Creating a smoother transition for youth
Just when a young person being treated for mental illness may need help the most, he or she is often transferred from youth-focused child and adolescent programs to adult services.
“Age 18 is such a critical period for a person as they move into adulthood,” says Dr. Kristin Cleverley, CAMH Clinician-Scientist in the Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and CAMH Chair in Mental Health Nursing Research at the University of Toronto. “It’s also typically the time when a young person who is in mental health treatment often needs to transition to adult care,” frequently based on program and funding decisions, rather than on client needs.
“We do know there is a large drop-out rate from mental health treatment at this milestone; it’s also a high-risk age for suicide among young people,” says Dr. Cleverley. What is not well understood are the specific factors that may enable – or undermine – success during that transition.
In February, Dr. Cleverley is launching the Longitudinal Youth in Transition Study (LYiTS), which will track 135 young clients of CAMH and other mental health services (both inpatient and outpatient programs) as they move through the age 18 milestone. Participants, starting at age 16 or 17, will be assessed each year over a period of three years. The assessment will look at their mental health symptoms, life functioning, service utilization, readiness to transition to adult services and other factors.
Defining an effective transition
For those who make a transition to adult services in the mental health system, “we will be able to pinpoint elements of a good transition,” says Dr. Cleverley. These may include factors such as appropriate hand-off of client records, and collaboration between the youth and adult services.
Meanwhile, in a related qualitative study, the research team will conduct more in-depth interviews with young people and their family members to identify key themes both before and after the transition. “There’s an enormous amount of change occurring simultaneously in the lives of young people at this age, with finishing high school, transitioning to work and/or post-secondary education and changing living situations,” says Dr. Cleverley. Yet as they move towards independence, young people confronting mental health problems often need to depend even more on family members and health providers.
The case for change
Dr. Cleverley cites a number of reasons driving this research:
• Treatment drop-out rate: An estimated 50 per cent of youth in child and adolescent mental health services drop out at entry to adult services.
• Prevalence: Mental health challenges surge in adolescence – an estimated 35 per cent of 16-year-olds have experienced a mental disorder, and most adult mental illnesses have their onset in adolescence.
• Suicide: Suicide is the leading cause of non-accidental death among youth aged 15 to 24.
A personal motivation
Dr. Cleverley also has a personal motivation for this research. In 2011, she lost her younger brother, David.
A talented athlete and sometimes thrill seeker (he was nicknamed Superman as a boy), David had started a career in corporate sales in the high-tech sector in Ontario. But he was unsettled, and continued to battle depression, anxiety and alcohol problems.
“When he sought treatment, he bounced around different programs and services, visited many emergency rooms, and his diagnosis kept changing,” recalls Dr. Cleverley. “Looking back, it was such an incredibly stressful time for him and our family. It was clear to us that some of the programs were not appropriate for my brother at his stage in life. Certainly, a youth-focused program would have been more appropriate but, given his age, he was sent to adult programs.”
David pursued a life-long dream and moved to B.C. in the fall of 2010; however, rather than finding the peace he was hoping for, his mental health deteriorated and he was hospitalized after attempting suicide. After a brief hospital stay, David was discharged without a follow-up plan or aftercare. With the support of his family, he decided to stay in B.C. and “lead a simpler life.” He joined his cousin’s church, found factory work, and quit alcohol. While he appeared to be doing better, he was still struggling with his mental health, and he and his family began discussing next steps to receive treatment. However, David didn’t get that chance.
After a floor hockey game with friends, the group decided to cool off by diving off the cliffs into Cultus Lake, B.C. David, being Superman, ascended higher than the others. He hit the water awkwardly and was tragically killed. He was 26 years old.
“One of the hardest things for my family was that we couldn’t help him get the continuity of mental health care he needed at a critical time in his life,” she says.
Making an impact
Results of the new study will provide “a foundation for decisions on effective clinical care for transitional-aged youth in the future,” says Dr. Cleverley. That could involve changes to care pathways, collaboration between youth and adult services, youth-friendly service design – such as service on evenings and weekends – and ways to make transitions smoother. “In collaboration with other CAMH researchers, we’re also seeing the potential for technologies such as apps that can engage younger clients at an important part of their lives,” she says.
“Through this research, I want to make an impact on services and care for youth, their families, and service providers,” says Dr. Cleverley.