To improve mental health, tackle problems early

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This is part of a series on improving mental health research, diagnosis and treatment. Join the conversation on Twitter with the hashtag #OpenMinds

There's a bogeyman that terrorizes Jacob Hartley. Jacob calls this monster "Bugger."

Jacob has always been an eccentric child, his mother Jennifer Hartley says. But his vivid imagination took a dark turn around the age of nine; he became fixated with the idea that other people's DNA could infect him and change who he was.

Bugger plants these insidious ideas in Jacob's head, making him believe his surroundings are contaminated. It prevents him from touching other people. It restricts him from going to school. Bugger is Jacob's obsessive compulsive disorder – and finding proper treatment for it has been nothing short of a nightmare. As Jacob, now 12, explains: "It's like having someone there and then they just stalk you and keep stalking and telling you what to do. … I try to fight it, but I can't do it."

His mother has lost track of the number of times she's brought Jacob to the hospital emergency department. She sought out support groups, hotlines and resource centres, but since he wasn't in immediate danger of hurting himself or others, Jacob's case was considered low-priority. The wait to see a specialist felt interminable and his condition continued to worsen.

Jacob's desperate quest for treatment is shared by many children and adolescents across the country. According to the most recent information from the Mental Health Commission of Canada, more than one million, or 23 per cent of Canadians aged nine to 19, are living with a mental illness. And by some estimates, a staggering three out of four young people who have mental-health issues do not receive the help they need. At almost every turn, they encounter barriers to accessing timely and appropriate care, ranging from a lack of resources to their own reluctance to seek help due to shame, embarrassment or fear of prejudice.

Untreated, they risk failing at school, floundering at work, getting into trouble with the law, facing homelessness, being repeatedly hospitalized or dying by suicide.

The Mental Health Commission reports the total cost of addressing mental-health problems and illnesses over the next 30 years is expected to exceed $2.5-trillion. Yet some of these costs could be prevented. An estimated 70 per cent of mental-health problems emerge in childhood or adolescence and evidence shows the earlier they're tackled, the better the chances of positive outcomes.

Such a big problem requires big solutions, especially as more young people, freed from the discrimination of previous generations, speak out and seek help. While we've seen increased attention and funding from various levels of government (from community boards to federal agencies), we will be left with a patchwork of initiatives unless concrete steps are taken to improve access to diagnosis and provide funding for treatment nationwide. A few initiatives under way are worthy of national attention.

Dismantling silos

One of the boldest of these initiatives seeks to radically change how young people receive mental-health treatment with the ambitious goal of driving down waiting times. Modelled after Australia's Headspace National Youth Mental Health Foundation, the ACCESS Canada project aims to provide one-stop hubs where youth can seek the various services they need.

The $25-million, five-year project, parts of which are currently under way, is funded by the federal government's Canadian Institutes of Health Research and the private Graham Boeckh Foundation.

A critical step is to streamline the perplexing array of mental-health service providers. ACCESS (an acronym for the unwieldy formal title, Adolescent/young adult Connections to Community-driven Early Strengths-based and Stigma-free services) will integrate various community services at its 12 sites across the country. In most of these settings, the project will involve establishing a central community space, where young people and their families can see a trained clinician, peer support workers and family support workers, who could provide front-line services and connect them to specialized services, says Ashok Malla, director of the prevention and early intervention program for psychoses at Montreal's Douglas institute that is leading the project. Those reluctant or unable to visit these centres in person will have access to clinicians and specialists online.

The goal is to have ACCESS clinicians assess young people within 72 hours of seeking help and to get them appropriate care within one month.

That compares with current waiting times of five or six months in some of the project's targeted sites and a year or more for some 6,000 children and adolescents in Ontario. According to a report released in May by Children's Mental Health Ontario, the number of kids left waiting is expected to double by 2016.

Reducing waiting times is "the most critical part," Dr. Malla says. "We don't want them to end up in the emergency department. It's not a good place for young people to be."

Yet, that's precisely where many wind up.

