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EXPLORINGMENTALHEALTHSERVICESANDSUPPORTSFORCHILDREN,YOUTHANDFAMILIESINCALGARY

AREPORTTOTHEUNITEDWAYCALGARY&AREADRAFTMARCH31

KATHYGERMANNPHD,MSCGAILMACKEANPHD,MPABLYTHEBUTLERBCOMM

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TableofContents

Acknowledgments........................................................................................................................5

Listofacronyms............................................................................................................................6

Executivesummary.......................................................................................................................7Keyfindings.................................................................................................................................................7

Thesuperordinatefinding........................................................................................................................8Possiblepathwaysformovingforward.....................................................................................................9

Buildanewfoundation:Developacontinuumorframeworkformentalhealthservicesandsupportsthatisgroundedinaphilosophicalshift..................................................................................................9Disruptionstoaddresskeyissues...........................................................................................................10

Somelessdisruptivebutpotentiallyimpactfulshort-termactions.........................................................11Amultitudeofstrengthsandpassionforchange:Apowerfulbaseformovingforward.....................12

Introductionandoverview.........................................................................................................13Purposeoftheproject...............................................................................................................................13Overviewofthereport..............................................................................................................................13Definitions..................................................................................................................................................14

Methods........................................................................................................................................15Advisorygroup...........................................................................................................................................15Qualitativemethods...................................................................................................................................15Limitationsandstrengths..........................................................................................................................17

Findings.......................................................................................................................................18Insufficientattentiontothe“frontend”–supportsfoundationaltochild,youthandfamilymentalwellbeing....................................................................................................................................................19

Earlychildhooddevelopment.................................................................................................................20Credibleandaccessibleinformationforyouthandfamiliesaboutmentalhealthproblemsandillnesses................................................................................................................................................................23

Gapsandchallengesinaccessingandreceivingmentalhealthservicesandsupports.........................25Gettingin:Accessingmentalhealthservicesandsupports...................................................................25Assessmentchallenges............................................................................................................................41Supportsforthewholefamily...............................................................................................................44Supportswhilewaitingfor,andbeyond‘treatment’............................................................................47Transitions...............................................................................................................................................51

Systemissues.............................................................................................................................................57Whysomuchfragmentation?................................................................................................................58Resourcing..............................................................................................................................................62Capacity–qualityofsupportsandprofessionaldevelopment..............................................................65

ServiceprovidersuggestionsregardingpotentialrolesfortheUnitedWay.........................................67Strengths...................................................................................................................................................67

AdvisoryGroupdiscussionMarch14,2018:Theneedforsystemdisruption.........................68GapandChallenges:Wheretofocus........................................................................................................69Howtogetthere:Priorityactions.............................................................................................................71

Discussion....................................................................................................................................75Theneedforaphilosophicalshift............................................................................................................76

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Personandfamily-centredcare,mentalhealthpromotionandrecovery:Inspirationforare-designedsystem?.......................................................................................................................................................77

Personandfamily-centredcareandservices.........................................................................................77Mentalhealthpromotion.......................................................................................................................77Recovery.................................................................................................................................................78

Aboutaligningwithprovincialdirections:ValuingMentalHealthNextSteps.........................................79Thoughtsaboutmovingforward.............................................................................................................80

Pathwaysformovingforward:Somepossibilities.................................................................80Disruptiveactions......................................................................................................................................81

Buildanewfoundation:Developanintegratedcontinuumorframeworkformentalhealthservicesandsupportsthatisgroundedinaphilosophicalshift..........................................................................81Disruptionstoaddresskeyissues:Access,transitions,andbettersupportsforchildren,youth,andfamilies...................................................................................................................................................82

Somelessdisruptivebutpotentiallyimpactfulshort-terminterventions.............................................84Concludingremarks...................................................................................................................................85

AppendixA:Compilationofsummarytables..........................................................................86

AppendixB:Interviewguides....................................................................................................94Interviewguideforserviceproviders......................................................................................................94Interviewguideforyouthandfamily.......................................................................................................97

AppendixC:ChallengesIdentifiedinthisReviewandRelevantValuingMentalHealthNextSteps.............................................................................................................................................99

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“Therecanbenokeenerrevelationofasociety’ssoulthanthewayinwhichittreatsitschildren.”

-NelsonMandela

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AcknowledgmentsManyindividualscontributedtothisprojectandthedevelopmentofthisreport.Greatappreciationandthanksareextendedtothe47individualswhosofreelygavetheirtimetoparticipateinakeyinformantinterview.Withouttheirparticipation,thisprojectwouldnothavebeenpossible.DeeprespectandgratitudeisalsoextendedtomembersoftheAdvisoryGroup(listedbelow)thatwasdevelopedforthisproject.TheirpassionforservingCalgary’schildren,youth,andfamilieswithexcellence,combinedwiththeirexperienceandwisdom,significantlyenrichedandinformedthiswork.AverywarmthankyouisalsoextendedtoYaredBelayneh,DianeAltwasserandAmyAlexanderoftheUnitedWayCalgaryandAreawhoweremostsupportiveinthiswork.AdvisoryGroupMembersAllisonBichel SeniorProvincialDirector-Addiction&MentalHealthandMaternal,

Newborn,Child&YouthStrategicClinicalNetworks(SCNs)(AHS)MichelleClark ExecutiveDirector,BurnsMemorialFundAvrilDeeganLanaDunn(alternate)

Director,ChildandAdolescentAddiction,MentalHealth&PsychiatryProgram(CAAMHPP)(AHS)Manager,CollaborativeInitiatives,CAAMHPP(AHS)

CarolynFrew ChiefOperatingOfficer,CaryaMichelleGagnon President,PalixFoundationPatriciaJones ChiefExecutiveOfficer,CatholicFamilyServicesLaureenMacNeil ExecutiveDirector,CMHACalgaryRegionJanicePopp RegionalManager,Calgary&AreaRegionalCollaborativeServiceDelivery

(RCSD)AngeliqueJenneyChloeWestelmajerJanetStewart(alternate)

ResearchChairinChildren'sMentalHealth,Wood'sHomesProgramSupervisoroftheResearchDepartmentandWholeFamilyTreatment,Wood’sHomesProgramManager,Wood’sHomes

RobbieBabins-WagnerCathyKeough(Alternate)

ChiefExecutiveOfficer,CalgaryCounsellingCentreDirector-CounsellingInitiatives,CalgaryCounsellingCentre

JoanneWeninger ChiefOperatingOfficer,AlbertaChildren’sHospitalFoundationJodyWolfe Manager,CorporateStrategy,UnitedWayCalgaryBrianZelt ExecutiveManager,Outcomes&ClinicalDevelopment,HullServices

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ListofacronymsListofacronymsACES AdverseChildhoodExperiencesADHD AttentionDeficitHyperactivityDisorderAHS AlbertaHealthServicesAMH AddictionandmentalhealthASD AutismSpectrumDisorderCAAMHPP ChildandAdolescentAddiction,MentalHealthandPsychiatryProgram(AHS)CCAMH CalgaryCouncilonAddictionandMentalHealthCIHR CanadianInstitutesofHealthResearchCMHA CanadianMentalHealthAssociationCDVC CalgaryDomesticViolenceCollectiveDSM DiagnosticandStatisticalManualofMentalDisordersED EmergencydepartmentECMap EarlyChildhoodDevelopmentMappingProjectER EmergencyroomFASD FetalAlcoholSpectrumDisorderMH MentalhealthMHCC MentalHealthCommissionofCanadaNFP Not-for-profitNGO Non-governmentalorganizationPaCER PatientandCommunityEngagementResearchRCSD RegionalCollaborativeServiceDeliverySCN StrategicClinicalNetwork(AHS)VMH ValuingMentalHealth

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ExecutivesummaryInthefallof2017,theUnitedWayofCalgaryandAreaembarkedonaprojecttoexploretheexistingcontinuumofmentalhealthservicesforchildren,youth,familiesandtheirnaturalsupportsinCalgary.Anindependentconsultingteamwascontractedtoconductthisinquiry.Thespecificpurposesofthisworkwereto:• Conductareviewofcommunity-basedmentalhealthservicesandsupportsforchildren,youth,

familiesandtheirnaturalsupportsinCalgaryinordertoidentifysystemgapsandbarriersorchallengestoaccess;and,

• Makerecommendationsforaddressingidentifiedgapsandchallengessoastoimprovethecontinuumofmentalhealthcareforchildrenandyouthinthecity.

KeyfindingsBasedprimarilyontheconductof35interviewswith47individuals,includingserviceproviders,funders,researchers,youthandfamilies;reviewoffindingsfromotherresearchregardingyouthandfamilyexperienceswithmentalhealthservices;andinformedbyanexpertAdvisoryGroup,thekeyfindingsoftheinquiryincludethefollowinggapsandchallenges.• Insufficientattentiontothe“frontend”–mentalhealthpromotion,mentalillnessprevention,

earlychildhooddevelopmentandearlyidentificationofandinterventionsfordevelopmental,learning,psychosocialandotherconcerns.Morepreventativeworkisrequiredtobolsterchild,youthandfamilysotheydon’trequireformalmentalhealthservicesinthefirstplace.

• Gapsandchallengesassociatedwithaccessingandreceivingmentalhealthservicesandsupports.

Theseinclude:

o “Gettingin”-Accessingmentalhealthservicesandsupports.Children,youthandfamiliesexperiencemanychallengesin“gettingin”tomentalhealthservicesandsupportsforavarietyofreasonsincluding:lackofawarenessofwhatisneededandwhatisavailable;restrictiveprograminclusionorexclusioncriteria;lengthywaitlists;and,thecosts,hoursandlocationsofservices.Difficultiesinaccessingservicesgenerateadditionalstresswhenfamiliesarealreadystrugglingtosupporttheirchildoryouth.Serviceproviderssimilarlystruggletokeeptrackofwhatservicesareavailable.

Theseaccesschallengesandgapsplacechildrenandyouthatriskfor“fallingthroughthecracks”andmissingoutonsupports.ThemostwidelycitedgroupofchildrenatriskforthisarethosewhoareexperiencingsignificantmentalhealthorotherrelatedchallengesbutwhoarenotillenoughforadmissiontoAlbertaHealthServices’(AHS’s)ChildandAdolescentAddiction,MentalHealthandPsychiatryProgram(CAAMHPP).

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o Assessments.Ideally,thegoalofassessmentistoidentifytherightresourcesandtherightintensityofserviceforachildoryouthattherighttime.Thereisaneedforarapidandappropriateassessmentsothatchildren,youthandfamiliescanreceivethesupportstheyneedinatimelymanner.Anumberofchallengesmakeachievingthisdifficult.

o Supportsforthewholefamily.Astrongthemeemergingfromyouthandfamilyexperiences

istheextremeandoftenlongtermdistressthatfamiliesendurewhentheirchildisexperiencingamentalhealthproblemorillness.Theyarenotalwaystreatedwithkindnessorcompassion.Thereneedstobesupportforthewholefamily,notjustthechildoryouth.Anintergenerationalapproachthatalsosupportsparentalmentalhealthisimportant.

o Supportswhilewaitingforandbeyond“treatment”.Therecanoftenbealengthywaitlist

forclinicalservicesandtreatment,leavingfamiliestocopewithmentalhealthconcernsorbehavioursthatcanbeextremelystressfulandchallengingtomanageandthatcansignificantlyimpacttheentirefamily.Supportsareneededduringthis“inlimbo”period.Theyarealsoneededthroughoutthecourseofmentalhealthproblemsandillnessestohelpchildren,youthandfamilieslivewell.

o Transitions.Transitionsfromoneagegrouptoanother,orfromoneservicetoanotherare

timeswhenservicesmaybelackingorpoorlycoordinated,creatingthepotentialforgetting“droppedout”ofthesystem.Themostwidelycitedproblematictransitionsare:transitionsfromoneagencyorservicetoanother;transitionsbetweencommunitybasedNGOservicesintoAHSacutecare,andbacktothecommunity;andtransitioningfromadolescentmentalhealthservicesintoadultservices.

• Systemissues–thereisnoplannedsystemofservicesandsupportsforchild,youthandfamily

mentalhealth.Theresultisafragmented,piecemealarrayofservicesthatresultsinpoorchild,youthandfamilyexperiencesandpoorcontinuityofcare.Manyfactorscontributetothisfragmentation,particularlythelackofacommonlanguageorframeworkforcollaborationanddivergentunderstandingsof“mentalhealth”.

ThesuperordinatefindingThesuperordinatefindingisthattheseissueshaveplaguedthesystem,notonlyinCalgary,butprovincially,nationallyandinternationally,fordecadesandthatitistimeforanewapproach-somethingdisruptivethatwillopenthedoorforcollaborativeinnovationandchangethatbettersupportschildren,youthandfamiliesinCalgary.Aphilosophicalshiftisneeded–arethinkaboutexistingwaysofthinkingandworking,movingtowardasystemthattrulyfocusesonwhatchildren,youthandfamiliesneedtoachieveandsustainmentalwellbeingandtolivefulfillingandenjoyableliveswhetherornottheyhaveamentalhealthproblemorillness.

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Someprinciplesunderlyingthisphilosophicalshift,identifiedbykeyinformantsandAdvisoryGroupmembersfortheprojectinclude:

• Thefocusshouldbeonthefundamental“technology”ofhealthcare:humanbeingssupportingandservingotherhumanbeingsinakindandcompassionatemanner.

• Thefocusshouldbeonthewholefamilyandtheirnaturalsupports;notjusttheindividualchild

oryouth.

• Thefocusshouldbeonwhatchildren,youth,familiesandtheirnaturalsupportsneedtofunctionwellontheirjourneytowellbeing.Therewillalwaysbeaneedfordiagnosisandtreatmentforacertainproportionofthepopulation,buttobetterservefamilies,thesystemneedstoembraceamoreholisticapproachthatconsidersthewholeperson/familyincontextandfocusesonwhattheyneedtobewellandtomanagewellatthepresenttime.

• Thefocusshouldalsobeonprovidingsupportstochildrenandyouthandfamiliesbeforethey

needtousetheformalsystem–information,peersupport,sports,recreationalactivitiesandsoon,andmentalhealthpromotionandmentalillnesspreventioneffortscanbepowerfultoolshere.

• Thefocusshouldbeonstrengthsandbuildingcapacity–helpingchildren,youthandfamiliesto

helpthemselves,butnotnecessarilyonlybythemselves;rather,withthesupportofmanyeasilyaccessiblepeopleandsupportstohelpthemalongtheway.Forpeopletofeelempowered,theymustbeabletoaccessthesupportstheyneedwhentheyneedthem.Thereneedstobeanappropriatebalancebetweenprofessionalcareandself-help/empowerment.

PossiblepathwaysformovingforwardBasedonthefindingsoftheinquiryandadeliberativedialoguewithAdvisoryGroupmembers,anumberofpossiblepathwaysformovingforwardhavebeenidentified.Someofthesepathwayswilldisruptcurrentwaysofworking;othersmayaddresspressingissuesinthemoreimmediateterm.

Buildanewfoundation:DevelopacontinuumorframeworkformentalhealthservicesandsupportsthatisgroundedinaphilosophicalshiftThemostdisruptiveapproachismakingthephilosophicalshiftandre-designingtocreateanintegratedsystemfocusedonmeetingthementalhealthneedsofchildren,youthandfamilies.Animportant“disruptionwithinthedisruption”istheintegralinvolvementofchildren,youth,andfamiliesinthisprocess;thatis,“nothingforuswithoutus”.Thisisthestartingpointforasystemgroundedinwhattheyneed.

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Therearemanywaystoapproachthisandcarefulconsiderationwillberequiredtofindthemostpromisingway(s)forward.Differentperspectivesandideashavebeensharedaboutthis,includingthefollowing:

• “Startsmall”withsimpleonedayintegrated,cross-agencyplanningmeetings• Createacoordinationtablethatbringsagenciestogethertofindwaystoimprovecoordination• Bringcasemanagersfromcommunity-basedNGOsandAHS(andotherrelevantgovernment

organizations)togethertodiscusstheirapproachestocasemanagement(itwasthoughtthatthisprocesswouldhelppeoplefromboth“sides”understandtheapproachestheytake,andthechallengestheyexperience)

• BringpeoplefromNGOsandAHStogether,alongwithyouthandfamilies(i.e.,peoplewithlivedexperience)totalkabouthowthingscurrentlywork,perhapsusingsomeexamples

• Conveneasmall,cross-organizationalgrouptopilotsomethingnew,evaluateandfine-tuneit,thenscaleitup

• Achieveagreementonwhat“mentalhealth”means,andidentifysharedprinciplesforservingCalgary’sfamilies;or,tostartwithafulloutcomprehensivevisioninganddesign

• Engageinafull-outprocesstodevelopan“ideal”continuumorframeworkofmentalhealthservicesandsupportsforchildren,youthandfamiliesinCalgary

Whetherstartingonbigorsmallactions,highlyskilledfacilitationwillberequiredtobringstakeholderstogether-ideally,children,youth,families,NGOs,governmentorganizations(healthandothersectorsaswell),andtheprivatesector(e.g.,privatepsychologists)inaconstructivespace.TheUnitedWayisdevelopingaco-designlab,whichmaybeanexcellentvehicleforthiswork.

