Building a mental health and addiction service delivery system for emerging adults. Presented by: Simon Davidson, Jenny Carver, Despina Papadopoulos

Transcription

1 Building a mental health and addiction service delivery system for emerging adults Presented by: Simon Davidson, Jenny Carver, Despina Papadopoulos

2 Faculty/Presenter Disclosure Faculty: 1. Simon Davidson, 2. Despina Papadopoulos and 3. Jenny Carver Relationships with commercial interests: None Grants/Research Support: None Speakers Bureau/Honoraria: None Consulting Fees: RFP for Project Other: Employee of 1. Children s Hospital of Eastern Ontario (CHEO), 2. Mental Health Commission of Canada (MHCC) and Stella s Place Toronto / 2

3 Our focus for today 1. Overview of Project 2. Looking through the Emerging Adult (EA) lens 3. The facts about EA 4. Taking the Next Step Forward 5. Proposed Recommendations 6. Discussion and small group exercise THOUGHTS, COMMENTS and QUESTIONS WELCOME THROUGHOUT PLEASE!! / 3

4 Reflecting on Young Adults we have worked with

5 Youth Perspective So what I was told about transitioning, was that there was going to be a wait period. And during that wait period I was not going to be seen by anyone when anything came up, I didn t really have anyone to go to and I didn t feel supported at all. So when this kind of emerged, I was not well at all. Young Adult Summit Participant / 5

6 Caregiver Perspective So the message I think that I really want to communicate is that for us as a family, what we experienced was we had to find things. There was no system. No systemic approach to any of this. Caregiver Summit Participant / 6

7 Overview

8 Overview The Mental Health Commission of Canada s (MHCC) National Mental Health Strategy addresses transitional age services Collaboration (RFP) with research team from Children s Hospital of Eastern Ontario (CHEO) Source document Taking the Next Step Forward: Building a Responsive Mental Health and Addictions System for Emerging Adults (in final draft format) Youth Transitions into Adult Mental Health Services Uptake and Engagement Project Stakeholder Engagement / 8

9 Youth Transitioning into Adult Mental Health Services

10 Background 75% of mental disorders have age of onset prior to age 25 (Kessler et al, 2001; Government of Canada, 2006) 52% of young people (16 25 y/o) disengage from services during the transition from CAMHAS to AMHAS (Singh et al, 2008) Highest drop out rate of all age groups (Edlund et al, 2002; Pottick et al, 2008) Most vulnerable youth are also the most likely to disengage Family & Peer involvement support service engagement Service re engagement is often crisis driven / 10

11 Who we need to keep in mind All young people between the ages of 16 to 25 are emerging adults Identified young people requiring mental health services Identified young people whose conditions are stable and could use follow up Young people not yet identified (EIEI) and those with emerging disorders Youth in the Justice and Child Welfare Systems Marginalized young adults Should be cross sectoral and multidisciplinary / 11

12 Early Identification & Early Intervention (EIEI) is Essential & Yields Better Outcomes Universal wellness, mental health promotion and mental illness prevention programs MUST be part of the overall plan reduce prevalence of mental illness and addictions improve mental wellbeing and resiliency ultimately improve the overall well being of Canadians Improve the safety of communities Attempted suicide Suicidal Ideation Mental health problems Improve the integrity of the school and workforce Wellness, promotion, prevention / 12

13 Tip of the iceberg Death by suicide Attempted suicide Suicidal Ideation Mental health problems Wellness, promotion, prevention / 13

14 Transitional Care: Current Issues Funding challenges Fragmentation specialists Planning not inclusive Generally no authentic Youth and Parent Engagement CAMHS AMHS issues Mental Health and Addictions often still siloed *Pockets of excellence in Services for Young People do exists but minimal / 14

15 The Impact Untreated children, adolescents and young adults with mental health concerns become more vulnerable and less resilient with time (Wattie, 2003; McGorry, 2012; Garber & Clarke, 2009, McGorry et al, 2011) Significantly higher rates of school leaving, justice involvement, unemployment (Davis et al, 2007; Davis et al, 2007; Newman et al, 2009; Wagner & Newman, 2012; Vander Stoep et al, 2003) Suicide and self injury is the second leading cause of death for Canadian youth (Statistics Canada, 2009) One in 5 of all deaths among young adults 15 to 24 due to suicide (Government of Canada, 2006) Concern about marginalized young adults: Child Welfare emancipated, Aboriginal/Inuit, homeless, rural/remote, justice involved, newcomers / 15 Concurrent problem substance use

16 The Bottom Line Unable to find an EA program anywhere in the world that: Is fully funded and sustainable Systematically engages young adults and parents (own care and and system services planning) Offers a well integrated full continuum of mental health services for young people Very few evidence informed practices with EA Has been comprehensively evaluated / 16

17 Taking the Next Step Forward: Research, Policy and Engagement

18 Research, Policy and Engagement Consulted with up to 50 experts from around the world including families, caregivers and youth Exhaustive policy and program literature search; International Summit (Oct 2012) Input from provincial, and national leaders in policy and program development recommendations Gathered and compared relevant policy documents from across Canada and internationally Integrated available literature from peer reviewed studies / 18

