Young people between 16 and 24 years old have more challenges than other age groups in getting mental health and addiction services in Canada, a new study comparing mental health care across five provinces has found.
"Wherever we looked, they were the group that had the poorest access to care," said Dr. Paul Kurdyak, senior scientist at the Institute for Clinical Evaluative Sciences (ICES) and co-author of the report.
"This is a real problem because this is the age at which mental illnesses have their first onset. So you want really rapid access," said Kurdyak, who is also a psychiatrist at the Centre for Addiction and Mental Health (CAMH) in Toronto.
For example, the study — called Toward Quality Mental Health Services in Canada — found that children and youth aged 10-19 made up the highest percentage of people who had their first medical contact for their mental health disorder or addiction in an emergency department.
Although the study says that's "partly expected since youth have the highest rates of incidence of mental illness, and a shorter time period for symptom detection," it also suggests "there is most certainly room for improvement in early identification (including by parents/guardians, in schools and in primary care)."
British Columbia, Alberta, Manitoba, Ontario and Quebec agreed to share health data with researchers, including hospital discharge and physician billing records, to try to help paint a picture of the state of mental health and addiction services.
Dr. James Bolton, medical director of the Winnipeg Regional Health Authority Crisis Response Centre, said the resulting findings that getting help is especially challenging for youth are borne out in his own work on the front lines.
"We see a lot of people who are struggling and especially young people," he said. "Day to day we see young people coming in with new mental health problems. It's hard for them to find the right care; it's hard for them to get sustained on the right care."
Suicide attempts higher in Manitoba
One of the most striking findings in the study is the rate of suicide attempts by people suffering from mental illness or addictions.
In all four provinces that provided data — Ontario, Manitoba, Alberta and B.C. — young people had the highest rates of suicide attempts, especially between ages 15 and 19.
But in Manitoba, the rates were much higher than in the other provinces, with about 18 attempts per 1,000 teens in that age group who suffered from mental illness or addiction. The rate for both B.C. and Alberta were around 10 attempts.
The lowest rate was in Ontario, at fewer than five attempts per 1,000 teens. Information on suicide attempts in Quebec was not provided in the report.
The researchers caution that the rates are likely even higher than indicated in the report, because they were only able to measure hospitalizations due to suicide attempts, meaning that if someone went to the emergency department but wasn't admitted, they would not show up in the data.
Bolton, who was also involved in the study, said he could only speculate about why the rates of suicide attempts among youth struggling with mental illness and addiction are so high in Manitoba.
One factor, he said, could be the relatively high proportion of Indigenous people in Manitoba's overall population. According to 2011 data from Statistics Canada, 16.7 per cent of people in Manitoba identify as Indigenous compared to single-digit percentages in the other provinces measured.
"Unfortunately, people with Indigenous backgrounds tend to be more likely to think about suicide and attempt suicide," Bolton said.
Another factor, he said, could be that most mental health resources in the province are centralized in Winnipeg, leaving people living in northern or remote areas vulnerable.
'Making the invisible visible'
Kurdyak, the project leader, said one of the reasons youth may have difficulty accessing consistent mental health and addictions services is likely due to jurisdictional divisions at the provincial government level.
"Most provinces are structured in such a way that child and youth mental health services are funded by one ministry ... and children and youth age out of that system at the age of 18 and age into the adult sector," he said.
For example, in Ontario, the Ministry of Children and Youth Services oversees mental health care for children up to age 18, and then the Ministry of Health and Long-Term Care takes over for adults.
"Any time you have two types of ministries overseeing what is a trajectory of illness, there's opportunities for barriers and gaps in treatment."
The study is meant to be a first step in identifying where the gaps in mental health and addictions care lie — both within and between provinces — so they might be able to learn from one another, Kurdyak said.
In addition to rates of suicide attempts and access to care through emergency departments, the researchers also looked at whether people with mental illness or addictions had consistent access to a family doctor, physician followup after hospitalization, suicides and deaths from other causes.
Mental health "lags behind" other areas of the health-care system, such as cardiovascular health or cancer, in terms of using rigorous measurement to improve care — largely because the public will to look closely at mental health and addiction wasn't there until recent years, he said.
Studies like this one are "making the invisible visible," Kurdyak said.