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The crossroads of mental illness and opioid use: Let’s meet youth when and where they need us

Louise Bradley is the president and CEO of the Mental Health Commission of Canada. Kim Corace is the director of clinical programming and research in the Substance Use and Concurrent Disorders Program at the Royal Ottawa Mental Health Centre.

On Aug. 31, International Overdose Awareness Day, we all have an obligation to raise the alarm on the silent crisis stalking our communities. In 2017, there were nearly 4,000 apparent opioid-related deaths. Even more staggering, in 2016-2017, nearly one-third of hospitalizations for opioid poisonings resulted from purposely self-inflicted harm – including suicide attempts. When it comes to young people at the ages of 15 to 24, that number jumps to 44 per cent.

Increasingly, our understanding of the intermingling of mental illness and substance use is becoming clearer. The work being done on both fronts is of crucial importance, but it’s in the blurry zone where the two intersect that greater attention and focus is required.

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Among young people, opioid addiction is less likely the result of treatment for physical chronic pain. But that isn’t to say that their drug use isn’t blunting a different kind of distress. Young people are struggling with complex challenges, including adverse childhood experiences, which can lead to problematic substance use.

As clinicians can attest, conversations with young people are not just about substance use – but also the context around it. From problems with school, to struggles with friends and parents, young people are only too willing to share their burdens. They express repeated frustration that the silos between mental health and addiction care often preclude them from receiving treatment for one if they also require help for the other.

We believe attention to overdoses linked to suicides is crucial. However, we caution the crisis is bigger than opioid-related suicides – with 4,000 people taking their own lives each year. Suicide is the second leading cause of death among young people in Canada. For Indigenous populations, that number is between six and seven times higher than it is for non-Indigenous Canadians.

These startling statistics point to a gap in services. Failure to treat both the symptoms and the underlying concerns of mental illness and addictions is a recipe for a revolving door to temporary treatment.

As awareness grows around the opioid crisis in our country, it would be a mistake to fail to examine more closely how people – especially young people – may be choosing to die by suicide through overdose. Our shared frustrations at the need for better preventative measures and greater access to treatment are echoed by parents across the country. While there is no one-size-fits-all solution, we believe there are concrete ways to improve the care young people get when they are experiencing concurrent substance-use and mental-health problems.

Understanding how young people want to be treated by health-care providers is the first step. They will make time for what’s important to them, so invite them to share their concerns, don’t demand that they talk about their drug use.

Another huge barrier to appropriate treatment is immediacy. It’s critical to strike while the iron is hot and have a host of resources and services available at a one-stop shop. Don’t ask young people to walk across the street to get a naloxone kit from the closest pharmacy – having all the tools at the ready is key to ensuring they get into the right hands.

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Be flexible. Young people who are struggling with mental health and substance use may not adhere to specific appointment times and conventional schedules. A willingness to meet them on their terms will increase the likelihood of effective intervention.

Young people with substance-use and mental-health problems are hit with stigma from all sides. Be open-minded, because underneath their symptoms reside people no different from you or me – people who deserve to be treated with dignity and respect.

We must close the gap in services that results in too many young people with concurrent disorders unable to access the help they need. And we need to do more to bridge the gap between child and adult services, so young people don’t find themselves without appropriate care at a time in their lives when it’s needed most. We also need to invest in evidence-based interventions to prevent problems from occurring.

On International Overdose Awareness Day, and every day, we should be mindful that everyone struggling with addiction and mental illness has a story – often one fraught with early life disadvantages. As care providers, community leaders and family members, we can help reorient their trajectory towards recovery and resilience through services and supports that meet their unique needs.

If we build it, they will come.

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