For mental health and substance use
Reprinted from the Treatments for Young People issue of Visions Journal, 2006, 3 (1), p. 4-5
I am excited to introduce this issue of Visions, with its focus on youth treatments for mental health and substance use problems. I commend the editors for their wisdom and vision in bringing such a timely and critical topic forward. And I think you will be happy, in reading about the well-established and innovative programs that exist for youth, to discover how far this field has come. Yet, some of the experiences and perspectives conveyed by our writers indicate that we still have a long journey ahead in creating an environment of care and support that is youth centred in every way.
Why should we care
Youth well-being is something that affects all of us in a myriad of ways. Recognizing the uniqueness of youth as a group and providing developmentally and culturally appropriate supports and treatments are key to our collective potential.
In my role as director of the Provincial Youth Mental Health and Substance Use Program at BC Children’s Hospital, I come in daily contact with youth and their families. I am often dismayed to hear of the numerous failed attempts at finding youth-specific treatment, or of the pitfalls of applying adult management to younger individuals. All too often, such system issues leave the youth and family feeling frustrated and demoralized. At the same time, I am often thrilled to see the dedicated supports that many youth have. Whether a family member, school counsellor, coach, family doctor or probation officer, the network of individuals who are working hard for the well-being of youth is extensive and tends to self select committed and compassionate people. This network of support is essential for youth, their families and the community as a whole.
The articles we have chosen represent a wide range of topics within the area of youth treatments. Some discuss programs or strategies that have stood the test of time; others are innovative and evolving daily. It is important to have both solid evidence behind our treatment, and to have strategies that meet the rapidly shifting, highly trendy life of youth. Programs must be built around evidence-based practices. However, this does not simply mean applying existing evidence. More importantly, new evidence must be created by programs through their own design and research. This is critical for youth treatments in mental health and addictions, as there is a real need for firm scientific literature on youth-specific treatments.
The younger ones
An important question to ask is, why are youth-specific treatments needed and what are the critical components of such treatment? The answers lie within many layers that span the scope of the biological, psychological, social and spiritual continuum of the lives of youth. The younger years are a time of global change in all these areas. Puberty and the years pre- and post-puberty are when the human brain, mind and body undergo profound growth and change. These changes affect the individual completely ranging from the physiologic emergence of psychiatric symptoms, to issues of emotional regulation and self-esteem. Youth also experience immense behavioural and social change. They are faced with numerous tasks, such as establishing coping mechanisms for stress and determining their own identity within their family, peer group and greater community. Youth must establish a fine balance between having the supports they need, yet moving forward in personal independence. It is no wonder that issues of stigma, privacy, stage of change, trauma vulnerability and recovery environment become pivotal for youth during these years. Perhaps it is a combination of such factors that lead to findings that youth ages 15 to 24 years are more likely to report suffering from mental illnesses and/or substance use disorders than any other age group.
The impact of untreated mental illness or addictions on the developing brain, body and acquisition of important psychosocial skills can be profound, far reaching and often fatal. Comprehensive, integrated treatments of a high standard that involve family, peers, schools and other community links are critical. Care must be ongoing and along a continuum, providing entry at any stage of change and/or presentation of problem. Providers must be competent and comfortable within the culture of youth, including issues such as ethnicity, gender, sexual orientation and socioeconomic status. Treatments are best when developmentally appropriate and matched to the needs of the individual, yet flexible enough to serve changing needs by providing a diverse menu of choices.
Treatment’ can only occur if there is ‘engagement.’ Resistance to entering a treatment system, whether it is self-care, peer support or hospital based, is common. Approaches that are creative, minimally intrusive, strength based and that involve harm reduction may help with the challenges of engaging and retaining youth.
Progress is being made
In just the last few years, I have seen major progress in the area of youth mental health and addictions treatments in this province. Through the support of the Ministry of Health and the Provincial Health Services Authority, the first Provincial Youth Mental Health and Substance Use Program was established in 2003 and is rapidly expanding. As part of the province’s Child and Youth Mental Health Plan, a concurrent disorders experts group was established to assist in prioritizing goals for youth with concurrent disorders. There has been focused training on Aboriginal cultural sensitivity, cognitive-behavioural therapy, dialectical behaviour therapy, interpersonal therapy, suicide prevention and early psychosis intervention. In addition, the Ministry of Health and the Ministry of Children and Family Development have supported tackling the problems of crystal methamphetamine use by youth, and BC is the fi rst Canadian province to develop an integrated crystal meth strategy.
I am truly inspired to see the direction we are heading as a community in recognizing the unique and diverse needs of youth. This is evident across the sectors of health, child protection, forensics and corrections, and education. Our collective hopes are for these efforts to reach every community, family and individual. We are all intricately connected to the well-being of the next generation. Today’s youth are, after all, our future.
Dr. Kang is Director of the Provincial Youth Mental Health and Substance Use Program at BC Children’s Hospital. She is also a consulting psychiatrist to the BC Women’s Reproductive Mental Health Program and a faculty member at UBC, where she researches mental health and addictions services and policy.
Currie, J.C. (2001). Best Practice: Treatment and Rehabilitation for Youth with Substance Use Problems. Ottawa, ON: Health Canada, Offi ce of Canada’s Drug Strategy.
Provincial Youth Mental Health and Substance Use Program, BC’s Children’s Hospital: contact program coordinator Linda Barker at [email protected]
Child and Youth Mental Health Plan’s concurrent disorders experts table: contact Monica Armstrong at [email protected]
Crystal Meth Secretariat: visit www.pssg.gov.bc.ca/crystalmeth