DisruptionstoaddresskeyissuesAnumberofinnovativeactionsoutlinedbyparticipantsinthisreviewcouldaddressseveralidentifiedchallengessimultaneously.Theseinclude:integratedservicehubs,peersupport,ande-mentalhealth.Eachisbrieflydescribedbelow.1. Experimentwithintegratedservicehubsorsimilarapproachesthatenablerapidaccessto

multipleservicesandsupports.Thereviewrevealedagreatdealofenergy,enthusiasmandactionaroundtheconceptofintegratedyouthservicehubs,basedontheoriginalheadspacemodeldevelopedinAustraliaandnowbeingadoptedindifferentformsinmanyothercountries,includinginAlberta.Integratedhubsareunderstoodas,“theintegrationofhealthandsocialservicesunderoneroofinayouth-friendlyenvironment1”.Thesehubswouldaddressaccessandintegrationissues,inparticular.

2. ExpandyouthandfamilypeersupportinCalgary.Giventhatpeerscanhelpaddressanumberofissuesincludingprovidingsupportswhenpeoplefirstbegintoexperienceissues;servingasafirst

1Salt,V.,Parker,N.,Ramage,K.,&Scott,C.2017.Community-basedmentalhealthserviceshubsforyouthenvironmentalscan.Edmonton:PolicyWiseforChildren&Families,pg.3.

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contactinagencies;workinginemergenciesandin-patientunitstosupportpeoplethroughtheprocess;and,soon.Peerscaninteractwithyouthandfamiliesinmanywaysincludinginperson,throughtexts,e-mailsandtelephoneandthuscanbehighlyaccessibleforpeople.Thus,theyhavegreatpotentialtohelpyouthandfamiliescopewithissuesbeforetheyneedtoaccessformalservices;theycanbeasupportwhilepeoplearewaitingforappointmentsandtreatment;and,theycansupportpeoplethroughthejourneyandmaketheexperienceforchildren,youthandfamiliesamorehumaneandcomfortingone.Peersupportisanintegralcomponentofintegratedservicehubs,sothereisanopportunitytoexpandthepeersupportthroughintegratedservicehubsaswell.PeersupportisalsoakeyrecommendationoftheMentalHealthCommissionofCanada(MHCC):

“Peersupportworksbecausepeoplewhohaveexperiencewithmentalhealthissuescanofferencouragementandhopetoeachother–oftenreducinghospitalization,providingsocialsupportandimprovingqualityoflife.Itcanalsoconnectfamiliesexperiencingsimilarsituations,helpingthembetterunderstandthementalhealthsystemandimprovingtheirabilitytotakecareoftheirlovedone’sneeds.2”

3. Implemente-mentalhealthsolutionstosupportyouthandfamilies.Manyintervieweesreferenced

variouse-mentalhealthsolutionstosomeofthegapsandchallengesidentifiedherein,yetAlbertawasnotedtobe“waybehindtheeight-ball”inthisarena.ThismaybeabouttochangegiventhatAHS’sAddictionandMentalHealthStrategicClinicalNetwork(SCN)andpartnersrecentlyreceivedaCanadianInstitutesofHealthResearch(CIHR)researchgranttoteste-mentalhealthforadolescentsandyoungadultsexperiencingthethreemostcommonlyoccurringmentalillnessesinyouthandyoungadultsunder25:anxiety,mood,andsubstancedisorders.Theprojectwillinvolvee-mentalhealthinnovationsincludingpeer-to-peerandfamilysupport;internet-basedcognitivebehaviouraltherapy;and,internet-basedscreeningforalcoholconsumption.BeyondthisCIHRgrant,therearemanyotherpotentialapplicationsfore-mentalhealth.Oneexampleisaphoneapptoimproveaccessandnavigation.Astartingpointforthisworkmaybetoconsultwiththosewhohaveconductedresearchabouttheuseandeffectivenessofvariouse-mentalhealthtechnologies,andseektoidentifythoseapproachesthatmayeffectivelyaddressvariouschallengesaddressedherein.Animportantreminderwouldbetoensurethatyouthinparticularareinvolvedintheseprocessessincetheywouldlikelybetheprimaryusersofthesetechnologies.

Somelessdisruptivebutpotentiallyimpactfulshort-termactionsTherearemanyotherpossibleandlessdisruptiveactionsandpathways;manyhavebeenoutlinedinthesummarytablesinthe“Findings”sectionofthisreport.Threethatseemtohavegoodpromisearebrieflydescribedbelow.2MentalHealthCommissionofCanada.2016.TheMentalHealthStrategyforCanada:AYouthPerspective.Author,pg.16.Retrievedfrom:https://www.mentalhealthcommission.ca/sites/default/files/2016-07/Youth_Strategy_Eng_2016.pdf

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1. Access–increaseawarenessaboutwhatservicesareavailableandhowtoaccessthem.Some

possibilitiesincludetargetedsocialmarketingcampaigns(customizedapproachesfordifferentgroups,suchasyouth,families,serviceproviders,primarycarephysicians,clinics/networks,schools).Acautionisthatincreasedawarenesswouldideallyresultinincreaseddemandforservices.Otherstrategiestoincreaseservicesneedtobeconsideredintandemwiththisaction.

2. Access–increasethenumberofsingle-sessionandwalkinmentalhealthservicesforyouth

andfamilies,andtestnewwaysofreducingwaitlists.AnumberofagenciesinCalgaryhavefoundwaystoincreaseaccessthrough,forexample,theuseofdetaileddatatoanticipateresourceneedsandeliminatewaitlists;walkinclinics;single-sessionclinics;theuseofanintakeandengagementteamwherethefirstcontactwithaclientisviewedasaninterventioninitself;anapproachof“screeningpeopleinratherthanout;andbarrier-freecounseling.Lessonscanbelearnedfromtheseorganizations.Itmaybehelpfultoconveneadialogueamongstagenciestosharepracticesthatcouldhelpreducewaitlistsandproviderapidaccesstosupports.

3. Transitions-begintomovetowardan“everydooristherightdoor”approach,andmore

warmentriesandhand-offsacrossthewebofmentalhealthservicesandsupportsinCalgary.Oneapproachmightbetoconvenemeetingswithstakeholderstotalkabouthowthismightwork,andperhapsdevelopapilotproject.Thismightbesomethingthatasmallgroupofactorscomestogethertoworkon,pilot,refineandscaleup.

Amultitudeofstrengthsandpassionforchange:ApowerfulbaseformovingforwardThisinquiryrevealedanumberofsignificantchallenges,perhapsresultinginaratherone-sidedpicture.Inreality,thereisaricharrayofmentalhealthservicesandsupportsforCalgary’schildren,youthandfamilies.And,thereisagreatdealofinnovationunderway.Anumberofinterviewees,forexample,spokeofAHS’sCAAMHPPrograminglowingterms,describingtheprogramasinnovativeandprogressive.Itwassimilarlynotedthattherearemanyexcellentcommunity-basedNGOprogramsandservices.Thereisalsoastrongandshareddesiretodobetterforchildren,youthandfamiliesinCalgary,andtoworktogethertodoso.Somekeypointsaboutthisinclude:• Amongstallparticipantsinthisreview,thereisastrongandsharedpassionforchild,youthand

familymentalwellbeing• Thereisalsoasharedpassionforabettersystemofsupports/servicesforchildren,youthand

families• Thereisamplegoodwillanddesiretoworktogethermorecollaboratively• Peopleareexcitedaboutthisprojectandeagertoparticipate-manysimplysaid,“Howcanwe

help?”• Manyideaswereofferedformovingforward

Allofthisequatestoapowerfulbaseforchange.

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Introductionandoverview“Successfulkidsarethefutureofourcity3.”“Healthyemotionalandsocialdevelopmentinearlyyearslaysthefoundationformentalhealthandresiliencethroughoutlife.Anestimated1.2millionchildrenandyouthinCanadaareaffectedbymentalillness–yet,lessthan20percentwillreceiveappropriatetreatment…Youthwhoareengagedinchildandmentalhealthservices,andwhorequirecontinuedservices,arealsooftennotwellsupportedastheypreparetoentertheadultmentalhealthsystem…Increasedaccesstoappropriateservicesandsupportsacrossthecontinuumofcareisneeded4.”

Thementalhealth(MH)andwellbeingofchildrenandyouthisakeyresourceforavibrantandresilientsociety,yettheexistingarrayofMHservicesandsupportsforyoungpeopleacrossthecountryisinsufficienttomeetcurrentandfutureneeds.

SimilarissuesfaceCalgarychildren,youthandtheirfamilies.Inthefallof2017,theUnitedWayofCalgaryandAreaembarkedonaprojecttoexploretheexistingcontinuumofmentalhealthservicesforchildren,youth,andfamiliesinCalgary.Anindependentconsultingteamwascontractedtoconductthisinquiryanddocumentthefindings.

PurposeoftheprojectInthisreport,findingsoftheinquiryarepresented.Thespecificpurposesofthisworkwereto:• Conductareviewofcommunity-based5mentalhealthservicesandsupportsforchildren,youth,

familiesandtheirnaturalsupportsinCalgaryinordertoidentifysystemgapsandbarriersorchallengestoaccess;and,

• Makerecommendationsforaddressingidentifiedgapsandchallengessoastoimprovethecontinuumofmentalhealthcareforchildrenandyouthinthecity.

TheUnitedWayofCalgaryandAreawillusethefindingsofthisinquiryforongoingplanningandeffortstopromoteastrengthenednetworkofcommunity-basedchild,youthandfamilymentalhealthservicesandsupportsinCalgary.

OverviewofthereportThisreportisorganizedinthefollowingmanner.First,abriefdescriptionofmethodsusedfortheinquiryispresented.Thisisfollowedbyapresentationoffindings.Forthosewhowishtomovequicklythroughthisdocument,asummarytableispresentedattheendofeachsectionoffindings.Eachtableliststhekeypointsforthefindingaswellasexistingstrengthsandeffortsunderway,andinterviewee

3UnitedWayCalgary,online.Retrievedfrom:http://www.calgaryunitedway.org/impact/kids4MentalHealthCommissionofCanada,online.Retrievedfrom:https://www.mentalhealthcommission.ca/English/focus-areas/children-and-youth5RecognizingthatacutecareservicesarenotinthepurviewoftheUnitedWay

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suggestionsforaction.Itshouldbenotedthattheselattertwolistsarebasedonlyoninformationprovidedbykeyinformants;theyarenottheresultofanycomprehensivesearchoranalysis,andhenceareinevitablylimitedandincomplete.AcompilationofallsummariesispresentedinAppendixA.ThepresentationoffindingsisfollowedbydescriptionofasignificantturnintheinquirythatoccurredattheMarch14,2018meetingoftheAdvisoryGroupdevelopedtosupportthisproject.Atthismeetingitwasagreedthatthechallengesidentifiedinthisinquiryarenotnewandthatdisruptivechangeisneededinordertomakerealprogressandchange.Adiscussionsectionfollowsthisdescription,andthereportisconcludedwithapresentationofsomepossiblepathwaysformovingtheworkofthisinquiryforward.

DefinitionsTheterm“mentalhealth”isproblematic,giventhatdifferentpeopleuseittomeandifferentthings–andhowpeopledefinetheterminfluenceswhatkindsofservicesandsupportsaredeemedtoberelevant.Indeed,thisisachallengeidentifiedbykeyinformantsinthisproject(see“Systemissues”intheFindingssectionbelow).Forpurposesofthisreport,theterm“mentalhealth”isusedinapositivesense,asinthepresenceofmentalwellbeing-thesetermsareusedinterchangeably.Theterm“mentalillness”hastraditionallybeendefinedasa“medicallydiagnosableillness”thatsignificantlyimpairshowpeoplethink,feel,behaveand/orinteractwithothers,causingsignificantdistress6.Theterms“mentalhealthproblem”and“mentalhealthissue”refertomorecommonmentalhealthcomplaints,oftenexperiencedtemporarilyasareactiontolifestressors,thatarelesssevereandofshorterdurationthanmentalillnesses7.Agrayarea,andamanifestationofasystemnarrowlyfocusedondiseaseratherthanchild,youthandfamilyneedsandfunctioning,isthosechildrenandyouthwhomaynothavea“medicallydiagnosableillness”butwhoneverthelessareexperiencingissuesthatimpacthowtheythink,feel,behaveandinteract.Theseissuesmightinclude,forexample,childhoodtrauma,neurodevelopmentalissues,severebehaviouralissuesorlearningdisabilities.Someofthesechildrenandyouthmayrequireextensiveandongoingsupport,justlikethosewith“medicallydiagnosable”illnesses,whileothersmayrequireless.Todealwiththismatter,andforlackofbetterterms,whenweusetheterm“mentalillness”inthisreport,weincludethosewith“medicallydiagnosable”illnessesandthosewithotherissuesthatrequiremoreintensivecareandsupport.Whenweusetheterms“mentalhealthproblems”or“mentalhealthissues”,wealsoincludechildrenandyouthwiththeseotherkindsofissueswhorequirelessintensivesupport.Also,weusetheterm“family”initsbroadestsense,includingmothers,fathers,otherrelatives,andnaturalsupports(e.g.,friends,teachers,mentors,neighbours).

6Barry,M.,Jenkins,R.2007.ImplementingMentalHealthPromotion.Edinburgh:Elsevier7Barry,M.,Jenkins,R.2007.ImplementingMentalHealthPromotion.Edinburgh:Elsevier.

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MethodsTheapproachadoptedforthisprojectwastwofold.First,theprojectwassignificantlyinformedandshapedthroughtheformationofanadvisorygroupthatprovidedinsightandadviceoverthecourseoftheproject.Second,anumberofqualitativemethodswereusedtocollectalargeamountofrichinformationregardingmentalhealthservicesandsupportsforchildren,youth,andfamiliesinCalgary.

AdvisorygroupAveryimportantpartoftheprojectwasformationofanadvisorygroup,composedofexperiencedandknowledgeableserviceprovidersfromanumberofcommunity-basednot-for-profitorganizationsandAlbertaHealthServices(AHS)thatprovidementalhealthservicesandsupportsforCalgary’schildren,youthandfamilies.TheUnitedWayrecommendedanumberofpeopleforthisgroup;theconsultingteamalsoidentifiedanumberofmembersthroughkeyinformantinterviews.Thepurposeofthegroupwastoadviseontheprocessoftheinquiry,toreviewanddiscussfindings,andtodiscussandadviseonpossiblewaysforwardfortheUnitedWay.Thegroupmettwiceoverthecourseoftheproject–onceonNovember30,2017toreviewpreliminaryfindings,andagainonMarch14,2018toreviewasynthesisoffindingsanddiscusspossibleactionsorstrategiesthatcouldimprovethecontinuumofmentalhealthservicesandsupportsforCalgary’schildren,youthandfamilies.

QualitativemethodsQualitativemethodswereusedforthisinquiry;thatis,thefocuswasonunderstandingtheexperiencesofserviceproviders,researchers,andusersofchildandadolescentmentalhealthservicesinCalgary.Thisformofinquirywaswellsuitedtotheprojectbecauseitallowedin-depthconversationswithknowledgeablepeopleaboutvariousaspectsofthe“system”-particularly,gaps,challengesandstrengths-toinformtheproject.Approachestakentocollectinformationincludedthefollowing:• Keyinformantinterviewswithserviceprovidersandothersystemstakeholders(e.g.,funders,

researchers)(hereafterreferredtocollectivelyas“serviceproviders”)–peoplewithsubstantialknowledgeofchild/youth/familymentalhealthservicesandsupportsinCalgary.InitialinformantswereidentifiedbyUnitedWayCalgaryandArea.Asnowballsamplingmethodwasadopted,meaningthatoriginalkeyinformantswereaskedtoidentifyotherpeoplewithrichknowledge,andthesepeopleweresubsequentlyinterviewed.Intotal,26interviewswereconductedwith36serviceproviders.Theinterviewslastedfrom30to90minutes;theywereaudio-recordedwiththeparticipants’permission,anddetailednotesweretaken.AlistofparticipatingorganizationsisprovidedinTable1.TheinterviewguidesforkeyinformantinterviewscanbefoundinAppendixA.

