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 health 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