Challenges & Choices: Finding mental health services in Ontario
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Almost one in five children and youth has a mental health problem. These problems can show up in different ways. Children may be frequently sad or rebellious; have difficulty paying attention; have problems eating, sleeping or getting along with schoolmates; or they may skip school. As an adolescent, they may use alcohol or other drugs.
While it can be difficult to find mental health services for anyone, parents may find it particularly difficult to find services for children and youth. This is because these services fall under more government ministries, and involve more laws than adult services. There is also a shortage of child and adolescent mental health specialists, which can mean long waiting lists.
While it can be frustrating to find services for your child, don't give up! Try to be hopeful and be persistent. The Internet is a valuable tool for doing research. (For a list of helpful Web sites and phone numbers, see Appendix B
Assessment and referrals
Two-thirds of referrals to children's mental health services are for behavioural problems. Behavioural problems are more common among boys as boys are more likely to act out their problems. Girls, on the other hand, are more likely to hold in their problems, which can lead to emotional problems, such as depression and anxiety. Young people's difficulties often arise from stressful life events, such as abuse, neglect, a parent dying, parents divorcing or other major changes.
Adolescents who struggle with gender identity and sexual orientation may develop feelings of loneliness and depression. Because of this, rates of suicide are higher among gay youth.
Children are unlikely to find mental health services on their own. They are usually referred by a family member, doctor, school, court or the Children's Aid Society. As teenagers, they may be able to refer themselves, but it depends on the agency's policies. At some agencies, therapists are required to tell the parents or caregivers that the youth has approached them.
Assessments can be done by many different specialists, including child or adolescent psychiatrists (who are specially trained to evaluate, diagnose and treat children and adolescents), nurses, child and youth workers, social workers or psychologists.
During an assessment, the specialist usually speaks to both the child and his or her parents, or any other adult who has referred the child. The specialist will ask each person's opinion of the child's problem. The specialist will also want to know, for example, how the child is doing at school and what the child's relationships are like with friends and family members. As well, the therapist will want to determine if the child has any medical problems that are affecting his or her mood, thoughts or behaviour. If the child is very young, the assessment may include other methods of evaluation. For instance, children may be asked to draw or play with certain toys if they can't use words to express themselves.
If the child is having emotional problems and learning difficulties, it is important to refer the child for academic or psychometric testing. This kind of testing assesses both the child's academic and emotional well-being. Psychometric testing can be provided by schools, hospitals or psychologists working in private practice. Because there are long waiting lists, parents may choose to have their child tested by private psychologists; however, this can be quite costly.
A child's assessment is rarely clear-cut. It can be difficult for parents to know if their adolescent's unusual behaviour or mood is a normal part of adolescent change or a real concern. Because of this, parents sometimes delay getting help. And before they know it, they have a crisis on their hands. Long waiting lists can prevent youth from getting help when the situation is critical.
Children's problems often come and go. They may seem to disappear for a while, and then return in a different form or during a stressful time. Because children are continually growing and changing, results of an assessment may suggest several different things that need to be done. These suggestions will depend on the child's stage of development and age. For instance, when the child is younger, the specialist may want to focus on language and speech or communication. As the child gets older, the specialist may suggest supportive therapy and possibly medication.
Treatment and support
Depending on the problem, a child could receive services from the following places:
- family doctor or general practitioner's office
- school (if a social worker or guidance counsellor is on site)
- youth clinic, mental health or addiction treatment centre or community residential treatment program
- children's mental health agency psychiatric unit of a children's hospital or
- psychiatric hospital
- private practice or
- program for young offenders, if the child or youth is in trouble with the law.
Children are usually treated in outpatient services. While they are rarely hospitalized, they may be if they:
- are a danger to themselves or others
- have been living in an unhealthy environment (e.g., an abusive home) or
- have experienced severe symptoms of an eating disorder or early onset depression, schizophrenia or bipolar disorder.
