Navigating the mental health system for youth and families

A mom and dad wait to talk to the crisis nurse in Lindsay’s Ross Memorial Hospital about their child, who has been brought to the emergency room several times for mental health situations in the last few months. The parents have been up all night and it shows: their eyes are clearly red and swollen from another night of crying and worrying, their brows wrinkled from another night of explaining — again — the situation to first responders.

Acronyms, diagnoses and waiting lists are duly recited with exhausted clarity — they sound and look like flood victims who have protected their home with a three-foot wall of sandbags (built exactly to recommended specifications) to stop a swollen river that’s six feet high and rising.

In our system we carefully balance individual and collective rights, in theory, to prevent abuses by the state. In this case, the child is over 14 so he can refuse the crisis nurse or doctor permission to even talk about their case with the parents. And, provided that the child is not a clear and immediate threat to themselves (usually the next morning), the child cannot be legally held for further help, regardless of what happened the night before and the week before and the six months before that. If the parents can feel anything at all this point it’s a giant invisible thumb on that scale of rights. So when the nurse can’t talk about the child in question she mentions a ‘Families Journeying Together’ program run by Canadian Mental Health Association (CMHA) to address the mental health issues arising from having a child with a mental health issue. It’s probably needed in this case but it feels like a mechanic telling you need some body work done as the seized engine of your car has burst into flames.

Fortunately for our parents in this story, there are a lot of programs for youth mental health in the City of Kawartha Lakes. As reported in the first story on this issue (Are the Kids Alright?: Youth Mental Health in Kawartha Lakes), these parents are far from statistically alone in the City of Kawartha Lakes. And, when they manage to navigate the confusing list of organizations and survive the waiting times that seem like an eternity, they will find an array of programs. It is a system stretched to capacity but the programs are there.

Chimo Youth and Family Services offers counselling and therapy, day treatment, in-school and court services and residential treatment. The Boys and Girls Club  runs targeted prevention programs in conjunction with local school boards (Reach Youth Support Program, Take it EASY, Flex Your Head) and a specialized youth mental health program (run in conjunction with Chimo) called Adventure Quest that has been delivered at the Club for the last eight years. The John Howard Society offer several programs — a free service open to all youth — that helps and encourages mental wellness under their umbrella of S.O.S. (strategies, options, solutions.) Unless mandated by a court order all these programs are voluntary but are staffed by caring professionals who specialize in engaging youth to participate in their mental well-being.

All parents worry about their child’s future. It’s part of the job description. For the parents of a child dealing with a mental health issue, those worries will intensify as the family works their way through the non-linear process of addressing and improving mental health, which may be complicated by issues of addiction, behaviour and legal issues, to name just a few. There may well be a pill for it, but that will only be one element of an action plan with many moving parts. So many moving parts, in fact, that parents might have to go to Children’s Services Council to get a case manager to deal with the other agencies involved in their child’s care. At some point though, perhaps even after some small success on the roller-coaster ride of therapy and programs, the fear of ‘what happens when they are older?’ strikes. And according to local experts, that fear is not entirely unfounded.

One historical problem has been systemic: some organizations deal with children and when that child becomes a (young) adult, a different service provider must now take over. In the social services this is called ‘transitioning.’ As Lynda Nydham of Children’s Service Council tells the Advocate, “transitions for youth in any service sector present many challenges, and families would not likely consider them to be seamless. Other examples would include youth with dual diagnoses, and youth with neurodevelopmental disorders that are not eligible for developmental services. There are a number of local, regional, and provincial initiatives that are currently in place to support better transitions for youth with any kind of special need to the adult sector; all of these are works in progress.”

As Teresa Rye, program manager at Chimo explains, local youth mental health organizations are using ‘The 4Step Process’ which was “developed in our committees with the support of the Centre for Addiction and Mental Health as per the implementation of the Open Minds, Healthy Minds comprehensive mental health and addictions strategy in the province.

“The continual oversight of this local process is through the TAG (Team Approach to Growth) Committee comprised of children and adult service partners from CKL and Haliburton.”

Jonathan Hewitt, a program manager at the Canadian Mental Health Association (the lead local agency for adult mental health) explains those four steps as connection between agencies, connecting with youth to start the transitioning process early, agency collaboration and specific approaches while the youth is in ‘transition’ between agencies.

If that sounds complicated it’s probably because it is. It’s also a reflection of how we as a society treat mental illness. There’s an excellent awareness campaign by the Centre for Addiction and Mental Health that reminds us: “mental health is health.” But that’s not how we treat it. If (God forbid) a child had cancer, their treatment would not be different when they turned 18. Some health care providers might change over time but they would still be basically in the same system. For mental health, transitioning into adulthood means going to an entirely new system.

And that system is chronically underfunded with less programming options. Explains Hewitt, once children transition to adult services “much of the funding for supports is reduced or is non existent for the adult sector. Furthermore, supports are also more dependent on the input of the individual and their willingness to engage with service providers. This can become a barrier for youth and their families when challenges in engagement lead to problems with maintaining services as they are voluntary in nature.”

For the parents of kids dealing with a youth mental health issue, they have to tackle challenges one day at a time, hoping that the local coordination going on between agencies continues to bear fruit and probably praying that any services for their soon-to-be-adult child will be there at all.