• Keyinformantinterviewswithpeersupportersandresearcherswhoarestudyingtheexperiences

ofchildren/youthandfamilieswithmentalhealthservicesandsupportsinCalgaryandAlberta.

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Tounderstandthe“system”fromtheperspectiveofchildren/youthandfamilies,nineinterviewswereconductedwithelevenpeople,asfollows:

o FivepeersupportworkersfromCMHACalgary;eachofwhomspokeoftheirownexperiencesinthesystem,aswellastheirobservationsabouttheexperiencesofpeopletheyhaveworkedwithintheirpeersupportroles.

o ThreePaCER(PatientandCommunityEngagementResearch)patientresearchersfromtheUniversityofCalgarywhoconductedaqualitativestudyexploringfamilies’experiencesgoingtotheEmergencyDepartment(ED)withchildren/youthexperiencingamentalhealthcrisis.Thesefamiliesalsohavelivedexperienceaccessingotherkindsofmentalhealthservicesandsupports.ThisresearchwaspartofajointprojectofAddictionsandMentalHealthandEmergencyDepartmentStrategicClinicalNetworkslookingatyouthandfamilyEDexperiences.

o OneresearcherfromtheUniversityofCalgarywhoisapartofateamstudyingtransitionsofyouth/youngadultsintoadultsystemsofcare.

o Oneparentwhovolunteeredtobeinterviewedabouttheirfamily’sexperienceswithCalgaryservicesandsupports.

Intotal,35interviewswereconductedwith47people.Inadditiontotheseformalinterviews,anumberofinformalconversationswithotherserviceproviders,familymembers,researchersandfunderswerealsoconducted.

• ReviewofAHSreportssummarizingthefindingsfromtwosurveysconductedinAlbertaEmergencyDepartments,anothercomponentoftheStrategicClinicalNetworksprojectdescribedearlierregardingtheexperiencesofchildren/youth/familieswhohaveaccessedAlbertaemergencyroomsformentalhealthissues.Therewasagoodresponsetoboththeyouthage15-24(n=982),andthefamilyofchildrenandyouthage7-24(n=553),surveys.

• ObservationoftheBrainTrust2meetingheldbyAlbertaHealthServices(AHS)onFebruary28,2018.Thiswasafulldaymeetingofapproximately80peopletohearaboutanddiscussfindingsbothoftheEDsurveys,andthePaCERqualitativeresearch,regardingtheexperiencesofchildren/youth/familieswhohavegonetoanemergencyroominAlbertaformentalhealthconcerns.

• ReviewsofwebsitesofrelevantCalgary-basedorganizations,andotherprovincial,nationalor

internationalorganizationsmentionedbykeyinformants.• Reviewsofdocuments,includingasmallnumberofacademicarticlespertainingtotheexperiences

ofchildren/youthandfamiliesinusingmentalhealthservicesandsupports,andanumberofreportssuchastheGovernmentofAlberta’sValuingMentalHealthreportsandpublicationsbytheMentalHealthCommissionofCanada.

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• TwomeetingswiththeAdvisoryGroupfortheproject.Detailednotesweretakenduringthese

meetings,andparticipantswereaskedtoprovidewrittencommentsonparticulartopicsTable1.Keyinformants:ParticipatingorganizationsAccessMentalHealth(AHS) CUPSAddictionandMentalHealthStrategicClinicalNetworkandMaternalNewborn,ChildandYouthStrategicClinicalNetwork(AHS)

HullServices

BurnsMemorialFoundation Independentparentingeducationandhealthychilddevelopmentconsultant

CalgaryCounsellingCentre MentalHealthPromotion&MentalIllnessPrevention(AHS)

CalgaryRegionalCollaborativeServiceDelivery(RCSD)

O’BrieninstituteforPublicHealth,UniversityofCalgary–PaCERresearchteam

CanadianMentalHealthAssociation(CMHA)Calgary

PalixFoundation

CanadianMentalHealthAssociation(CMHA)Calgary–PeerSupporters

PolicyWiseforChildren&Families

Carya SheldonKennedyChildAdvocacyCentreCatholicFamilyServices UnitedWayCalgaryChildandAdolescentAddictions,MentalHealth&PsychiatryProgram(CAAMHPP)(AHS)

UniversityofCalgaryFacultyofSocialWork

ChildandYouthMentalHealth,Provincial(AHS) ValuingMentalHealth(GovernmentofAlberta)Children’sLink Wood’sHomes

LimitationsandstrengthsTherearesomelimitationsofthisinquirythatshouldbeconsideredwhenreviewingthisreport.First,therearemanydozensofnot-for-profitorganizationsinCalgary,eachofferingnumerousservicesrelevanttochild,youthandfamilymentalhealth.ItwasnotwithinthescopeoftheprojecttoconductacomprehensivereviewoftheentirearrayofexistingservicesinCalgary.Someperspectivesmaythereforebemissing.Second,thereisnoestablishedoragreeduponframework,continuumorpathwayofmentalhealthservicesandsupportsforchildren,youthandfamiliesinCalgary.And,therearemultiplepathwaysinto,through,andoutofservicesgiventhatchildren,youth,andfamiliesmayhavedifferentlevelsofneedandatdifferentages;thattheymaymoveinandoutofcrisis–attimesrequiringmoreintensesupport;andthatmentalillnessescanbecomplexandmulti-faceted.Forexample,thepathwayforachildoryouthhavingtroubleswithbullyingatschoolmaybequitedifferentfromthepathwayofayouthwhoisexperiencingafirstpsychoticepisode.Thismakesitdifficulttoidentifyallofthepossiblegapsandchallengesthatmayexist.However,thehighlevelofagreementacrossthe47peopleinterviewedforthisproject,congruencewithfindingsoflargerinquiriessuchastheGovernmentofAlberta’sValuing

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MentalHealth(VMH)8review,reviewsinotherprovinces,andoftheMentalHealthCommissionofCanada,lendsagoodlevelofconfidencethatkeyissuesandchallengeshavebeenidentified.Third,itwouldhavebeenidealtohavegreaterrepresentationofchild/youth/family/naturalsupportvoicesinthisinquiry.Giventhetimeandeffortthatwouldhavebeenrequiredtoobtainethicalapprovalandfindparticipants,thiswasnotfeasible.Nevertheless,thefindingsareenrichedsignificantlythroughtheinclusionofatleastninepeoplewithlivedexperienceofmentalhealthproblemsandillnesses,andthroughtheopportunitytoreviewthefindingsoftheSCNPaCERresearch.Thehighlevelofcongruencebetweenserviceproviderconcernsandyouth/familyconcernsagainlendscredencetothefindingsreportedherein.Animportantstrengthoftheinquiryistherichinformationgatheredthroughthelargenumberofin-depthinterviewsconductedwithknowledgeableindividuals,enablingadeeperunderstandingofthecurrentstateofaffairsinCalgary.Theopportunitytoheardirectlyfromyouthandfamiliesabouttheirexperiences,aswellastospeakwithpatientresearchersabouttheirqualitativeresearchfindings,addedanimportantdimensiontothiswork.AnotherstrengthistheuseoftheAdvisoryGroup,whichwasabletovalidate(ornot),andfurtherelaborateonthefindings.ThediscussionsattheAdvisoryGroupmeetingswererichandledtothedevelopmentofnewinsightsandCalgary-specificideasformovingforward.Inthenextsection,findingsoftheinquiryarepresented.

FindingsInthissection,thefindingsfromtheinquiryarepresentedinthreebroadcategories,asfollows:

• Insufficientattentiontothe“frontend”–supportsfoundationaltochild,youth,andfamilymentalwellbeing

• Gaps/challengesrelatedtoaccessingandreceivingmentalhealthservicesandsupportso Access–“Gettingin”tomentalhealthservicesandsupportso Assessmento Supportsforthewholefamilyo Supportswhilewaitingfortreatmentorclinicalcare,andinbetweentreatmentso Transitions

• SystemissuesInthesectionsbelow,eachgaporchallengeisdescribed.Effortsalreadyunderwaytoaddressgaps,and/orsuggestionsofkeyinformantstoaugmentorleveragethatworkortrysomethingnew,arealsooutlinedintableformat.Asnotedpreviously,thecontentinthesetablesisbasedoninformation

8GovernmentofAlberta.2015.ValuingMentalHealth:ReportoftheAlbertaMentalHealthReviewCommittee2015.Author.

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providedbykeyinformants;itisnotaresultofcomprehensivereviewofexistingservicesandassuch,isinevitablyincomplete,andacompilationofallsummarytablesispresentedinAppendixA.Notealsothatwedescribethesystemissueslast,butthisisnotbecausetheyaretheleastimportant.Indeed,thedominantfindingfromthisreviewisthatthereisnoplannedsystemofservicesandsupportsforchild,youthandfamilymentalhealth.Manydescribedthisastherebeingnocontinuumofservicesandsupports,and/orapatchworkofservicesthatisincrediblychallengingtonavigate.Onefamilymembersaid:“It’sallcracks”(SCNPaCERresearch).Factorscontributingtothisfragmentationaredescribedinthe“Systemissues”sectionofthefindings.

Insufficientattentiontothe“frontend”–supportsfoundationaltochild,youthandfamilymentalwellbeingAtleasthalfofkeyinformants,includingyouthandfamilies,notedtheimportanceof“workingonthefrontend”ofmentalhealthservices;thatis,promotingmentalhealthandresilience,andpreventingmentalhealthproblemsbeforekidswindupincrisis.Thesepracticesarewideranginginnatureandcanoccuratmanylevels(e.g.,individual,family,community)including,forexample,actiononthesocialdeterminantsofhealth(e.g.,foodsecurity;safe,stableandaffordablehousing;adequateandsustained

incomeandsoon),strengtheningprotectivefactorsandreducingriskfactors9.Manyintervieweesincludedearlychildhooddevelopment,parenting,theearlyidentificationofissuesandearlyinterventioninthis“upfront”workaswell.Theyalsonotedthatpayinggreaterattentiontomentalhealthpromotionandmentalillnesspreventionwouldresolveanumberofthechallengesinherentinthecurrent“system”.

“Weneedmoreofthatearlyonpiece–beingawareofandsupportingthesocialdeterminantsofhealth–weallknowthat’sthebangforthebuckearlyon–prevent,identifyearly,provideearlyintervention–that’sahugepiecethatwillstoppeoplefromneedingtogoupthepyramid10[ofcare].”(Serviceprovider)

9Protectivefactorsenhanceandprotectmentalwellbeing–theyinclude,forexample,parentalresilience,goodcopingandsocialskills,goodsocialconnections,socialandemotionalcompetence,supportiveandcaringparents,concretesupportsintimesofneed,safeandsecurelivingandeconomicsecurity.Riskfactorsincreasethelikelihoodthatmentalhealthproblemsandillnessesmaydevelop–theyinclude,forexample,lowself-esteem,poorcopingskills,insecureattachments,abuseandviolence,poverty,andhomelessness.10‘Thepyramid’isreferencetoapyramidalmodelofservicedelivery,whichbeginswithmentalhealthpromotionandillnesspreventionforallchildren/youth/familiesatthebase,andincreasinglymoreintenselevelsofcare/servicemovingupthepyramid,culminatinginspecializedcareforindividualswithseverementalillnessatthetopofthepyramid.

“Weneedmoreofthatearlyonpiece–beingawareofandsupportingthesocial

determinantsofhealth–weallknowthat’sthebiggestbangforthebuckearlyon–prevent,identifyearly,provideearly

intervention.That’sahugepiecethatwillstoppeoplefromneedingtogoupthepyramid.”

(Serviceprovider)

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“Wekeeppayingmoretogodownthepathofpayingmoreforillnesscare,butIthinkweneedtogodownthepathofpayingmoreforprevention…mentalhealthjusthastobestandardlearningforeverybody.Weknowalotabouthowtoidentifyearlysignsofmentalillness,butwedon’tknowasasocietywhatmentalhealthis,andthenweneedtoknowhowtocreateenvironmentsthatpromotepositivementalhealth.”(Serviceprovider)

“Whatareyouprovidingattheuniversallevelthattouchesallkids…andthenwhatareyouprovidingatthetargetedlevelforthosewhohavesomeneedbutaren’tyetintheclinicalrealm?Andtome,that’sanareawherethere’srealpotentialfortraction.Ifwecouldgetbetteratthoseprogramstobolstermentalhealthearlieron.”(Serviceprovider)

“IfyoulookatresearchaboutACES[adversechildhoodexperiences]–childhoodtrauma–mostofouradultissues–mentalorphysicalhealthrelatedandothersocialillscanbecontributedtochildhood...ifyou’rereallyinthebusinessofearlyinterventionandprevention,itseemstomeyoureallywanttoputmoreofyourmoney…intochildren’shealthandmentalhealthasawhole.Ourmodeldoesn’treflectthatatall.Westillverymuchmaintainadiseasemodeloratreatmentmodelinourhealthcaresystem.”(Serviceprovider)

Asmallnumberofpeoplerecognizedthatmentalhealthpromotionisalsoimportantforthosewhoareexperiencingmentalillness–thatis,thatitispossibletolivewellwhilehavingongoingmentalhealthproblemsorillnesses.Thisapproachisreferredtoas“recovery”andisdescribedmorefullylaterinthisreport.

EarlychildhooddevelopmentAtleasthalfadozenintervieweesspoketotheimportanceofearlychildhooddevelopment,referencingwell-establishedresearchindicatingthefirstsixyearsoflifesetthestageforlifelongmentalandphysicalwellbeing.Oneintervieweenotedthesinglebestpreventionprogramisuniversalhomevisitingwhereeverymotherwithanewbabygetsahomevisit.Inparticular,intervieweesnotedthatparentingeducation,andalso,earlyassessment,identificationandinterventionsfordevelopmentalorotherissuesareparticularlyimportant.

SupportsforparentsParenting,specificallyeducationaboutparentingandthecriticalimportanceofnurturingrelationships,wasraisedbyanumberofinterviewees.Somenotedthatparentingeducationforallparentsisneeded,ratherthanonlyfor“atrisk”families.

“Whatareyouprovidingattheuniversallevelthattouchesallkids…andthenwhatareyouprovidingatthetargetedlevelforthosewhohavesomeneedbutaren’tyetintheclinicalrealm?Andtome,that’sanareawhere

there’srealpotentialfortraction.Ifwecouldgetbetteratthoseprogramstobolstermental

healthearlieron.”(Serviceprovider)

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“There’slotsofparentingsupportthat’soutthere[but]ittendstobetargeted.Soittendstobe“those”familiesthatreallyneedit.Andreally,allfamiliesreallyneedit…Irememberafellowinaparentingclasswhosaid‘Betweenmeandmywife,wehavefivedegrees.Idon’tknowanythingaboutchilddevelopment’.It’sacommonthingfornewparentsthattheyhavenoideawheretoevenstart.Sotheyfallbackonthewaytheywereraised,whatthey’veheard,whattheyreadonGoogle…wehavetobelookingatstrategiesthatwe’vebeenusingformanyyearsthatdon’thelp...So,tohaveasystemthatisthoughtfulabouthowweprovideparentsupportwouldbeareallygreatthing.”(Serviceprovider)“It’snotenoughtohaveparenteducationwhenyou’veidentifiedthatthere’sarisk–youneedtohaveskillbuildingearlieronforparents…evenfor[myself]…IneededtohaveconcretesupportsandIneededtounderstandaboutmychildandyouthdevelopmentandIneededpeersandsocialtiesaroundme.”(Serviceprovider)

Itwasalsonotedthatexistingparentingprogramsshouldbereviewedintermsofwhethertheyaregroundedinrecentdevelopmentsinbrainscience,andtheimportanceofnurturingrelationshipsbetweenparent/caregiverandchild.OneintervieweenotedthatanumberofprogramscurrentlyusedinAlbertahavenotyetintegratedthisresearch,buttherearenewprogramsthathavedoneso.

