The Family Navigation Project

The Family Navigation Project presents: ALYSON SCHAFER

2012-11-08T06:05:00.000-08:00

Hi everyone!

I’d like to first thank those who came out to our last fundraiser, The Long Run, a play shown at the Al Green Theatre downtown Toronto. We raised over $2000 for the Family Navigation Project, and more importantly, Rachel and her cast/crew were thrilled to have so much support, so thank you for coming out! I hope it was both entertaining and informative for everyone.

Continuing the momentum, we have another event coming up the evening of Wednesday, December 5th 2012 at 7:00pm here at Sunnybrook in the McLaughlin Auditorium. Alyson Schafer is a well known Adlerian psychotherapist, parenting expert and best-selling author from Toronto. She has spoken in both national and international arenas on the topic of parenting, in addition to hosting workshops, tv segments, and individual counselling. Perhaps you have seen her on Cityline, or heard of (or even read!) her best-selling books, “Honey I Wrecked the Kids,” “Ain’t Misbehavin’,” and “Breaking the Good Mom Myth."

For this event, Alyson will be speaking on the topic of parenting teens who may be struggling with signs and symptoms of mental illness and/or addiction, and how families can work together to cope when these issues happen. She will speak for approximately 1 hour before opening up the floor to questions and audience discussion. The cost is $10, with all proceeds going towards the Family Navigation Project; a Foundation representative and donation box will also be available to anyone who is inspired to contribute more. Note than anything over $25 is eligible for a charitable tax receipt.

I hope you are all able to attend. Alyson is a wonderfully engaging and highly sought after speaker who will have some excellent insights into how families can manage kids who might be slipping through the cracks. Moreover, if you know anyone or any other organizations that might be interested in this event, please feel free to let them know about it!

If anyone has any questions or comments, as usual, please feel free to get in touch with me.

Again, I hope to see you all on Wednesday, December 5th at 7pm here at Sunnybrook!

The Long Run: A Fundraising Event in support of Mental Health Awareness Week

2012-09-06T06:51:00.000-07:00

Hello everyone!

I’m writing with some updates on the progress of The Family Navigation Project and also information about an upcoming fundraiser.

First, I have an exciting announcement! After 8 months of hard work with our business consultants, Adair Roberts and Dr. Nancy Schmidt, the Family Navigation Project finally finds itself with a presentable business plan. This document is a huge step forward for the Family Navigation Project and will prove to be a key tool in turning this idea into a functioning place of care. The business plan explicitly outlines the function of what will be the Family Navigation Centre, as well as including an implementation plan to realize this vision. We are eagerly looking forward to the future launch of the Family Navigation Centre. To all those who have contributed to and supported our vision – thank you! From the beginning of this journey, we’ve maintained that the Family Navigation project must be built by parents, for parents. We couldn’t have done it without you.

We also have an exciting fundraising and awareness event in the works for Mental Health Awareness Week (October 7-12, 2012). The Family Navigation Project has partnered with the Miles Nadal Jewish Community Centre to present a short play the evening of Thursday, October 11^th, 2012 at the Al Green Theatre. This play, entitled “The Long Run,” was written by Rachel Ganz, an undergraduate student at the University of Toronto and is based on her own experiences with bipolar disorder. A 45-minute, one-act play, “The Long Run” chronicles a situation in which three teenaged siblings have been left at home alone by their manic mother. A very powerful piece, Rachel won the award for Best Playwright this past winter in Ryerson’s film competition. She has graciously volunteered her talent in the name of raising awareness for youth mental health and the Family Navigation Project. The evening will begin with the presentation of this play, to be followed by an expert panel discussion on bipolar disorder, and more broadly, youth mental health and navigating the system.

The Al Green Theatre can seat 275 people and we are striving to fill every last one of those seats to show Rachel and her team the appreciation and support she deserves, raise the profile of the Family Navigation Project, and more generally, promote the discussion of youth mental health in an effort to further increase awareness and reduce stigma.

Tickets will be sold at a price of $25.00 with a reduced price for students of $10.00. If you are interested in purchasing tickets and/or know others who would like to attend, please contact me directly either by email or at 416 480 6100 ex 3828. We would really appreciate the support, so please, if you’re interested, do hound your social networks for those with similar sympathies to our own. I have attached a digital copy of the event with further information that can be shared with anyone who expresses interest. I hope you can all attend.

If anyone has questions, comments, concerns, etc – please contact me. I’m happy to speak to any and all of you about the fundraiser in particular or more generally about the Family Navigation Project.

Again, a huge thank you to everyone who has supported our efforts over the last couple years. I hope to see you at the Al Green Theatre on Thursday, October 11^th.

An Evening with Amy Sky

2012-05-09T11:34:00.002-07:00

This past weekend, The Family Navigation Project held its first fundraising event to kick off our fundraising campaign and I'm happy to report it was a huge success!