Various specialists may be involved in a child's care (e.g., psychologists, child and youth workers, nurses, child and adolescent psychiatrists, speech or language therapists and families). Children benefit from the many perspectives provided by a team of professionals.
Treatment for children or youth generally consists of:
- working with parents to teach them ways to avoid conflict and to be supportive when interacting with their child. This is an increasingly common part of treatment that may include educational or parents' groups.
- psychotherapy, with the child individually and with participating family members. (For more information on family therapy, see Section 4.) The therapist may use a cognitive-behavioural approach (see Section 4 for a definition) or offer supportive counselling. Because there are often many people involved in a child's care, a case manager may also help co-ordinate services provided by the various caregivers. These caregivers work in schools, hospitals or the community.
- medication. However, medication is prescribed less often to children than adults. Parents' and professionals' first choice for treatment isn't usually medication. This is because there is little, if any, research on the long-term effects on growing children. Yet research shows that therapies that work to change behaviour do work, so these are often preferred.
Parents and professionals have to consider the potential benefits of medication for the child. Will using the medication mean the child will lead a happier life? Will the child have an easier time growing up? Will there be less disruption in the child's development? Parents and professionals also have to consider the potential side-effects of the medication. Parents should be aware that schools may encourage medication as a way to manage or control a child's behaviour. If a doctor or teacher recommends medication for your child, it is important to determine if he or she is simply harder to handle or is affected by a mental health problem. (For more information on medication, see Taking medication, in Section 7
The percentage of adults 55 years of age and over is growing. As we age, our needs change. Our need for health care, social services and institutional care tends to increase. And yet the needs of older adults are often neglected.
The main mental health problems affecting older adults are dementias (along with paranoia), depression and anxiety. They may also experience many other problems, including physical health problems, grief over friends or partners dying, feelings of isolation and loneliness, language barriers, stress around recent immigration and abuse.
Older adults are most commonly abused financially (e.g., by theft or fraud). However, the abuse may also be physical. For example, an adult child may hit, slap or punch an older adult. Or the abuse may be psychological (e.g., when partners or adult children are critical, controlling or threatening).
Older adults tend to be referred to mental health specialists by other adults (e.g., a family member or caretaker.) These people often have the difficult task of figuring out if the older adult's behaviour or mood is normal. Is their behaviour just a part of growing old, or is it something to be concerned about? For instance, memory or concentration problems may be a result of the aging process. Or these problems could be related to dementias, depression or other mental health problems. Problems such as misuse or overuse of alcohol and prescription drugs may be difficult to detect and can affect the older adult's abilities. Older adults often have to rely on others to refer them for services. This means they may not get services until their situation has reached a crisis and someone else decides it is time for them to seek help.
The shame and stigma associated with mental health problems can be particularly severe for older adults. They grew up in a time when there was less openness and understanding of mental health problems. Unfortunately, the fear of being discriminated against, along with the fear of being put in a hospital, often prevent older adults from seeking help on their own.
Assessment and referrals
Older adults are usually assessed by a family doctor or geriatric outreach team. These teams are made up of doctors, social workers, nurses and occupational therapists. The assessment generally takes place in the older adult's home to see how the person manages and to find out if changes are needed to make it easier and safer to continue living at home. To see a geriatric psychiatry team, older adults usually require a referral from their family doctor.
Treatment and support
While older adults usually receive care from geriatric psychiatrists or geriatric outreach teams, in general, there are not enough professionals to respond adequately to their needs. Treatment usually consists of support, education for family and caregivers, and possibly medication. Team members work with community agencies to provide the support needed.
Treatment for older adults may also include addiction services.
Other care for older adults with mental health problems tends to be mainly social services, rather than actual treatment for mental health problems. These social services may be offered through:
- seniors' clubs
- drop-in centres
- Meals on Wheels, which delivers meals to the home and
Community Care Access Centres (CCAC). (See Home care, in Section 8.) CCACs mainly provide in-home support services (e.g., a personal support worker comes to the home to prepare meals for older adults who need help with activities of daily living).
Challenges & Choices: Finding Mental Health Services in Ontario