Situation canadienne

Dans les communautés à l’échelle nationale, l’incapacité de répondre aux besoins spécifiques des jeunes sans abri dont les besoins en santé mentale sont complexes et l’absence de services appropriés, offerts en temps opportun provoquent une situation de crise chez les jeunes sans abri, leurs familles, les organismes communautaires et les structures qui tentent de leur venir en aide.

Bien qu’il soit difficile de savoir exactement le nombre de jeunes (de 16 à 24 ans) au Canada aux prises avec l’itinérance, rapports et littérature estiment qu’il existe « au moins 35 000 jeunes qui sont sans abri durant l’année, et peut-être 6 000 chaque nuit »[1] [2] De plus en plus, ils vivent dans la rue ou dans des refuges, en proie également à des problèmes de santé mentale, allant de l’anxiété, de traumatismes et de la dépression à des maladies graves et complexes incluant la schizophrénie, les troubles bipolaires ou troubles concomitants.

Les résultats sont dévastateurs car au Canada, les jeunes les plus marginalisés continuent de passer entre les mailles du filet des systèmes de santé et de santé mentale. Au cours de notre travail avec les jeunes sans abri, nous avons été témoins des nombreux obstacles que ces jeunes doivent affronter en tentant d’avoir accès au système de soutien en santé mentale. Dans de nombreux cas, les jeunes ne sont pas admissibles aux services et généralement, les systèmes de santé mentale pour enfants et adultes ne leur offrent pas des services adéquats – pas plus que ceux développés pour les adultes sans abri ayant des besoins en santé mentale complexes.

Ces dernières années, nous avons observé une hausse sensible de jeunes qui connaissent itinérance et isolation au sein de leurs communautés et qui sont également aux prises avec des problèmes de santé mentale complexes. Compte tenu des réalités liées à l’itinérance chez les jeunes, et du fait que s’avèrent les principaux déterminants de la santé mentale, l’inclusion sociale, une vie sans discrimination et violence et l’accès aux ressources économiques, telles que logement et emploi, etc., cela ne devrait surprendre personne.

Ce que nous savons

Étant donné que les problèmes de santé mentale se répercutent sur la vie des jeunes que nous voyons, la Communauté nationale d’apprentissage sur les jeunes sans abri a mis tout en uvre pour mieux comprendre la taille et l’étendue du problème tout comme les obstacles aux services auxquels sont confrontés ces jeunes. Au cours des trois dernières années, nous avons effectué une évaluation des besoins de nos organismes œuvrant auprès des jeunes et nous avons découvert que bien au-delà de 50 % des jeunes sans abri et à risque de le devenir dont nous nous occupons présentent des problèmes de santé mentale d’une forme ou d’une autre.

Méthodologie

Le jeudi 27 février 2014, des membres de la Communauté d’apprentissage répartis dans tout le Canada ont procédé à notre évaluation des besoins en santé mentale des jeunes qui ont eu accès à nos programmes ce jour-là (14 organismes dans 12 communautés canadiennes bénéficiant de 36 programmes). Chaque organisme s’est livré à l’évaluation des besoins selon ses connaissances respectives et les antécédents des jeunes qui ont profité de son programme ce jour-là. À partir des renseignements disponibles (examen de dossiers, autoévaluation, observation, etc.), le personnel du programme était en mesure de déterminer la prévalence des problèmes en santé mentale que les jeunes manifestaient lors de cette journée. L’ajout de questions spécifiques sur la toxicomanie et les troubles concomitants constituait une première.

Résultats

En 2014, nous avons évalué 1 054 jeunes sans abri. Sur ce nombre :

  • 56 % ont des problèmes de santé mentale
  • 50% ont des problèmes de toxicomanie
  • 35% présentent des troubles concomitants
Obstacles au logement

Les jeunes ont de la difficulté à se loger adéquatement en raison de problèmes de santé mentale et de toxicomanie, et de troubles concomitants.

Soutien supplémentaire

Un très grand nombre de jeunes dont nous nous occupons ont besoin d’un soutien en santé mentale bien au-delà de ce que nous pouvons leur offrir.