We were lucky enough to have Torontonian singer-songwriter and Juno aware nominee Amy Sky give an intimate live performance as part of an evening cocktail reception that involved discussions around mental health navigation for families and teens. We heard from Amy herself about her own struggles with mental illness, as well as from a mother-daughter duo who gave an incredibly moving account of just how difficult and destructive it is for everyone involved when a teen is in crisis and unable to access the resources they so desperately need. The need for The Family Navigation Project became clear to anyone who wasn't already convinced.

We'd like to thank everyone who helped tirelessly prepare for the event, and all those who attended - it was an enlightening and memorable evening for all.

Fundraising for The Family Navigation Project

2012-04-18T10:52:00.002-07:00

Exciting news! Work with our consultants is progressing, and with that comes The Family Navigation Project's official fundraising campaign launch! We've been so fortunate to garner the interest and support of the community, and have had many inquiries as to how people can donate to our cause. To make it easier for everyone, we've set up an online sponsorship page where you can make a donation that will go directly to The Family Navigation Project and receive a charitable tax receipt as well.

Our overall fundraising goal is $5 million. While this may seem like a lofty target, we are already nearly a third of the way there! We've set the target of $5 million because often, families simply cannot afford what are often the high costs associated with seeking treatment, particularly when a youth requires residential care only available in the US. The Family Navigation Project requires $3 million to operate, and the additional $2 million will go toward a fund for families who need financial aid to support recovery. This project is homegrown and close to the hearts of everyone involved. We want to jump in with both feet and ensure all families, regardless of their financial abilities, get the help and care they deserve.

Please help us move forward in making The Family Navigation Project a viable and invaluable resource for the thousands of families who are suffering. We are happy to accept and so appreciate any amount, whether it's $1 or $10,000. Share this link with family and friends - anyone and everyone you know who recognizes the importance of supporting youth and their families as they deal with the turbulence of mental illness and addiction.

Help us help families. Help make The Family Navigation Project a reality today.

Consent in a culture of freedom

2012-03-05T12:59:00.000-08:00

"The toddler must say no in order to find out who she is. The adolescent says no to assert who she is not."

- Louise J. Kaplan, psychoanalyst

As The Family Navigation Project progresses, we encounter more and more stories of youth and their families who have struggled with mental illness and addiction to varying degrees. These accounts come from all sides of the story - youth themselves, parents, teachers, peers, care providers, consultants, government, lawyers, legal enforcement - and help to create a more complete picture of the many issues at hand when faced with a youth battling mental illness and addiction. Sometimes, it seems like a honeypot effect, or when you learn a new word and then seemingly encounter it repeatedly, only in this case it's a situation. Since I've become involved with this project, I've found even my personal inbox flooded with second- or third-hand accounts of families' struggles, news articles, and research findings related to youth mental health and addiction.

The Family Navigation Project's primary mission is to help guide and support families in their quest for treatment for their child, an undeniably common theme in which is that of consent. A tricky and controversial subject, to say the least. Families talk of their struggles to get their children to agree to treatment. Sometimes, after much persuasion and appeal to insight, they will go willingly. Other times and certainly more commonly than at least I ever would have imagined, interventionists and escorts are involved in transporting these youth, willingly or unwillingly, to treatment.

The Canadian culture is one which unquestioningly prides itself on placing strong value on freedom and individual rights. Naturally, given the significant part played by our health care model in the Canadian identity, this culture of freedom extends to our ability to access and receive health care. In Canada, there is no set age at which you can make medical decisions or refuse medical treatment. Instead, the Health Care Consent Act says you can consent to or refuse to treatment based on your ability to understand the treatment and not based on your age; and for the purposes of the Mental Health Act, a minor is considered an adult once over the age of sixteen. Likewise, the Health Information Act allows minors to refuse disclosure of health information to their parents, as long as their have the mental capacity to understand the rights and powers of the Act, and consequences of using those powers.Oftentimes, this is well-founded. Research consistently shows that adolescents will be more likely to seek and consent to treatment if their confidentiality is guaranteed.

Over the years, informed consent and the right to refuse treatment have come to be considered basic human rights. Legal bodies have recognized that minors who show maturity and competence also have constitutional rights and deserve a voice in determining their course, if any, of medical treatment. On their side is consistent evidence that shows adolescents have cognitive ability and capacity to reason that is quite similar to adults'. However, adolescents often float in a limbo-like state the dependence of childhood and the independence and autonomy of adulthood, and their emotional maturity cannot be equated with cognitive maturity. There is a need to balance these issues of constitutional rights with both cognitive and emotional maturity in mind, and also with issues of parental rights.

