Youth mental health care in Canada is the ‘orphan’s orphan’

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Note: This photo is not a depiction of any sources named in this article.

Note: This photo is not a depiction of any sources named in this article.

Julia Vance was a 19-year-old, first year Queen’s University student when she first began experiencing panic attacks almost every hour. On top of this, she was constantly tired and had completely lost her appetite.

Vance struggles with depression, a mental health illness she describes as the “inability to be okay.”

A study released by Statistics Canada last September, which showed an increase in reports of young people with mental illnesses, has highlighted the inaccessibility of psychiatric and psychological mental health services, and the need for re-evaluation of funding.

From her personal experience, Vance says she understands the lack of recognition of mental health illnesses in the Canadian healthcare system.

About 10 per cent of Canadians aged 15 and older reported experiencing symptoms of at least one mental health disorder, according to the Statistics Canada study, an increase from four per cent in 2002.

Mental health care involves both psychiatric and psychological treatments. Psychiatrists have the authority to prescribe medications after a diagnosis from a doctor. Psychologists are focused on observation, documentation and interpretation of personal and emotional effects of the brain.

“Medical doctors go through a different stream than clinical psychologists and part of that will include exposure to psychiatry and drug-based treatments,” says Dr. Andrea Howard, assistant professor of psychology at Carleton University. “Clinical psychology is more geared toward assessments and behavioural and cognitive interventions,” she says.

Howard says that for mental health issues, the first point of contact, especially with youth, is usually with a family doctor.

For young people like Vance, who was not living in her hometown when she began facing symptoms of mental illness, seeing a family doctor is not always the first step of action. Vance says one of the hardest parts was convincing herself she wasn’t alone.

MindyourMind, a provincial non-profit mental health program based in London, Ontario, works to connect young people struggling with mental illnesses, reaching out to youth from all over Canada due to its online presence. Their aim is to reduce the stigma of mental health and provide the means to psychiatric and psychological services.

Maria Luisa Contursi, program director and co-founder of MindyourMind, says mental health is often described as the “orphan of Canadian health care,” and children and youth viewed as the “orphan’s orphan.”

“I think the first step is for policy to be created and generated with youth voices present,” says Contursi. She emphasizes the difference between working with youth rather than for them, a misunderstanding she says the government struggles with today.

Inali Barger, who also works with MindyourMind, agrees that the first step to increasing accessibility and effectiveness of funding for youth mental health services is understanding the issue from a young person’s perspective.

“Youth need to be at every table where important decisions are made. If they are not at the table, they are on the menu, whether that is the intention or not,” Barger says.

Contursi explained how psychiatric services are covered under OHIP but psychological services are not, a system that has caused concern in how Canada is dealing with youth mental health.

“The challenge in Ontario is that only rich youth have access to psychological services,” says Dr. John Lyons, endowed chair of child and youth mental health research at the Children’s Hospital of Eastern Ontario. Only psychologists who work in hospitals are covered under OHIP, he says.

Clinical psychologist Dr. Cathy Chovaz says she sees a need for greater funding to psychological services, based on her experience working with children.

“Clinical psychology is a fee-for-service, which means many families cannot afford us,” she says. “I believe better insurance plans and more inclusiveness within OHIP would help target younger populations.”

In contrast, Lyons says it’s not an issue of needing more funding but rather an improvement of management of mental health services.

“That’s the game in Ontario; you create these waiting lists and then you advertise these waitlists to journalists and then use that to leverage the province to give you more money,” he says. “Sometimes money just reinforces bad habits.”

Lyons works with psychologists around the world, experimenting with his theories that mental health should be based on individualized growth rather than generally-accepted solutions.

“The mental health system is all about finding people and getting them to show up. It’s seen as a service,” Lyons says. “A service is a business where you’re hiring somebody to buy a product, like a hairdresser or butcher. Mental health is a transformational offering, it’s a personal change business and yet it’s managed like it’s a restaurant.”

Lyons says this perspective has left him “unpopular in certain circles,” however, he says a reorganization of the management of the Canadian health care system is needed.

“You can’t manage what you don’t measure, and if you’re not measuring the acts of a personal change business, you can’t actually manage it,” he says. “We end up managing access to care but not the effectiveness or the impact of that care.”

Chovaz, on the other hand, says money is needed to provide psychological services in schools, adding that adult psychopathology generally presents itself by the age of 14 years. With accessibility issues, youth are less likely to attain the resources they need to prevent mental illnesses from developing, she says.

She says youth with disabilities have an even harder time receiving mental health care. Chovaz also works with deaf children struggling with mental illness, a minority that she says deserves more recognition.

“There are many Canadians who do not have a family doctor, yet they are able to communicate with a clinician in a walk-in clinic,” she says. “Deaf children and adults, especially those whose first language is sign language, often do not have easy communication with their own families.”

Chovaz says more funding needs to be devoted to understanding and accommodating the needs of deaf children struggling with mental illnesses so “linguistically and culturally sensitive competent clinicians” will be available to them.

Although proposed solutions differ, psychiatrists and psychologists alike agree that accessibility of Canadian mental health care services needs improvement, beginning with those for youth.

Vance has been on medication for a year and a half and sees her psychiatrist weekly. She says she has fewer days where she “just feels down” and hasn’t had a panic attack in the past few months that she can remember. She describes the process of getting better as a “slow, very steep, uphill climb,” but one that is possible.

As for the systemic issues of mental health care, Vance says she hopes it will improve but says it’s important to understand that “it’s something that can’t be fixed overnight.”

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