It's a large room with plenty of unique touches one would find in a tight-knit workplace.

Family photos hang at desks. A picture of Madonna is pinned to a board. The walls are exposed brick, and one bears a large white board covered with the names of people the staff are helping today.

You have to go through two levels of security just to get into the office. They won't tell the general public where it's located. But in this secret space somewhere in the lower city, the Crisis Outreach and Support Team (COAST) is answering calls of youth with mental health issues across the city.

COAST youth calls

2011: 550 individuals called for help

2010: 500 individuals 

2009: 461 individuals 

2008: 504 individuals

2007: 474 individuals 

The 15-year-old organization handled 2,533 cases in 2011, 550 of them were people under the age of 18. Of COAST's roughly 30 staff, four work on the child and youth team.

Many of the team's calls come from schools where a student is having some kind of mental health crisis, whether it is a break down, a violent outburst, or the looming feeling that they're going to hurt themselves. They also hear from families, or sometimes, the youth pick up the phone themselves.

Referrals on the rise

"When you look at the (youth) referrals that have come in to COAST in the last 15 years, it just keeps going up," said Terry McGurk, COAST founder and executive director.  "The community is quite stressed."

Mental Health 101 Town Hall

When: Oct. 24

Where: McIntyre Performing Arts Centre, Mohawk College

Time: Doors open at 7 p.m., session runs from 7:30 to 8:30

Cost: free

COAST deals with people who have serious mental health issues. Its team includes child and youth workers, nurses and social workers, as well as four plain-clothed police officers who accompany workers on potentially aggressive calls.

Each morning, the members of its child and youth team come into work and check the calls that came in overnight, when an adult team member might have taken a youth call. Then they head to the white board to see a list of cases, shuffled in order of importance, to determine who to visit that day.

Their duties vary according to call. Sometimes it's to take someone to the hospital. Sometimes it's to coax an anxious teen out of her room.

"We see depression, anxiety, OCD," said Esther Bulk, a child and youth worker. "We see school issues with attendance because of drugs or alcohol or family, and usually those have an underlying mental health issue. Bullying is a huge factor."

Determining risk

When they answer the crisis line, they determine the danger with a series of questions. Has the youth attempted suicide before? If so, that's a risk factor. Are there supportive family members around? Has this person made a plan for suicide?

Even gender and age are involved in assessing risk, Bulk said. Boys are more likely than girls to attempt suicide, and the most dangerous age is the "transitional years" between 16 and 18.

After a few hours on the road, the workers return to their desks to do paperwork. They do follow-ups on previous calls while taking new ones.

The child and youth team members only work weekdays. That's when the demand is highest. This is their busiest time of the year when kids go back to school.

"The stressors really come from the school, especially with young kids," McGurk said.

Origins of COAST

McGurk founded COAST after two-year-old Zachary Antidormi was stabbed to death by a neighbour with schizophrenia. Zachary's parents, both who worked in mental health, knew their neighbour was dangerous but couldn't inspire the courts or the police to take action.

Every October, on the anniversary of the founding of COAST, McGurk takes his staff to the Mandarin restaurant to celebrate "surviving another year," he said.

"We even forward the crisis line to a cell phone. Staff have to excuse themselves to take the call. But it's our time."

McGurk is happy with the work COAST has done with children and youth. And their mental health is a subject we need to be discussing, he said.

"Children and youth are really in dire straits, and we need to talk as a community about how we're going to as a community respond to that."