How and when does an adolescent show the maturity and ability to make meaningful, well-informed decisions regarding treatment? Critically, in the case of youth mental health and addiction, how is this requirement of maturity reconciled with a situation of pervasive substance use; and the ability to make informed decisions impacted by mental health concerns? In Canada, these questions are often avoided via loopholes in the various Acts that avoid defining terms such as "imminent" (in the case for disclosure when it will avert or minimize imminent danger to health or safety (I'm sure parents who have been in this situation can think of more than a few instances in which this precondition applied)), and "competence."

Having no set age of consent limits the ability of parents and caretakers to force youth into outpatient or inpatient treatment in favour of appealing to the youth's maturity and competence. However, this appeal certainly isn't doing them any favours when their resistance to accept treatment places them in harm's way. For parents trying to ensure that their seriously ill and oppositional kids get the help they so desperately need to address their problems and ensure their safety, this is an extremely disheartening and frustrating experience in the face of an already heartbreaking situation.

With no age of consent, many Canadian families find themselves seeking treatment in the US, where the age of consent varies by state. Unsurprisingly, a plethora of treatment facilities exist in those states whose age of consent for substance abuse treatment is eighteen. Here, parents with a teen under eighteen can, in certain circumstances, take the initiative to force their child into a residential treatment program. England blends Canadian and American customs, allowing competent minors' refusal to be overruled by the consent of a person with parental authority, or by the court in certain circumstances.

However, Canada is neither the US, nor England and it seems unlikely that any laws that would compromise our perceived culture and identity will change. I'm not particularly advocating one way or the other more than I find myself pondering and recognizing these very real cultural and legal circumstances within which The Family Navigation Project ironically finds itself navigating.

New Year; more questions; same project.

2012-01-19T08:56:00.000-08:00

First off, welcome to 2012. I'm expecting big things! By the end of the year, I'm hopeful we will have a fully functioning program for anyone and everyone who needs somewhere to go, and we will exist within a completely overhauled and newly collaborative mental healthcare system that immediately responds to the needs of the community.

Just kidding.

By the end of the year however, I do hope we'll be considerably closer to launching The Family Navigation Project. As for a system overhaul, well I'm afraid that's still at least a few years away. For now, perhaps an update on our progress is overdue.

When we brought our consultants on board, one of the first questions that we set out to answer was who The Family Navigation Project is for. The question seemed to have an obvious and uncomplicated answer - youth and their families. Turns out it's neither obvious nor uncomplicated. Apart from who we're navigating, another question we've repeatedly been faced with is what we're navigating. Over the last eight weeks, we've been meeting with various players in the mental healthcare system to both gauge their reaction to and solicit suggestions for our project, and also to get a sense of the system within which we'll be working. This last part is something that is easily and readily forgotten when one gets caught up in conceptualizing new, innovative solutions to the current youth mental health crisis that has recently become a rather sexy topic. When I first started in this job and my parents asked me what I was doing, I essentially told them that "we're going to create an independent resource for families that will solve all their problems navigating the terribly disconnected mental healthcare system! Mom, dad, look at me go!" Once again, turns out it's not so simple.

Consider for a moment the definition of a "system." On a very basic level, it's an assemblage of interacting, interrelated, or interdependent parts that form a complex and unified whole. Essentially, what that means for The Family Navigation Project is that if it wants to help families navigate the mental healthcare system, it needs to understand and be a part of that system of interacting, interrelated and interdependent resources that contribute to the unified goal of health for our society. We need to understand how it works, and more importantly, how to work within it. Naturally, this brings along some constraints, especially in light of that fact that many people feel that as it stands, our resources are neither interdependent nor unified. We can't navigate if we a) don't know what we're navigating, and b) don't have the pieces in place to do so. Take, for example, a family who approaches us wanting to find and access the best resource for their anxiety-ridden, substance-abusing adolescent. "Best" by whose standards? Since there's little to no oversight or demand for standardized service descriptions or outcome research, can we really give you an evidence-based recommendation as to what the "best" resource is? Moreover, what happens when the resource we decide to refer to has a six month waiting list? We're left with a situation in which the pieces are not in place to allow us to serve our function.

So, do we modify our function to fit with the system? Or, do we attempt to modify the system to fit with our function (a rather ambitious task for a donor-driven, grassroots project)? Can we walk the line between the two? Can we even define our function before taking these factors into account? These are questions to which, with the help of our extremely knowledgeable and driven consultants, we're still exploring possible solutions. This is where we're at for now, a point in which one question begets another; but as they say, "seek and you shall find."