19 Taking the Next Step Forward Taking the Next Step Forward applied a systemic perspective by viewing the needs of emerging adults with different lenses to address: service capacity & delivery knowledge exchange system design policy framework / 19

20 Current Landscape in Canada National Limited policies in place/ being implemented for the provision of mental health services to EAs Provincial All provinces identify children and youth mental health as a priority No province is consistently implementing CAMHAS/AMHAS transitional protocol for EAs No province is tracking EAs across the CAMHAS/AMHAS transition No province has mandated services designed to address the needs of EA beyond first episode psychosis Regional Areas Lack of co ordination between agencies is a significant barrier to the provision of care to Eas Few funded services that target this age group (transition supports or EA responsive) Despite the lack of capacity, pockets of excellence do exist!! / 20

21 International: Learnings Robust EA specific policies, services, and dedicated funding yield best results Include high profile champions National policy and funding initiatives driven by identifying urgent health priorities Nationally funded, evidence based practice and clinical guideline registries, monitoring, and research/training funding programs Short comings in data collection restrict performance monitoring and improvement / 21

22 What we know about transitions! EAs under go many transitions as they move into adulthood Dependent to Independent Student to Employee Systemic Change Legal Status IATROGENIC? Institutional Developmental Sectoral Appropriate support will involve coordination between: Health care Schools Vocational services Workplaces Justice system Housing services Families Peers Government leadership Funders Reporting / 22

23 Projected Priorities: What we heard 1) Increase interministerial collaboration 2) Incorporate developmentally based service criteria 3) Resolve cultural and administrative differences between agencies 4) Incorporate data collection and increase accountability to monitor outcomes for young adults 5) Access for vulnerable populations 6) Increase evidence based EA service capacity in AMHAS / 23

24 Key Principles for EA Service Provision 1. Responsive 2. Developmentally Appropriate & Family Connected 3. Youth engaging and peer driven 4. Informed 5. Recovery oriented / 24

25 Some Models for Emerging Adults Transition Management Models Shared Management Model Champlain LHIN Protocols, Tools and Supports Good2Go System Design Models Youth One Stop Shops (OSS) Youth Space, UK Service agreements BRIDGE UK Head Space and Orygen Youth Health, Au / 25

26 Proposed Recommendations: National, Provincial/Territorial/ Regional

27 Proposed Emerging Adult Service Framework Continuum of Services Policy Scaffold and System Supports

28 Proposed Report Recommendations: National Implementation and Funding 1) Develop a National Action Plan for EA mental health and addictions 2) Establish a National EA Advisory Group 3) Establish a knowledge exchange policy for provinces to share information about EAs 4) Create an annual report card of National outcomes on EA mental health 5) Establish funding for a longitudinal tracking study to include youth transitions from CAMHAS to AMHAS 6) Appoint a Canada Research Chair for Emerging Adult Mental Health / 28

29 / 29 Proposed National EA Mental Health Initiative

30 Proposed Report Recommendations: Provincial/Territorial Implementation and Funding 1) Establish EA mental health and addictions as a provincial priority starting with the most vulnerable populations. 2) Establish a premier led interministerial cabinet committee to oversee EA outcomes (wait times, engagement, satisfaction, success) 3) Establish provincial/territorial EA Advisory Council and Regional Leads 4) Identify a single ministry to be accountable for EA outcomes 5) Establish service delivery standards for EA services and evidence informed practices 6) Mandate hospitals and community based mental health and addictions providers to respond in a developmentally appropriate way 7) Core 8 Basket of Services / 30

31 1. Acute inpatient mental health beds 2. Community based, comprehensive day treatment services 3. Community based mobile high intensity clinical teams 4. First episode/early intervention for all diagnoses including screening, assessment, treatment services 5. System navigators 6. Peer support/mentoring roles 7. Family engagement, education, and support 8. Transition team coordination resources / 31 Proposed Recommendations: Regional Core Basket of Specialized EA Services Mental Health Promotion: Prevention and Literacy throughout

32 Next Steps

33 Knowledge Exchange, Uptake and Engagement 1) Extract key messages from the Taking the Next Step Forward source document and develop consensus document 2) Develop video series with support from Youth Council 3) Engage various stakeholders champions, families & caregivers, Emerging Adults with lived experience) across Canada 4) Ensure that key messages and action items that influence meaningful change have been communicated across Canada to diverse audiences including policy and decision makers / 33

34 Questions and Discussion 1. Would these proposed recommendations work in your jurisdictions? If yes, how might you apply these recommendations in your jurisdiction? 2. What can we add or change? 3. What are some strong practices in your region that engage and respond to EA? (What is working well?) 4. What are some significant, pressing challenges in your region? (What s not working?) / 34

35 Thank you! Contact us: Simon Davidson: Mario Cappelli: Jenny Carver: Despina Papadopoulos: / 35

36 THANK YOU!! Take the Next Step Forward with us. Walk the talk.

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