Understanding Peer Support in Youth Mental Health Across Canada
Young people in need of mental health services often face long wait lists, complicated pathways to care, and poor-quality services. Both evidence and experience show that it is critical, developmentally and socially, to address the mental health of adolescents and young adults; over 75% of mental health problems first appear in adolescence and young adulthood, but only 20-25% of youth in Canada with these challenges receive appropriate help.
AOM is a national research project being conducted across Canada. Its objective is to improve the mental health of young people by making better care more easily available at the right time. Services provided at AOM sites are designed to address the main challenges of usual services: barriers, wait lists, engagement, and quality of care.
The ACCESS Open Minds framework involves the creation of engaging and appropriate youth mental health services for young people aged 11-25 years old and their families and carers. Youth, families, and carers have communicated the need for engaging services offered from peers to peers to be part of the larger service framework. Both the ACCESS Open Minds network and framework value the inherent support that a peer with lived mental health experience can provide to a fellow community member who is experiencing their own mental health problem.
The Mental Health Commission of Canada defines Peer Support as ‘the help and support that people with lived experience are able to give to one another. Key elements of peer support are built on shared personal experience and empathy, a focus on an individual’s strengths not weaknesses, and working towards the individual’s wellbeing and recovery’.
According to ACCESS Open Minds, ‘evaluating peer support services is an aspect of best practice in care provision, and it ensures that the quality of services is continuously monitored, maintained, and improved’.
This study will use qualitative methods to learn about current peer support work (PSW) and collaboratively conceptualize and document how to adapt existing work to strengthen its emphasis on youth engagement.
Research Questions Include:
- Do youth and service providers perceive PSW as an acceptable adjunct to the mental health services available at AOM?;
- What are the principal mechanisms or key components of PSW that contribute to engagement from the perspective of youth and key stakeholders (peer support workers and service providers from AOM) for youth presenting for the first time at AOM?;
- What critical components of PSW help facilitate engagement of a diverse group of youth including those who typically experience barriers to accessing and engaging in mental health services?;
- What do youth and key stakeholders define as engagement (recognizing the need for services, agreeing to services and regularly attending mental health services at AOM?;
- What dose (ranging from 1 to 4 sessions) of peer support is tolerable to youth at the first point of entry to AOM?;
- What type of training activities have been developed (or are required) to prepare peer support workers to deliver this intervention in the proposed study?;
- What models of mentorship and supervision are suggested for peer support workers? and;
- How does the workplace environment need to change and adapt to integrate peer support workers in AOM sites?
This study is being led by Dr Gina Dimitropolous at the University of Calgary and supported by the ACCESS Open Minds Network
Indigenous Gender and Wellness
Developed during CIHR’s Indigenous Gender & Wellness Idea Fair and Learning Circle that brought together Indigenous people and allies to develop project proposals focused on Indigenous gender and wellness the ACCESS Open Minds Indigenous Council was awarded awarded a Canadian Institutes of Health Research Indigenous Gender & Wellness Development Grant, which will allow participating communities to explore, map & develop a program to build and strengthen healthy relationships in Indigenous communities.
Nominated Principal Investigator: Gregory Brass
Youth Mental Health - Network Catalyst Grant
In Canada, youth mental health and substance use services are delivered by a vast tapestry of providers spanning different sectors, including hospitals, primary care and community organizations. Currently, there is minimal standard data collection or evaluation metrics across these sectors, communities or provinces. Because of this lack of common evaluation, researchers, clinicians, services and funders have no clear picture of the state of youth mental healthcare across Canada, nor which treatment approaches and services are effective for whom.
The Canadian Institutes for Health Research (CIHR) awarded a Network Catalyst Grant to address this challenge in the youth mental health sector, which is now compounded by the COVID-19 pandemic.
This initiative is led by ACCESS Open Minds, with direction from Dr. Jai Shah to design and implement a common evaluation framework for youth mental health and substance use services, this grant will bring together:
- AOM, operating in multiple urban, rural and Indigenous communities across Canada
- Provincial IYS initiatives such as Foundry (British Columbia), Youth Wellness Hubs (Ontario), Aire ouverte (Quebec), and a new Alberta Integrated Services Initiative
- Other local youth mental health community-based programs
Read the full press release here.
Pathway for Rapid, Internet-based, Self-referral to Mental health services for youth (PRISM)
Pathway for Rapid, Internet-based, Self-referral to Mental health services for youth
PRISM-ACCESS Open Minds is a services research project conducted in collaboration with the ACCESS Open Minds pan-Canadian network for youth mental health service transformation, community organizations (e.g., Kids Help Phone, mindyourmind), and Canadian-based health technology companies.
PRISM-AOM aims to develop, implement, and evaluate the use of an online self-referral pathway to facilitate rapid and direct access to mental health services for youth.