PsychosocialandpsychoeducationalassessmentwaitlistsAnotherchallengenotedbyseveralintervieweeswasthedifficultyofgettingpsychosocial,psychoeducationalandothersimilarkindsofassessmentsdoneforchildrenintheirearlyyears.Intervieweesreportedlengthywaitinglistsforsuchassessmentsinthepublicsector,ranginguptosixorsevenyears.Whilesuchassessmentsareofferedintheprivatesector,theycanbeprohibitivelyexpensiveandthereforenotaccessibletoeveryonewhomayneedthisservice.Oneintervieweenoteditis“criminal”tonotbefindingthesechildrenuntiltheyreachkindergartengiventhelong-rangingimpactsofnotinterveningearly,includingerosionofselfesteem,developmentofchallengingbehaviours,andlackofsupportsforlearning.Itwasalsonoteditbecomesmoredifficultforchildrentoaccessappropriateservicesastheygrowolder.TwointervieweesspecificallyreferencedfindingsofalargestudyconductedbyAlbertaEducationregardingthedevelopmentofkindergartenchildren.TheECMap(EarlyChildhoodDevelopmentMappingProject)11studyrevealedthatlessthan50percentofkindergarten-agedchildreninAlberta,includingCalgary,aredevelopingappropriately;and,nearlyathirdarefallingbelowtheCanadiannorm–theyarenotgettingthesupporttheyneedinthecrucialearlyyears.

11See:http://www.ecmap.ca/images/ECMap_Reports/ECMap_Final_Report_20141118.pdf

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Somepointsmadebyintervieweesinclude:

“Wedon’trecognizechildrengoingofftherailssoonenough…needtohavesomekindofsystemforcatchingthatbecauseit’scriminalthatwe’renotfindingthesekidstilltheygettokindergarten–that’sridiculous.”(Serviceprovider)

“Therearehighwaitlistsofsixyearsforkidstogeta[psychosocialorpsycho-educationalassessment]–sowe’renotgettinganinterventionforkidsatanearlierstage,whichagainisamentalhealthconcernifyouhavekidswithlearningdisabilitiesandADHDandthey’renotgettingtheassessmentforsixorsevenyears.Ifyouarelookingandseeingakidataround8or9whenthosestarttocomeout…andifyouhavetowaitanothersevenyears…ifyoudon’tgetanassessmentandinterventionearly,thenthebehaviourscontinueandtheselfesteemdropsandallthesementalhealthissues,itbecomesharderandhardertoaccessservices.Andyoualsohavealackofunderstandingofhowtoaccessservicesandafearofservices.”(Serviceprovider)

“There’shugewaitinglistsintheschoolsystemforanystandardizedpsychoeducationaloremotionalbehaviouraleducationaltestingandfamiliesendupcomingtoprivatepractitionersorothersandarepayingthousandsofdollarstohavetheseassessmentscompletedbecauseiftheydon’ttheycouldbeonawaitinglistforyears.Tome,that’sunacceptableifwehavekidswithdevelopmentalorlearningoremotionalbehaviouralchallenges.Everyyearthatwedelaythose,that’sonemoreyearthatthey’rebehindintermsofgettingservicesandsupports.”(Serviceprovider)

Othersmentionedtheimportanceofdaycaresandpreschoolshavingknowledgeofearlychilddevelopment,earlyidentificationofproblemsandearlyintervention:

“Thereareprobablymoreproblemswithdaycareandpreschoolswherethereareidentifiedproblemsrightaway…andthere’sanawfullotofundereducatedpeoplewhoarebrightbuttheyjustdon’tknowwhattolookforandtheydon’tknowwhotocall.Idon’tknowifthosedaycareshavepartnershipswithchildren’smentalhealthcentreswhereifsomethingcameuptheycouldjustcallandsaycouldwehavesomebodycomeoverandcheckthiskidoutortalktoaparent.I’veneverheardofsuchathing.”(Serviceprovider)

“There’shugewaitinglistsintheschoolsystemforanystandardizedpsychoeducationaloremotional

behaviouraleducationaltestingandfamiliesendupcomingtoprivatepractitionersorothersandare

payingthousandsofdollarstohavetheseassessmentscompleted

becauseiftheydon’ttheycouldbeonawaitinglistforyears.Tome,that’sunacceptableifwehavekidswithdevelopmentalorlearningoremotionalbehaviouralchallenges.Everyyearthatwedelaythose,that’sonemoreyearthatthey’rebehindintermsofgettingservicesandsupports.”(Serviceprovider)

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CredibleandaccessibleinformationforyouthandfamiliesaboutmentalhealthproblemsandillnessesAstrikingfindingfromthePaCERresearchandalsoidentifiedbyyouthinthisreviewwasthethirstofyoungpeopleforknowledgeaboutmentalhealthissuesandillnesses.AyouthspeakerattheBrainTrust2forumspokeofstrugglingtofindinformationthatwouldhelpherunderstandandmakesenseofwhatshewasexperiencing.Whilesheencounteredmanyserviceprovidersinherjourney,noneofferedheranyinformationaboutherillness.AnotheryouthwespokewithsimilarlydescribedbeingrelievedtogetadiagnosissoshecouldGoogleitandlearnallshecould.Aserviceprovidersimilarlynotedtheneedforeducationandinformationprovision.Othersalsospokeaboutthevalueofeducation/informationtohelpparentstalkwiththeirkidsaboutmentalhealthproblems.

“Wecan’toverlooktheneedtoprovideeducationandsupportsthatwillpreventkidsandfamiliesfromneedingmoreinvasiveandintrusiveservices…Thatneedstobethereforsure…Sothateducationpieceiskeyandhavingthatprovidedinapublicwaythroughtheschools,throughcommunityevents,throughprimaryhealthcareprofessionals.”(Serviceprovider)

Inthetablebelow,asummaryofkeypointsforthissetofgaps/challengesispresented.Informationprovidedbykeyinformantsaboutexistingstrengthsandefforts,andsuggestionsforaddressingchallengesisalsoincluded.

Table2.Summary.Gaps/challenges,strengths,andpossibleresponsesrelatedto:Servicesandsupportsfoundationaltochild,youthandfamilymentalwellbeingKeygaps/challenges• Insufficientattentiontothepromotionofmentalwellbeing,resilience,thepreventionofmental

healthproblems,andearlyidentification/earlyinterventionforemergingmentalhealthordevelopmentalissues

• Earlychildhooddevelopmentiscrucialandacoreopportunitytopromotementalwellbeing,preventmentalhealthproblems,identifyissuesandinterveneearly;ECMapstudy:manychildreninCalgaryarenotgettingthesupporttheyneedduringtheircrucialearlyyears

• Thereareextremelylongwaitlistsinthepublicsectorforpsychosocial,psychoeducationalandotherkindsofassessmentswhichmeanschildrenmaynotgetaccesstothesupportstheyneedinatimelymanner

• Morepreventativeworkisrequiredtobolsterchild/youth/familymentalwellbeingsotheydon’trequireformalservices/supportsinthefirstplace;or,wherethereisaneednotyetrequiringclinicalcare–thereisgreatpotentialfortractioninthisarea

Existingstrengths/effortsunderwayasidentifiedbykeyinformants• First2000DaysNetwork–enablingcollectiveactiontoimproveearlychildhooddevelopment

outcomes• AHS’s“EarlyYears”book–allnewparentsreceivethisbook;hasrecentlybeenupdatedtointegrate

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newknowledgere:brainscience• AHSandAlbertaEducation–comprehensiveschoolhealthinitiativesthroughoutAlberta• AHS–MentalHealthCapacityBuildinginschools–workingwithmorethan180schoolsre:positive

mentalhealth• BurnsMemorialFund–workthatiscongruentwithmentalhealthpromotion–Children’sFundgoals

relatedtochilddevelopment(healthy,safe,accesstooptimalhealthcare;readyforschool,experiencessuccessandgraduates;opportunitytoparticipateinrecreationalactivitiestohelpthemdiscovertheirtalents);movingtowardgreaterfocusonsocial-emotionallearning;FamiliesMovingForwardProgram;workre:naturalsupports

• Carya–numerouspositivementalhealthpromotionandmentalillnesspreventionprogramsthataddressriskandprotectivefactorsforchildren/youth/families(e.g.,selfesteem,copingskills,selfconfidence,relationships,creativity);parentresilience,youthandcommunityengagement

• CouncilofChampionsforChildrenandYouth–lookingatbuildingresilience• TheAlex–numerousinitiativesaimedatpreventingcrisis–mentalillnessprevention;theAlex

CommunityBus• CUPS–Servicesbasedonaresiliency;supportsforlowincomeCalgarians• ChangeinMindinitiative(PalixFoundationandtheAllianceforStrongFamiliesandCommunitiesin

theUS,CUPS,BigBrothers,BigSistersCalgaryareparticipating–aninitiativetointegratebrainscienceconceptsintoaction)

• UnitedWay,CalgaryandArea–AllinforYouth,EnoughforEveryonePovertyReductionStrategy• AlbertaChildren’sHospitalresourcelibraryre:child/youthmentalhealth• AHS–doingworkregardingmentalhealthliteracy–educationaboutmentalhealthissuesand

illnesses;communityeducationservices• School-basedmentalhealthservices/supports(significantinvestmenthere)

o ComprehensiveSchoolHealth-AHSo MHCapacityBuilding(MHCB)initiative–AHSo PolicyWiseandtheAHSMaternalNewbornChildandYouthSCN-basedona

recommendationfromValuingMentalHealth,currentlyexaminingmentalhealthsupportsforchildrenandyouthinschools

o SafeandCaringSchools-AlbertaEducation–promotionofpositivementalhealth;socio-emotionallearning;healthy,respectfulrelationships;

o MHLiteracyProject–AHSo Smiles–basedonDr.StanKutcher’sMHliteracyprogram–forGrade9-10students(AHS)o Secondaryeducationworkre:MH

§ UniversityofCalgary-CampusMentalHealthStrategy§ AlbertaGovernmentworkre:post-secondarymentalhealth

Possibleresponsesasidentifiedbykeyinformants

• Focusonbuildingresilienceandstrengtheningprotectivefactorsforchildren,youth,families,naturalsupports,communities

• Parenteducationbasedonnewbrainsciencewouldbebeneficialforallparents

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GapsandchallengesinaccessingandreceivingmentalhealthservicesandsupportsOneofthestrongestthemesemergingfromthekeyinformantinterviewswasrelatedtothechallengespeopleexperienceinaccessingandreceivingtreatment,supportsandservicesformentalhealthproblemsandillnesses.Almosteveryinterviewee–serviceprovidersandyouth/familiesalike-mentionedthesechallenges.Gapsandchallengesincludethefollowing:“gettingin”–findingandaccessingmentalhealthservices;issuesrelatedtoassessmentsformentalhealthproblemsandillnesses;theneedforsupportsforthewholefamilywhenachildoryouthisexperiencingmentalhealthproblemsorillnesses;theneedforsupportsforchildren,youthandfamilieswhiletheyarewaitingfortreatment/clinicalsupport;and,issuesrelatedtotransitionsfromoneservicetoanother.Eachoftheseisdescribedindetailbelow.

Gettingin:AccessingmentalhealthservicesandsupportsServiceproviderintervieweesconsistentlynotedthatthereareveryfewformallydefinedpathwaystoaccessmentalhealthservicesorsupportsinCalgary.Nevertheless,ifoneistothinkintermsofpathwaysinto,through,andoutofmentalhealthservices,theinitialpointmightbeseekinghelp.Figure1belowdepictswhatseemstobe,formany,thisearliestpartofthejourneyintotheserviceworld;thatis,itisverydifficulttofindappropriatesupportsandservicesandtoaccesstheminatimelyfashion.Assuch,evenasthe“journey”ofhavingamentalhealthproblemorillnessbegins,itishardtoevenfindandgetonthepath.Inthisdepictionofthe“journey”,peopleoftenspendmonthsoryearsstrugglingtofindhelpbeforetheyreachacrisisthatleadssometoseekhelpinanemergencydepartment(ED).

• RevisitparentingandotherECDprogramminginAlberta–aretheybasedonbrainscience?• AHSCAAMHPPprogramisdoingsomeworkwithdaycareoperators,communityprovidersaround

increasingmentalhealthcapacity–talkingabouttheimpactsoftraumaandmentalhealth• Workwithdaycarestoincrease/applyknowledgeofbrainscience;helpthemtoidentifyissuesearly

andreferappropriately(linktoworkbyMuttartFoundation’s“WellAhead”initiative–workingwithdaycares)

• Explorechildcareconsultationservices(re:childdevelopment,screening,earlyintervention)forchildcare/daycaresettings(e.g.,Ontariomodel)

• Screeningandearlyintervention-Exploreissuesre:timelyassessmentfordevelopmentaldelay,learningdisabilities,socio-emotional/behaviouralissues;implementstrategiestoreducewaitlistsfortheseassessmentsandexpediteaccesstoappropriatesupports

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Figure1.Aninitialpathwaytowardseekinghelpforchild/youthmentalhealthproblemsandillnessesSeveralpotentialpointsofentryintothe“system”werementioned,butitwasalsonotedthatthereareproblemswithsomeoftheseaccesspoints,makingthemlesseffectivethantheymightbe.Someoftheseinclude:

• Primarycare–butthereareanumberofcapacityissueshere.Forexample,familyphysiciansandnursepractitionersmaylackexpertiseinmentalhealthissues(thisisdescribedinfurtherdetailinasectioncalled“Lackofcapacityinprimarycare”below)

• Privateservices(e.g.,psychologists)–canbeexpensive,andtheremaybewaitlists

• Telephoneoronlineresources(e.g.,AccessMentalHealth;and811(AHS);211;Wood’sHomes)–peoplemaynotbeawareoftheseresources,theymaynotknowwhattheyneed,orwhattoaskforwhentheycall

• Schoolsandpost-secondaryinstitutions–mayormaynothavethecapacitytosupport

children/youthwiththeirmentalhealthconcerns

• Emergencydepartments(ED)s–theexperienceofgoingtotheEDcanbetraumaticandchildren/youth/familiesmaynotgetthesupportstheyfeeltheyneed

• Child/youthbeginstohaveissues• Searchforinforma9onabouttheissue• Searchforhelpbegins

Seekinghelp

GAPCan’tfindhelp • GotoEDbasedonfamily

physicianrecommenda9on• TheMHissueescalatestocrisislevel,sogototheemergencyroom• EDexperiencecanbetrauma9cforchild/youthandfamily/naturalsupport

EmergencyDepartment

• Don’tknowwhatisneededorhowtofindhelp• Don’tknowwheretofindinforma9onthatwouldhelp• Confusingarrayofservices• Waitlists;exclusioncriteria• MayvisitfamilyphysicianwhomaylackMHknowledgeormaythinkthatgoingtotheEDwillexpediteaccesstoMHservicesàsendtotheED

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• Communitybasedagencieswithstorefront/walk-inservices–peoplemaysimplynotknowthattheseservicesexist

Acommonstorywasthatyoungpeopleorfamiliesbeginningtoexperienceissuesmightspendalotoftimetryingtofindinformationandappropriatesupports,butoftenwindupbeingfrustrated.Eventually,withoutsupport,theymaywindupincrisisandintheemergency.Butoncethere,theymaynotgetthehelptheyexpected.Itwascommonlystatedthatunlessoneisatseriousriskofharmingoneselforothers,theyaremorelikelytobesenthomewithareferraltoservices-sometimeswithwaitlistsofseveralweekstoseveralmonths.

“IendedupinahospitalstayatUnitXafteraverybadtimeinthe,inthepsychward…Iwaspickedupbyanambulance…you’renotabletogetthoseservicesuntilyou’reattheendofyourrope...itseemstobetheonlywaytogetinthereright?”(Youth)

ThroughtheAHSsurveys,welearnedthat80percentofchildrenandyouthvisitingtheEDwithaddictionormentalhealth(AMH)issueshadoneEDvisitoveratwo-yearperiod.ThisiscontrarytopreviousperceptionsheldbymanyinthehealthcaresystemthattheseyoungpeoplearegoingbackandforthtotheEDfrequently.Mostofthemonlypresentonce,asafterthefirstexperienceintheED,goingbackisoftenseenasalastresort.Finally,parentsspokeaboutnotwantingtotaketheirchildbacktotheED,butthattheyareoftendirectedtodosobyhealthcareprofessionalssuchastheirfamilyphysician.AstrongthemethroughouttheAHSSCNsurveyandPaCERresearchwasthatgoingtotheEDendsupbeingaharmfulexperience.EDsarenotcurrentlydesignedtohelpchildren,youthandfamiliesinanyconsistentway.EDstaffoftendon’tknowhowtoproperlysupportchildren,youthandfamiliesexperiencingamentalhealthcrisis.Theprotocolsfollowedoftenfeellikepunishment:

“Mydaughterhadherpersonalitemstakenandputintoasmallcell-likeroomwithaguard.Sheaskedmewhyshewasbeingpunished.Ihadnoanswers.IhadnoideaswhatitwouldbeliketogototheERforthis,noidea.”(SCNPaCERresearch)

Inthesectionsbelow,someoftheissuesassociatedwiththisgaparedescribed.

