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Drugs such fluoxetine have been linked to a possible increase in suicide risk among youth. (DARREN STAPLES/REUTERS)
Drugs such fluoxetine have been linked to a possible increase in suicide risk among youth. (DARREN STAPLES/REUTERS)

OPEN MINDS: Better mental health care

For kids in need of mental-health care, too often we offer drugs, not help Add to ...

This is part of a series about improving research, diagnosis and treatment. Join the conversation on Twitter with the hashtag #OpenMinds

Here’s a startling fact: Nearly three-quarters of all mental-health problems emerge during childhood or adolescence. Here’s another: Only one in five young people who need mental-health services get the help they require, according to the Canadian Mental Health Association.

What do those numbers add up to? Despite all the well-intended talk about ending the stigma surrounding mental health, we have a long way to go to help kids who are suffering.

Part of the blame falls on the reluctance of some families and sufferers themselves to seek treatment. But too many patients and their families have learned the hard way that, even when they look for it, getting help for mental-health problems is far more difficult than it should be. Despite growing calls to provide more services in primary-care settings, many family doctors don’t have adequate resources or training to give patients the help they need, especially in complex cases. In big cities, waiting lists for mental-health specialists can be months long; in smaller, more remote areas, people find few resources at their disposal.

Across the board, there is a consensus that the delivery of services is disjointed, unco-ordinated and underfunded. And as happens with other complex or difficult-to-treat health conditions, medications and emergency rooms often end up filling the gaps.

According to a May report from the Canadian Institute for Health Information, emergency-department visits for mental-health problems among five- to 24-year-olds rose by an astounding 45 per cent between 2006-07 and 2013-14. Inpatient hospitalizations lasting at least one night also rose nearly 40 per cent among young people over that time period.

The report notes that the prevalence of mental-health problems among youth does not appear to have risen significantly over that time period, which suggests that anti-stigmatization campaigns are working.

However, it should also be noted that a trip to the emergency room does not provide long-term solutions for a young person dealing with a mental-health disorder. It is only a place to go in a moment of crisis.

The same CIHI report found that, in 2013-14, one in 12 people aged 15 to 24 in British Columbia, Saskatchewan and Manitoba was taking an anxiety or antipsychotic drug such as quetiapine. That is an alarming number and raises serious questions about the current approach to treating mental illness, particularly considering the vast majority of drugs on the market have never been tested on – or approved for treating – children.

In the vast majority of cases, doctors prescribe antidepressants or antipsychotics to young people “off label,” or outside the drug’s approved indication. While that’s perfectly legal, the mounting number of prescriptions being written for young people suggests we need to make clear that these drugs aren’t risk-free. A Saskatchewan-based study last year in the Canadian Journal of Psychiatry found that in 1983, six out of every 1,000 individuals 19 and under were taking an antidepressant. By 2007, that rose to nearly 16 out of every 1,000 people.

Selective serotonin reuptake inhibitors (SSRIs), including fluoxetine (sold under the brand name Prozac) and sertraline (known as Zoloft) were responsible for most of the increase – drugs that have been linked to a possible increase in suicide risk among youth. Although there is considerable debate over the suicide link, plenty of research has shown that SSRIs may not be any more effective than placebo at treating depression.

Of course, it’s also worth mentioning that children are increasingly being put on antipsychotics to treat behaviour issues, sleep problems, anxiety and other issues despite unclear efficacy and plenty of evidence that those drugs can cause serious harm, including tremors, spasms and metabolic disorders.

The health-care system owes it to vulnerable young people to do better.

Medications can play an important role in treating mental illness, but there are legitimate concerns about overreliance. The absence of a robust system that can meet the needs of patients who need mental-health services shouldn’t mean that those patients are instead handed a prescription for a drug that might not work and might even cause harm.

This overreliance on medications is a symptom of a much wider problem, according to Dr. Marshall Korenblum, chief psychiatrist at the Hincks-Dellcrest Centre for children and families in Toronto. “When, as a society, we don’t have adequate non-medicine supports in place, people turn to meds for a quick fix,” he said.

If kids are lucky, they will get more than just prescriptions or an emergency-room visit when in crisis. They will get to see a specialist who can develop a rigorous, holistic treatment plan. Even luckier children will also have access to in-school support systems specifically designed to treat mental illnesses.

For the vast majority of families, however, those scenarios are completely out of touch with reality.

The past decade has seen a remarkable improvement in the way we talk about mental health. But awareness, while important, can only take us so far. What families desperately need now are commitments from the federal and provincial governments to make a broader range of mental-health services much more accessible, and to provide evidence-based therapies rather than the quick fix of a simple prescription.

The Centre for Addiction and Mental Health has purchased advertisements to accompany this series. The organization had no involvement in the creation or production of this, or any other, story in the series.

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