Changing The Landscape for Student Mental Health: The Case of the Mobile Mental Health TeamLouisa Drost – Mohawk College

Su-Ting Teo, MD – Ryerson University

Challenges for Student’s Who Need Mental Health Services

The origins of mental disorders are in childhood and adolescence (Kessler et al., 2005)

Graduates of child and adolescent services “aging out”

Young people with emerging mental health problems can fall between the gaps between child and adolescent services and adult services, which can delay receiving appropriate intervention (Department of Health and Ageing 2005)

Left undiagnosed and unchecked these disorders can have a worsening course in affected persons for decades

“Service system is weakest where it needs to be strongest”

Transition more complex for students who require more intensive services

Campus ChallengesGlobal Burden of Disease

Today’s Student Impacts PSE Wellness Staff

Increased stress managing a complex, crisis oriented caseload

Counselling is not meant as a long-term therapy relationship

Back log/wait times in services

Staff stress managing complex, crisis oriented caseload resulting in case manager function

Need for clinical supervision

Service demands exceed service delivery models resulting in campus treatment facility for students

Increase risk and liability on institution give high risk profile

Context – brief, SF, skill based practice;

career/academic counselling

Lack of community referral sources

Lengthy wait times for outpatient

services

Increased stress managing a

complex, crisis oriented caseload

Impact of Students in Crisis to Institution

Student in

crisis

Counselling

Security

EMS/Police

InstructorsSSA’s

Manager

Risk Team

Current Challenges with Services for Post Secondary Students

Post Secondary Community Supports

Hospital

The Ideal Health Service System for Post Secondary Students

Post Secondary Community Supports

Hospital

MHCC Executive Summary on Emerging Adults

Shifting Perspective

There are well over 50 community partners working with youth and/or working with people with mental health and addictions concerns in Hamilton.

The evidence

base

Draft model

Community partners consultation

Revise model

Youth feedback

process of developing a model

Less intensive mental and/or addiction services

Less intensive youth services

More intensive mental and/or addiction servicesLess focus on youth

Less focus on Mental Health and Addiction Services More Intensive Services for Youth

Most intensive mental and/or addiction servicesIntensive services for youth

Benefits of Community Collaborations

Streamlined referral system

Increased communication between Post Secondary, health, and community stakeholders

Shared responsibility for care

Increased awareness for student mental health needs.

Collaboration strengthens working relationships between PSE and community partners

Youth centred care resulting into successful effective practice

A Sustainable Community of Practice!

Goal in the Hamilton Model

The Youth Wellness Centre seeks to lay the foundation for a clinical program aimed at reducing psychiatric morbidity through early identification and treatment that is:

Efficient

Evidence-based

System linked

Youth-based

Designing a Youth-Centred Model

Youth ParticipationPeer Support

Family SupportAccessible

Tech-friendly

15

Model Chosen

The YWC will provide two main services:

Early Intervention: For youth struggling with mental health and addiction difficulties. This includes the mobile team engaging youth on campus.

Transition Support: For youth transitioning from PSE Services to community and adult mental health and addictions services.

How Have We Operationalized these Ideas and input?

Youth Wellness Centre is co-located in downtown Hamilton with Alternatives for Youth (addictions). 

The YWC will serve youth ages 17 to 25, and will remain involved with youth for up to 3 to 5 years.

Participate in the Hamilton Community Protocol on Violence Threat Risk Assessment.

Raise awareness of mental health and addictions issues through education and outreach at Post Secondary Schools.

Build capacity for youth-centered care within St Joe’s mental health and addictions program.

Key Lessons in Collaboration and Service Needs

• For psychosis, a system of early intervention services exists

• Policy and reform documents highlight the need and a need of increasing priority

An Early Intervention service should:

• Raise awareness of mental health issues

• Have a distinct clinical identity that is friendly to youth and their families

• Provide multi-modal treatments across the biopsychosocial spectrum

• Be involved for medium to long term (2-5 years)

• Evaluative/Research Capacity

The Mobile Wellness Team

Substance Counselling

Peer with lived experience

Mental Health Nurse

Therapist

Family Care Coordinator

https://youtu.be/KSc8Ha02VTE

Challenges for Post Secondary Sector

Who are the stakeholders? How do you start the conversation Role overlap and role confusion Competing factors between community

hospitals/health and PSE

Evaluation

Evaluation: YWC will provide

• Screening (GAIN-SS and GAIN-Q3)

• Assessment (GAIN-I)

• Early Interventions (DBT Skills, online, face-to-face CBT, peer support, family education)

• Transition support to SJHH and community programs

• Mobile outreach

• Ongoing monitoring of outcomes

• Pre and Post measures for shared groups

Progress To Date

Launched March 16, 2015 over 40 referrals - the majority (aprox 40%) self-referrals

Youth Council launch in May

Mobile Team—service at PSE has started. Marginalized youth strategy in planning phase.

Coordination of Youth MHA initiatives across the LHIN, including Niagara via the Region’s Mental Health Program

Where To Start in Your Community

Implementation through community discussions Proposals to Fund Initiative Engaging youth with lived experience, through a

youth council to support creation of the model Youth Leadership roles

Emerging Model

Campus Groups: a Postsecondary Schools, Community Services, and Hospitals partnership for Substance Use/ Addictions

Mental Health Innovation Fund – Ministry of Training, Colleges, and Universities

Collaboration between Ryerson University, OCAD University, and George Brown College AND LOFT Community Services AND CAMH, Hospital for Sick Children, and St. Michael’s Hospital

Components of LOFT’s TAY Addictions Campus program

Weekly psychiatrist

Trained peer mentors

Specialized Addiction program – evening groups on campus

Supportive Housing- low,

med , high support

Timely tight referral to community / hospital

resources

Care coordination pilot through Health Links

Students from Ryerson University

George Brown CollegeOCAD University

Crisis

phone/text 24/7

Staffing Mon-Fri 9am-9pm

Sat: 1-9pm

Groups and recreational

activities

Acceptance and Commitment

Therapy

Partners and RolesPartners Roles

PSE: George Brown College, OCAD University, Ryerson University

- Referral of students- Shared/ collaborative care- Sites for treatment groups

LOFT Community Services - Case management- Group facilitation- Train and support peer mentors- Crisis phone/ text 24/7- Housing supports- Recreational activities

Hospital for Sick Children - Consultation to LOFT staff on Acceptance and Therapy model

Centre for Addictions and Mental Health - Evaluation Framework- Urgent Care Clinic – psychiatrist access

St. Michael’s Hospital - Access to weekly psychiatrist

Take Home Messages

The system as a whole needs to be able to actively monitor individuals at risk and focus on preventing first episodes or relapses as well as treatment.

Partner with community agencies, primary care, schools, and other key stakeholders is critical to success for youth.

Talk to you LHIN or equivalent about funding/grants to begin your community of practice.

Consider delivery of services in the most convenient location and least intrusive manner with the mobile team.

Service Assessment Tool for Post-Secondary Student Mental Health

Concurrent Session Eight | 75 Minute Interactive Session

4:45PM – 6:00PM East Meeting Room 1

Questions or Comments?

Questions for us?

These are conversations that we need to continue as a CACUSS community to “think outside the box” to service student

What do you see as possible challenges with teams?

What have you tried in your community?

What are your concerns?