Through this pathway, youth with mental health concerns will be able to connect with, and refer themselves directly to a local team specializing in youth mental health care using their phone, computer, or tablet. Parents and service providers will also be able to refer a young person to mental health services via PRISM-AOM. Clinicians will be able to triage, track, and manage referrals through a secured platform.
PRISM-AOM will be customized, launched, and tested in several Canadian healthcare settings participating in the ACCESS Open Minds network.
Shalini Lal, Ph.D., M.Sc., B.Sc.O.T. (Reg.QC)
Future Skills Centre Collaboration
In collaboration with ACCESS Open Minds, Foundry and Youth Wellness Hubs Ontario, the Centre for Addiction and Mental Health’s (CAMH) Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health will implement this two-year project focused on helping 360 youth facing barriers due to mental health challenges enter the job market. The Future Skills Centre’s $2.32 million investment for this team (Leads: Drs. Joanna Henderson and Srividya Iyer) will provide an evidence-based basket of supports, including working with employers to promote positive workplace experience and knowledge. Learn more here.
Positive symptom remission trajectories following early intervention services in first episode
Olivier Percie du Sert, PhD, Integrated Program in Neuroscience, McGill University
Supervised by Dr Ashok Malla
This study is an ambitious project combining a state-of-the-art mixed-methods approach with an extensive and multidimensional assessment 10 years following initial treatment in early intervention services for psychosis. As such, this represents the most comprehensive study of the long-term outcome for first-episode psychosis in North America.
The Experience and Mental Health Needs of Asian Immigrant LGBTQ Youth
Jishian Ravinthiran, Master’s Candidate, Psychiatry Program, McGill University
Supervised by Dr Lucie Nadeau, Dr Srividya Iyer (ACCESS OM Montreal sites and partnering campus)
This study will explore the struggles Asian immigrant LGBTQ youth face because of their overlapping minority identities, and the experiences and beliefs these youths have about mental health and allied social support services.
Research shows LGBTQ youth, Asian immigrants, Asian LGBTQ people and Immigrant LGBTQ adults are distressed by negative experiences that target their different identities, but no research to date has looked at the specific concerns of Asian immigrant LGBTQ youth in Canada, though they may share many struggles with these previously researched groups. This is worrying because recent trends in immigration suggest that the number of these youths are likely to increase in metropolitan areas, and mental health and allied services should be prepared to address the unique challenges this increasing population faces.
To address this, this study will have Asian immigrant LGBTQ youth and service providers interviewed to understand how these youths’ different identities affect their lives and the mental health and allied services they seek and obtain. These interviews will be transcribed and analyzed to identify the common experiences and perceptions these youths have of mental health and allied services. These experiences and perceptions will be presented to policy and decision makers who will discuss the current strengths of services for these youths and recommendations that can be made to fill any unmet needs.
Finally, this discussion will be integrated with the perspective of the youths and service providers to holistically describe the experiences of Asian immigrant LGBTQ youth and provide recommendations for their care.
The Service Level Needs of Youths at Clinical Risk for Psychosis: A Mixed Methods Study
Sarah McIlwaine, Master’s Candidate, Psychology Program, Concordia University
Supervised by Dr. Jai Shah (Dorval-Lachine-LaSalle site)
Approximately half of youths seeking help from mental health services are at risk for developing a major psychiatric disorder. Despite this high level of need, it still remains unclear whether the mental health services offered to such youth are appropriate and respond to their needs.
For instance, services offered to youths at-risk for psychosis primarily aim to prevent the development of a first psychotic episode. However, the relevance of this aim is questionable since many of these youth have poor outcomes irrespective of whether they develop psychosis.
This creates a need to consider broader outcomes, to re-examine the appropriateness of current interventions, and to determine the service needs of youths at-risk for psychosis. To do this, youths and their caregivers will be recruited at the ACCESS-Dorval-Lachine-LaSalle site. Both the youth and caregiver will be interviewed upon entry to the clinic, then 3 and 6 months later. This allows us to capture how their needs change over time and to understand why their needs have changed. Afterwards, we will conduct 3 separate focus groups with youths, caregivers, and ACCESS service providers at two time points. The first set will help identify what each stakeholder perceives to be the needs of at-risk youths. The second set will put forward recommendations on how ACCESS services can be improved for at-risk youths.
Overall, the proposed study will provide rich information regarding the experience of the at-risk for psychosis state and will support the development of more specialized services.
Working with Youth as Stakeholders in Mental Health System Transformation
Eugenia Canas PhD Candidate, Health Information Science Program, Western University
Supervised by Dr. Helene Berman, Nadine Wathen (Chatham-Kent site)
Working with Youth as Stakeholders in Mental Health System Transformation will examine how a service site in ACCESS Open Minds, the Chatham-Kent Health Alliance (CKHA), engages its Youth Advisory Council during the process of transformation. The aim is to reveal the everyday realities of youth stakeholder engagement, including what makes it effective, what gets in the way, and the various impacts it has on the culture of care. A key question asked is how youth perspectives contribute to the definition, and delivery, of appropriate care.
