1. Adolescent Mental Health; Access and Barriers to Services Peter Szatmari MD Chief of the Child and Youth Mental Health Collaborative SickKids, CAMH and U of T Patsy and Jamie Anderson Chair in Child and Youth Mental Health

2. Financial Disclosure Nothing to declare

3. Objectives The current situation in access to services for youth with mental disorders, addictions and DDs; it’s a crisis Some reasons for the crisis Some innovative solutions What I am trying to do in my new job

4. The Current Situation Long wait lists Fragmented system, within silos, little communication between systems No overall vision, each agency has its “private” mandate, no accountability Many services provided are not “evidence- based” or if evidence based not delivered with fidelity

5. Why? The system is not funded to meet the demand The prevalence of disorder is greater than expected The system is inefficient Based on the “mental hygiene” model of the early 1900’s or the “boutique” clinic model The stigma associated with youth and with mental health

6. New Studies on Prevalence The Ontario Child Health Study from 1983 (the OCHS sequel to go out into the field 2014) National Comorbidity Study-R; Adolescent studies; Kessler and Merikangas The Smokey Mountain studies; Costello and Angold ECA Montreal

7. How many adolescents have mental health disorders?  How common are mental health disorders among children and youth? lifetime prevalence>40%; within last 12 month=20%  With severe and chronic impairments? 10%  What are the more common disorders in adolescence? anxiety> behaviour> mood> substance use  What percentage receive mental health treatment? 16% in Ontario (1983); 30% in the USA

8. What predicts service use? Severity Diagnosis (anxiety and SUDs not seen) Comorbidity Ethnicity Irony; those least likely to respond are seen The majority <6 visits

9. Solutions? The MCYS mental health strategy for child/youth services; lead agencies, accountability, core services, single access New models of service delivery specifically tailored for youth A shift to seeing the population as the client, not just those that attend a clinic

10. Figure 1. A public health strategy for children’s mental health Waddell et al CJP 2005

11. 11 Ultra – High Risk Youth Low intensity treatment (web-based) outreach Primary care Emergency Room *Schools * including C + U Outreach to aboriginal youth justice “Integrated Collaborative Care Teams” shelters high intensity treatment (clinician-based) Parents & youth ASD/DD Services others Welfare Assessment (web-based) Case Navigator Existing services Social media

12. Conclusion See better days ahead; people are coming out of their silo’s Increase communication and collaboration across sectors Evidence base in increasing and a better understanding of implementation Technology as a means to deliver key services