Obstacles au soutien

Une grande majorité de jeunes qui ont besoin d’un soutien supplémentaire ne peuvent l’obtenir en raison de plusieurs facteurs (la plupart étant rattachés à leur itinérance). Il y a plusieurs raisons pour lesquelles les jeunes sans abri ne peuvent avoir accès aux services de soutien nécessaires pour leurs problèmes de santé mentale ou de toxicomanie. On a demandé au personnel chargé d’effectuer l’évaluation des besoins de dresser une liste des obstacles auxquels sont confrontés les jeunes sans abri pour avoir accès aux services.

Les principaux obstacles sont les suivants :

1)Absenced’un diagnostic formel : sans un tel diagnostic, les  jeunes ne peuvent avoir accès aux services.

2) Programmes inadéquats : les programmes actuels n’ont pas toujours su comment apporter du soutien aux personnes semblables à certains jeunes dont nous nous occupons. Cette situation est souvent due à l’instabilité de logement qui empêche d’assurer un suivi, à l’absence d’un réseau de soutien positif et à l’absence de défense des droits.

3) Longues listes d’attente : les listes d’attente pour les services en santé mentale sont souvent trop longues pour des jeunes qui vivent une crise durant laquelle ils ont besoin de services. Les jeunes peuvent également bénéficier des coordonnées d’une ressource et lorsque finalement on les contacte, bien souvent il est impossible de les joindre.

Réponse actuelle

Les services disponibles sont souvent intégrés au sein d’établissements (hôpitaux, cliniques, etc.) où, nous le savons, les jeunes s’y rendront rarement, et trop peu sont implantés dans la communauté, et que les jeunes fréquentent déjà. Les services communautaires ont l’avantage d’avoir déjà établi des relations avec les jeunes et se prêtent mieux à la rencontre de professionnels en santé mentale dans ce « milieu sécurisant ». Trop peu de jeunes sont capables ou désireuxde s’engager dans les structures actuelles créées pour intervenir en situation de crise en santé mentale. En substance, ce système est déficient pour des centaines de jeunes.

En ne traitant pas ces problèmes en santé mentale, les jeunes se retrouvent souvent en zone neutre par rapport aux services et au soutien. Isolés et ordinairement dépourvus d’aptitudes sociales et à la vie quotidienne parce qu’ils ont vécu hors de leur foyer et sur la rue, ils sont trop jeunes pour faire partie du système pour adultes lorsqu’ils cherchent du soutien en santé mentale – et ont passé l’âge d’avoir accès aux services pour enfants et adolescents. Ils font face à la maladie mentale sans parents pour défendre leurs droits s’ils étaient restés à la maison, et en plus ils vivent avec le stigmate de l’itinérance.

Tout un dilemme – compte tenu de leur situation d’itinérance, il leur est plus difficile d’aller à l’école, de garder un emploi ou de suivre un traitement en vue d’un rétablissement; et le fait qu’ils présentent des problèmes de santé mentale signifie que sur le plan statistique, ils sont susceptibles d’être sans abri plus longtemps.

Un changement s’impose — Le statu quo n’apporte rien aux jeunes sans abri

Même si nous sommes conscients de la complexité des interventions sociales déployées au sein du système de santé, qui se doit de répondre à des normes rigoureuses pour de meilleures pratiques médicales, nous croyons que d’autres mesures s’imposent pour apporter du soutien aux jeunes sans abri. Il faut développer des partenariats entre les organismes en santé mentale et ceux qui s’occupent des jeunes sans abri.

1. Rencontrer les jeunes dans leur milieu — Partenariats entre les organismes pour les jeunes et les fournisseurs de services en santé mentale

Les jeunes sans abri ont tendance à se méfier des grandes institutions comme les hôpitaux. Des recherches récentes et des preuves anecdotiques voient d’un bon œil l’intervention des travailleurs en santé mentale auprès des jeunes dans leur milieu, offrant ainsi leurs services au lieu de les obliger à venir à eux. Les travailleurs en santé mentale doivent d’abord rencontrer les jeunes sans abri en dehors du contexte hospitalier/clinique, mais plutôt dans un milieu qui leur sont familier, par exemple dans un refuge pour jeunes, des haltes-accueil ou des endroits neutres dotés d’un personnel de soutien. Dès que des liens se sont tissés, les jeunes peuvent se rendre à l’hôpital/ à la clinique s’ils se sentent à l’aise de le faire.