Lackofawarenessofwhat’sneeded,whatisavailable,andhowto“getin”Anumberofrelatedissuescontributetopeoplenotbeingabletofindtheirway“in”toservices.Thisincludesthatfamiliesmaynotknowwhattheyneedorhowtoaccesssupports,themyriadarrayofservicesavailableinCalgary,andinclusionorexclusioncriteriathatrestrictaccesstoprograms.Thesearedescribedinmoredetailbelow.

Familiesmaynotknowwhattheyneed,whattoaskfor,whattosay,orhowtoaccesssupportsFirst,serviceprovidersstressedthatfamiliesmaynotknowwhatsupportstheyneedorwhattoaskforwhentheycall;andtheydon’tknowhowtoaccesssupports.Itwasalsonotedthatyouthandfamilies

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mightbeunsureofwhattosayordiscloseoverthephone.And,whentheydoconnectwithaservicesuchas211orAccessMentalHealth,theymaystillbefrustratedparticularlywhenthey’retoldtogotoaprogrambutthenfindtheyaren’tabletoaccessit.Thischallengeamplifiesthedistressexperiencedasparents/caregiversstruggletohelptheirchildoryouth,creatingaviciouscycle:beingindistressmakesitmoredifficulttofindsupports,andtryingtoaccesssupportsfurtheraddstothedistress.

“Iwouldsayourcurrentsystemreliesheavilyonthefamiliesandyouthtoknowwhattheirneedsare,soyoufirsthavetobeabletoidentifywhatitisthatyouneedbeforeyougolookingforwhatthatmightbe.SoIthinkthatnavigationofthesystemisabarrierinandofitselfwhenwe’rerelyingonfamilieswhoareindistress,strugglingwiththeiryoungpeopletofigureoutwhatitisspecificallythatwouldbehelpful,andthere’snorealplacetohelpthemsortthatout.”(ServiceProvider)“Ifyou’reinasituationwhereyourchildissufferingwithmentalhealthissues–it’sverystressfulandconfusingandyou’retryingtomanagebehavioursandyouwantthebestandyoudon’tknow–you’reinanewarena.It’simpossibletotryandfigureouthowtonavigatethat.”(Serviceprovider)

“FamilieshaveahardtimeknowingwhattoaskforwhentheycallAccessMentalHealth–they’rebeinginterviewedoverthephoneandtheintervieweristrainedandhasquestionstoask,coveringlotsofareas,butparentssometimesareunsureaboutwhattoshareandsometimesweneedtohaveaclinicalorprofessionalsupportingthemthroughthat–beingawareofwhatthey’relookingforandwhattheirneedsare.If,forinstance,achildisneedingmedicationreviewortoseeapsychiatrist,youcan’tcallAccessMentalHealthforthat,andlotsofpeopledon’tknowthat.”(Serviceprovider)

Youthandfamiliesalsodescribedfindingandthengettingintoservicesasthebiggeststruggleinthecurrentsystem.Asisdescribedinmoredepthbelow,thereare:aconfusingarrayofservicestonavigate;inclusionandexclusioncriteriathatrestrictaccess;andoftenalackofhelpfromserviceproviderswhoalsooftendon’tknowthesupportsandservicesthatareavailable.

“Asfarasaccessibilitygoes,themainissueIbelieveisthe,youknowthehoopjumpingandthebureaucracyandthewaitlists.”(Youth)“That’sabigproblem,peopledon’tknowwhat’soutthere,theydon’tevenknowwheretostart…findingresources.”(Youth)

AconfusingarrayofservicestonavigateAlargenumberofinterviewees–serviceprovidersandyouth/familymembersalike–spokeaboutaconfusingarrayofmentalhealthservicesandsupportsinCalgary,anddescribedthechallengeofnavigatingthroughthem.SomespokeofthewealthofmentalhealthresourcesinCalgarybutalmostallintervieweesspokeabouthowdifficultitistofindthem.Manymentionedexistingdirectoriesof

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servicessuchasAccessMentalHealthand811(HealthLink),and211,butsaidpeopleeithermaynotknowtheyexist,ormaynotfindthemhelpful.Inaddition,manyprogramshavespecificinclusionorexclusioncriteriawhichbarentrytomany.Thechallengeismademoredifficultwhenfamiliesrequiremorethanonekindofserviceandmustnavigatetheirwaythroughmultipleagencies.

“It’sveryhardforfamiliestofigureoutwheretheyshouldgo.Therearelistingsanddirectoriesofservices.Woodspublishesalistofallthethingsthattheyoffer.AccessMentalHealthhastheirdirectory–butthosearechallengingforparentstofindandmakesenseof.”(Serviceprovider)“Theseareallsuchseparateservicesthatarenotreallyoperatinginanorganized,integrated,coordinatedwayanditbecomesveryconfusingfortheyouthandtheirparentstryingtonavigateallofthis.Theyalreadyhaveaverycomplexchildandnowthey’retryingtomakesenseofalloftheseservicesandeachservicemayhaveaparticularthingthattheycanaddress.”(Serviceprovider)“Wehavemanyfamilieswhotellus,andyouthwhotellus,andareinapositiontospeakindependently,thatthewholesystemofhowdoyougetreferredtosomething,doyoumeetacriteria,canyougoindependentofparentalpermission–it’saquagmireoutthere.”(Serviceprovider)“Iknowthatwhenpeoplecallthementalhealthnumber…Iknowtheysayit’squitesimple,butthat’snotwhatI’mhearingfromfamilies.WhatI’mhearingisthey’refrustrated.They’vebeentold,‘Gotothisprogram;gotothatprogram;gotothisprogram’buttheycan’tgetintoanyoftheprogramsforawholebunchofreasons.Eitherthere’ssuchalongwaitlist…orpeoplearen’tcallingthembackonceagainbecausethere’ssuchagreatbiglist.Andhealthservicesareprettyswampedinavarietyofareasandtheyonlyhavesomuchcapacity…Butfamiliescanbegettingdesperate.”(Serviceprovider)

Youthpeersupportersalsodescribedthechallengesyoungpeopleexperiencedtryingtonavigateasfollows:

“It’sastressfulthingforsomeonewhoismentallyunwellletalonesomeonewhoisstrugglingwithanykindofdevelopmentaldisabilityormentalillness,like,it’sanincrediblydifficultsystemtonavigate.”(Youth)

“Iknowthatwhenpeoplecallthementalhealthnumber…Iknowtheysayit’squitesimple,butthat’snotwhatI’mhearingfromfamilies.WhatI’mhearingisthey’re

frustrated.They’vebeentold,‘Gotothisprogram;gotothatprogram;gotothisprogram’buttheycan’tgetintoanyoftheprogramsforawholebunchofreasons.”(Service

provider)

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“Ithinkthat,inmyownexperienceandthroughwhatIseewiththepeopleItalktoatworkeveryday,it’stheaccessibility…and,andwhatIhearalotofisthatwewenttothisplace,theysaidtheycouldn’t[help]butifyougotothisplacethenmaybetheycanhelp...theygoonawaitinglist,andthenwhatdoyoudointhemeantimeandit’sthebiggeststruggle.”(Youth)

Inclusionand/orexclusioncriteriathatrestrictaccesstoprogramsandservicesYouthandfamiliesdescribedthenarrowinclusionandexclusionthatrestrictaccesstomentalhealthprogramsandservicesasoneofthemostchallengingandfrustratingaspectsofthecurrentstate.Someyouthpeersupportworkerssaidthatiftheycouldchangeonethingaboutthecurrentstateitwouldbegettingridofrestrictivecriteria,sothatchildren,youthandtheirfamiliesdidnothavetoturntomultipleservicestryingtofindhelp.Nobodyshouldbedeniedhelp.

“[Interviewer:Whatwouldbethe‘ideal’?]Oh,Iwouldsaynobodyisdeniedservicesandnomatterwhatcrisisleveltheyareat…soIwouldsaynobodyisdeniedhelp.”(Youth)

Serviceproviderintervieweesdescribedthesamechallenge:

“So,there’sinclusionandexclusioncriteriathatiscertainlyelusivetoparentsandsometimesconfusingtootherprofessionals.IfindthatthesecriteriaareespeciallynarrowingintheAHSmentalhealthsector.”(Serviceprovider)

PeoplemightcallaninformationservicesuchasAccessMentalHealthor211andbereferredtoanumberofprograms;however,whentheycallthoseprogramstheylearntheyarenoteligible.Forexample,someprogramsarerestrictedtochildren/youth/familieswhoarepatientsinAHS’sChildandAdolescentAddiction,MentalHealthandPsychiatryProgram.Acommonlycitedexamplewasthatchildren/youthwithneurodevelopmentaldisorderssuchasautismmaynotbeeligibleformentalhealthprogramsbecauseautismisnota“treatablediagnosis12”:

“Autismandmentalhealthcanbeconnected.So,there’stwodifferentkindsofsupportsandtheyareaddresseddifferently.Sothegapthat’shardisifyouhaveanautismdiagnosis,mentalhealthmaysay,‘Oh,well,wecan’tsupportyoubecauseyouhaveautismandwedon’tknowhowtosupportpeoplewhohaveautism’.Andthenpeoplewhosupporttheautismdiagnosis,theygo,‘Oh,well,wedon’tknowhowtohelpwithmentalhealth’.”(Serviceprovider)

Familiesindistress,tryingtofindappropriateservicesandsupportsfortheirchild/youthcanfindthisprocessverydifficult.Iftheyreachouttoaserviceandfindtheycan’taccessit,itmaytakealotofeffortforthemtoreachoutsomewhereelse.Perhapsthebiggest,andmostfrequentlydescribedexclusioncriteriaarethoseforadmissiontohospitalortoAHS’sCAAMHPprogram.Thisisdescribedinaseparatesectionbelow.

12[Seethe“Transitions”sectionbelowformoredetailre:children/youthwithneurodevelopmentalissues

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ServiceprovidersarechallengedtokeeptrackofwhatisavailableServiceprovidersconsistentlysaidthatthey,too,strugglewithfindingservicesandsupportsforyoungpeopleandtheirfamilies,giventhelargenumberofprogramsandservicesandtheirinclusionorexclusioncriteria.Oneintervieweecommentedthateven211can’tkeepupwiththeservicesandsupportsthatareavailableinCalgary.Somenotedtheyoftengetinvitationsfrom211andothersimilarsystemstoupdatetheirlistofprograms.Thisupdatingofprogramsischallenging,especiallyfornot-for-profits(NFPs),sincefundingenvelopesandprioritiesoftenchange,andtheNFPsmustchangetheirprogrammingaccordingly.Thus,thereisanongoingshiftingofprogramsandsupportsmakingitdifficultforeveryonetokeeptrackofwhatiscurrentlyavailable,andwhatthecriteriaareforadmission.

“Fundingenvelopesandprioritiescanshiftandchange…andthecriteriaforenteringthemshiftsandchanges,soit’snoteasytokeepupwiththat…wesendAccessMentalHealthabouta30or40pagesummaryeveryyearofwhatwe’reoffering.That’sisdifficultnotonlyfromaprofessionallevel,butmoresofrompeopleseekingservices.“(Serviceprovider)

Anotherconcernnotedbysomeserviceproviderswasaboutreferringpeopletootherservicesforfearthattheywillbenotbeacceptedand/orconcernabouthowtheywillbetreated:

“Ofcourse,there’sprovincialinitiativeslike211andotherthingsthatweallthetimearegettinginvitations…toupdateourlistofprograms.So,they’reoutthere,but…they’reabitofanightmareevenforahighlyskilledintakeworkertorememberwhat’schangedandwhat’stheentrancecriteriaand…youdon’talwayshavetheconfidenceabouthowtheclientsarereceivedwhentheygetthere–whetherthey’llmeetatacloseddoororsomelimitofpractice,orthey’lljustgetdropped.”(Serviceprovider)

“Ofcourse,there’sprovincialinitiativeslike211andotherthingsthatweallthetimearegettinginvitations…toupdateourlistof

programs.So,they’reoutthere,but…they’reabitofanightmareevenforahighlyskilledintakeworkertorememberwhat’schangedand

what’stheentrancecriteriaand…youdon’talwayshavethe

confidenceabouthowtheclientsarereceivedwhentheygetthere–whetherthey’llmeetatacloseddoororsomelimitofpractice,orthey’lljustgetdropped.”(Service

provider)

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Inaccessibilityduetohours,costsandlocationofservicesOtherintervieweesnotedthatnotall,butmanycommunity-basedservicesprovidedbyAHSandNFPs,operateonaMondaytoFriday,8to4basis,makingservicesinaccessibleforyouthandfamilieswhoareoftenworkingorinschoolduringthesehours.Thismakesaccessparticularlydifficultforfamilieslivinginpoverty,especiallytheworkingpoorwhomayhavemorethanonejob.Furthermore,transportationandparkingcosts,aswellascostsofservicesmaypreventaccess.

“FamilieslovetheirchildrenbutarebeingaskedtocomeMondaytoFridaybetweeneightandfourandwedon’trecognizethatpeopleoftencannotdothatrepeatedlywithoutriskoflosingtheirjobs.”(Serviceprovider)“Itisharderfor[familieslivinginpoverty]tonavigateandgetfromplacetoplaceandtheyareworkingtwojobsandAHSservicesendatacertaintimeoftheday…theworkingpoorneedaccessiblehours.”(Serviceprovider)

Whileprivatepsychologistsareasolutionforimprovingaccess,eventheyhavewaitlists,particularlychildandfamilypsychologists,thecostsofprivatecarecanbeprohibitive,andthehoursofservicemaynotbeanybetterthaninthepublicornotforprofit(NFP)sectors.

Manyyouthandfamiliesdescribedfindingandgettingaffordablepsychologicalcounselingasparticularlydifficult.“Mostofmystruggleshavebeenfindinganaffordableplaceformentalhealthcareandit’sonlybeensincestartingtoworkhereandkindofdoingmyownresearchthatI’vebeenabletofindplacesthatofferslidingscalecounselingyouknowfree,freegroupsandnowofcoursepeeroutreachsothat’sasuperamazingandimportantthingjustlikepeopledon’t,that’sabigproblem,peopledon’tknowwhat’soutthere,theydon’tevenknowwheretostart.”(Youth)

“ItwouldhavebeensuperawesomeforexampleifwhenIwasgrowingupmyfamilyhadbeenputintouchwith[nameofservice]whoofferslidingscaleandfreesupportgroupsandchildren’scounselingandthatsortofthingversusapsychologistthatwehadtoseekoutindependentlythatchargedus180dollarsanhourforaconsult…Youknowlike,familiesjustdon’tnecessarilyknowwhat’soutthereandtheywanttodotheirbestfortheirkids.”(Youth)

“Mostofmystruggleshavebeenfindinganaffordableplaceformentalhealthcareandit’sonly

beensincestartingtoworkhereandkindofdoingmyownresearchthatI’vebeenabletofindplacesthatofferslidingscalecounselingyouknowfree,freegroupsandnowofcoursepeeroutreachsothat’sa

superamazingandimportantthingjustlikepeopledon’t,that’sabigproblem,peopledon’tknowwhat’soutthere,theydon’tevenknow

wheretostart.”(Youth)

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Intermsoflocationofservices,ahandfulofserviceprovidersspokeofneedingtobringservicestowherethepeopleare,suchasmallsandleisurecentres.Oneintervieweesaid,“Oneofourdreamsistoisthatyouthcouldhaveourtherapistshousedinnon-traditionalsettings–likeFranklinMall…weneedserviceswherekidsandfamiliesare.”