The rates of emergency department visits by individuals aged five to 24 with a mental disorder jumped by 45 per cent between 2006-2007 and 2013-2014, according to a report released in May by the Canadian Institute for Health Information. The report also showed nearly 40 per cent of children and young people who went to a hospital emergency department for a mental disorder had three or more repeat visits, suggesting "challenges in obtaining appropriate care in the community."

By co-ordinating services and bringing them together under one roof, Dr. Malla says ACCESS will cut red tape and put a stop to the endless referrals patients encounter before seeing a specialist.

Jennifer Hartley says this streamlined approach would have alleviated a huge amount of stress for both the family and for Jacob, who is now in a one-year day treatment program at the Children's Hospital of Eastern Ontario.

"If [only] you could just go to one place and say … 'Here are our issues. How can you help?'" Hartley says. "You do that for so many other things. Like, you go to your bank, right? And you can get your mortgage, you can get your bank account, you can have your RRSPs, you can have all of that. Something like that is needed [for mental-health care]."

ACCESS will do just that if Dr. Malla and his team succeed in bringing existing service providers together at each site.

"Often it's not just lack of resources, it's just willingness for people to work together, you know, because they've never worked together before," he says.

In Australia, Headspace (established in 2006) has a network of some 80 centres throughout the country where youth can seek a wide ranges of services, including for general and mental health, counselling, employment, and substance abuse. Headspace reports that it has since helped more than 120,000 young Australians dealing with such issues as depression, anxiety and stress.

Mental-health literacy

While it may take years before the ACCESS model becomes the norm, a renowned teen mental-health expert is advocating for a more immediate route: mental-health literacy in schools. Think of it as a Swiss Army knife solution – multiple problems tackled with a single tool.

Stanley Kutcher, a professor in the department of psychiatry at Dalhousie University, has helped introduce mental-health literacy to high schools throughout the country, including Alberta, Ontario and Nova Scotia, as well as in other parts of the world, such as Brazil, Malawi and Tanzania.

His approach teaches young people what it takes to maintain good mental health and to understand mental illness. The idea is to help students distinguish between what's normal and what's worrisome, and to boost what he calls "help-seeking efficacy," that is, to learn when and how to get help. When mental-health literacy is taught in regular classes to all students, the same way students learn math or history, it decreases the shame and prejudice associated with mental illness, he says.

Dr. Kutcher notes that the benefits of mental-health literacy are immediate and extend to those who teach the material as well.

"Right away, in the most simple way possible … we deal with teachers and students, and that spills over into school environments. You can't get any simpler or any cheaper than that," he says. And because teachers ideally learn how to teach mental-health literacy the same way they do other curricula subjects, they aren't dependent on training from mental-health experts, who may not be available in certain areas, he adds.

There's yet another advantage that may seem counterintuitive. Dr. Kutcher explains that increased knowledge of mental-health issues doesn't necessarily lead to a glut of new cases demanding already overstretched services. Rather, he says, the quality of referrals that mental-health services receive changes. "You get kids who really need to be there," he says, noting that it actually helps improve access to those who need it most.

Simple as his solution may sound, its application rests on an idea that some may find challenging: that schools are not just for reading, writing and arithmetic. "Our social contract has changed," he says. "People are now realizing that the school should not only be a place to educate, but it should also be a vehicle for assisting in care."

Mental-health literacy training might have helped Shilpa Narayan reach out for help sooner.

The 19-year-old Simon Fraser University student was 12 when she began experiencing anxiety and depression. "I was just confused, I was lost. … It was something that was so new to me," Narayan says, noting there were days she simply couldn't get out of bed. "It was scary."

Besides not knowing how to identify and express her mental-health concerns, she also feared what others would think. "If you speak out or if you reach out for help, you're considered weak," she says.

She suffered in silence for months before confiding in a teacher. That teacher brought her to a school counsellor, who put her on the path to finding treatment.

Although the solutions for improving mental-health care in this country are varied and many, some young people say that having sympathetic listeners in their lives is a good start.

"Conversation and education is key," Narayan says. "No matter what, it's good to even have a few people that you can talk to that you trust, that you can be fully open and honest with."

The Centre for Addiction and Mental Health has purchased advertisements to accompany this series. The organization had no involvement in the creation or production of this, or any other, story in the series.