Falling deeper into a dark place: The increasing number of adolescents seeking care for mental health issues has skyrocketed, but stagnant funding is straining the system
It would be a heartbreaking experience for any mother.
Kathy Brunsdon sat by the phone for a week at her Stittsville home, making call after call, concerned about her 15-year-old daughter Hannah.
Daron Richardson, a 14-year-old girl who lived nearby, had recently died of suicide.
And Kathy was concerned that Hannah was displaying the warning signs she was reading about. She already had a psychiatric referral in at CHEO, but hadn't heard anything back.
"I don't remember anything," Hannah, a Canterbury High School student, said about the time. "I felt like I was hovering above myself. It was just a horrible time."
"I hadn't heard back and Daron Richardon's suicide happened and I started to panic," she said. "I tried calling for an entire week, leaving a message every day. I sat right there by the phone. I don't remember moving from the phone, just waiting and waiting and waiting."
Since then, mental health services for youth throughout the city have seen a spike in demand.
SPIKE IN DEMAND
In 2011, CHEO saw 1,479 psychiatric crisis visits to its emergency department, mostly teenagers with depression and anxiety related issues. That's 50 per cent increase in two years, served by the same 25 beds and staff numbers that the psychiatric ward had in 2009.
CHEO has stated that in Ontario, one in five youth have some type of mental health problem, but only one in six of those get the help they need. That means for every 30 youth in Ontario, five have mental health problems that may go untreated.
Ottawa has seen a swell of awareness in the media and at public events since the high-profile death of Daron Richardson, daughter of former Ottawa Senators assistant coach Luke Richardson in November 2010, and Jamie Hubley in October 2011, city councillor Allan Hubley's son
"Certainly in November 2010, over a couple of week period of time we saw this remarkable increase," said Dr. Hazen Gandy, director of child and adolescent mental health services at CHEO. "We expected the volume of business to return to the consistent level, but it's continued since then."
It's a cause and effect that has spiraled out of control, leading youth and parents alike through traumatizing months on a waitlist before they can get treatment.
Comparing CHEO's increase in demand for psychiatric services to other hospitals is hard - children's hospitals vary significant in catchment area and size, and the detailed mental health statistics only began to be released in 2011.
But CHEO had more than 1,400 visits to the emergency room for mental health issues in 2011, the greatest number in the province. The second-highest demand in Ontario was at the Children's Hospital at the London Health Sciences Centre with 845. The third, Lakeridge Health Corporation, saw 625.
Gandy said overall emergency room visits have gone up, but the increase in mental health visits exceeds the overall increase.
"There are other places seeing a fairly significant increase, so I don't think we're alone," he said. "But certainly in eastern Ontario, we're seeing substantial increases."
The youth psychiatry program at the Royal Ottawa Mental Health Centre serves referrals for 16 to 18-years-old from CHEO's emergency room, so the demand has hit the program just as hard.
"We started seeing some increase at the end of 2009, but there has been a big surge since Daron Richardson, and then that was followed by Jamie Hubley," said Dr. Smitta Thatte, youth psychiatry clinical director. "And it hasn't stopped."
In 2009, Thatte said the department had 10 to 12 referrals a month - today, they see 25 to 30 youths a month.
"Definitely more than a two-fold increase in referrals," Thatte said. "There is always somebody waiting."
Campaigns like Do it For Daron - an awareness campaign for recognizing mental illness and reducing stigma - has helped identify many more youth who can benefit from help.
"You're told that it will be nine months (on the waitlist)," said Kathy. "And OK, but someone just died. And supposedly the parents didn't know at all, there were no cues. And here I am, and I'm trying to make things better and I can't because there's nobody to help me, nobody to guide me."
Gandy said he hasn't seen an increase of parents crying wolf, and CHEO truly is seeing more patients who have significant mental health issues coming forward.
"When they said that I must have a mental illness, it was right around the time they started Do it For Daron," Hannah said. "So that was a huge part of my story, being able to realize, and realize that it's OK. And to realize I needed to get help before it turned into something that I wasn't able to be in control of."
It's an increase that has forced every mental health organization in Ottawa to respond and make changes in the way they offer services, including permanent changes to their day-to-day operations.