LongwaitlistsThenextchallengeforpeopleisthatoncetheyfindanappropriateserviceorsupport,theymayencountersignificantwaitlists.Intervieweesspokeofwaittimesrangingfromafewweekstotwoyearsormore,dependingontheservice.This,peoplenoted,isextremelyproblematicespeciallywhenpeopleareincrisis,andalso,giventherapidgrowthanddevelopmentofchildrenandyouth,theimportanceofinterveningearlyinordertopreventdevelopmentofmoreseriousproblems.Havingtowaitweeksormonthsforsupportaddsfurtherdistressforchildren,youthandfamilies.

AkeyfindingfromtheSCNPaCERresearchwasthataftervisitingtheEDincrisis,childrenandyouthoftenfindthemselvesonawaitlistforamentalhealthserviceorprogram.Manyfamiliessaidtheywishedtherewassomekindofsupport,andataminimumsomeonetocallforhelpiftheirchild/youth’sconditiondeteriorateswhiletheyarewaiting.

“IlefttheERinshockwithalistofnamesandnumbers,frightenedIwouldlosemychildtothisillnessbutuncertainwhatIcoulddoasaparenttosupportmychild.”(SCNPaCERresearch)

Serviceprovidersalsospokeoflongwaitlists,manynotingthattheyareunacceptablylongwhenpeoplearesickorhurting:

“Ourwaitlistfor[program]isateightmonthsnow…eightmonthsistoolong.Ifyou’rehurting,you’regoingtobebrokenineightmonthsorhavegivenup.”(Serviceprovider)“Ouraveragewaittimesarefromonemonthtofourteenmonths.”(Serviceprovider)“Thereareamazingprogramsbutit’sdifficulttoasksomeonetowaitfourmonthstogetacommunitycounselor…ifkidshadsomewheretogoinatimelymanner,wouldithelpwithwaittime.”(Serviceprovider)

“IlefttheERinshockwithalistofnamesandnumbers,frightenedIwouldlosemychildtothisillnessbutuncertainwhatIcoulddoasaparenttosupportmychild.”(SCN

PaCERresearch)

“Ourwaitlistfor[program]isateightmonthsnow…eightmonthsistoolong.Ifyou’rehurting,you’regoingtobebrokenineightmonthsorhavegivenup.”(Serviceprovider)

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“Sosomeoneinamentalhealthepisodeishavingtowaitonawaitinglisttogetintoseeourpsychnursesorourpsychiatrist...Weusedtobeabletoguaranteepeoplecouldgetinintwoweeks,nowtheywaituptosixweeksandthat’salongtimewhenyou’resick.”(Serviceprovider)

LackofcapacityinprimarycareAspreviouslynoted,familydoctorsandothersworkinginprimarycareclinicsmightseemtobeanaturalplacetoseekhelpforchild/youthmentalhealthissues.However,anumberofintervieweesnotedthisisnotnecessarilythecase,foranumberofcapacity-relatedreasons.Familyphysiciansandnursepractitionersmaylacktrainingandexpertiseinmentalhealthissuesandillnesses.Theyoftendon’tknowwhereelsetosendachildoryouthforhelpwhenthingsaregettingworse.Thismaybethecaseespeciallywhenthechildoryouthisonawaitinglistformentalhealthsupports.Itwasalsonotedthatmanypeoplethinkphysicianscannotassistwithmentalhealthissuesbeyondwritingaprescription.Further,physicianofficehoursareinconvenient,andthosewhoworkonafeeforservicebasisdon’thavetimefortherelationalworkthatisneededtoaddressmentalhealthconcerns.Also,anumberofintervieweesnotedthatyouthtendtowanthelpintheimmediatesense,ratherthanwaitingforadoctor’sappointmentandthengettingareferraltoothersupports.Thatis,whenyouthareincrisis,theywantsupportimmediately;areferralsystemdoesnotsupporttheirneedswell.

“Isawatalkonaresearchprojectthatshowedthatfamilydocsarethelasttoknowandthelasttobeconsultedaboutamentalhealthissue….Whentheyaskedkidsaboutit,kidsthinkdocsareonlythereforphysicalhealthandtherewasnopointintellingthemwhetheryouhadanymentalhealthproblems.Andfamiliesfeltthesameway–theyfeltthedoctorwouldjustgivethemmedicineinsteadofcounseling.Thereagain,someresearchtoindicatethatlotsofphysiciansdon’tgetmentalhealthtraining–theydon’tidentifyamentalhealthissuesandsotheydon’trespondtoit,andtherearen’tthepartnershipsaroundreferrals.But,theyaredefinitelyapointofinterventionorentryintothesystemthatisnoteffective.”(Serviceprovider)

Youthandfamiliesdescribedmixedexperienceswithseekinghelpthroughtheirfamilyphysician.Someyoungpeoplegotprescribedmedicationsthatworkedforthem.Mostsaidthattheirfamilyphysiciandidn’thaveagoodideaaboutpotentiallyhelpfulmentalhealthservices(e.g.,affordablecounseling,AccessMentalHealth,othercommunityservices)otherthanprivatecounselors,whichareunaffordableformanypeople.

“Yeah,soIhavegonetomyfamilydoctorbefore.Inmyopinion…

familydoctorsdonothaveenoughknowledgeaboutmentalhealth

resourcesandaccessiblecounselingandwhatnot.I’vealwaysbeen

referredtoaprivatepsychologistthroughmyfamilydoctor…whichobviouslycostmoneyifyoudon’thavecoverage…Iwasnevertold

aboutCalgaryCounsellingorAccessMentalHealthoranythinglikethat

throughmyfamilydoctorandobviouslythat’smyfamilydoctorandImighthavejusthadbadluckandotherpeoplemaybedifferent.”

(Youth)

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“Yeah,soIhavegonetomyfamilydoctorbefore.Inmyopinion…familydoctorsdonothaveenoughknowledgeaboutmentalhealthresourcesandaccessiblecounselingandwhatnot.I’vealwaysbeenreferredtoaprivatepsychologistthroughmyfamilydoctor…whichobviouslycostmoneyifyoudon’thavecoverage…IwasnevertoldaboutCalgaryCounselingorAccessMentalHealthoranythinglikethatthroughmyfamilydoctorandobviouslythat’smyfamilydoctorandImighthavejusthadbadluckandotherpeoplemaybedifferent.”(Youth)

Underservedgroupsandthose“fallingthroughthecracks”Anumberofgroupsofchildrenandyouthwerenotedbyintervieweestobeunderservedorfallingthroughthecracks.Mostfrequentlymentionedwerechildrenwithneurodevelopmentalissues;othergroups,allofwhomarealsoatgreaterriskfordevelopmentofmentalhealthproblemsandillnesses,include:justice-involvedyouth;LGBTQ2Sandparticularlytransgenderyouth;refugeesandimmigrants;thosewhoarehomelessand/orlivinginpoverty;and,Indigenouschildrenandyouth.

ChildrenwithneurodevelopmentalandbehaviouralissuesWhenaskedaboutgapsand/orchallengesorplaceswheresomechildren/youthmightbe“fallingthroughthecracks”,manyintervieweesmentionedchildren/youthwhohavesomekindofneurodevelopmentalissuesuchasautismspectrumdisorder(ASD),fetalalcoholspectrumdisorder(FASD),orothersimilarissues,andthosewithseverebehaviouralissues.Partoftheissueisthatinmanycases,thereismorethanoneissue,andalsothattheseissuesdon’tfitneatlyintotheboxof“treatablementalillnesses”.

“TheASDpopulationisonegroupthatmyheartbreaksfor.Wedon’tseemtobemanagingwell.Thereareanumberofareaswherewedoareallygoodjobofassessing,butnooneisabletoprovidethetreatmentandsupportrequired.CommunityservicesaredoingthebesttheycanIfyouarelookingatco-occurringASDandmentalhealth.WereallystruggleinCalgarytoprovideservicesforthisgroupofkids,aswellasotherkidswithseverebehaviouralissues.”(Serviceprovider)AnumberofyouthinterviewparticipantsdescribedlivingwithacomplexarrayofissuesthatcouldincludeacombinationofASD,ADHD,learningdisabilities,andamentalillness(e.g.,anxietyand/ordepression;bipolar).Somealsofitintoothergroupsthatweheardbyservice

“TheASDpopulationisonegroupthatmyheartbreaksfor.Wedon’tseemto

bemanagingwell.Thereareanumberofareaswherewedoareallygoodjobofassessing,butnooneisabletoprovidethetreatmentand

supportrequired.CommunityservicesaredoingthebesttheycanIfyouare

lookingatco-occurringASDandmentalhealth.WereallystruggleinCalgarytoprovideservicesforthisgroupofkids,aswellasotherkidswithseverebehaviouralissues.”

(Serviceprovider)

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providerstobeunderserved(e.g.,LGBTQ2Syouth,youthstrugglingwithpoverty).Rarelydidtheirconditionsandissuesfitintoaneatlittlebox.Theytoldstoriesofhowtheirparentsstruggledtogetthemhelp,andhowtheycontinuedtolookforservicesontheirownwhentheygotolder.

“I’vestruggledwithmentalillnessandthementalhealthsystemformostofmylife.I’vebeenincounselingsinceaveryearlyage,sinceIwasaboutfourorfiveyearsold.Yeah(chuckle)kindofthrownaroundthesystemthatway.It’sdefinitelyavery,verybrokensystemI’veexperiencedandreallyamazingpeoplewithinitandsomereallynotsoamazingpartsofthesystem.YeahIstruggledwithanumberoflearningdisordersgrowingupandwasprettymuchconstantlyintouchwiththeschoolcounseloranddoctorsandpsychologistsandsoonandsoforth.”(Youth)

Otherunderservedgroupsandthose“fallingthroughthecracks”Anumberofotherunderservedgroupswereidentifiedasatriskbothofdevelopingmentalhealthproblemsandalsoof“fallingthroughthecracks”.Theseinclude:• Justice-involvedyouth–oneintervieweespokeatlengthaboutthechallengesfacedbyjustice-

involvedyouthinaccessingmentalhealthservicesastheymovethroughthejusticesystem.Thisisanissuethatisinpartduetoprocesseswithinthejusticesystem,aswellaslackofmentalhealthservices.YoutharereferredtoaForensicAdolescentprogramrunbyAHSaftertheyhaveenteredaplea.Atthatpoint,theyareplacedonawaitinglist:

“Andit’salengthywaitlist.Theymaybewaitingaverylongtimeforservices.Theseyoutharedefinitelyfallingthroughthecracks.Manyoftheseyouthhavemaltreatmentortraumaissuesthathavenotbeenadequatelyaddressed,orothermentalhealthchallenges.EventuallytheywillbeseenbytheForensicAdolescentProgram,whichhasveryfewstaffandlongwaittimes.They’regettingtheirtreatmentayearortwoyearsaftertheiroffence.Notjustbecauseofthewaitlistbutthecourtprocessneedstounfoldfirst.”(Serviceprovider)

Iftheseyouthcontinuetocommitoffences,theywindupintheCalgaryYoungOffendersCentre–themostcostlyandinvasivealternative.What’sneededinsteadisquickandeffectiveintervention.

• LGBTQ2S,andparticularlytransgenderyouth–Thispopulationwasnotedtohaveahigherriskof

developingmentalhealthproblems,butthereareinsufficientsupports.Inregardtotransgenderyouth,thereisaclinicatAHSthatprovidesmulti-disciplinaryservicesonceamonth;however,thereisathree-yearwait-listforentryintotheclinic.

• Refugees,immigrantsandthoseforwhomEnglishisasecondlanguage–anumberofserviceprovidersnotedtheyareseeingahugeinfluxofpeoplefromcountriesaroundtheworldwhoareexperiencingtrauma.Thosefromacutecaresettingssaidthatpsychiatristslackexpertiseinthisareaandtrainingisneeded.Thereisalsoaperceptionthatthispopulationis“weighingheavily”oncommunityresourceswhereexpertiseforsupportingthesepeoplelies.RefugeesandimmigrantshaveuniqueneedsandrequireculturallysafesupportsthatmaybeincongruentwithEuro-centric

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approaches.Itwaspointedout,however,thatnotallpeoplerequiretherapy;somemaydowellwithsupportssuchashelpingtheirchildrengetsettledinschool,orusingothernaturalsupportstohelpthemmanage.

• Youthwithaddictionissues–oneintervieweeobservedthatAlbertaingeneralisunderservedin

regardtoyouthaddiction,andparticularlytreatmentthatisn’t12-stepbased.• Youth/familieswhoarehomelessorlivinginpoverty–anumberofintervieweesalsosaidthat

youthandfamilieswhoarehomelessorlivinginpovertyareunderserved.Itwasnotedthatmanyyoutharenotnecessarilylivingonthestreet,butmaybecouchsurfing.

• Indigenousyouthandfamilies–Indigenousyouthandfamiliesweredescribedasbeing

underserved.Barriersforthispopulationoftencoincidewiththoseofpoverty(e.g.,costsoftravel,parking,servicesonlyprovidedonweekdaysandsoon).Indigenouscommunitiesareheterogeneousandmoreknowledgeisneededabouthowtheyexperiencevarioustreatments/supportsandhowthesemightneedtobeadapted.OneintervieweealsospokeaboutdifficultiesinrecruitingstaffwithexpertiseinunderstandingandtreatingIndigenousfamiliesorwhoarethemselvesIndigenous.

NotillenoughforadmissiontohospitalorAHSprogrammingAsreferencedpreviouslyandlinkedtoinclusion/exclusioncriteria,anotherstrongthemecomingoutofthekeyinformantinterviewsistheissueofchildren/youthnotbeingillenoughforadmissiontoAHSprogramming–thatis,theChildandAdolescentAddiction,MentalHealthandPsychiatryProgram(CAAMHPP),orforadmissiontohospital.AnumberofintervieweesnotedthatifachildoryouthisseverelyillandisadmittedintoAHSservicesorhospital,theygenerallygetgood,integratedcarewithintheAHSsystem’swiderangeofservicesandsupports.Oneintervieweenoted,forexample,that,“ifyougetintoAHSprogramming,yougettappedintoawiderangeofserviceswithgreaterintegration”.

However,acommonscenarioisthatchildrenandyouthdon’tmeetthethresholdforadmissionintoAHSprogramsorhospital,eventhoughtheyareexperiencingsignificantissuesthatcanbedifficultforthemandtheirfamiliestomanageathome.Asdescribedpreviously,familiesaresometimesreferredtoprogramsorclinicians,buttheymayencounterlongwaittimesofseveralweekstoseveralmonths.A

numberoffamilieshadtheexperiencetakingtheirchild/youthtotheED,expectingtheywouldbeadmittedbecausetheyfelttheywereseverelyill.Manytimes,however,thechildwasnotadmitted.

“After12hoursofwaiting,mydaughterwassenthome,andasaparentIfailedtogetherthehelpItoldherwewouldgetifsheagreedtogo.”(SCNPaCERresearch)

“After12hoursofwaiting,mydaughterwassenthome,andasaparentIfailedtogetherthehelpItoldherwewouldgetifsheagreedtogo.”(SCNPaCER

research)

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Youngpeoplealsodescribeddifficultygettingintomentalhealthcareservices,astheyweren’tillenough.Whenaskedaboutthe‘ideal’system,manyofthemnotedthatthisissomethingtheywouldchange.

“Iwouldcompletelyabolishthe,likeIsaidbefore,the,you’re,you’renottryingtohurtyourselforotherssowewillnothelpyou.”(Youth)

Serviceprovidersspokeatlengthaboutthisgap/challenge.Someoftheircommentsarepresentedbelow.

