Dr. Anthony Levitt, left, and Dr. David Kreindler are part of Sunnybrook’s efforts to improve treatment for youths with mental health issues and their families
THE FIRST SIGN CAME when 13-year-old Mark* lost interest in his beloved soccer. By age 14, his straight-A grades were a thing of the past and his attendance at school was sporadic. He had a new group of friends, and irrational arguments with his parents and siblings were the new norm. His parents tried to connect Mark with a psychiatrist after finding drug paraphernalia in his room, but Mark would refuse to follow through with appointments. Then one night, he just didn't come home at all.
"The parents were in absolute panic," says Dr. Anthony Levitt, Sunnybrook's psychiatrist-in-chief. "Mark arrives home the next morning around 10 a.m., still inebriated and with scratches and bruises, and can't recall the last 10 hours. The nature of both his mental illness and his drug addiction are now life threatening. The parents are in crisis and have no idea what to do."
For families like Mark's, figuring out Canada's complicated mental health-care system is a struggle. Parents piece together information about resources and programs from hospitals, community agencies and social services but are ultimately left on their own to make sense of the approximately 400 treatment programs throughout Canada and the U.S.
And just getting a youth into the system isn't enough; choosing the wrong plan means unnecessary financial strain on the family and, even more damaging, the wrong treatment for the patient. Too many false starts may make the teen give up on trying new treatment options altogether, and the entire family suffers. It's a common situation: Statistics Canada points out that while up to 20 per cent of youths suffer mental health issues, only 20 per cent of those patients get the attention they need.
Dr. Levitt aims to ease the burden on these families with the Family Navigation Project, a Sunnybrook-based resource that would partner families with experts in the mental health-care system. "We're trying to create a place where families in crisis can connect and find the right resources," explains Dr. Levitt. "The mental health system is a bit of a black box for many people. The point of the Family Navigation Team is to shed light on what's inside the black box, helping parents to access the information and resources that will best meet their needs and to stay engaged with the family to make sure that care is effective."
These navigators will do the legwork families can't possibly do themselves, such as physically visiting program sites to learn the nuances families won't find by researching them online. Parents will no longer throw darts at a list of treatment options, but rather work with an insider who intimately knows the approaches of individual therapists at clinics out-of-province – and details right down to, for instance, who is in the program at a given time and whether those individuals might enhance or interfere with Mark's treatment. "There's no clear path or place to go for the family or Mark, really, and that's what we're trying to create: a place where families in crisis can connect and find the right resources," says Dr. Levitt, adding that families often consult a long list of options before finding the right one.
While new to Canada, the Family Navigation Project model is common in the U.S., where therapeutic placement specialists connect youths and their families with the right treatment programs. Sarah Finney, a consultant with Salt Lake City's Educational Consulting Services, says the model works because families simply cannot do everything themselves. The legwork required is simply too extensive and family decisions are often clouded by emotion. Having an impartial guide goes a long way to find the right treatment at the right time. "What's on the Web is only what anyone wants to show, and it's very difficult for families to distinguish what's real and what's not real about these programs," she explains. "Also, it's not the program's job to say out of the hundreds out there whether they are the best program for you or not, because they don't know. They may think they can do a great job with your child, but they don't know that I know that five places can do better."
And while Dr. Levitt will continue to benifit from consultants in the U.S., the Family Navigation Project will finally allow consultants to learn from our knowledge at home. Sunnybrook, with the largest youth psychiatry division in Canada, is a natural location for the Family Navigation Project. Sunnybrook oversees North America's largest mood and anxiety disorders clinic for adolescents, and its Centre for Youth Bipolar Disorder, the only program of its kind in Canada, provides comprehensive and highly specialized care for adolescents between 13 and 18 with bipolar disorder. Dr. Levitt expects the project will improve access to services and enhance resource-matching for youths with mental health issues across Canada and will be duplicated elsewhere.
That will save a lot of heartache and wasted time for teens like Mark and their families.
"We know that's an issue," says Dr. Levitt. "With the Family Navigation Project, we're getting in the boat with the parents, families and youths. We're helping to take them and lead them in the right direction – and we stay with the family until we find the right path."
And Mark? He's finally on the right path himself, having finished one treatment program and on his way to another. His family is grateful for the navigation that set him in the right direction – something they couldn't have done on their own, Dr. Levitt says. "They send me photos of him, and he looks incredibly healthy."
*Name changed to protect privacy
Fresh Start
A unique Sunnybrook school program is helping students with mental health issues by focusing on how they're functioning, rather than their grades.
"There is quite a gap in how sick you need to be on the inpatient unit and how well you need to be to be functioning at school – and there isn't a whole lot out there for teens who need to fill that gap," explains Dr. David Kreindler, consulting psychiatrist with Sunnybrook's Fresh Start program.
The program features the only Section 23 classroom in Toronto with a parallel focus on functioning and mental health. (Section 23 is the Toronto District School Board's designation for any alternative classroom that includes a therapeutic component targeted at, for example, mental illness, teen pregnancy or a severe learning disability.) Through its multidisciplinary team (a teacher, a child-youth worker, three social workers and a psychiatrist), Fresh Start creates a clearer picture of why these students are struggling.
"Even though our students get a Grade 10 credit toward their high-school diploma, the focus is not on getting homework done or doing essays," says Linda Conn, Fresh Start's coordinator. "All the work is done in the classroom because the teacher wants to determine what is getting in the way of students doing work."
Enrolment is capped at eight students at a time (maximum age 20) and the program can last up to 12 weeks; students are transitioned back into regular or alternative schools early when appropriate. Students work with the Fresh Start teacher and a child youth worker in the morning, learn life skills in the afternoon and see Dr. Kreindler one-on-one once a week. If the student consents, there can also be a family therapy component that focuses on student-parent communication concerns.
"We work as a team, and we're all able to share our professional expertise and perspectives to develop a really good idea as to how that student is functioning and how they're interacting with their peers," says Dr. Kreindler. "And that really sheds a lot of light on what it is that is getting in the way of them functioning academically socially."