Pine River Institute and the Private Pay Paradox

2011-12-08T16:35:00.000-08:00

Let's recap what it is we're doing here for a minute: we're trying to bring to life a program that will help families with a troubled youth in crisis navigate and access the mental health care system and its resources. Necessarily, this requires us to have a very thorough and nuanced understanding of what resources are available to our future clients, particularly in Ontario. So, last Friday, I found myself in the backseat of a vehicle on the way toward Shelburne, Ontario for a meeting with the staff and students at Pine River Institute I'd arranged a month prior. I'd heard a range of opinions about Pine River Institute and it was my understanding that it has certainly had its ups and downs in terms of success in its short lifespan. About 18 months ago however, PRI acquired a young, vibrant Clinical Director from the US, previously at a therapeutic boarding school and residential treatment centre in Montana; and she brought the therapeutic model from Montana with her. Since then, the program has essentially started anew, with funded beds fully occupied and a long waiting list to boot.

As the 410 becomes the 10, and the rain and slush covered highways become back country roads with fresh snow-covered trees, the hustle and bustle of the city disappears. With the snow falling and few cars on the road, it's both beautiful and calming. Ten minutes down the windy, woodsy road and a turnoff down another windy, woodsy drive, we pull up in what looks like an old summer camp property. The main building stretches across the lawn, with a cabin housing the gym and signs pointing toward the hiking trails on either side. The property is expansive and the views incredible. All this, and we're only an hour from Toronto. Inside the main building, you're greeted with a warm and inviting environment and by staff and students who immediately smile and say hello. And it is here where former troubled teens are making leaps and bounds toward recovery, maturity and a new sense of self.

On paper, Pine River Institute is a co-ed addiction and mental health residential treatment program for teens aged 13-19 who have an addiction (drugs, alcohol, gaming, disordered eating) and often other problematic features like symptoms of anxiety or depression, self-harming behaviours or suicidal thoughts, low self-esteem, or difficulty with anger management. After a 4-8 week Wilderness/Outdoor Leadership component in Algonquin Park, where teens detox, hash out their frustrations and come to a state of acceptance (all while building fires and pitching tents, canoeing and portaging, hiking, participating in group activities, and talking to therapists), they return to the main campus where they'll live until they're ready to transition home - anywhere from 4-12 months, perhaps longer if needed. The teens here go to school, get two hours of physical activity a day in a myriad of sports and activities, and eat a balanced, healthy (and delicious, if I might say so myself) diet, alongside individual, group and family therapy.

Off paper, the program is something you might have to see in action to really understand. That was the case for me, at least. I'd read all the materials, and heard first-hand from my colleagues who have visited PRI and other similar programs in the US about the nature of the program, but until I saw it for myself, I really can't claim that I understood it going in. Speaking with the senior staff, you immediately understand that they believe whole-heartedly in the approach they're taking. Speaking with the students, you understand it's working. The therapeutic model is centered on emotional development and is heavily relationship-based, the idea being that it is through relationships that you discover your sense of self and the support you need to build the internal structure required to survive when (if) you return to your pre-treatment environment. The program values honesty, integrity, maturity and acceptance. Family involvement is strong. The Clinical Director, Dr. Victoria Creighton, is warm and non-threatening; it is easy to see how teens would respond to her. She and her staff teach maturity; she believes that you have to create a positive peer culture, one of empathy and respect. She also believes that time, and a safe, comfortable, and structured environment are key factors to recovery for these kids. And in talking to them, you'll find that they believe this too. It appears they've internalized the therapeutic model and everyone - students and staff - speaks the same language; the kids we spoke with are painfully honest about their past, but are calm, polite, and very insightful, as well as being positive and engaging. I can honestly say I've never encountered a 17-year old boy who speaks with the maturity and insight I saw in my brief encounter with the boys at Pine River.

Of the 36 beds available, 29 are OHIP-funded by the Ministry of Health and Long-term Care. The waiting list is anywhere from 6-12 months. Not surprising, considering they boast an 80% success rate. What is surprising is that the 7 remaining private-pay beds are empty. Yes, empty, while both parents and OHIP continues to send kids to programs in the US. This is both surprising and disappointing to me - call me naive, but I'm only trying to understand. There seems to be this reluctance to pay for care in Canada and this sense of entitlement that even if and when you can pay for top-notch treatment, you shouldn't have to because health care in Canada is free, right? ("Free"). So assuming that you're going private, even if the opportunity arises for you to send a child to a Canadian institution, people seem to have more faith in the American ones - kids are sent to the US because there's this understanding that because everybody has to pay for care, it's more likely that "you get what you pay for." Better quality, in effect. Now I of course understand that sometimes the situation necessitates American institutions, particularly when it involves issues of consent and compliance, but I'm having trouble understanding why you wouldn't want to send your child to a Canadian program if you had the option and it was appropriate, and I simply can't wrap my head around the fact that OHIP is still funding kids to go to American programs without fully funding a Canadian one.

The argument used to be that there is nothing in Canada comparable to what you find in the US, but now, finally, there is. And it's working. Peer-reviewed outcome data, however, is sparse due to small sample sizes, but considering the waiting list and success rate (and, if you want, consider that there was an American teen in the program), I'd say it's worth at least a reevaluation of priorities by OHIP; and by the rest of us, perhaps a reconsideration of what private pay care in Canada means. Would you?