“Ifkidshaveahighlevelofcomplexityandacuityandtheyneedtobeaninpatient,thesystemdoesthatreallywell.Butthere’saclusterinthemiddlethataren’tquitesickenoughforadmissionbutarereallytoomuchorstrugglingwithincommunityresources.Theywinduppresentingtotheemergencydepartment.”(Serviceprovider)“It’sthegroupthat’sinthemoderate[levelofneed]…ifyou’reintheextremeendofthingsyou’regoingtogetservice.Ifyou’reinthemoderaterangeandyou’reachildoryouthwhoisstrugglinganditmightnotbeusefulforyoutobehavingadiagnosis,butit’shardertogetservicebecauseyoumightnotbemeetingthemandateformentalhealthservices,forexample,thatwouldbeprovidedincommunitymentalhealthclinicsprovidedbyAHS.Thenarrowingofthemandateforthosekindsofservicesispotentiallyproblematic.Atthesametimeifyouwereabletobeefupsomeoftheworkgoingoninuniversalandtargetedareas13youcouldoffsetthat…Butwe’renotgoodenoughatdoingthatyet.”(Serviceprovider)

“Oneofthefrustrations–wehavekidsroutinelygoingtohospitalswhoareinacutestatesofneedingsignificantsupportsthatarefarbeyondwhatwecanmanage…andwehavekidsbeingturnedaway…basicallystampedas“fine”andsentbackintothecommunity…AndIhaveheardsimilarstoriesofparentsandfamilieswhohavebeenturnedbasicallybacktothecommunityand

13Thisisareferencetobroadermentalhealthpromotionandmentalillnesspreventionefforts

“It’sthegroupthat’sinthemoderate

[levelofneed]…ifyou’reintheextremeendofthingsyou’regoingtogetservice.Ifyou’reinthemoderaterangeandyou’reachildoryouthwhoisstrugglinganditmightnotbeusefulforyoutobehavingadiagnosis,butit’shardertogetservicebecauseyoumightnotbemeetingthemandateformentalhealthservices,forexample,thatwouldbeprovidedincommunitymentalhealthclinicsprovidedbyAHS.Thenarrowingofthemandateforthosekindsofservicesispotentiallyproblematic.Atthesametimeifyouwereabletobeefupsomeoftheworkgoingoninuniversalandtargetedareas1youcouldoffsetthat…But

we’renotgoodenoughatdoingthatyet.”(Serviceprovider)

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it’slike–you’vegotasuicidal17yearoldwhodoesn’tmeethospitalizationcriteriaandnowyou’reexpectedtobeonwatchathomewiththem.Someofthescenariosthatparentsandcaregiversareputin….forsomeofthemoreextremepopulation,it’sprettyfascinatingwithsomeofthedecisionsthatarebeingmade.I’msurprisedthereactuallyhasn’tbeenmoreparentsandfamiliescryingfoul.”(Serviceprovider)

Thischallengelinksdirectlytoanotherchallengethatisdescribedbelow;thatis,theneedforsupportsforchildren,youthandfamilieswhiletheyarewaitingfortreatment.Inthetablebelow,asummaryofkeypointsforthissetofgaps/challengesispresented.Informationprovidedbykeyinformantsaboutexistingstrengthsandefforts,andsuggestionsforaddressingchallengesisalsoincluded.

Table3.Summary.Gaps/challenges,strengths,andpossibleresponsesrelatedto:Gettingin–AccessingMHservicesandsupportsKeygaps/challenges• Lackofawarenessofwhat’sneededandwhat’savailable

o Families/youthmaynotknowwhatsupportstheyneed,whattoaskfor,ormaybeunsureaboutwhattheyshouldshare

o Familiesandyouthdon’tknowwheretofindsupportsàtheywindupintheEDasalastresort

o Serviceprovidersarealsochallengedtokeeptrackofalltheavailableservicesandtheirinclusion/exclusioncriteria;primarycarephysiciansmaysimplyopttosendtotheED

• Exclusioncriteriaornarrowinclusioncriterialimitaccess• Lengthywaitlistsforclinicalsupports;and,costs,hoursandlocationofservices=barrierstoaccess• Acurrentlackofcapacityinprimaryhealthcarere:child/youth/familymentalhealthissues/illnesses• Children/youthnotillenoughforadmissiontohospitalorAHS’sCAAMHPprogram–wheredothey

goforhelp?• Anumberofunderservedgroups/populationswhoareathigherriskforproblemsandalsooffalling

throughthecracks:o Children/youthwithASD,FASD,otherdevelopmentalandbehaviouralissueso LGBTQ2S,andparticularlytransgenderyoutho Youthinvolvedwiththejusticesystemo Familiesandyouthlivinginpovertyand/orwhoarehomelesso Youthwithaddictionso Newcomers(refugee,immigrantfamilies);familiesforwhomEnglishisasecondlanguageo Indigenousfamilies

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Existingstrengths/effortsunderwayasidentifiedbykeyinformants• Calgaryis“rich”inmentalhealthservicesandsupports;manythatoffere-therapy,telephone,text,

chat,andwalk-inservices;othersoffersingle-sessionvisitstohelppeoplecopeandmakeaplanformovingforwardwhilewaitingformoreintensivesupport

• CalgaryCounselingCentrehaseliminatedwaitlistsbyusingdatatocustomizesupportsforclientsandpredictresourcerequirements;andbysupervisingstudentsorpost-graduatestudentstoworkwithclients

• Crisiscounselingisavailableatleastinthefollowingagencieso Wood’sHomes–24/7crisiscounselingviatelephone,text,livechat&mobileresponseo Wood’sHomes-EastsideFamilyCentre–nochargewalkincounselingforfamilieso KidsHelpPhone(pilotingatextmessagingapproachinManitoba)o DistressCentreConnecTeeno AfterhourscrisissupporttoUofCstudents(Wood’sHomes,CalgaryCounselingCentre,

DistressCentre)• Someorganizationsareworkingwithprimarycaretobuildcapacity.AHS,forexample,has

CANReach–afellowshipwithpediatriciansandfamilyphysicianswhichincludesonlinemodulesandofferscontinuingmedicaleducationcreditsPossibleresponsesasidentifiedbykeyinformants

• Morepreventativeworktosupportchildren/youthandbolstertheirmentalwellbeingsotheydon’tgetintocrisisinthefirstplace

• Morementalhealthliteracytrainingforthegeneralpublicandyouth;educationforparents/youth• Increasepublic/family/youthawarenessaboutwhere/howtoaccessservices–marketingcampaign,

brandingstrategy• Findwaystoreducewaittimes–rethinktraditionalapproaches• E-mentalhealth(e.g.,appsorsocialmediaforfindingservices)• BuildMHcapacityinprimarycare• Increasethenumberofsinglesessionandwalkinclinics;Ontariorequiresallfundedmentalhealth

serviceproviderstoofferwalk-inclinics• Expandpeersupportservices(phone,online,in-person)• Locateserviceswherechildren/youth/familiesgather–e.g.shoppingmalls,leisurecentres• Implementcommunity-basedintegratedservicehubs/one-stop-shops;exploreorganizationsthat

arecurrentlyoperatinginthiskindofmanner(e.g.,TheAlex)

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AssessmentchallengesOncechildren,youthandfamiliesdogainentryintomentalhealthservicesandsupports,theymayfaceanumberofotherchallengesrelatedtoassessmentanddiagnosisthatcanimpacttheirjourneythroughthesystem.AttheNovember30,2017AdvisoryGroup,membersdiscussedanumberoftheseissues.Thebottomline,theyconcludedisthatthegoalistoidentifytherightresources/solutions,andtherightintensityofsupportsattherighttime:whatkindofassessmentisneeded,andwhen?Someofthechallengesraisedincludethefollowing:• Thereisaneedforarapidandappropriateassessment,triagingtomoreintensiveassessmentas

required,butinsomecases,itcantakeyearstogetaninitialassessment.

• Differentprovidersusedifferentassessmenttools,andthusmakedifferentdecisionsaboutwhatsupportsareneeded.Dependingonwhoisdoingtheassessing,itcouldbepossibletowindupwithfivedifferentrecommendationsfortreatment.Isitpossibletodeveloporagreeuponacommonassessmenttooltobeusedacrossorganizations?

“So,thereisamatchingcomponentthatneedstobebetterunderstood.Theprocessofassessment,whichdoesn’tneedtobehoursuponhours,butthereneedstobeaconsistentwaytoassessneedsofyoungpeopleandthenprovidethemostappropriateservicesandsupports.”(Serviceprovider)

• TraumaasaconceptisnotaddressedintheDSM(whichclassifiesillnesses/diagnoses)yettrauma

inrelationtotheintensityofsupportsrequiredisahugedrivingfactor.Thatis,thecurrentdiagnosticsystemusedbycliniciansismissingalargepieceregardingtheintensityofservicethatisprovided,andthiscanaffectqualityofcare.

• Alotofresourcesareoftenexpendedoncomprehensive,multi-disciplinaryassessmentsthatmay

notbenecessaryandthatdivertresourcesawayfromactualtreatmentandsupports.

“OneofthebiggestconcernsIhaveaboutservicesinmentalhealthintheformal[Health]systemistherequirementforaformalassessmentthat’susuallyteambased,thatisreallyexpensiveandalsoservesasagatekeeper.Sowhathappensisifyouhavetohaveasocialworker,psychologist,psychiatrist,nurse,maybean[occupationaltherapist]atthisassessmentmeeting.Lookatalltheresourcesyou’reputtingintothatcase.Withhundredsoffamiliessometimeswaiting.Whenyoudon’tevenknowatthatstagethatyouneedthatkindofresource…therearecasesthatneed[thatkindof]assessment–mybetis20percentorlessofclientsdoorless,andweputupallthoseresourcesupfrontandthentherearefewerresourcesinthebackend.”(Serviceprovider)

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• Aviablealternative,itwassuggested,wastofirstsimplyhaveaninitialconversationaboutwhatbroughtthechild/youth/familyin,whattheyneedandexpecttohappen,andwhatsupportsthey’veaccessedtodate.Thisismoreofaperson-centredinitialtriagingstepbeforeanyformalassessmentisdone.

Intermsofthepointabove,youthandfamiliesalsostronglysupportedtheconceptofamoreperson-centredprocess,startingwithaconversation,tryingtosortthroughwhatmightbehelpfulnow,andthenprovidingimmediatesupportbeforejumpingintomorecomplexassessmentsanddiagnoses.Oneyouthreferredtothisasa“gentlerapproach.”

“Ithinkjustkindof,justkindoftalking…andlisteningtotheotherperson‘causeIfindwithassessmentsalotofthetimeit’sjustsomeonesittingoppositeyouaskingalotofquestions,you’reusuallynotmakingeyecontact,tickingoffboxes,ratherthanhearingthepersonandgettingtoknowwhat’sactuallygoingonandthenIfeellikesometimesthenitbecomesmorediagnosisfocusedratherthanwhethertherightsupportforthisindividualfocused.”(Youth)“JustbecauseofhowisolatedIwasfeelingsoIwastalkingtomydoctorandthenhereferredmetothehospitalwhichwasn’tagreatfirstthingtohappenwhenyoukindofopenuptoyourdoctor,thatthefirstplaceyougetsentisthehospital(chuckle)...Yeah.Therewasnoconnections[tootherprogramsorservices]throughit.Itwasjustfortheassessmentpiece.”(Youth)

Diagnosis:ProsandConsThereweremixedperspectivesontheimportanceof“gettingadiagnosis”,andwhereinthechildandfamilyjourneygettingadiagnosisbestfits,ifiteverdoes.SomekeyinformantsandAdvisoryGroupmembersfeltthatlookingatyoungpeoplethroughthesediagnosticlensescouldruleoutaccesstosomekindsofprogramming.Forexample,childrenwithautismwillhaveadifficulttimeaccessingmentalhealthprogramming.Oncelabeledwithadiagnosis,childrenandyouthgetdirectedtoanarrowsetofprograms.Ontheotherhand,havingaspecificdiagnosiscanresultinaccesstotheappropriatekindsofsupports.Somekeyinformantssuggesteditmightmakemoresensetolookatthewholechildinthecontextoftheirenvironmentandlookingacrosstheirlifespan.Ratherthanspendingconsiderableresourcesandefforttryingtoarriveatadiagnosis,startingwithaconversation,andthenworkingwiththechildandfamilyandothernaturalsupportstofigureoutwheretheyareat,andwhatwouldbemost

“Ithinkjustkindof,talking…and

listeningtotheotherperson‘causeIfindwithassessmentsalotofthetimeit’sjustsomeonesittingoppositeyou

askingalotofquestions,you’reusuallynotmakingeyecontact,

tickingoffboxes,ratherthanhearingthepersonandgettingtoknow

what’sactuallygoingonandthenIfeellikesometimesthenitbecomesmorediagnosisfocusedratherthanwhethertherightsupportforthis

individualfocused.”(Youth)

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helpfulatthecurrenttime,seemstomakealotofsense.Adiagnosismaybehelpfulatsomepoint,however.Youthandfamiliesalsodescribedhavingmixedperspectivesabouttheimportanceofadiagnosis,andwhereitmightbehelpful.Theyfeltitmightbedifferentforeverybody.Forsome,astwoyouthnoted,itmightbe“empoweringandasighofrelief”:

“Ifeellikeit’sdifferentforeverybody.Formeitwasveryempoweringandlikea,likeasighofrelief‘causeIhadbeenstrugglingwiththesethingsformyentirelifeandhaven’treallyknownwhyoryouknowhowto,howtoresearchandhowtogethelpandfindpeopleyouknowrelatetomeandthatsortofthing.(Youth)“So,gettingthediagnosesthatIhavewassuperrelievingtomebecauseIwasabletoGooglethetermsandlearnmoreaboutitandconnectwithotherpeoplewhoyouknowsharedsimilarexperienceswithme…Iknowthatsomepeopledon’tlikediagnoses.Theyfeellikeit’sverylimitingbutI,Ifounditempoweringpersonally.”(Youth)

Inthetablebelow,asummaryofkeypointsforthissetofgaps/challengesispresented.Informationprovidedbykeyinformantsaboutexistingstrengthsandefforts,andsuggestionsforaddressingchallengesisalsoincluded.

Table4.Summary.Gaps/challenges,strengths,andpossibleresponsesrelatedto:AssessmentKeygaps/challenges• Whatkindsofassessmentsareneededandwhen?Howmanychildren/youthactuallyneedafull,

multidisciplinaryassessment–theseareexpensiveandtherearewaitlists.Whenwouldalessintense,rapidapproachbemoreappropriate,andwhatwouldthatlooklike?

• Itcantakeyearstogetaninitialassessment• Noagreementonaparticulartypeofscreening/assessmenttoidentifytheunderlyingtraumaand

howtheissuegetsframed;differentapproaches=differentrecommendationsforcare/treatment• TraumaisnotaddressedintheDSMyetitisahugedrivingfactorinrelationtoclinicalseverity–

diagnosissystemismissingabigpartoftheintensityofneed• Needtodoabetterjobofmatchingtheserviceneedwithwhatthechild/youth/familyneeds• ThereareadvantagesanddisadvantagesofhavingaformaldiagnosisExistingstrengths/effortsunderwayasidentifiedbykeyinformants• TheACESscreeningtoolbeingisusedbyAHSCAAMHPP• Somecommunity-basedNGOshaveasofterapproachtoassessment,beginningwithlisteningand

havingagentleconversationPossibleresponsesasidentifiedbykeyinformants

• Workcollaborativelytoreviewassessmentprocesses-co-createarapidandappropriateassessmenttooloraone-stoptriageservice

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SupportsforthewholefamilyAstrongthemeemergingfromtheexperiencesofyouthandfamilieswithmentalhealthservicesistheextremeandoftenlong-termstressanddistressthatfamiliesendurewhentheirchildisexperiencingamentalhealthproblemorillness.Whileserviceproviderinformantsnotedhowstressfulitcanbetosupportachildwhoisillandalsonavigatethe“system”,thevoicesofyouthandfamiliesamplifiedthismessageexponentially.Thebottomlineisthatthereneedstobeservices/supportsforthewholefamilythroughoutthejourney.Manyyouthandfamiliesdescribedexperienceswheretheyfelttheywerenottreatedwithrespectandtheywerenotlistenedto.Youthtalkedaboutbeing“expertsintheirownexperience”,andfamiliessaidtheyhadusefulinformationabouttheirchild,butnobodyaskedthemaboutthis.

“NooneaskedmehowIwas,whatImightknow,whatIneeded,oranythingaboutanyofourfamily.”(SCNPaCERresearch)“ButIwanttoknowthemedicalinformationandwhat’shappening,shouldIcallmyhusband,butthesocialworkerknewnothingaboutwhatwasgoingon...calmingmewasforstaff,nottohelpme.”(SCNPaCERresearch)

Anotherfamilywastold,whentheyaskediftheycouldstaywiththeirchildinanEDsetting,thattheir“parentalrightshadbeenrevokedfor25hours,astheirchildhadtriedtocommitsuicide”.(SCNPaCERresearch).Ayoungpersonspokeabouthowwhenshestartedhavinglearningandbehaviouralproblemsearlyoninelementaryschool,herfamilywasinvestigatedforabuse,whichwastotallyunfoundedandmadeherafraidtoseekhelp.

