When Cassandra Arthur reached a crisis point as a teenager because of episodes of severe depression, she ended up at a hospital emergency department because neither she nor those trying to help her knew where else to seek help.
The first time, at age 17, Arthur's depression had driven her to the point of suicide, but her high school psychologist got wind of her plan to take her own life and contacted her parents. She was taken to the emergency department of a Toronto hospital and admitted to the children's psychiatric ward for 11 days.
Twice more that year, she went to the ER when she felt herself being pulled down into the black hole of depression and was again admitted, the last time for almost a month.
"I kind of felt at a loss and I was dealing with serious anxiety and I didn't know where else to go," said Arthur, now 20.
"It kind of felt like I was bouncing in and out of hospital rooms, essentially. I might get a little bit of help in there, but as soon as I would leave, I wouldn't know who to contact or what resources I had.
"And even people within the community, like family doctors or the school psychologist, they weren't educated as to what other resources there were either."
It's an all too common scenario for young people dealing with disorders like depression and anxiety, said Dr. Paul Kurdyak, director of health systems research at Toronto's Centre for Addiction and Mental Health (CAMH).
In a study published this week in the Canadian Journal of Psychiatry, a research team led by Kurdyak found that among Ontario children and youth aged 10 to 24 with mental health issues, there was a 33 per cent jump in the number of emergency department visits between 2006 and 2011.
Although hospitalizations overall were relatively rare, the rate of admissions also rose — by 53 per cent over the study period.
At the same time, visits to community-based doctors increased by only about 15 per cent, with family physicians providing the most care, followed by psychiatrists and pediatricians.
"What we're finding is that people are preferentially going to emergency departments," said Kurdyak, who is also a senior scientist at the Institute for Clinical Evaluative Sciences.
There are likely a number of reasons why young people needing urgent care are seeking help at emergency rooms, he said, including difficulty getting an appointment on short notice with their primary-care doctor. Wait times to see a psychiatrist are typically much longer.
Kurdyak, whose clinical practice includes working in CAMH's emergency department, said many people come there because they feel they have nowhere else to turn.
"The other story I hear is people being put on a wait list (for community-based care) that's fairly lengthy and then having their situation deteriorate, so it has become an emergency," he said. "And then there's the unavoidable crises that will develop, independent of access."
Despite providing 24-hour care, a hospital emergency department isn't ideal for those with mental health issues, Kurdyak said.
"A loud, chaotic, busy, frenetic emergency department, certainly like those in my experience in downtown Toronto, is not a very therapeutic environment for somebody to go to when they're stressed out in the way that these people are."
Arthur agreed, recalling what it was like on her first visit to the ER, where she waited for five or six hours before the decision was made to admit her.
"You had people screaming and throwing up and people bleeding," she said. It was hardly a comforting atmosphere for a scared teenager who had been planning to take her own life.
Arthur blames the lack of community mental health services for the fact that more and more young people like herself end up making multiple trips to the hospital ER to get help.
"I felt like there were not that many things that I could have done to stop myself from using the ER.
"I remember asking the school psychologist and others for help and ... nobody knew what to do. Every time, it was 'Oh, go to the hospital.'
"So you're in this weird limbo of who do I ask for help?"
Yet Kurdyak said efforts are being made in Ontario to bolster access to community-based care for youth with mental health issues, which he called "a huge prevention opportunity."
"If young people have access to the services they need early, the evidence would suggest that you will spare them and the system a burden down the road."
Arthur may be proving that principle.
When she was about to turn 19 and found herself slipping into another severe depression — the illness runs in her family — Arthur and her mother started researching where she could get treatment, instead of having to opt for another trip to the ER.
They discovered an in-patient program at CAMH, which provided her with individual and group counselling.
Now at George Brown College, where she is enrolled in a year-long program that helps people transition into post-secondary education, Arthur hopes to move on to a bachelor of commerce or management studies program at Humber College.
And while she acknowledges that dealing with bouts of severe depression will be a life-long challenge, "I feel like I'm definitely in a much better place now."