Streamlined bureaucracy help youth
“I felt very alone. I felt worthless,” Lepine recalled.
She eventually moved to London and, at age 23, was referred to FEMAP by local crisis workers.
“I actually felt cared for,” Lepine, now 26, said. “I was made to feel like my existence mattered.”
Her psychiatrist also helped her restart her medication, filing an exceptional access program form to waive her prescription costs. Years later, she continues to see him regularly, as existing patients are not dropped when they age out of FEMAP’s target range.
In November, the London Health Sciences Centre announced that work was underway on a second FEMAP location, set to open in early 2021 as part of a $4-million fundraising effort to reduce wait times, expand services and double the program’s clinical staff.
To date, close to $2.8 million has been raised, but money remains a stumbling block.
The program still has no hospital budget. It is run on philanthropic donations collected through the hospital’s foundation.
The lack of public funding for the country’s youth mental health crisis defies a proper long-term economic analysis, Osuch said.
“You can have someone partially or completely disabled from these illnesses, if they’re not treated.”
Psychiatric standardization
Psychiatry needs reform if we’re going to have an impact on youth mental
health, said Benoit Mulsant, head of psychiatry at the University of Toronto.
Too often, he said, psychiatry is seen as a subjective process guided by the clinician’s personal intuition and experience, rather than defined by a clear set of measurable tools more common in other areas of medicine.
“You want your accountant to use a calculator,” Mulsant said. “Why wouldn’t you want a psychiatrist to use a tool to diagnose you? … We don’t have the kind of standardization of care that exists in other areas of medicine. We are reinventing the flat tire with every patient.”
FEMAP’s Osuch said this uncertainty creates a culture of skepticism among patients.
“I can send the same exact patient to six different psychiatrists, and I can get very different diagnoses,” she said. “It makes people think ‘Oh, these illnesses are not real, because we can’t measure them.’
“They’re very real. We just don’t have the technology yet.”
Psychiatry should take a page from Cancer Care Ontario, said Paul Kurdyak, lead mental health researcher at the Institute for Clinical Evaluative Sciences.
He points to the agency’s founding in 1995 as the catalyst for incredible progress in fighting the disease, chiefly due to its focus on standardizing care.
Without the same kind of approach in psychiatry, policy makers have an obscured view of how to deploy resources.
“The province of Ontario actually spends quite a bit of money (on mental
health),” Kurdyak said. “But they don’t have a sense of value for money.”
National suicide strategy
One of the key measurements of success in youth mental health work is suicide numbers. On that score, experts say Canada has a long way to go.
With the 47th-highest suicide rate in the world, Canada is among the topthird of all countries. For youth suicides, Canada is fifth among more than 30 nations in the Organisation for Economic Co-operation and Development.
In Indigenous communities, especially in the far north, suicide is a widespread crisis. If Nunavut were its own country, its suicide rate would be the highest in the world.
As one of the few Western nations without a national suicide strategy, Canada’s approach to measuring and treating the problem is failing young people, said Peter Szatmari, a physician and mental health researcher with CAMH, SickKids Hospital and the University of Toronto.
“The emergency room is separate from community organization, separate from schools, separate from social support systems. None of the systems are working together for kids. Currently, they’re all funded differently. While they work well in their sphere of influence, they don’t work well between their spheres of influence,” he said.
National suicide strategies, appearing in more than 40 countries over the past four decades, are associated with significant drops in suicide rates, including nine per cent in Finland and 18 per cent in Scotland, both over 10 years.
The World Health Organization has described them as “essential” to reducing suicides.
Canada has a federal suicide framework, adopted in 2016, which prioritizes awareness campaigns, destigmatization, increased statistical reporting and accelerated research efforts into suicide prevention.
But many health experts, including Szatmari, say a framework of suggestions doesn’t go far enough.
“Strategies provide clear roadmaps, with goals, timelines, resources, assigned responsibilities and a robust plan for their evaluation,” a 2016 editorial in the Canadian Medical Association Journal said.
“A framework is not a strategy. It does not bring necessary resources to bear, nor does it mandate the federal and provincial–territorial actions and multisectorial partnerships required to underpin effective suicide prevention across Canada.”
In a statement, the Public Health Agency of Canada (PHAC) said it works collaboratively with different levels of government and organizations on “initiatives that promote positive mental health.”
“Suicide prevention and mental health promotion are a shared responsibility across sectors and jurisdictions — from national initiatives to community-based programs,” the statement reads.
Though Canada lacks a federal strategy, some provinces have taken the reins.
In 1997, Quebec established the Help For Life strategy, pouring resources into reducing access to the means of suicide, encouraging more responsible media coverage and investing in awareness, research and crisis intervention.
By 2012, Quebec’s suicide rate had fallen to 13.7 per 100,000 people, from its 1999 high of 22.2. Among teenagers and young adults, the province saw a 50 per cent drop in suicide rates.
Other regions with suicide prevention strategies include Alberta, New Brunswick, Manitoba and Nunavut, each of them implementing them with varying levels of success.
For Canada to translate its disparate regional strategies into federal action, it would need commitment from each province and territory.
Ian Dawe, mental health director at Trillium Health Partners in Mississauga, said that when resources are properly marshalled for public health crises, “we’re actually pretty good at changing numbers that were seen to be intractable... This is suicide’s time.”
With files from Emma Renaerts/University of British Columbia School of Journalism
This is the eighth in a series of stories examining youth mental health, part of a cross-border investigation involving the Toronto Star, the Investigative Journalism Bureau (University of Toronto’s Dalla Lana School of Public Health) and journalism faculty and students from the following universities: Stanford University, Temple University, University of Missouri, Syracuse University, City University of New York, University of British Columbia, Ryerson University, Carleton University and the University of King’s College.