Teen mental health support can learn from cancer care in Ontario, psychologist says
The Current20:11What teen mental health support can learn from cancer care
As health institutions struggle to deal with a rise in youth mental health hospitalizations, some medical professionals think looking at the improvement of cancer care in Ontario since the 1990s could help address the current mental health crisis.
“We know how to provide good health care in Ontario in particular areas, but we’ve never thought to apply that expertise and know-how to the mental health system,” psychologist Dr. Paul Kurdyak told The Current.
According to two new studies, published in the Canadian Medical Association Journal on Monday, the number of Canadian children who visited emergency departments or required hospital treatment for self-harm jumped significantly during the COVID-19 pandemic.
Dr. Natasha Saunders, a senior author for one of the studies, said that during the pandemic, young people aged 10 to 18 had a 29-per-cent increase in emergency department visits for self-harm and a 72-per-cent increase in hospitalizations for self-harm.
Saunders, who works as a pediatrician at SickKids in Toronto, said the study confirmed what they’re seeing in their workspace.
“We see a lot of distress in young people, a lot of concerned parents, understandably,” she said. “It’s real, it’s palpable, and what this study really showed was it put numbers behind the anecdotes.”
Although the studies are alarming, Kurdyak — a part of the same study as Saunders — believes this is an exacerbation of a pre-existing problem, not a new one.
What is “exciting” this time around though, according to Kurdyak, is that it “feels like we are back at the beginning of Cancer Care Ontario.”
“Kids especially are more comfortable talking about mental health [and] much more comfortable seeking care,” he said. “Now, we need to build a system to meet the needs.”
Experts encourage parents and educators to find ways for children to learn social skills missed in the beginning of the COVID-19 pandemic when classes moved online and schools temporarily closed.
A difficult situation
Kurdyak is the director of health outcomes and performance evaluation at the Centre for Addiction and Mental Health in Toronto.
“I think we can probably safely say that the reason these kids and their families are showing up at the emergency department … is they do not know where to go,” he said. “And things have gotten to a state where they finally do need intervention.”
Sheri Madigan, a psychologist and professor at the University of Calgary, said families are struggling to find psychologists who don’t have a completely full caseload, so they go to the emergency room because they have nowhere else to go.
“What you’ll hear from many professionals treating children in the emergency department is they also don’t feel like they have the capacity to serve all of these children,” she said.
“They’re not feeling like they have really the services and supports and training to be able to really provide kids the help that they need.”
We’re in a really tough spot right now where parents aren’t getting the support and the coaching they may need to support their young child.-Dr. Natasha Saunders, pediatrician
Learning from cancer care
Kurdyak draws a parallel with cancer care in Ontario, which he said “was a mess” before Cancer Care Ontario, a provincial agency responsible for improving cancer services, launched in 1997.
It was subsequently subsumed under Ontario Health in 2019, as part of Doug Ford government’s controversial consolidation of health agencies.
According to Kurdyak, families used to have a hard time finding access to care because hospitals in Ontario that provided cancer care worked independently from each other.
Cancer Care Ontario created an oversight structure for all of these different hospitals, according to Kurdyak. They set standards of care based on evidence, and they insisted cancer care providers follow a certain level of quality.
“What allowed that to happen is the building of critical system infrastructure; figuring out where cancer treatment centres need to reside so people can get the care that they need; putting the services behind once door,” he said.
“The end result is that it went from no oversight and organization and the access and quality of care very much depending on where you lived, to getting … the same very good standard of care, no matter where you live in Ontario.”
Kurdyak says Cancer Care Ontario’s efforts ensured a sustained commitment to work toward improving cancer care in Ontario — and that a similar playbook should be considered for the mental health system.
“It’s going to take time. But I think one of the key factors as we start is … understanding what services are out there, because we really we really don’t know.”
Furthermore, cancer was a highly-stigmatized illness decades ago. Kurdyak saw this first-hand at the age of 13, when his mother was diagnosed with breast cancer.
“She didn’t tell her friends. She felt terrible during chemotherapy,” said Kurdyak, who is now 55. “She basically stayed in a bedroom and wouldn’t interact with the family while she felt well, and she only came out once she felt she could be.”
Kurdyak said that more recently, “cancer came out of the closet.” Once people were no longer ashamed to talk about their diagnosis, they felt empowered to speak up and demand better service.
Dr. Saba Merchant and Psychologist Cassandra White share advice on how parents can recognize and respond to mental health challenges in their kids
Changing for the better
For the time being, Saunders said there isn’t a good answer to what parents should do if the resources aren’t there to treat their child.
“I think families are often left alone, to navigate the system on their own, to either pay privately if they can afford it,” she said.
“But we’re in a really tough spot right now where parents aren’t getting the support and the coaching they may need to support their young child. So we need to change this.”
Kurdyak says he’s seen more debates and discussions around improving mental health facilities now then ever before — and crucially, politicians are taking notice.
“They’re not changing as quickly as I’d like … but when I think of I when I graduated, became a psychiatrist versus now, I don’t think we’re putting this genie back in the bottle.”
