Last year, when 17-year-old Kiana was "struggling to hold it together," she wasn't sure where to turn. The Toronto teenager had dropped out of school and was haunted by "weird thinking and unresolved issues about my childhood." She knew her mental health was precarious and her life was unravelling.
Concerned friends pointed Kiana (who asked that her surname be withheld) to Oolagen, a youth mental health centre in downtown Toronto. She visited the walk-in clinic, saw a counsellor immediately and was referred for therapy.
"It is really helpful for me, way better than seeing a doctor or a psychiatrist," Kiana said. "They helped me come up with solutions to my problems."
She's back in school, happier and feels her life is back on track.
Oolagen is one of 440 community-based agencies across Ontario that offer mental health services for people aged 12 to 18. The network, which helps more than 150,000 youth annually, is financed by the Ministry of Children and Youth Services to the tune of more than $500-million a year.
Ontario is the only province that offers youth mental health services outside the health system, a model that has been in place since 1971.
The counselling, provided principally by social workers, most commonly involves depression, anxiety, parent-youth conflicts, family violence and trouble at school. Young people who are suicidal or who have severe mental health problems are referred to emergency rooms and hospital-based psychiatric services.
An estimated one in five Canadians – including children and youth – suffer from a diagnosable mental illness. Almost all have mild or moderate illness that is treatable.
But only one in four young people receive treatment, in large part because it can be hard to come by. The waiting time for psychological care stretches to months and sometimes years. Psychological care is not covered by medicare, so a basic treatment plan (10 one-hour sessions) would cost parents at least $1,800.
Community mental health agencies offer an accessible, affordable alternative. Yet, these groups are largely invisible. Most don't even use the words "mental health" in their names; rather, they have generic monikers, such as Pathways for Youth, Children's Centre, and Child and Parent Resource Institute.
"We know the work being done in these agencies is effective. A lot of young people with mild and moderate mental health problems are getting the help they need," said Gordon Floyd, chief executive officer of Children's Mental Health Ontario. "But the system is uneven, unco-ordinated and not visible."
The youth mental health system is also poorly financed and badly overseen by its government funder. Ontario's auditor-general has raised this issue on three occasions, in 1997, 2003 and most pointedly in 2008.
The good news is that change is afoot. In 2011, Ontario adopted a Comprehensive Mental Health and Addictions Strategy, with particular emphasis on youth.
Since then, the province has invested a bit in mental health services within the health system, to cut waiting times for treatment of children and youth with life-threatening problems such as severe depression and eating disorders.
It has also made a big commitment to mental health programs in schools, bringing back school nurses and school counsellors whose jobs were slashed in the Mike Harris years. (Many community health centres such as Oolagen also have counsellors in high schools.)
In coming months, the community health centre model will also be modernized. Instead of 440 contracts with individual providers, the Ministry of Children and Youth Services will finance a lead agency in each of 34 regions and they will, in turn, fund others. More importantly, the new contracts will ensure that the same core services are offered in each region, to try to create more continuity and eliminate overlap. This approach should create more accountability and more bang for the buck.
One of the great strengths of Ontario's approach to youth mental health is that services are community-based, not provided by a faceless bureaucracy. On-the-ground service providers should, in theory, be more responsive and innovative. But for that to happen, they can't work in isolation and on shoestring budgets as is often the case now.
The next step needs to be to get the word out to young people (and their parents) that these services exist and are accessible, while creating a real network that shares ideas and solutions as well as ideals.
The walk-in clinic approach is ideally suited to teenagers; yet, most centres have limited hours – if they have a walk-in clinic at all – because they don't have enough money.
"Young people need services when they need them," said Lydia Sai-Chew, chief executive officer of Oolagan. "Adolescents are not patient and are easily discouraged by waits."
Adolescence is also a vulnerable time of life, when about 70 per cent of all mental health problems first arise. "If we can get them help early, we can prevent these problems from becoming huge issues for the rest of their lives," Ms. Sai-Chew said.
About 75 per cent of children and youth who get counselling and treatment at community mental health centres emerge better. That's an astoundingly good success rate in the mental health field.
But too many young people are simply not getting help, or being forced to wait too long for the help they need. "We simply can't keep up with the demand," Ms. Sai-Chew said.
We need to do better by young people with mental health issues. We can pay to treat them now, or we can pay much more in their adult years.
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