Post on 27-Jul-2020
Ten Hot Topics in Child and Youth Mental Health
Ian Manion, Ph.D., C.Psych.
20% of 4-16 year olds have MHA
problem
(OCHS)
<1/3 will receive targeted
MHA services (Merikangas et al,
2011)
By age 16, 35% experienced
mental disorder (Costello et al 2003)
50% drop out of MHA service at entry to adult
services
(Pottick et al, 2008)
70% of adult mental illness
begins in adolescence
(Kessler et al, 2007)
1. Youth engagement
2. Youth substance use and addictions
3. Technology and social media
4. Transitional aged youth
5. Education super highway
6. Self-Care and peer support
7. Youth suicide prevention
8. School mental health
9. Integrated youth wellness hubs
10. Resiliency
Ten Hot Topics
1. Youth Engagement
Youth Engagement Promotes Health and Decreases Risk Armstrong & Manion, 2007; 2013
“The more meaning found in engagement, the less likely youth were to report suicidal
thoughts in spite of risk factors”
Youth are engaged if...
• they are meaningfully involved • they make decisions, gain leaderships skills and see their
ideas develop • there's a social aspect to their involvement • they see change and progress happening • their imaginations are touched • they are in a safe space where they have ownership and
control
• their voices are being heard and valued
2. Youth Substance Use and Addictions
Which drug is responsible for the most deaths, injuries, and accidents amongst youth?
19% did not screen positive for emotional or behavioural
concerns, nor problematic substance use.
Sources: Henderson, J. & Chaim, G. (2013). National Youth Screening Project Report. Toronto, ON: Centre for Addiction & Mental Health. Henderson, J. & Chaim, G. (2014). Ontario Youth Screening Project Report. Toronto, ON: Centre for Addiction & Mental Health.
10 Youth Concurrent Disorders: Results from 14 Canadian Communities
• Be aware of your own values and attitudes (re: substance use).
• Avoid judging, labelling, and blaming.
• Focus on rapport building, your greatest asset in building trust.
• Provide information and raise awareness-
• Emphasize safety and harm reduction.
• Express concern in a non-confrontational manner.
Guidelines for responding to a youth who may be at-risk for substance abuse
• Be informed, but don’t feel you need to be a drug expert.
• Use teachable moments; “What did you learn?”
• Focus on strengths, resiliency, good choices
• Never confront when the person is under the influence. Ensure safety for youth and staff.
• Refer to community or school resources, i.e. addictions worker, public health nurse, guidance counsellor.
Responding to a youth who may be at-risk for substance abuse (cont.)
3. Technology and Social Media
Some Facts
• 86% visit social media daily • 63% of children and youth spend 3+ hours on screen time • 16% 5+ hours on social media • 20% report being cyberbullied • 26% play video games daily (40% boys vs 11% girls) • 1/8 report symptoms of a video-gaming problem
(preoccupation, tolerance, loss of control, withdrawal, escape, disregard for consequences, disruption to family/school/social life
• 1/3 youth drivers text and drive
The most pronounced concerns lie in: • Low or decreased self-esteem during or after using social media. • Negatively comparing yourself to others via their social media content
– focus on shortcomings) – feeling envious of others while engaged with social media.
• Using social media as your prime leisure activity. • Feeling disconnected and not interacting in person as often as you normally
would. • Decrease in ability to concentrate. • Increased or unusual social anxiety when interacting with people offline. • Feeling a need to share everything you’re doing offline on social media. • “FOMO” (Fear of Missing Out) • Using social media as a distraction to avoid or suppress unpleasant emotions. • Irregular or disordered sleeping patterns. • Increase in fatigue and/or stress during or after using social media.
What to do? • Reach out, offline:
– Substitute your social media time with face-to-face – Put down your phone and other devices when you’re with others.
• Tune up your mind and body: – Exercise. Meditate. Find a new healthy hobby; learn a new skill or language. – Get some sleep for physical and mental wellbeing
• Unplug and erase: – Take some time away from the Internet a – Take social media off your radar by uninstalling apps, removing shortcuts from your home
screens and bookmarks from your browsers.
• Set firm boundaries. – Time of day, how long, – Stay away from SM that leaves you feeling low – Set a timer
• Get support:
4. Transitional Aged Youth
• Lack of easy transition jeopardizes life trajectories of young people (Pottick 2007).
• At peak age of onset, highest burden of illness, system weakest and most discontinuous (Singh 2008, McGorry 2007, Pottick 2007).
• 60% of youth with MH problems disengage in the transition (Harpaz-Rotem 2004).
