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Ontario mental-health services struggling to keep up with youth demand, report finds

A worker walks through the Centre for Addiction and Mental Health (CAMH) Emergency Department in Toronto in this file photo.

Mark Blinch/The Globe and Mail

A new report on children and youth mental health and addiction in Ontario paints a bleak picture of the challenges facing today's youth and the difficulties the health-care system has had in adapting to increased demands.

Youth visits to doctors and emergency departments, as well as hospitalizations, have risen sharply in the province from 2006-14, highlighting the need for more mental-health care and addiction services that are easier to access, speedier and more geographically dispersed, according to the 2017 Scorecard of Mental Health of Children and Youth in Ontario.

"Historically, it's been an ocean of unmet need and the number of kids accessing services has increased," says Dr. Paul Kurdyak, a psychiatrist with Toronto's Centre for Addiction and Mental Health and a scientist with the Institute for Clinical Evaluative Sciences, (ICES) a non-profit research institute that released the report. "The system is becoming more responsive to the need … but we need to learn lessons from other areas of the health-care system, where real progress has been made in defining who needs services and then creating an actual system to meet those needs.

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"When a child develops a cancer, there is a whole array of processes and care that automatically snap into place so the child and family receive the care they need. This report shows the [mental health/addiction] services provided to youth and children [which for the purposes of this study are from birth to age 24] are not so systematically arranged. Not as well-organized. And not as easy to access."

Dr. Kurdyak added there is a pressing need for more health-care services in Northern Ontario, where issues such as suicide and self-harm "remain a persistent and troubling phenomenon," reflecting specific mental-health needs within First Nations communities.

Youth visits to doctor offices jumped 25 per cent between 2006 and 2014, according to the report. In the same period, the rate of emergency department (ED) visits for mental health and addiction soared 53 per cent. Hospitalizations were even higher, with a 56-per-cent rise.

Anxiety disorders were the most common reason for ED visits among children and youth during the period and the second most common reason for hospitalizations, behind mood disorders. In 2014, only 4 in 10 (38 per cent) children and youth who were admitted to hospital for mental health and addictions received follow-up care with a physician within seven days of being sent home from hospital.

"The rising use of emergency departments as a point of access, and the low rates of follow-up, are both areas of concern that need to be addressed," says Dr. Kurdyak, who works in the emergency department at CAMH. "I hear from young people all the time, 'I don't know were to go. I couldn't wait.'"

"The fact that 50 per cent of youth who come to ERs haven't seen a physician first suggests the different silos of health care aren't integrating well … and that some of this is preventable with earlier, and timelier care," agrees Dr. Astrid Guttmann, a pediatrician at the Hospital for Sick Children and chief science officer at ICES.

However, she added she does see an upside to the spike in visits. "Perhaps some of the stigma surrounding mental health and addiction is decreasing."

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Dr. Kurdyak says the report card shows that clearly something is happening in this generation "where they are experiencing higher rates of depression and anxiety.

"It's speculation on my part, but I do wonder about the 24/7 access to social media. If you're prone to depression and anxiety to begin with, you're bound to read into comments about yourself as negatively as possible.

"Social media is actually 24/7 scrutiny media. It's relentless."

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