How to get help and other questions...

2011-12-07T11:33:00.000-08:00

If you look to the links below, evidently, people have questions about mental health. Despite the widespread prevalence of mental illness and the importance of mental health and well-being to global functioning, it can seem like a rather elusive topic with people frequently tip-toeing around it.

Can I fast-track a psychiatric evaluation? - The Globe and Mail

Can depression be treated without drugs? - The Globe and Mail

If you suspected that perhaps you or someone you know may be struggling with depression, or any other mental health concern for that matter, what's the first thing you would do? I would assume, much in the same way I do with unfamiliar topics, that you might immediately Google your questions or concerns. Maybe you consult the "Health and Well-being" or "self-help" section at Indigo. Maybe you call your doctor. Maybe you call someone you know who works in the field or "has been there" so to say, either themselves or with a loved one.

Maybe (probably) you encounter an extensive list of signs and symptoms. Maybe (probably) you see ads for local counseling clinics. Maybe (probably) you are bombarded with references to a wide range of pharmaceutical industry-sponsored medications. Maybe (probably) you discover information on how to manage your depression without medications. Maybe (probably) you are encouraged to call your doctor.

Hopefully, in one form or another, you are encouraged to get help. Now, I did a little experiment in which, first, I Googled some of the phrases I figured people might typically Google if they found themselves in the aforementioned situation and then I spent some time browsing book titles online and on bookshelves. What I found was exactly what I have referred to above - everything you ever wanted to know about depression (to the extent of our current understanding) and a plethora of self-help techniques, ranging from diet and exercise advice to self-monitoring workbooks and empowerment techniques - a vast collection of resources for help with depression. What I didn't find was information on how to get that help. In fact, very few sources explain what get means, in both senses of the word. How do you understand how and what it means to get help, and equally important, how do you physically access help?

So, we've decided to fill the gap with a practical Q&A-style handbook to getting help for depression, tentatively and appropriately entitled, "How to get help for depression." So, all your Google search results told you to call your doctor and/or find a psychiatrist or psychologist if you are experiencing 5 or symptoms. What if you're experiencing 3 or 4? What if you, like millions of other Canadians, don't have a family doctor? What if you're in crisis and you've managed to get a referral to a psychiatrist...but the wait list is 6 months? How do you know if you even need a psychiatrist, as opposed to a psychologist, as opposed to diet, exercise or meditation?

These are the pragmatic types of questions we plan to answer - the questions you have about "getting" help (both understanding and accessing) once you've "gotten" depression. We'll assume you've done your research on depression itself, and if you want more information, you'll find it in the back pages.

That little announcement off my chest, I'd like to get help from you! Help me understand what answers would best serve you, and help me access that help by giving me feedback. So, I'm going to ask you to send me (by comment, email, phone call, anything!) the questions you or anyone you know have had, still have or would have if you found yourself needing help for depression. Health care professionals are often crazily pressed for time and resources completely overwhelmed that they might not always spend the time with patients and families to answer questions and address concerns that can sometimes make all the difference in the help-seeking experience. This is a great opportunity to ask those questions and address those concerns, so I encourage you to have your say so this book becomes the most practical and accessible resource it can be for individuals, friends, colleagues and families struggling with depression.

You can't please everyone, but you can please someone.

2011-11-22T11:18:00.001-08:00

“I don’t know the key to success, but the key to failure is trying to please everybody.”
Bill Cosby

When I first started working here, the ambition of this project excited me. I was going to help anyone and everyone needing help finding mental health care, simple as that. Turns out it's not so simple. Didn't I know that? The short answer: yes. The other short answer: my naive and ambitious self still gets the best of me, but I'm letting it slip because my years of being able to claim naivete seem to be slipping away themselves.

Over the weekend, my father was in town for a conference and our conversation took a turn toward sub-specialties. He recalled a conversation with a fellow psychiatrist who specialized in geriatrics in which my father sought an opinion on a geriatric case complicated by the addition of dialysis. Not feeling comfortable addressing my dad's query, this colleague referred him to another psychiatrist who further specialized in renal psychiatry.

This led me to question whether such increasing specialization is really a luxury and whether it is always an efficient use of our resources. I don't have an answer and I'm not sure there necessarily is an answer, but I believe that it would have to exist within the context of the infrastructure. It seems that the opportunity for specialization works for Toronto because it exists within an infrastructure of hundreds of psychiatrists and some of the biggest and best institutions in Canada. This allows the renal psychiatrist to focus solely on renal cases and those who don't fit his mold will be picked up by one of the many other psychiatrists in town. On the other hand, this model would definitely not work in Kenora where there is one psychiatrist (sometimes two), a small and strikingly ill population, and very limited resources. If my father chose to further specialize within psychiatry, there would be nowhere to go for those who don't fit into his mandate. As we become increasingly specialized, we narrow the scope of who we help, and when the source of help is already limited, we can't necessarily afford further limitations on who we are able to help.