2. Développer des programmes d’intervention pour s’occuper des jeunes sans abri

En partenariat avec les organismes pour les jeunes et les fournisseurs de services en santé mentale, nous avons besoin de programmes axés sur les besoins spécifiques des jeunes sans abri. De nombreux fournisseurs de services en santé mentale ont établi des programmes à l’intention de groupes culturels particuliers. À la lumière de leur succès, il est nécessaire de développer et de piloter des programmes visant à établir des pratiques exemplaires/prometteuses pour intervenir auprès des jeunes sans abri.

3. Transfert des connaissances issues de pratiques émergentes et prometteuses

Il existe des communautés qui développent des programmes pour répondre aux besoins spécifiques des jeunes sans abri. Nous devons développer un processus de compréhension et de diffusion des pratiques prometteuses. La Communauté nationale d’apprentissage sur les jeunes sans abri est la seule en mesure de faciliter ce dialogue national entre les organismes et les fournisseurs de services en santé mentale.

La Communauté nationale d’apprentissage sur les jeunes sans abri

La Communauté nationale d’apprentissage sur les jeunes sans abri est un réseau pancanadien d’organismes de premier plan œuvrant auprès des jeunes à l’échelle du pays; leur collaboration permet d’aborder les principaux problèmes liés à l’itinérance, d’échanger sur les pratiques prometteuses, de développer des stratégies et des outils visant à renforcer notre secteur afin de mieux prévenir, réduire et mettre fin à l’itinérance chez les jeunes au Canada. Mis sur pied en 2006 dans le cadre du Programme d’initiatives nationales d’Eva’s Initiatives (Toronto), ce réseau pancanadien s’avère le seul du genre destiné aux jeunes sans abri. Collectivement, nous offrons des services et du soutien à plus de 15 000 jeunes par année.

Pour tous renseignements, veuillez contacter :

Melanie Redman

Directrice, Initiatives nationales

Eva’s Initiatives pour les jeunes sans abri

mredman@evas.ca

 

 

[1] Gaetz, S, Coming of Age: Reimagining the Response to Youth Homelessness in Canada. Toronto: The Canadian Homelessness Research Network Press, 2014, page 7.

[2]Dr Gaetz poursuit en expliquant «[qu’] il est important de noter que cela n’inclut pas les jeunes qui ne font pas partie du système de refuges, sont totalement sans abri et passent la nuit à la belle étoile ou dans d’autres lieux impropres à l’habitation, ou ceux qui demeurent temporairement avec des amis et n’ont aucun endroit où rester (dorment chez l’un et chez l’autre). »

Canadian Landscape

In communities across the country, the failure to address the specific needs of homeless youth with complex mental health needs and the lack of appropriate, timely services is resulting in a crisis for homeless young people, their families and the community agencies and structures that seek to support them.

While it is difficult to fully know the number of young people (16-24 years old) in Canada experiencing homelessness, reports and literature estimate that there are “at least 35,000 young people who are homeless during the year, and perhaps 6000 on any given night.” Increasingly they face life on the street or in shelters, while also contending with mental health issues ranging from anxiety, trauma and depression to severe, complex illnesses including schizophrenia, bipolar disorder, or concurrent disorders.

The results are devastating as Canada’s most marginalized young people continue to fall between the cracks of health care and mental health systems.  In our work with homeless youth, we have witnessed the multiple barriers that these young people experience when trying to access the system for mental health support. In many cases, youth are ineligible for services and typically they are not well served by children and adult mental health systems – nor well suited to services developed for homeless adults with complex mental health needs.

In recent years we have seen a significant increase in young people facing homelessness and isolation within their communities who are also experiencing complex mental health issues.  Given the realities of homelessness for young people, and the fact that the most significant determinants of mental health are social inclusion, freedom from discrimination and violence, and access to economic resources, such as housing, employment, etc., this should not be a surprise.

What We Know

Given the impact that adverse mental health plays in the lives of the many youth we see, the National Learning Community on Youth Homelessness has worked to better understand the size and scope of the issue as well as understand the barriers to services these youth experience. For the past three years, we conducted a needs assessment of our youth-serving agencies and discovered that well over 50% of the homeless and at-risk youth we worked with have mental issues of some kind.