The research approach used in this study results in rich description of what happens in an organization. This study will consist of one-on-one interviews and observation of meetings where youth stakeholders and site adults work together. Study findings will bring forward the perspectives of both youth and adult professionals at the CKHA. Their experiences will be key to understanding how engagement works, and to translating these findings into materials that can inform professional practice locally and in other AOM sites.
This study is relevant to ACCESS Open Minds and other initiatives that seek to improve youth mental health. Scholars, and national and provincial strategies for systems change, have called for the meaningful inclusion of youth to help improve our system. The level of investment that ACCESS Open Minds dedicates to youth engagement warrants an in-depth examination of the process. This study will share engagement best practices and lessons learned to the entire AOM network, and create new scholarly publications.
Barriers and Facilitators to Accessing Mental Health Care for Street Youth
Julie Deschênes, PhD Candidate, Social Work Program, University of Montreal
Supervised by Dr Amal Abdel-Baki, Céline Bellot (RIPAJ site)
Many street-involved youth are reported to have experienced abuse/neglect as children, which increases their vulnerability to developing mental health problems. Stresses related to the street experience contribute to this vulnerability. Several obstacles encountered by youth (e.g., mental health problems, lack of a supportive social network, lack of links between different services, low schooling) can have an impact on the youth’s situation and on access to appropriate mental health services. Certain factors seem to facilitate access to care (e.g., liaison/partnership between services, contact with family and friends).
The issues involved in youth homelessness are complex and involve several dimensions that may relate to the individual, his or her social network, clinical condition, the health care system, discrimination, etc. The following are some of the factors that may have an impact on youth homelessness
This project focuses on the mental health care pathways of these young people (11-25 years old) within the institutional and community network in order to highlight the obstacles and facilitators that have an impact on access to and continuity of mental health services. The perspective of the various players involved (the young people themselves, their families, institutional and community stakeholders, and service managers) will promote a more comprehensive understanding of the elements that can have an impact on the effectiveness and speed of access to care.
The results of the project will make it possible to identify the strengths and shortcomings of the current context in order to propose solutions for optimizing these services.
Treatment Delays and Pathways to Care in Youth Mental Health
Kathleen MacDonald, PhD Candidate, Psychiatry Program, McGill University
Supervised by Dr. Srividya Iyer (Dorval-Lachine-LaSalle site)
Most mental health problems emerge before the age of 25. In Canada, suicide is the second leading cause of death in young people; and mental illness is ranked as the second highest healthcare expenditure for this age group. Yet, many youths with mental health problems remain untreated, or face delayed detection and multiple help-seeking contacts before getting care.
Young people and their families consistently describe mental health help-seeking as a painful, long and complicated journey. For youth, who are at a critical point in their personal development, these longer durations of untreated illness have grave individual, familial and societal costs, and are associated with worse clinical outcomes. While the need to reduce treatment delays is undisputed, significant gaps remain in our understanding of how young people enter mental health services and the delays they experience.
My doctoral project seeks to: (1) examine pathways to mental health services and treatment delays among youth with mental health problems and (2) to investigate the individual and systemic factors that predict them. To do so, I will conduct a validated interview with young people and their families as they enter mental health services at select ACCESS Open Minds sites. The interview will allow us to gather knowledge on the help-seeking experience, the pathways encountered within the healthcare system, and the delays experienced before getting help. This knowledge is essential we are to truly improve youth mental health services and outcomes as recent Canadian and international initiatives are trying to do.
Examining the Impact of Service Delivery Fidelity on Patient Outcomes
Miriam Kinkaid, PhD candidate, Epidemiology Program, McGill University
Supervised by Dr. Rebecca Fuhrer (Data to be collected in England)
The ACCESS-OM transformation of youth mental health services is partly based on the lessons learned from other successful youth mental health transformations, such as early intervention (EI) services for youth with psychosis. However, there are still many questions about exactly which parts of such complex health care service are important in helping patients.
For this project, a questionnaire that can access how well EI services for psychosis are delivered (i.e., their “fidelity” to the best model of care) will be developed. The questionnaire will then be used to collect data on “fidelity” in EI services for psychosis in England. Although this first version is being developed for psychosis and for use in England, in a second phase, it is intended to be modified for use in Canada. The data collected with the questionnaire will be combined with other health data to assess whether EI services decrease patient hospitalizations and suicide, and whether and how these outcomes are affected by “fidelity” to the best model of care. England is an ideal location for this research because they have also undergone a mental health services transformation with early intervention services for psychosis, and they now have over 155 EI services across the country.
The study will provide a questionnaire that could easily be modified and used to measure service delivery in the Canadian youth mental health services transformation. It will also provide information about which parts of youth mental health services are most important to improve youth mental health.