So, what exactly does all this have to do with The Family Navigation Project?

Well, one of the most important steps to turn this project into an operating program is defining its scope - who are we going to be helping? We've already determined that there is a gap in the current mental health care framework since this project arose from parents with an unmet need and the goal of The Family Navigation Project is to address that need. However, before we can do that, we need to determine the characteristics of who can best be served by our project, because when you put a service out there, everyone whose current needs are unmet are going to try their luck. Without a clearly targeted scope and with the inevitable influx, our resources will quickly become overtaxed and we'll be cornered into choosing quantity over quality, breadth over depth, which is against everything that we've promoted from the get-go. This is something that I've been trying to wrap my head around because while the practical side of my brain is well aware that this is a necessary component of running this program efficiently and successfully, the other side still wants to help everybody who will have nowhere else to go if we don't help them.

Who did we set out to help? Families needing help navigating the mental health system. Yes, but who are these families? Do they have a child with a substance use issue? Schizophrenia? Eating disorders? Mood disorders? Developmental delays? Anxiety? Do they have concurrent medical conditions, like epilepsy? Can they afford treatment? Do they want treatment? What kind of treatment? What constitutes treatment?

One of the most practical pieces of advice you acquire early in life is that you can't always please everybody...but you can please somebody. In our quest to define the scope of The Family Navigation Project, it is inevitable that we will leave people out. There will still be families struggling to navigate the mental health care system until access and coordination of services is made a priority at the systemic level - something that is largely out of our few hands here at Sunnybrook. But by defining who we are able to serve and in turn serving this group with the best care possible, we also hope to serve (in a roundabout way, albeit) those we are forced to exclude by defining the groups that are still left with unmet needs. We have to let the gaps speak for themselves, and trust that these unmet needs will be tackled by another collaboration of passionate, ambitious individuals, of which there is no shortage. I have to remind myself that we are working in Toronto, not Kenora.

The health-care system needs a lot of things...

2011-11-08T08:54:00.000-08:00

The Globe and Mail: "Health-care system needs a front door"

In the article linked above and published yesterday, Andre Picard pushes for health care reform once again. While I'm not going to comment on whether his facts are straight - i.e. what exactly is responsible for the backlog in the ER, what the hold-up with eHealth is, or whether or not Community Health Centres and Family Practice Teams provide excellent care - I am going to use this opportunity to point out a couple of recurring themes in his and others' rants and raves about Canadian health care and, in the context of the mental health care system, what we're doing here at Sunnybrook with The Family Navigation Project to address some of these issues.

1. No "front-door" access.

Picard writes, "Put another way, there is no place where patients can routinely go to access the care they need promptly and efficiently and that tracks them throughout the health-care “journey.”"

It seems that, for years, individuals and families requiring access to the mental health care system have been advocating for the same kinds of changes in the mental health care system. Meanwhile, Family doctors are acting as gatekeepers, but what happens when they aren't sufficiently trained (I'm talking to you 6-week psychiatry rotations!) to recognize when a referral to mental health services is appropriate? The next point of access becomes the ER, (or first when you can't even get an appointment with your own or any GP in the first place) in which non-acute crises are pushed aside and acute crises are temporarily admitted to inpatient units until they are safe (yes, as we continue to shut down psychiatric beds, "safe" becomes the standard for discharge, not "well"). Once you are safe, you are released into the wild with little to no follow-up and/or coordination of care.

What if you didn't need to go through that revolving door that leaves you lost and stranded?

The Family Navigation Project's primary objective is to establish a team of professionals that will essentially act as a front door for families in mental health crises - a sort of tele-ER that will respond immediately to your call, triage accordingly, and if required, match you up with a Navigator who will, as Picard wishes for, track you throughout the health care journey.

2. Lack of continuity of care.

This is by no means the first time this theme has come up, and it is not a problem that solely plagues mental health. There is little to no continuity and coordination between services and service providers, and I imagine you would be hard pressed to find somebody who disagrees with that statement. There are services available that provide case management and will coordinate with other services, but these require that you are already involved with a service provider. But, how do you access one in the first place? And how do you know which is the right service for you?

That's where The Family Navigation Project steps in. Our intake workers and Navigators will be well informed of the smorgasbord of resources that are available, including how to access them, who they serve, their strengths and weaknesses, the current environment within those services, and in turn, whether or not a particular resource is an advisable choice for your family. (Then there is the issue of whether or not the appropriate services exist in the first place, which depends entirely on who you're seeking to serve. Sounds like another topic for another blog post for another day).

