations between private and public funders can create change.

WHAT CAN WE DO?

In order to effectively address the needs of EA transitioning to adult mental health and addiction services, an integrated, accessible, and responsive service system needs to be in place. We require a full continuum of services — from universal prevention and health promotion to the most intensive level of services for a small proportion of EA with the most complex needs. Developmentally competent service providers must deliver evidence-based assessment and intervention services and supports across this continuum. We also need to keep track of how EA are faring as far as engagement and outcomes. Taking the Next Step Forward makes recommendations for a continuum of services offering seamless movement through and between levels of service intensity, based on individual, changing needs.

Coordinated approaches will need support and leadership from all levels of government and, most importantly, require the input and guidance of EA and their families and communities. In Taking the Next Step Forward, we offer a reframing of the problem: where we once asked how to support youth who are transitioning to adult mental health services, we now advance a systemic view that addresses more generally how to support EA and their engagement with the full range of prevention, assessment, treatment, and psychosocial services. We make recommendations around an EA service continuum adapted from, and building on, existing provincial/territorial and national mental health and addiction strategy and planning documents, including the MHCC’s Mental Health Strategy for Canada. In order to prevent harm, address needs, and ensure access to services at the required level of intensity and specialization, our ultimate goal is to have a full continuum of EA services available in every jurisdiction.