CHEO has stopped taking any elective cases, meaning waitlists for services to support children with ADHD or anxiety disorders have been stretched even further.
They've hired more crisis workers to cover evenings and weekends and have asked other partners, like family physicians, to provide more mental health care.
"We've really shifted our resources for acute care, and that's allowed us to manage the trends," Gandy said. "It's robbing Peter to Paul. It's not like we're adding new resources."
The Youth Services Bureau (YSB) has been one of the partners to step up to try and fill the gap.
Francine Gravelle, director of mental health services at the YSB, has responded with a walk-in clinic that can help before youths get treatment somewhere like CHEO.
"A five month waitlist (at the Royal or CHEO) isn't realistic," Gravelle said. "Not all should be waiting when a few (counselling) sessions can provide them with the support they need."
YSB runs a variety of mental health services, including short-term and long-term counselling, but the walk-in clinic, held twice a week at their Carling Avenue location started in January 2011.
First, they went through their own wait-list of clients who wanted access to counselling, before opening up the clinic for others. Originally one day a week, it expanded to two days this past October.
"When they wait, their situation deteriorates," Gravelle said, of the children and youths. "That helped clients, knowing that when they need service, they could just come by."
And it's been what a large percentage of their clients needed. April 2011 to March 2012 saw 680 clients come to the walk-in - and 67 per cent didn't need referrals for future services, taking some pressure off CHEO.
"As one parent said, it's a bumpy ride," Gravelle said. The walk-in clinic provides a buffer zone for clients in the grey area between in-crisis and at risk of suicide.
Seeking treatment for youth mental health can be tough.
"I think this is a great time to be looking at how the different groups and agencies can partner together, and there are solutions," Gandy said.
Resources can be funded through the Ministry of Education, Ministry of Health, or Ministry of Children and Youth Services. YSB is funded by the Ministry of Children and Youth Services, while CHEO gets funding through the Ministry of Health.
"This whole system is somewhat fragmented," said Thatte. "So really the parents and the patients don't know which door to go in, and many times they are referred to different places."
The consensus is that a better network of services needs to be formed to support one another, and to provide integrated care.
"The reality is, the system is complicated. It has silos, it's not easy to navigate," Gandy said.
"How do all these agencies begin to talk to each other to make it easier to get the right service at the right time?"
And for Hannah and Kathy, a mother and daughter who spent hours researching and studying the course of treatment, they would like to see prevention taught earlier.
Hannah ended up on a nine-month waitlist for CHEO and eventually, after insurance covered some private treatment, was able to get help at the Royal, which had a shorter waitlist. She participates in YouthNet at CHEO, a support group that doesn't require a doctor's referral, and runs a gender-specific group session, as well as organizing therapeutic arts and recreation activities.
But she thinks that getting to that breaking point where she couldn't bring herself to get out of bed in the morning - days she can't even remember - wouldn't have happened if she had been taught coping strategies in school from an early age.
"You don't just wake up one morning and you're feeling suicidal. You wake up each morning just feeling a bit worse," Hannah said. "So I think we need more of what we have. A YouthNet here, YSB centres, walk-in centres in different places."
Gandy said with more resources, not only could youth who haven't been admitted be treated, but those who are high-risk patients could potentially be discharged sooner.
And fundraising for awareness shouldn't shift focus, Thatte said. But she said they remain hopeful that increased awareness in the community will result in pressure on the government to increase resources.
At CHEO, they've made almost all the changes they can with the resources they have. But staff are still anxious about future growth, as they expect numbers to continue to rise.
"Certainly if it continues to increase at the rate that we've seen, it's not going to be sustainable for us," said Gandy.
A mental health strategy for Canada titled Changing Directions, Changing Lives was recently released, which highlights improving access to the right combination of services and treatments, and an increase in funding to fix the current problem.
The report supports partnerships and treatments in a variety of ways, but sums it up in the introduction with one clear statement: the status quo is not an option.
CHEO recommends using www.e-mentalhealth.ca as a resource for parents or youth looking for information. The YSB crisis line is available for youth or parents 24-hours a day at 1-877-377-7775 or by email at firstname.lastname@example.org.
31 May 2012