Methodology

On Thursday, February 27, 2014 Learning Community members across Canada completed our mental health needs assessment for the youth who accessed our programs on that day (14 organizations in 12 Canadian communities that incorporated 36 programs). Each organization completed the needs assessment based on their respective knowledge and history of the youth who accessed their program that day. From all available information (file reviews, self-reporting, observation, etc.), program staff were able to ascertain the prevalence of mental health issues that youth experienced on this assigned day.  This was the first year that we added specific questions on addictions and concurrent disorders.

Findings

In 2014, we assessed 1054 homeless youth. Of these young people:

  • 56% have mental health issues
  • 50% have addictions issues
  • 35% have Concurrent Disorders

Barriers to Housing

Mental health issues, addictions and Concurrent Disorders make it difficult for youth to access adequate housing.

Additional Support

An overwhelming number of youth we work with require additional supports beyond what we can provide.

Barriers to Support

A vast majority of youth who require additional supports cannot access these supports for a variety of factors (most are connected to being homeless). There are a number of reasons why homeless youth can’t access services they need to support their mental health and/or addictions issues. Staff completing the assessment were asked to list the barriers to services for homeless youth.

Top barriers to services:

1) Lack of a Formal Diagnosis: without a formal diagnosis, youth cannot access services.

2) Inadequate Programs: existing programs have a poor history of helping individuals similar to some of the youth we work with. This is often connected to unstable housing for follow up work, lack of a positive support network and lack of advocates.

3) Long Wait lists: wait lists for mental health services are often too long for youth who are experiencing a health crisis and require services during their crisis. Also youth may use a service provider’s contact information and when they are finally called, often the youth cannot be located.

Current Response

Services that are available are often embedded within institutional settings (hospitals, clinics, etc) which we know youth will rarely access, and too few are community based where youth are already connected. Community-based services have the added benefit of pre-established relationships with youth and are more amenable to meeting with mental health professionals in that “safe place”. Too few young people are able or willing to engage within the current structures that have been created to respond to this mental health crisis. In essence, this system is broken for thousands of youth.

These untreated mental health issues often lead youth into a “no man’s land” in relation to services and supports. Isolated and usually lacking social and life skills due to their time out of family and on the street, they are too young to fit into the adult system when seeking mental health supports – and too old to be able  to access services for children and youth. They face mental illness without the advocates that their parents might have been were they still at home, and with the added stigma of being homeless.

A perfect double bind – the fact that they are homeless makes it difficult to attend school, hold down a job, or get the treatment that will lead to recovery; and the fact that they have mental health issues means they are statistically likely to be homeless for longer.

Change is Needed — The status quo is not working for homeless youth

While we appreciate the complexities of social interventions deployed within the mental health system that are often challenged to meet rigorous standards of medical best practice, we believe more needs to be done to support homeless youth. Partnerships are needed between mental health organizations and organizations working with homeless youth.

1. Meet youth where they are–Partnerships between youth organization and mental health providers

Homeless youth tend to be leary of large institutions like hospitals. Current research and anecdotal evidence supports the practice of mental health workers coming to youth where they are to deliver services instead of requiring youth to come to them. Mental health workers need to initially meet with homeless youth outside of the hospital/clinic setting and instead meet with them in an environment that youth are familiar with such as in youth shelters, drop-in centres or neutral locations with staff as support. Once rapport has been developed youth can begin to meet at the hospital/clinic if they are comfortable.

2. Develop intervention programs to work with homeless youth

In partnership with youth organizations and mental health providers, we need mental programs that focus on the specific needs of homeless youth. Many mental health providers have established programs for specific cultural groups. Based on the success of these, programs need to be developed and piloted to establish promising/best practices for working with homeless youth.

3. Knowledge Transfer of Emerging and Promising Practices

There are communities that are developing programs to address the specific needs of homeless youth. We need to develop a process of understanding and disseminating  promising practices. The National Learning Community on Youth Homelessness is uniquely positioned to facilitate this national dialogue between youth organizations and mental health providers.

National Learning Community on Youth Homelessness

The National Learning Community on Youth Homelessness is a pan-Canadian network of leading youth serving organizations across the country who work collaboratively on key issues, share promising practices and develop strategies and tools to strengthen our sector and work towards preventing, reducing and ending youth homelessness in Canada. Founded in 2006 through the National Initiatives Program of Eva’s Initiatives (Toronto), we are the only pan-Canadian network of its kind on youth homelessness. Collectively, we provide supports and services to over 15,000 young people every year.

