Reflections on the National Needs Assessment
Sean Kidd is a Clinical Psychologist and Head of Psychological Services, Toronto Centre for Addiction and Mental Health, Schizophrenia Division. He is an Assistant Professor in the University of Toronto Department of Psychiatry. His research focuses on community mental health and marginalized populations and service development in both inpatient and outpatient treatment settings.
The findings of this national needs assessment are important in that they clearly describe and highlight what many in the service sector grapple with on a daily basis – that mental health and addictions concerns are extremely common among homeless youth in Canada.
It ties in with research literature that links mental health and addictions with pathways into homelessness, the pervasive adversity faced in street contexts, and the complications that are linked with pathways out of homelessness. The importance of mental health and addictions is perhaps most evident in the untimely deaths of these young people, with suicide and overdose being the most common causes at a rate that greatly exceeds that of other Canadian youth.
What this report will hopefully provide is a tool for effective advocacy. As with most complicated social problems (or “wicked problems” as they are referred to in some contexts), the best strategy is to find one or more points of leverage – interventions that address one part of the problem in a way that has an impact on all of the others. Mental health is an important point of leverage. There exist effective tools to address mental health and improved mental health is linked with a greater likelihood of engaging supports, engaging in positive community activities, and improving quality of life.
Since youth homelessness and the various determinants of youth homelessness involve multiple service sectors, addressing any key aspect of it such as mental health will require cross-sector collaborations. Ideally, this would take the form of systems level or community/city responses to a problem that everyone agrees needs to be addressed. Here I put forward a few points for consideration as people think through how the information in this report might move this conversation forward.
1. Minding the gaps: There is increasing policy and practice attention being paid to transition aged youth in mental health services – recognizing the many problems that attend the shift from child/adolescent to adult sectors. Various models are being employed internationally, from teams that focus on supporting this transition through short term bridging intervention to sectors having better engagement with one another. This could be capitalized upon for homeless youth. We know where homeless youth come from. We also know that most youth are on the margins and run away several times before becoming homeless for a lengthy period. These youth might be the focus of both rapid intervention as well as a better bridging of sectors. The same might be said of youth exiting the streets. With the majority of resources concentrating on addressing crises and in establishing housing, many youth subsequently languish and do not succeed in staying in the more stable circumstances into which so much work and resources went.
2. Recognizing limits and the right service for the right young person: Many homeless youth are coping with severe and complex mental health and addictions concerns. Others have more mild challenges or none at all. Ideally in a system operating on partnerships, homeless youth services will be able to effectively screen to identify youth who need the support of specialists and provide a basic level of support guided by evidence based practices for those who do not. There are many models for doing this type of work, but some of the more efficient ones involve some time on site by a specialist (e.g., a Psychiatry Resident supervised by a Psychiatrist in a local hospital), who can in turn advise and engage in some supervision of staff with more diverse skill sets.
3. Making the case: Unfortunately as a field we are disadvantaged by a lack of research into interventions that address mental health and addictions among homeless youth. In such a context there is tremendous value in evaluating interventions that work. This ranges from specific interventions like family reunification intervention through to service collaborations that are making a difference. This also includes a pressing need for economic analysis. We know that intervening effectively with this group leads to fewer days in expensive prisons and hospitals, not to mention the myriad other social and financial expenses associated with an inadequate response to youth homelessness. The more we can bring forward specific approaches with evidence and dollar figures, the more effective advocacy efforts will be.
These are but a few ideas relevant to the conversation about addressing the mental health needs of homeless youth and will hopefully, in concert with this national report, assist advocates and service providers in their efforts. With the national mental health strategy emphasizing the need for timely and effective care for marginalized populations and the emphases upon early intervention and transitional aged youth, there exists an opportunity for getting the attention of policy makers. Additionally, given that at times the policy solution can feel like waiting for Godot, some community-based approaches can be just a phone call away. There are mental health professionals in a range of settings who would like to connect better with this population but simply do not know how to go about doing it.