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Adolescent Mental Health; Access and Barriers to Services

Adolescent Mental Health; Access and Barriers to Services. Peter Szatmari MD Chief of the Child and Youth Mental Health Collaborative SickKids, CAMH and U of T Patsy and Jamie Anderson Chair in Child and Youth Mental Health. Financial Disclosure . Nothing to declare. Objectives.

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Adolescent Mental Health; Access and Barriers to Services

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  1. Adolescent Mental Health; Access and Barriers to Services Peter Szatmari MD Chief of the Child and Youth Mental Health Collaborative SickKids, CAMH and U of T Patsy and Jamie Anderson Chair in Child and Youth Mental Health

  2. Financial Disclosure • Nothing to declare

  3. Objectives • The current situation in access to services for youth with mental disorders, addictions and DDs; it’s a crisis • Some reasons for the crisis • Some innovative solutions • What I am trying to do in my new job

  4. The Current Situation • Long wait lists • Fragmented system, within silos, little communication between systems • No overall vision, each agency has its “private” mandate, no accountability • Many services provided are not “evidence-based” or if evidence based not delivered with fidelity

  5. Why? • The system is not funded to meet the demand • The prevalence of disorder is greater than expected • The system is inefficient • Based on the “mental hygiene” model of the early 1900’s or the “boutique” clinic model • The stigma associated with youth and with mental health

  6. New Studies on Prevalence • The Ontario Child Health Study from 1983 (the OCHS sequel to go out into the field 2014) • National Comorbidity Study-R; Adolescent studies; Kessler and Merikangas • The Smokey Mountain studies; Costello and Angold • ECA Montreal

  7. How many adolescents have mental health disorders? • How common are mental health disorders among children and youth? • lifetime prevalence>40%; within last 12 month=20% • With severe and chronic impairments? • 10% • What are the more common disorders in adolescence? • anxiety> behaviour> mood> substance use • What percentage receive mental health treatment? • 16% in Ontario (1983); 30% in the USA

  8. What predicts service use? • Severity • Diagnosis (anxiety and SUDs not seen) • Comorbidity • Ethnicity • Irony; those least likely to respond are seen • The majority <6 visits

  9. Solutions? • The MCYS mental health strategy for child/youth services; lead agencies, accountability, core services, single access • New models of service delivery specifically tailored for youth • A shift to seeing the population as the client, not just those that attend a clinic

  10. Figure 1. A public health strategy for children’s mental health Waddell et al CJP 2005

  11. outreach “Integrated Collaborative Care Teams” Parents & youth Primary care Emergency Room Ultra – High Risk Youth *Schools * including C + U Existing services Assessment (web-based) Case Navigator Low intensity treatment (web-based) high intensity treatment (clinician-based) shelters ASD/DD Services Welfare Outreach to aboriginal youth justice Social media others

  12. Conclusion • See better days ahead; people are coming out of their silo’s • Increase communication and collaboration across sectors • Evidence base in increasing and a better understanding of implementation • Technology as a means to deliver key services

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