COVID-19 is disrupting the lives and hopes of young people, especially those vulnerable because of poverty, trauma and other inequalities. Even before the pandemic, mental health and well-being were a concern for many youth and their families. The pandemic has exacerbated the lack of access to care in our communities. Now more than ever, the federal government must make meaningful investments in high-quality, accessible, friendly and effective youth mental health services.
For more than five years, ACCESS Open Minds (Esprits ouverts), a pan-Canadian network dedicated to improving the health and well-being of young people, has been testing and evaluating an innovative mental health care model. According to recently released preliminary data, this model is positively transforming youth mental health service delivery.
This model can also save taxpayers money. For instance, every dollar invested in the ACCESS Open Minds model in Edmonton saved the health care system $10 in service costs. This translates to up to $4,500 per young person per year.
ACCESS Open Minds shows that early intervention can result in decreased hospitalizations, emergency room visits, outpatient clinic visits, specialist visits, GP visits, public residential admissions, and prescription drug dispenses from community pharmacies.
The benefits go beyond just saving health care dollars. According to the data, almost 84 per cent of youth referred to ACCESS Open Minds services are seen within 72 hours of initial contact, compared to more than four weeks of waiting in other delivery models. Not only are youth seen quickly but they also have access to several services and resources under one roof, such as psychotherapy, peer support, addiction treatment, housing and career support and pharmacotherapy. Families and carers are also supported through psychoeducation, peer support and other services.
The ACCESS Open Minds model was designed to be flexibly deployable within the framework of five core principles — early identification, rapid access, appropriate care, continuity of care, and youth and family engagement. Its inherent adaptability has contributed to its successful implementation at 16 sites in seven provinces and one territory that serve urban, rural, remote, Indigenous, post-secondary and homeless youths. At all these sites, more youth are getting the help they need and are experiencing positive outcomes including reduced distress, less severe mental health problems and improvements in school, work and social functioning.
These results show that a paradigm shift in youth mental health care in Canada is not only needed, but within reach. We may be in the midst of an “echo pandemic” of mental health problems. As governments look to facilitate economic recovery, they must therefore also work to ensure greater access to mental health services, particularly in the teenage and young adult years when nearly all new cases of mental health problems emerge and where transformation can make the most difference.
The government can start by heeding the House of Commons Standing Committee on Finance’s recommendation in its recent pre-budget consultation report: “Develop and implement a long-term mental health COVID-19 recovery plan to ensure all Canadians – especially the most vulnerable – can access the care they need, no matter where they live.”
If mental health services are to be effective, delivery approaches must be built in consultation with local communities, youth and families/carers. ACCESS Open Minds has done this by involving youths and their communities in the overall design of services down to the “look and feel” of the spaces in which services are housed. Close community involvement in service design also means that services are culturally appropriate and sustainable. This approach was especially important in First Nations and Inuit communities that represent a fourth of ACCESS Open Minds sites.
A common element across ACCESS Open Minds sites is a standard evaluation approach. Constant evaluation means that youth receive high-quality, evidence-based care; service providers can rely on data to understand and respond to client needs; and funders and decision makers have real-world, real-time data about on-the-ground impacts to guide their decisions.
Most importantly, it means that we can understand how youth are doing, and how services are operating across the country. For example, by using the same definition of wait times, we are finally able to track and understand what delays look like across the country, from urban Alberta to rural Cape Breton.
Research from ACCESS Open Minds is generating critical new knowledge. This data should act as the backbone for making evidence-based service and policy decisions. For the initial successes of ACCESS Open Minds to endure and be more widely deployed, two things are needed. First, all jurisdictions, with the support of the provinces, territories and the federal government, must make high-quality mental health care accessible to young people free of cost. Second, we need a pan-Canadian youth mental health network that can coordinate research, evaluation and data-driven decision-making, facilitate knowledge-sharing and best practices, build capacities and promote innovation across the country.
Health Minister Patty Hajdu’s mandate letter requires her to “set national standards for access to mental health services so Canadians can get fast access to the support they need, when they need it.” This has become an ever more urgent need as calls for Canada to “build back better” after the pandemic are growing. ACCESS Open Minds offers a promising, innovative model for Minister Hajdu.
Srividya Iyer, Ph.D. is at McGill University and the Scientific-Clinical Director (Nominated Principal Investigator) of ACCESS Open Minds, the first network to have been launched under Canada’s Strategy for Patient-Oriented Research (SPOR). It is funded through a partnership between Canadian Institutes of Health Research (CIHR) and the Graham Boeckh Foundation.
Yvonne Pelling is the lead of the ACCESS Open Minds Family and Carers Council.
Feodor Poukhovski-Sheremetyev is the co-lead of the ACCESS Open Minds National Youth Council.
Brittany Dalfen is the co-lead of the ACCESS Open Minds National Youth Council.
Clifford Ballantyne is the lead of the ACCESS Open Minds Indigenous Council.