It doesn't stop there, and this is one of the features that differentiates us from similar efforts. Like I mentioned before, the Navigator will track you throughout the entirety of your health care journey. They will follow up with you and with service providers to ensure they are continuously informed about your family's progress, and in doing so, they are able to adjust the treatment plan as necessary, responding to the changing insights and needs of the family as they arise. They also ensure that service providers are coordinated with each other so that everyone involved, including the family, is on the same page.

That's what I call continuity of care.

"Kids' mental health up to all of us"

2011-11-01T08:56:00.000-07:00

Article link: Kids' mental health up to all of us

Apart from the emphasis on economic loss due to mental health disability (which, at $51 billion, is definitely a significant measure of the extent of the problem and a prime motivator for government agencies to commit themselves to mental health reform), this article does a good job of highlighting the pervasive impact of youth mental illness and of highlighting the gaps in the current health care framework.

The article also points to the importance of the social and physical environment in maintaining mental health by locating youth mental health within a broader social network that includes all levels of the environment - from the individual and family, to the neighbourhood and schools, to societal mores. The many levels of environmental influence are important to emphasize because wellness requires involvement at as many levels as possible; help and resources don't and shouldn't end in the ER, on inpatient units, or in residential facilities. Instead, both preventative care and after-care need to be considered as key steps in maintaining health. This is an especially important point because it promotes the notion that all Canadians have the chance to help improve youth mental health wherever they are, in whatever they do and we can contribute to improving the social and physical environments that are equally important to the mental health of our youth.

Where does the Family Navigation Project fit in? In recognizing multilevel influences on individual and societal health and behaviour, we consider it a primary responsibility to ensure that our Navigators provide families access to the best and most comprehensive set of resources to help youth maintain their health. Through constant follow-up and monitoring of treatment outcomes, we'll ensure that youth and their families are directed toward an environment that promotes mental health at all levels.

I encourage everyone to take 5 minutes of your day to read through this article and think of ways in which you can contribute to improving youth mental health. It doesn't have to be a grand gesture - educate yourselves, open a dialogue with your friends and family about mental illness, advocate for community mental health services, raise your voice and speak to your MPP, donate your time to a fundraising event or push for mental health literacy in your child's school. Every voice counts toward removing stigma and improving care - be part of the change we need to see.

Ignorance is not bliss.

2011-10-27T08:05:00.000-07:00

This morning, I came across a couple of news pieces on CBC about the new youth mental health and addiction treatment centre set to open in Paradise, St. John's.

The centre will serve up to twelve kids at a time and is fully equipped with three separate living quarters with bedrooms and private bathrooms, a kitchen and lounge area. It also has a school area, a multipurpose room, a physical fitness room, and space for overnight stays for visiting family members. They have committed one living area to youth requiring secure treatment and will also permit observation of up to two kids at any point in time in need of either detoxification or closer observation upon admission. Lengths of stay depends on the staff's assessment of their needs, ranging anywhere from 3-12 months.

The family member accommodation is an important feature. Melissa Power, a nursing student who was treated for complex mental health issues in the past, points out in her interview with CBC that most teens keep their struggles to themselves for fear of being "sent away" from their homes, friends and family. The importance of fully involving families in the treatment and recovery process is vital, and this something the Paradise treatment centre recognizes.

Another, and perhaps the most important aspect of this new treatment centre is that it accepts and hopes to serve youth with complex mental health needs, which many addictions treatment centres deem exclusionary criteria, despite the high co-occurrence of mental illness and substance use disorders. It's about time the government pushed for more facilities that can accommodate youth with both mental health and addiction needs, whether they co-occur in any given case or not.

So, score one for youth mental health! This is a perfect example of the kinds of services that the Canadian mental health system so desperately needs more of.

Before you get too excited though, let me bring you back to ground level, because I, too, had a smile on my face reading the initial project development plan...before I came across videos and articles of Paradise residents' reactions to this treatment centre being built in their neighbourhood. Don't even get me started on the comments that follow the articles.

Just this past Monday, over 60 residents attended a public meeting to try to dismantle the government's plans to build the centre by yelling protests and interrupting health and town officials. They're concerned for their safety, they don't want their kids exposed to the kids in need of treatment, and they don't want to "see the drunks, drug addicts, bums, and so on" associated with St. John's. Spending all this money to serve twelve youth? "What a waste of taxpayers money. Give them a kick in the arse and send them home to their parents..."

This doesn't sound like Paradise to me.

I told you not to get me started. To even think those things, let alone voice them in a public arena but refuse to show your face on camera, illustrates just how far we still have to go to promote awareness and education about mental health and addiction, and make reducing stigma a real priority. If this were a treatment centre to teach kids how to live with diabetes, would it receive the same reaction?

