Mental health issues among youth have escalated during the COVID-19 pandemic, leaving many young people feeling isolated, stressed and anxious. Outlets previously available to them for dealing with stress and anxiety have been restricted or closed. In addition, for some there are new sources of stress, including family strife, food insecurity, social anxiety and unemployment. The result is that many young people are left feeling overwhelmed, with nowhere, or no one, to turn. For some, this can lead to tragic consequences.
With that in mind, we recently hosted an event with leading medical experts to discuss the challenges being faced by youth, available resources, and ways we can all assist our youth during this time. Moderated by Dr. Michael Baker, Professor of Medicine, University of Toronto; former Physician-in- Chief, University Health Network the panel discussion featured Dr. Joanna Henderson, Executive Director of Youth Wellness Hubs, CAMH, and Associate Professor, Department of Psychiatry, University of Toronto, Dr. Susan Abbey, Psychiatrist-in-Chief, University Health Network; Professor of Psychiatry, University of Toronto, and Ms Debbie Schatia, Director of Program Services, Covenant House; MSW from University of Toronto.
The following is a summary of the discussion, edited for length and clarity.
Dr. Joanna Henderson indicated that, Canada was already in a mental health crisis prior to the pandemic. Children, teens and young adults in particular have been struggling. Ipsos Reid data show that almost half of them reported their mental health had deteriorated during the pandemic. Social isolation has been the focus of CAMH’s work. They consider children and teens in context of their families, schools, communities – because things that impact those layers impact young people. When adults struggle with financial concerns, spousal conflicts, alcohol abuse, and other pressures, that translates into even greater struggle for the young people who live with them.
Partnering with young people, CAMH has developed new ways of delivering services to 12- to 25-year-olds. They’re thinking outside the box to find solutions to pandemic challenges, such as resources to help kids learn about gender fluidity, sacred Indigenous plant medicines and positive reframing. They recently developed a 12-week dialectic behaviour therapy skills group and ran an old cellphone drive.
Dr. Joanna Henderson emphasizes movement towards care systems that span up to 24 or 25 years of age, giving young people the chance to gain developmentally appropriate support from youth-friendly services and launch into an autonomous, productive, optimal state of health and well-being. Foundry BC and Youth Wellness Hubs of Ontario are two good examples.
Dr. Susan Abbey spoke about transitional-aged youth (TAY) age 18 to 25 who develop a major medical illness. TAY are at risk for autoimmune diseases (usually lupus), unintentional injury (from doing adventurous things), increasing rates of some cancers and stroke (for reasons not fully understood), and experimenting with substances (which can lead to infections and addictions).
TAY have mental and physical health needs while also needing to set themselves up as adults.
Medical illnesses may cause depression, anxiety and other concerns and often complicate the diagnosis and treatment of medical conditions.
Most at risk are TAY who:
- Must transition out of supportive pediatric care hospitals or programs into adult systems that expect them to manage their complex medical conditions.
- Are “aging out” of child protective systems.
- Develop major medical challenges that slow them down just at the age when they want to flourish, get educated and start relationships.
- Have significant mental health conditions such as bipolar disorder or schizophrenia that result in medical conditions and complicate their medical management.
- Do not comply with medical protocols and miss medications they should be taking.
All of this makes it hard for youth to set themselves up for the lives they want to live.
She discussed the need for a model in which mental health care is on an even plane with physical health care and calls for solutions co-designed by young adults and front-line staff that have a trained program coordinator, digital mental health resources and groups, and support over instant messaging/texting.
Everything is Not Okay is a new campaign being run by Addictions and Mental Health Ontario (AMHO), Canadian Mental Health Association Ontario (CMHA), Centre for Addiction and Mental Health (CAMH), Children's Mental Health Ontario (CMHO), Ontario Shores Centre for Mental Health Sciences (Ontario Shores), The Royal, and Waypoint Centre for Mental Health Care. They are working to end long waiting lists and provide supportive housing and better access to substance abuse treatment.
Dr. Joanna Henderson adds that the goal is for any young person anywhere in the province of Ontario to know that high-quality services exist that meet their needs and where to access them in a timely fashion. Everyone needs to take responsibility for identifying when young people are struggling and intervene earlier.
Debbie Schatia discussed what happens when homelessness and mental health challenges intersect in young people. In Canada, about 35,000 youth per year and 6,000 on any given night are homeless, not counting the “hidden” homeless, such as couch-surfers. Up to 35% of kids served by Covenant House Toronto have a severe, complex mental health concern (bipolar, schizophrenia or personality disorder), and 60% have general anxiety or depression. Almost all have had Adverse Child Experiences (ACEs) – physical and sexual abuse, neglect, family violence before age of 18. Half of them left home because of abuse or violence.
During COVID, Covenant House has been at near or full capacity – it’s been hard for youth to be at home – or return home – with their parents. The House has had to shut down due to social distancing. Their drop-in centre used to serve 100 people a day, now they serve between 15 and 30. More young people and adults live in tents than pre-COVID.
Causes for homelessness include racism, lack of LGBTQ2S+ tolerance, no affordable housing, poverty and precarious employment (which have worsened during the pandemic), and social isolation. A survey (Thulen and Noble 2020) of service providers during the pandemic shows that boredom, loneliness, anxiety, depression, sleep disturbances, pre-existing mental health conditions, and substance use and overdoses have all increased. School closures have triggered social isolation, one of the biggest determinants of mental health challenges, especially for youth with learning disabilities who need in-school support. However, youth with social anxiety may find the online format more engaging.
Covenant House recommends:
- Increased outreach – including virtual services to reach more youth (which may not work as many do not have cellphones or access to computers).
- Increased access to mental health and substance use treatment.
- Trauma-informed care, which fosters understanding of why young people react as they do and how to create safe environments that reduce symptoms.
- Prevention initiatives such as a housing-first approach.
- Stronger collaboration with mental health providers, child welfare, youth justice, and culturally safe services.
- Better access to financial and social support because COVID-19 has exacerbated youth poverty.
Tools for building resilience, reducing anxiety, coping, integrating for young people:
Dr. Susan Abbey recommends:
- Encourage youth to see themselves as part of an historical moment, to help others and to move forward.
- Help young people to develop increased resilience through mindfulness. This is a secularized practice founded on the Buddhist belief that life is suffering, and that, by accessing our own compassion and kindliness towards other people, we can help ourselves to deal with suffering and foster resilience.
Dr. Joanna Henderson says:
- A walk outdoors will help – emerging data show that time in nature and outdoors is part of mental health.
- Don’t overlook the importance of structure in the day, which benefits children and youth, such as getting up, showering, eating at regular times, exercising and relaxing.
- Promote family conversations that are not conflict-ridden. Don’t ask too many practical questions: Have you done your homework? Where are things at? Have you emptied the dishwasher?
- Facilitate young people’s connections with their peers, whether virtual or a bike ride with appropriate social distance.
- Encourage private conversations with extended family members who are allies or confidants.
Debbie Schatia suggests:
- Start where they’re at. Depending on their level of need and mental health challenges, try to connect them with supports and resources.
- Encourage them to learn about resiliency and mindfulness and do virtual yoga and a physical activity such as martial arts online.
- Help them to find a role in society, get them to a clinic that addresses some of their physical health needs and to a psychiatrist for mental health support.
Event host Marvi Ricker, Vice President and Director of Philanthropic Advisory Services at BMO Private Wealth, recommends that parents of youth who are suffering visit Jack.org to find information on how to talk to youth who need help.