Helping young people in Nova Scotia
Reprinted from the Young People: Transitions issue of Visions Journal, 2015, 11 (2), pp. 37-39
On August 22, 2009, the world lost a talented, sensitive and enthusiastic individual when Alex Fountain took his own life. He was a 20-year-old university student at the University of King’s College in Halifax, Nova Scotia, struggling with depression.
On April 4, 2013, the Queen Elizabeth II Health Sciences Centre Foundation announced an extraordinary gift from Fred and Elizabeth Fountain in honour of their son Alex. The gift funds the Stay Connected Mental Health Project, a five-year plan (2013–2018) to integrate a process of identifying young people with mental health and addiction challenges early on, teaching youth health care self-management, and building rapport between pediatric and adult services in Halifax.
The Stay Connected Mental Health Project comes under the Mental Health and Addictions Program Specialty Services, Nova Scotia Health Authority Central Zone (formerly Capital Health). It involves the pediatric and adult health authorities, and a number of community partners such as Laing House, a peer support organization for youth ages 16 to 29 with a diagnosis of mental illness, and Healthy Minds Cooperative, a health care co-operative that provides peer-based services to mental health consumers and their families. Local universities are also involved, with a goal to support youth with mental health and addiction problems to stay connected to the care they require.
The Stay Connected Mental Health Project is overseen by a coordinator and supported by an advisory committee made up of staff from both the adult and pediatric Mental Health and Addictions Programs, youth and family members. A part-time system researcher helps evaluate all the outcomes of the project.
Removing barriers, creating pathways
Seventy per cent of mental disorders have their onset before the age of 25, so it’s critically important to improve how we coordinate the care of young people and their families. The vision of the Stay Connected Mental Health Project is to shift the culture and practice of how youth and their families transition from pediatric to adult-based mental health and addictions services. Far too often, young adults fall out of care when they “age out” of pediatric-based services at 19.
Through enhanced mental health literacy, strategic planning and collaboration across health care settings, the Stay Connected Mental Health Project is overcoming system issues that create barriers. One of these barriers is the fact that the pediatric and adult-based services function as two separate health authorities, even though some service locations are separated by just a few city blocks. Additionally, the adult mental health mand addictions program is made up of more than 40 services. This makes it difficult for clinicians from pediatrics and the universities to know where to direct a young person.
These barriers are being replaced with pathways to care. Joint transition meetings with clinicians, youth and their families are helping young adults and their families stay involved in care during this life transition. Also, an easy-to-follow service landscape map is being created to aid clinicians in navigating the system. Central to the project is the development of guidelines that outline the procedural and clinical steps involved in transitioning a youth and their family when the youth approaches adulthood. These guidelines focus on an overlap of care when a youth ages out of pediatric mental health and addiction services (at the IWK Health Centre in Halifax) and requires ongoing care through adult services at the Nova Scotia Health Authority. These guidelines and the steps involved have been shared with the many clinical service teams at both pediatric and adult settings.
Project staff, working closely with staff at the IWK Health Centre, are developing content for self-management skill-building training aimed at youth receiving IWK mental health and addictions services. Helping youth get ready for being in charge of their own health care as they transition into adulthood is important for successful mental health care outcomes.
Some of the self-management content comes from www.teenmentalhealth.org, a website devoted to youth mental health literacy. The website was created by Dr. Stan Kutcher, the Sun Life Financial Chair in Adolescent Mental Health at Dalhousie University in Halifax.
The transition to adulthood and adult services can also be challenging for families. The Stay Connected Mental Health Project has partnered with hospital and community services to develop a family mentorship program that provides support and information to families of a youth in transition from the IWK to adult services.
The mentorship program pairs trained volunteers with family members of a youth in transition. The mentor is a family member of a young adult who has already transitioned from pediatric to adult mental health and addiction care.
‘Service landscape’ navigational map
This map of mental health and addiction services is intended to help IWK clinicians and family physicians identify the appropriate services and pathways for youth and their families as they transition to adult care. (Since a significant restructuring of the Nova Scotia Department of Health happened on April 1, 2015, the map development will be delayed until it’s determined what services will be provided where.)
Developmental resources for clinicians working in adult services
Working with teens and young adults requires particular skill. The project includes training for adult-based mental health and addiction clinicians to enhance their skills in working with teens and young adults. (The training component is still in the development stage.)
Specific initiatives related to campus mental health
Fred Fountain, who previously served as Chancellor of Dalhousie University, proposed that the Stay Connected Mental Health Project should reach out to local universities around mental health issues. A working group representing Dalhousie, King’s College, Saint Mary’s, Mount Saint Vincent and Nova Scotia College of Art & Design universities has been tasked with supporting the implementation of activities related to student mental health.
One activity of note has been the distribution of Transitions (© 2013), a mental health literacy guidebook directed at young people starting university (see www.teenmentalhealth.org/toolbox/transitions). It provides information on topics including time management, relationships, sexual activity, mental illness, suicide and addictions, as well as mental health self-help information and recommendations about when students should get help on campus. The universities have sent the Transitions app, as a link within an email, to thousands of first-year students during the first week of classes at the partner universities. Hundreds of copies of the Transitions book have been distributed around the campuses, and it can also be purchased from Amazon.
Other university activities include:
creation of an ongoing University Health-Hospital Liaison Committee, which meets twice yearly to develop relationships that will foster better access to care for students
a partnership with the Association of Atlantic Universities mental health working group
delivering mental health education to university faculty and staff (scheduled for late summer and fall 2015)
providing student peer support (in development, with intended rollout in fall 2015)
Two years in...
An unanticipated staffing turnover caused some delay, but the project is now solidly on track and moving full steam ahead. We don’t have meaningful statistics yet, but the Stay Connected Mental Health Project has met with great enthusiasm from all quarters, and individuals continue to step forward to join the ranks. In and of itself, this is the beginning of the cultural shift we envision. With this extraordinary gift from the Fountain Family, young people in our community will have greater access to coordinated mental health care at a time when they most need it—a meaningful legacy in memory of Alex Fountain.
“The Stay Connected Mental Health Project has brought the universities and hospitals together in a brand new way. Though we have met only a few times so far, we have already formed incredible partnerships that will see our students get the care they need in a timely and effective manner. The enthusiasm and good will shared around the table has given me a renewed sense of hope in my work.” —partner university spokesperson
About the authors
David is a Psychologist and health care administrator in Halifax, with a particular interest in access to evidence-based care. He is Program Leader, Specialty Services, and responsible for the development and delivery of the Stay Connected Mental Health Project
Debbie, Coordinator of the Stay Connected Mental Health Project, is a Psychiatric Nurse committed to decreasing stigma and improving access to care