Residents are outraged that a facility that treats youth with "serious" mental health problems will be in their neighbourhood, because "serious" means "violent and coming after you and your kids" right? Talk about perpetuating stereotypes. The solution is education and awareness - say, of the fact that people with mental illness are more likely to be the victim of violence than the perpetrator; or of the fact that 1 in 5 Canadians will experience a mental illness, and the remaining 4 will have a friend, family member or colleague who does. Those statistics make it relatively likely that these residents themselves will know a kid - whether it is their own, their kid's friend, a niece or nephew, or their neighbour's kid - for whom this treatment centre could be extremely beneficial. If people are unwilling to educate themselves, maybe next time there is a public meeting, there should be a public information session prerequisite.

The residents' response to this treatment centre truly broke my heart. However, I suppose if my heart broke every time someone made an ignorant comment, I wouldn't be very resilient. Instead, I'll emphasize the hurt that this lack of understanding and an unwillingness to learn is causing Canada's youth instead, and the necessity of promoting awareness, educating the public and reducing the stigma of mental illness and addiction so these kids and their families can get the help that can save their lives.

Follow this link to read the article on the residents' response:

http://www.cbc.ca/news/canada/newfoundland-labrador/story/2011/10/25/nl-paradise-treatment-centre-1025.html

And this one to watch what Melissa Powers has to say about it all:

http://www.cbc.ca/news/health/story/2011/10/27/nl-paradise-mental-health-power-1027.html

*Note: Neither I, nor anyone else, should understand these 60 residents' voices to be representative of all Paradise residents.
**Also note: My words are not representative of Sunnybrook Health Sciences Centre in any way, shape or form , but simply my own humble voice and opinion.

Have you ever...? What if...?

2011-10-20T08:04:00.000-07:00

What if you had to rescue your thirteen year old daughter from a crack house in downtown Toronto?

Have you ever had your teenager come home in a drug-induced stupor?

These are by no means an overstatement of the very real and very serious crises in which the families of troubled teens can sometimes find themselves. To get the support and funding we need to get this project off the ground, society needs to be made blatantly aware of the tragic instances that mental illness and addiction can induce for youth and their families. And for those who have been personally made aware by their own experience, sharing your story is an amazing way to help others feel less alone. Come together and support each other through shared experience.

This is my first official plea for help: share your story.

Help us by contributing your "what if..." and "have you ever..." statements.

Have you ever... felt lost, frustrated, or neglected trying to find the right resources for your child?

What if... there was a number you could call that could immediately connect you to a support team for guidance and advocacy?

In the news...

2011-10-20T08:02:00.000-07:00

Check out some of these links for current stories related to youth mental health in the news:

http://www.theglobeandmail.com/life/health/health-facts-and-arguments/our-daughter-was-in-and-out-of-psychiatric-wards-for-years/article2155171/

http://www.theglobeandmail.com/life/health/health-facts-and-arguments/i-didnt-want-to-tell-people-about-my-depression/article2167722/page2/

http://www.theglobeandmail.com/news/opinions/opinion/for-troubled-teens-a-visit-to-a-place-called-hope/article2074876/

http://www.cbc.ca/news/canada/toronto/story/2008/04/14/teens-drugs.html

http://www.thestar.com/News/Canada/article/414567

http://www.cbc.ca/whitecoat/blog/accountability/2011/08/10/do-mental-health-patients-fall-through-the-cracks/#.TqBj83MJPz4

Welcome!

2011-10-18T08:01:00.000-07:00

Hello anyone and everyone!

Welcome to my first blog post ever.

They say, when starting a blog, to write about what you know. Well, sure, I'll write about what I know, but I'll also write about what I don't know. Namely, why, in what claims to be a comprehensive, universal and accessible health care system, is there so little guidance and support for families and youth struggling to navigate the mental health care system?

This is a gap that Sunnybrook, in collaboration with the dedicated families and community groups, is striving to fill with The Family Navigation Project.

This blog will serve numerous purposes. I'll be posting everything from regular project updates to relevant news and media to random thoughts and quotes.

I'll also be asking for your help - a lot.

If you have an idea for a post, or come across a relevant article or video, let me know! Or, be a guest blogger! This project is really, truly about supporting the family and in order to best meet the needs of families in crisis, we need your input.

A major goal for this blog is to garner and promote awareness. Not just about this project (although of course, the more people who know about this incredible project and support its establishment, the better), but also awareness of the pervasiveness mental illness and addiction, and the devastation it causes for entire families and networks of friends and loved ones.

It is also important to generate awareness of the gaps in the current mental health care system. The disconnected patchwork of available resources is doing a disservice to the many millions of Canadians touched by mental illness and addiction.

Of equal, if not more, importance, I sincerely hope this blog serves as a widely accessible forum for your voices. Any personal story or experience, suggestions, opinions, frustrations - please share them with me and with others.

The idea for this project came from families struggling to navigate the mental health care system and The Family Navigation Project's establishment will continue to be driven by the needs of families first.

Be the voice that advocates for change and support others through shared experience.