The kids are gonna be alright

Nick Carveth was paralyzed by anxiety in his large high school classes. Although bright and articulate, the lanky teen didn’t dare speak up for fear his peers would judge him.

Smoking weed helped calm his nerves but before long Carveth was chasing his stress away with chemical drugs such as ecstasy. By age 16, he was carrying a crack pipe in his leather jacket, smoking it just to get through the day.

“My drug use was off the charts,” says Carveth, shaking loose a mass of dreadlocks tucked inside a hemp-coloured tam. He tried a handful of abstinence-based drug programs, but they didn’t address his mounting social anxiety and, by age 17, he’d been expelled from two different schools.

“I felt alone, like my problems were a life sentence, and there was no way out.”

Sadly, Carveth’s struggles are common. Psychiatric disorders are now the number-one reason young people in Canada are hospitalized and why suicide is second only to car accidents as the leading cause of death. Recent high-profile media tragedies involving mentally ill teens — from the suicide of bullied B.C. teenager Amanda Todd to the Christmastime massacre at Sandy Hook — are evidence of the devastation that can happen when kids don’t get the help they need.

“Families and youth in crisis often don’t know where to turn. Navigating Ontario’s complex and fragmented youth mental health care system can be daunting. We want to facilitate youth getting the right care at the right time in the right place,” says Corine Carlisle, a professor in the University of Toronto’s Department of Psychiatry. “We need to intervene earlier and follow up faster to get youth back on an optimal developmental trajectory. We especially want to provide timely, efficient care so that crises don’t become fatal.”

Identifying and treating mental illness early is a critical part of U of T Medicine’s strategy for improving youth mental health. From backing leading-edge research to developing new, team-based treatment models, the Faculty is helping to ensure teens like Carveth can live meaningful, productive lives — while also reducing the staggering costs to the health care system resulting from disabling, lifelong mental health problems.

Training more experts in youth mental health is key. Recently, the Department of Psychiatry introduced a new subspecialty program in child and adolescent psychiatry.

“We felt strongly there was a need to focus on underserved areas of psychiatry. The new subspecialty training will increase the number of specialists in child and adolescent psychiatry, making it easier for troubled kids to get the help they need,” says Department Chair Trevor Young, noting that historically mental health has been a stigmatized area of medicine and child psychiatry even more so a “poor cousin” within the field.

During a two-year program, trainees will serve as consultants to schools, correctional programs, family health teams and community-based children’s mental health agencies, treating kids with mental health problems together with other health professionals. Some of their training will be spent caring for young people with the most complex and difficult problems — such as concurrent substance abuse and mental illness issues — like Carveth’s.

But simply training more psychiatric experts is not enough. Research has shown that kids benefit from coordinated care between teams of health professionals — from emergency room staff to family doctors and child psychiatrists. That’s why U of T, the Centre for Addiction and Mental Health (CAMH) and The Hospital for Sick Children teamed up to form an integrated Child and Youth Mental Health program.

The program will help provide more coordinated care for kids with mental illness by integrating child psychiatrists into mixed treatment teams committed to working together, including family physicians, nurse practitioners and other professionals.

It will also ensure that scientific research, psychiatric training and clinical care are properly coordinated. Professor Peter Szatmari, director of U of T’s Division of Child and Adolescent Psychiatry who will lead the program, says this structure — where information, expertise and resources are shared — will be critical in tackling the growing needs of children, youth and their families.

“One in five children and youth has a mental health problem and only 15 per cent of them receive help from a mental health professional. There’s a huge gap between the need and access to these services,” says Szatmari, chief of the Child and Youth Mental Health Collaborative at the two hospitals. “I see myself as a matchmaker to bring some of the best minds in the field together with a common focus and vision, and come up with solutions. I don’t see child psychiatrists in private practice as a model for today.”

That’s why Szatmari plans to build on the joint program with CAMH and SickKids by setting up partnerships with U of T and other children’s mental health agencies and hospitals affiliated with the Department of Psychiatry.

Ramping up research is another priority, says Szatmari, because it identifies weak spots in the system and areas where future efforts should be focused. “A primary goal is to increase research productivity, mentoring the best and brightest so they can be more successful,” says Szatmari, also the director of Research and Training in child and youth psychiatry at U of T.

A good example is recent research by Carlisle, which found that follow-up care for Ontario teens with psychiatric issues is not optimal: less than half of young people aged 15 to 19 hospitalized with a psychiatric diagnosis received follow-up care within a month of being discharged.

“Timely aftercare is crucial in maintaining the health of youth with mental illness and avoids future hospitalization,” says Carlisle, the dynamic clinical head of CAMH’s Youth Addiction and Concurrent Disorders Service.

Coordinated care is especially critical for youth suffering from multiple issues, which is why, last July, CAMH opened a new inpatient unit offering 24-hour care for young people with concurrent disorders. The first program of its kind in Canada, the 12-bed unit — headed by Carlisle — will treat up to 150 youth from across the province each year.

“If you treat substance abuse and mental health issues together, the success rate is much higher,” Carlisle says, noting that of the first 20 youth to complete the program, only one so far has required readmission. “Our inter-professional team is phenomenal at engaging with these youth. These young people come here having given up on themselves. They feel their families, the schools and the justice system have given up on them too. It’s really powerful to see them turn their lives around and regain hope for the future.”

For Carveth, it was an outpatient day-treatment program specially designed for teens with mental health and substance abuse problems that helped him regain control over his life. The REACH (Recovery and Education for Adolescents Choosing Health) program, offered by CAMH and the Toronto District School Board, is a harm-reduction program that allows students to work toward high school credits while receiving treatment.

“The counsellors are so friendly and empathetic. They meet you where you are at the moment and you get to set your own goals, which helped build momentum in my recovery,” says Carveth, who thrived as part of a small group of six students. The program helped him understand how his drug use was a way of coping with anxiety and an undiagnosed obsessive-compulsive disorder.

Thanks to REACH, Carveth dropped his crack cocaine habit, learned to manage his anxiety symptoms and graduated from high school as an Ontario Scholar. Now 23, he’s finishing his third year in the Bachelor of Social Work program at Ryerson University, and passionately interested in counselling youth with mental illness and addictions.

“I got the help I needed to face and overcome these issues. That’s given me a career path and an opportunity to help others, one of the most spiritual things in life,” he says.

Check out this story and more in the Spring 2013 issue of U of T Medicine Magazine.