For more information please contact:

Melanie Redman

Director, National Initiatives

Eva’s Initiatives for Homeless Youth

mredman@evas.ca

français Approfondir le dialogue sur les jeunes sans abri et la santé mentale

Reflections on the National Needs Assessment

Sean Kidd, Ph.D.
Toronto Centre for Addiction and Mental Health
University of Toronto Department of Psychiatry

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.

Connected By 25 français

Connected by 25 is a 2014 winner of Eva’s Awards for Ending Youth Homelessness and is a great prevention program model.

“This program works.  More people are coming down with the same symptoms, more people like me can have success, a helping hand to push them to the next steps, a better future, not just their issues…CB25 is like a step by step introduction to becoming independent. The Navigator was patient.  That’s really hard to find” – Program Participant, 19

Connected by 25 is a collaborative project designed to meet the needs of young people between the ages of 16 and 24 in the Central Okanagan that are vulnerable in their transition to adulthood. The project seeks to build capacity within the community to ensure that young people at risk of falling through the cracks in their transition to adulthood have access to the services they require. It further serves to build capacity in youth themselves by offering the relational, emotional, and material supports they need. By building community connections and natural support networks, young people will experience an increase in their sense of belonging, increasing their resiliency, while mitigating risk factors in their lives.

Target Population

The target population for Connected by 25 is young people between the ages of 16 and 24 in the Central Okanagan who are vulnerable to mental health and/or substance use problems and face risks in their transition to adulthood.

This group includes, but is not limited to: Young people in care or on a youth agreement, those experiencing unstable living environments, Aboriginal youth, youth with learning disabilities, substance involved/dependent youth, and young people recovering from mental health and/or substance use disorders and FASD.

Project Decription

Youth Transitions Navigator

The project incorporates a dedicated a full-time Youth Transitions Navigator who works directly with young people between 16 and 24 years of age, providing them with direct supports and assistance in achieving a successful transition to adulthood. This includes one-to-one support, systems navigation, life skills development and strengthening connections to community and natural supports. The Youth Transitions Navigator plays an essential and much needed role in bridging the gap between youth and adult service delivery systems, providing continuity in service for young people that are at-risk of “falling through the cracks” in their transition from one system to another. The Youth Transitions Navigator stays involved with young people past their 19th birthday to ensure that the necessary supports and connections are in place to facilitate their successful transition to adulthood.

Project Lead & Community Capacity Coordinator

A part-time Community Capacity Coordinator works with community based, non-profit and government organizations to enhance collaboration, streamline service processes and build community capacity in supporting transitions for young people. This may include the development of transition planning protocols between organizations, increased awareness and education around services available to young people past their 19th birthday, systemic advocacy and reform related to the target population, and any other outstanding issues in this area.

Project Partners

CMHA Kelowna is the project lead for Connected by 25, and the following organizations have come together to partner for this project:

  • The Bridge Youth and Family Services
  • Ministry of Children and Family Development (MCFD)
  • IHA Mental Health and Substance Use Services
  • B.C. Housing
  • UBC-Okanagan

Navigation Supports and Services

Examples of Youth Navigator Activities Include:

  • Assisting young people to navigate systems of care: These can include services such as mental health,
  • addictions counselling, health care, etc…
  • Housing support: Assisting young people to develop the skills and connections to find and maintain
  • affordable, safe, and stable housing
  • Income support: Assisting young people in accessing income supports that they are eligible for (i.e.
  • income assistance, PWD, etc…)
  • Individualized client-driven support: Providing one-on-one support for client-defined goals
  • Life skills development: Money management, banking support, grocery shopping, meal preparation,
  • self-advocacy skills, and more
  • Employment and education support: Investigating and assisting with educational and vocational
  • supports and services
  • Social connection support: Helping young people to get involved in leisure, recreational, spiritual, and
  • cultural activities and engage them in the community to develop natural support networks
  • Community contribution: Recognize and enhance young people’s skills by connecting them with
  • community volunteer activities.
  • Access to primary health care providers and support-many young people from the target population
  • have no access to a GP

For more information on Connected by 25, please feel free to contact: Mike Gawliuk, Project Lead (250-861-3644 mike.gawliuk@cmha.bc.ca)