• Re-engagement is usualy crisis driven
• Essential to break down the silos (MHCC 2009).
Transitions:
Facilitating Transitions
Empirically informed practice guidelines 1. An active, future-focused process 2. Young-person-centered 3. Inclusive of parents/care-givers 4. Starts early 5. Resilience framework 6. Multidisciplinary, inter-agency 7. Involves pediatric and adult services, in addition to
primary care
Facilitating Transitions (cont’d)
8. Provision of coordinated, uninterrupted health care - Age and developmentally appropriate
- Culturally appropriate - Comprehensive, flexible, responsive - Holistic – medical, psychosocial and educational/vocational aspects
9. Skills training for the young person - Communication, decision-making, assertiveness, self-care, and self- management.
10. Enhance sense of control and interdependence in healthcare
11. To maximize life-long functioning and potential
5. Education Super Highway
Creating the Wrong Expectations
Pressure to: • It’s a race and you have
to finish first • University for a good life • College for weak
students • Need to have a clear
career path and climb that ladder
• Marks are everything
Reality of: • No one clear path • Many jobs don’t even
exist yet • College and university
co-exist • People will change
careers multiple times • Applied experience is
critical
6. Self-Care and Peer Support
Mental Health System Not Sustainable
• Note enough psychiatrists, psychologists, social workers, youth counsellors to ever meet the need
• Need to look upstream at prevention and promotion
• Self-care in critical in the presence or presence of a mental illness
• Need different ways of providing care
Why Peer Support?
Key Issues in Peer Support
• Benefits to provider and receiver • Better reach (geography, diversity) • Multiple modalities (face to face, group, virtual) • Multiple roles
– System navigation, skills building, complement to treatment – Step up and step down
• Critical to choose the right peers – Age, level of recovery
• Training and ongoing supervision – Role clarity, boundaries
• Safety net linked to care pathways • Problem of stigma
– Moving towards accreditation
7. Suicide Prevention
• One suicide is one too many • Whole community approaches to
suicide prevention
www.togethertolive.ca
Death Rates of 15 to 24 year old Canadian Youth: Stats Canada Data
1974-2009: mortality, accident and suicide rates among youth aged 15 to 19 years
(Statistics Canada, 2012)
Life Promotion Versus Suicide Prevention
8. School Mental Health
Mental Health in Schools
• Mental health literacy and stigma reduction o universality, accessibility, acceptability
• Promoting mental health (from safe schools to pro-social learning)
• Identification of mental health problems
• Mental health care delivery (onsite/facilitated)
• Schools can be a hard place to work so we need to support the mental health of teachers too!
9. Integrated youth wellness hubs
Improved outcomes for youth GOAL
System Transformation
Integrated Service Models: Key Features • Youth and family engagement • Integration of existing social services,
– Education, vocational services, justice, housing, addictions • Youth-friendly integrated service centers (co-created) • Online portals and maximized use of technology • School-based strategies (early identification) • Outreach through primary healthcare • Phased intervention (stepped care),
– Right level of care at the right time by the right provider – low intensity promotion/prevention as well as pathways to high
intensity specialized youth mental health services. • Commitment to evaluation • Governance that reflects the model
10. Resiliency
• Most simply put: resiliency is the ability to bounce back from adversity
• 2 things need to be present:
• Adversity
• biological, environmental, …
• The ability to overcome adversity and to thrive
• Internal and external resources
• Coping skills (e.g. emotional regulation)
A Model for Mental Health and Wellness
Keyes, 2003
Minimal mental wellbeing (languishing)
Optimal mental wellbeing (flourishing)
Maximum mental illness
Minimal mental illness
Example: a person who experiences a high level of mental wellbeing despite being diagnosed with a mental illness
Example: a person who has a high level of mental wellbeing and who has no mental illness
Example: a person who has no diagnosable mental illness who has a low level of mental wellbeing
Example: a person experiencing mental illness who has a low level of mental wellbeing
Resiliency
• Do something that scares you a little bit each day • Promote self-efficacy
• Focus on beauty marks rather than warts • Every young person has strengths
• Develop skills in emotional regulation • Healthy expression not over or under-control
• Learn to fail forward • Promote relationships (they are the key to everything) • Promote meaningful engagement in something bigger than
your problems
• Develops sense of belonging and meaning
Manion’s Tips to Build Resiliency
• Gender identity
• Public availability of psychotherapy
• Stigma reduction
• Parent stress
• Employment
• The cult of mental illness
• Bullying
• Youth gangs
• Youth justice
Some extra food for thought
Thank You! Questions?
Ian.manion@theroyal.ca