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Age gap means mental health stumbling block for youth in Ontario

Molly Schoo started mental health treatment at age 12.

Diagnosed with depression and an eating disorder, she was admitted to SickKids in Toronto and continued to get youth-oriented care throughout her teens.

By the time she went away to university, though, she was feeling better and no longer getting care at the children’s hospital.

Then she relapsed and had to withdraw from school.

She would have liked to return to SickKids but she couldn’t. She was now over 18 and too old for the services she had known for years.

“Trying to find care after that was excruciatingly painful,” says Schoo, now 23.

Schoo is one of many young people in Ontario, and across Canada, who hit a stumbling block in their mental health care because of the gaps between youth and adult services, which can lead to a different therapist, different institution, even a different government ministry handling your care.

“Mental health and addiction services for young people typically cap out at age 18,” says Christopher Canning, manager of policy and research at the Mental Health Commission of Canada.

There’s this forced removal from the system that young folks may have been in from young children or early adolescence.”

Once they have gotten too old for youth services, “transitional age” or “emerging” adults as they are called in the mental health care system, must find new professionals to treat them.

That process can involve wait times of six months to a year or more, or out of pocket costs for faster access.

And, when they do get to see a professional, they may find the treatment methods markedly different from their youth services experience.

“The way adult psychiatry, for example, administers care is a lot different from a child psychiatrist, who often focuses on the family and has parents involved in the care,” says Canning.

After seven months on a waiting list, and short stints in several different hospitals, Schoo got into an adult in-patient eating disorder program. But, with other patients as old as 55, she felt like an outsider because of her age.

And, she says, the staff’s approach was different, even less compassionate, from the kind she was used to in adolescent treatment.

It can be a common complaint amongst young adults.

“You develop a relationship with a trusted (care) provider or institution and suddenly that trust is gone because you’ve aged out,” says Dr. Mario Cappelli, a psychiatrist working with the mental health commission.

The transition to adult services comes at time of life that, for anyone, carries a great deal of change.

“You have young people that are moving out, finding work, going to school, and are meeting this phase of life that is complicated and hard,” says Canning.

Over 50 per cent of young people simply stop seeking treatment during this transition period, putting them at a “significantly higher risk of developing more enduring mental health problems later in life,” according to a 2015 Mental Health Commission of Canada report co-authored by Cappelli.

Usually these youth will only re-engage with mental health services when they are experiencing a crisis, like a panic attack or a relapse of depression, says Cappelli.

Then, they are most likely to be accessing services through adult emergency departments.

Multiple provincial ministries oversee mental health services in Ontario.

The Ministry of Health and Long Term Care funds most adult programs, and some child and adolescent services.

The Ministry of Child and Youth Services funds community-based mental health services for youth up to age 18.

Young Ontarians may also be routed to mental health services through the Ministry of Community and Social Services, Ministry of Justice and Ministry of Education through its schools.

“Young people and families have been frustrated trying to figure out where to go and who to talk to so they and their children can continue to receive the help they need as they transition out of youth services,” says Ministry of Health spokesperson David Jensen in an email.

The Ministry of Health and Long Term Care and the Ministry of Child and Youth Services are working together, in collaboration with other key ministries and with the advice of the (the provincial government’s) Mental Health and Addictions Leadership Advisory Council, to improve access to quality services and the transitions between them.”

One means of bridging the gap between child and adult services, says Cappelli, is to offer options that begin in adolescence and continue through a person’s mid to late-20s.

“The transition happens much later on ... when we know that there is more maturation emotionally, developmentally and physically,” says Cappelli, who sits on the board of one such organization, Stella’s Place, in Toronto.

LOFT Community Services, in southern Ontario, runs a Transitional Age Youth Program for 16 to 26-year olds.

With funding the Ministry of Health, the Ministry of Child and Youth Services and private donors, LOFT helps young people connect with, and navigate, mental and physical health care, learn life skills and find housing, if needed.

“We also have an adult and a seniors program,” says Julia Vanderheul, co-ordinator of the Transitional program. “If they still need care (at 26) we just transfer them to that adult program. It’s pretty seamless.”

LOFT has 500 staff and serves over 4,500 people per year from Toronto to Simcoe Country but, says Vanderheul, they lack the funds to expand.

Schoo, now in her fourth year at Western University in London, Ont., and a public outreach speaker for the youth mental health organization, says she thinks there should be a care system stretching from age 17 to 30.

“After 30 you’re likely not in university, you have a family, you have experiences that don’t relate to younger people in (psychiatric) groups and on wards.”

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