“Myfamilyisbrilliant.Theywerenotabusivetomeinanywaybut[serviceproviders]didn’tbelievemeormyfamily…sothenIbecamescaredto,youknow,toexpressanything‘causeyouknowitcausedabig,abigstressonmy,myparentsofcourseandthatsortofthing.”(Youth)

Manycommunity-basedserviceprovidersconsiderpracticinginafamilycentredwayasessentialbutrecognizeitisdifficult.Howdowedothis?

“[Thereisa]criticalroleoffamilyandsupportforfamilies–howdoyouwraparoundanentirefamilywhensomeoneyoulovehasamentalillnessoraddictiondisorder?”(Serviceprovider)

“Myfamilyisbrilliant.Theywerenotabusivetomeinanywaybut[serviceproviders]didn’tbelievemeormyfamily…sothenIbecamescaredto,youknow,toexpressanything‘causeyouknowitcausedabig,abigstressonmy,myparentsofcourseandthat

sortofthing.”(Youth)

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“WesharethatviewoftheimportanceofthefamilyandthefamilysystemandIalwaysgetconcernedthattheparentalresiliencepiecedoesn’tbecomeenoughofourfocusincontinuumsorframeworksbecausetherecanbementalhealthissuesgoingonwiththeparentsbuttherecanalsobeissuesinrelationshiptocustody,accessorevenjustrelationshipstabilitythingsthathaveahugeimpactonchildandyouthmentalhealth.SoIthinkhowwedefinewhatwe’retryingtodowithchildandyouthmentalhealthisreallyimportanttoconsiderthosepieces.”(Serviceprovider)

NeedformorefamilytherapyandanintergenerationalfocusServiceproviders,youthandfamiliesalsodescribedtheneedformorefamilytherapyservices,althoughoneyouthfoundthatfamilytherapyonlyfocusedonthelovedonewhowasill,andnotreallytheotherfamilymembers:

“Ifonebelievesthatachildortheyouth’smentalhealthisbestmanagedwithinasecurefamilyorrelationship,thereisaveryhugeshortageofanyonewhodoesfamilyworkinthiscommunity.Iwouldsaythatevenintheprivatesystemifyouhavemoney,it’sveryhardtofindsomeonewhowilldofamilytherapy.”(Serviceprovider)

Oneyoungperson,whohadgrownupwithaparentlivingwithseverementalillnessdescribedsomeofthelimitationsofthefamilytherapyshehadexperienced.

“Thefamilytherapysessionisalwaysguidedtowardsthelovedoneand,and,andspokenaboutthelovedoneand,and,andit’snever,you’renevertakenintoconsiderationwhenyou’redealingwiththesekindsofprocesses.”(Youth)

Someintervieweesalsocommentedontheimportanceoftakinganintergenerationalfocus.ThePalixFoundation,forexample,assertsthatinrelationtoadversechildhoodexperiences(ACES),accesstoqualitymentalhealthsupportsforadultsisprimarypreventionforchildren.Alongthisline,asmallnumberofserviceprovidersnotedalackofservicesforparentalmentalhealth–thatis,insituationswhereparentalmentalhealthissuesimpacthowtheyexperienceandinteractwiththeirchild/youthwhoisalsoexperiencingmentalhealthproblems.Thiscouldbe,forexample,significantparentingstress,orchallengesrelatingtotheirownchildhoodsuchasahistoryofunresolvedchildabuse.Thecarethatisneededinthesesituationsreachesbeyondsendingparentsfortreatmentfortheirownissues;italsorequiresfindingsupportstohelptheparentmeettheirchild’sneeds.Forexample,treatingaparent’sdepressionmaynotbeenoughtosupporthim/herasaparenttosupporttheirchild.Youthwhogrewupinfamilieswhereaparentstruggledwithamentalillnessdescribedtheimpactthishadonthemandtheirfamilies.Inotherwords,childrenandyouthcan’tbetreatedinisolationtotheirenvironmentsandwhenaparentisstrugglingwiththeirownmentalhealthissues,itismoredifficultforthemtosupporttheirchild.

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What’sneeded,intervieweessaid,isapositionthatisspecifictoparentalmentalhealth.AHS’sCAAMHPPdoeshavesuchaservice-aconsultationclinicforparentsthatincludesapsychiatristwithexpertiseinadultmentalhealth,asocialworker,andafamilytherapist.However,onlyfamiliesbeingservedbytheCAAMHPPcanaccessthisclinic.Thisisanotherexampleofinclusion/exclusioncriteriathatlimitaccesstoservices.Inthetablebelow,asummaryofkeypointsforthissetofgapsandchallengesispresented.Informationprovidedbykeyinformantsaboutexistingstrengthsandefforts,andsuggestionsforaddressingchallengesisalsoincluded.

Table5.Summary.Gaps/challenges,strengths,andpossibleresponsesrelatedto:SupportsforthewholefamilyKeygaps/challenges• “Parentsareinalotofpain”• Children/youth/familieswanttobehaveavoice/belistenedto,andbeunderstoodasexperts

regardingtheirownhealth,experiencesandneeds;theyneedandexpectservices/supportstobeprovidedinanempathetic,caring,respectfulandsafeenvironment,yetthisdoesnotalwaysoccur

• Parental/caregivermentalhealthiscrucial;anintergenerationalapproachisimportant,andsupportingparentswiththeirownmentalhealthneeds–aholistic,familycenteredapproach

Existingstrengths/effortsunderwayasidentifiedbykeyinformants• CatholicFamilyServices–intakeprocessasanintervention–thevalueoftalkingwithpeopleina

compassionatemannerforaslongastheywant(withhighlypositivefeedbackfromclients)• CMHA–trainsandemploysyouthandfamilypeersupporters

Possibleresponsesasidentifiedbykeyinformants• Familyandyouthpeersupport;inclusionofnaturalsupports• Engagechildren/youth/familiesindefiningissuesanddesigningservices/supports• Mentalhealthsupportsforparentsandfamiliesasawhole• E-mentalhealthsupports• Singlesessionandwalkinclinics• Integratedservicehubs• Psychosocialandothernon-clinicalsupports–e.g.,sports,recreation,arts

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Supportswhilewaitingfor,andbeyond‘treatment’Anotherpowerfulmessageemergingfromthechild,youthandfamilyperspectiveandalso,fromserviceproviders,isthelackofsupportwhilewaitingforclinicaltreatmentortherapy.Acommonexampleisbeingreferredtoaprogramorspecialistbuthavingtowaitseveralweekstoseveralmonthsforthatappointment.(SeeFigure2below.)What,then,arefamiliestodointhemeantimetosupporttheirchildoryouthwhomaybequiteill?Insomecases,parentswinduphavingtotaketimeofffromworktostaywiththeirchild,creatingadditionalstressrelatedtojobsecurityandfinances.

Figure2:Gapsrelatedtowaitingfor“treatment”Thekeymessagehereisthatclinicalcareortherapyinandofitself,isinsufficient.Afocuson“fixing”and“treating”stemsfromanarrow,biomedicalpointofviewthatfocusesprimarilyontheindividualandtheillness.Thisprovideslittleinthewayofhelpingpeoplemanagefortheseveralweeksormonthsbeforetheycanreceivethistreatment.Essentially,theyareleftinlimbowhiletheywait.

“Youcangotoaclinicianandhaveaonceamonthmeetingwiththem,butwhatdoyoudoforsupportstherestofthetime?Peoplereallyarelefttotheirowndevices.Wesupportthemtobuildtheirowncommunity.”(Serviceprovider)CMHA

Anotherserviceproviderspokeatlengthaboutthis:

“Frommyexperienceinthefield…sometimethebestinterventionwasayouthworkerandarecworkerandalotofotherwraparoundservicesthatdidn’tdirectlydoclinicalworkbecausethekidmightnotbethere.Butasupportnetwork…abunchofdifferentsupportnetworksincludingtheparent…theycanbuildoutthosesupportsystemsforself-esteemtotrytobuildupinvolvementinactivitiesthatwillleadtobettermentalhealth….Withoutitbeingreallyobviousandyou’renotsittinginaclinician’sofficeaskinghowyoufeel….Don’tgetmewrong-there’stotalvaluein

• SeenintheER,butnotillenoughforadmissionorAHSprogramàhome• ORreferredtotreatment• Encounterwaitlistsofseveralweekstoseveralmonthsfortreatment

Referredtotreatment

• Nosupportswhilewai@ngforappointment• Increasesstressonchild/youthandfamily• Maycreateeconomichardship,familydisrup@on

GAPInlimbo–wai@ngfor

treatment • Assessment• Treatmentorentryintoprograms/supports

Clinicalappointment

• Cyclecon@nues

GAPWai@ngfornextappointment

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communitycounseling…[but]alotofthedifferentteamsouttherearestartingtolookatmentalhealthinnotsuchaclinical,formalizedsetting.”(Serviceprovider)

Shecontinued:

“WhenwethinkofcoordinatingmentalhealthservicesIdon’tthinkweworkinaholistic…typeofthinkingandIthinkthat’stoobadbecausewecan’tjusthaveakidleaveahospitalandsay,‘Okay,inthreeweeksyou’llgotocounselingatoneofthecommunityagenciesandanursewillpopinonyouinacoupleofdays’.…Whileyouwaitforthosethings,whatelsecanyoudoand…I’veseenitwherekidswithself-regulationissues–andyouthworkershavetakenthemtohitgolfballsandtalkaboutthingsasthey’redoingit,inarelaxedandinformalway.”

Manyyouthandfamiliesfeltthattherewasasignificantroleforpeersupportinthis“waitingperiod”.Peersupportworkerswhoarecurrentlyworkingwithyouthandfamiliesfindthattheyareprovidingasupportrolewhilepeoplewaitforaparticularprogramandservice,andalsoworkwithpeopletohelpconnectthemwithotherserviceswhiletheyarewaiting.

“Iwouldlovetoseepeersupportlike,absolutelyeverywhereanditisgettingmorewidespread.”(Youth)

““WhenwethinkofcoordinatingmentalhealthservicesIdon’tthinkweworkinaholistic…typeofthinkingandIthinkthat’stoobadbecause

wecan’tjusthaveakidleaveahospitalandsay,‘Okay,inthreeweeksyou’llgotocounselingatoneofthecommunityagenciesandanursewillpopinonyouinacoupleofdays’.…Whileyouwaitforthosethings,whatelsecanyoudoand…I’veseenitwherekidswithself-regulation

issues–andyouthworkershavetakenthemtohitgolfballsandtalkaboutthingsasthey’re

doingit,inarelaxedandinformalway.”(Serviceprovider)

“Iwouldlovetoseepeersupportlike,absolutelyeverywhereanditisgettingmorewidespread.”

(Youth)

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Livingwithmentalhealthproblemsandmentalillness,therecoverymodelTheencountersthatchildren,youthandfamilieshavewithformalservicesandsupports,eveniftheyarelivingwiththesevereand/orcomplexmentalandemotionalhealthissues,formonlyasmallpartoftheirlife.Thatis,theamountoftimepeoplespendvisitingpsychiatrists,psychologists,socialworkers,andothercounselorsandservices,isminisculecomparedtotheamountoftimetheyspendlivingtheirlivesinthecontextoffamilies,othernaturalsupportsandcommunities.Ultimately,boththerecoverymodel(seedefinitioninboxbelow)andafamily-centredapproachtocare/servicesrecognizethisreality.Thefocusshiftsfrom“treating”mentalillnesstohelpingpeoplewithmentalillnessthriveandoptimizetheirwellbeing.TheyoungpeopleinterviewedwhohadparticipatedintheCMHACalgary’sRecoveryCollegedescribedthevalueofthismodel,notingthatpeersupportisanessentialcomponentofthismodel.

“We’reverymuchpersonfocusedasopposedtodiagnosisfocused…IfeellikepeerworkspecificallyandwhatCMHAisdoingisdifferentthanalotofotherorganizationsbecausethere’slikeaclientcounselorrelationshipinotherorganizationswhereaslikewithapeeryou’resittingacrossfromsomeonewho…we’renotassessingyou,we’renotwritingnotes,we’rejustlisteningandhelpingyoucometoyourownconclusionsandsupportingyouonyourownrecoveryjourney…we’renotfocusedonlikefixingthingsforpeople,justkindofsupportingthemfixingthingsforthemselves.”(Youth,Peersupporter)

WhatisRecovery?Theconceptofrecoveryinmentalhealthreferstolivingasatisfying,hopeful,andcontributinglife,evenwhenapersonmaybeexperiencingongoingsymptomsofamentalhealthproblemorillness.Recoveryjourneysbuildonindividual,family,cultural,andcommunitystrengthsandcanbesupportedbymanytypesofservices,supports,andtreatments.

Recoveryprinciples,includinghope,dignity,self-determination,andresponsibility,canbeadaptedtotherealitiesofdifferentlifestages,andtothefullrangeofmentalhealthproblemsandillnesses.Recoveryisnotonlypossible;itshouldbeexpected.

Championedbypeoplewithlivedexperienceofmentalhealthproblemsandillnessesfordecades,recoveryisbeingwidelyembracedbypractitioners,serviceproviders,andpolicymakersinCanadaandaroundtheworld.Itisrecognizedaskeytoachievingbettermentalhealthoutcomesandimprovingmentalhealthsystems.

“We’reverymuchpersonfocusedasopposedtodiagnosisfocused…IfeellikepeerworkspecificallyandwhatCMHAisdoingis

differentthanalotofotherorganizationsbecausethere’slikeaclientcounselor

relationshipinotherorganizationswhereaslikewithapeeryou’resittingacrossfrom

someonewho…we’renotassessingyou,we’renotwritingnotes,we’rejustlisteningand

helpingyoucometoyourownconclusionsandsupportingyouonyourownrecoveryjourney…we’renotfocusedonlikefixingthingsforpeople,justkindofsupportingthemfixing

thingsforthemselves.”(Youth,Peersupporter)

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Inrecovery-orientedpractice,serviceprovidersengageinshareddecision-makingwithpeoplewithlivedexperienceofmentalhealthproblemsandillnesses,offeringarangeofservicesandsupportstofullymeetaperson’sgoalsandneeds.

Recoveryapproachesstandontwopillars:

• Recognizingthateachpersonisunique,withtherighttodeterminetheirpathtowardmentalhealthandwellbeing;and,

• Understandingthatweliveincomplexsocietieswheremanyintersectingfactors(biological,psychological,social,economic,cultural,andspiritual)haveanimpactonmentalhealthandwellbeing.

RetrievedMarch28,2018from:https://www.mentalhealthcommission.ca/English/recoveryAnumberofintervieweesnotedtherearemanyotherkindsofpsychosocialsupportsthatpeoplecanusetocopewithormanagetheirmentalhealthproblems,suchassports,recreation/leisure,arts,skilldevelopment,buildingsupportivesocialnetworks.

“Wedoreallywellonthecommunitybasedsideofthingsandthat’swherewe’regrowingourresourcesandwherewe’rereallyseeingtherebeinganeedinthecommunityisthat,youcangotoyourclinicianandyoucanhaveaonce-a-monthmeetingwheretheycheckinortheygiveyouyourprescriptionforyournextroundofmedicationthatyouneedtotake,butwhathappensinthe80-90percentofthetimethatyou’renotaccessingthosesupports?You’relefttoyourfriendsandyourfamilytotakecareofyou.Youmayfindsomeothernon-profitthatofferssomekindofprogrammingandsupport,butreally,you’relefttoyourowndevicesandsowe’relookingathowcanwecapturethosepeople?Howcanwefindaspaceinthecommunityforthemtoliveinwherethey’rebuildingtheirowncommunity.”(Serviceprovider)

Othersspokeaboutfindingwaystoliveafulfillinglifedespitehavingamentalillness–andthevalueofbeingconnectedtoa“touchpoint”inordertodowell:

“Sometimesapersonmightbeexperiencingafairlyseverementalillness…andjuthavingthatmonthlytouchpointintoaresourceallowsthemtostaystableand/orflourish,whereasnothavingitcreateshugeissuesintermsoftheirlifeandintermsofthecosttothem,tothesystem.”(Serviceprovider)“[There’s]compliancewithtreatment,butwhatelseareyougoingtodotosupportyourselfwithlifestylemanagementthings,andespeciallykids….Thatalsoincludesthingslikecommunicationskillsandrelationshipskillsandemotionalmanagementandself-regulationandunderstandingthosepieces--buildingcompetence,resilience,supportiveenvironments,empowerment–allstrongwordsbuttheyallrelatetothingsthatcanbemodeled,taughtandshouldbepartofthechild’senvironment.”(Serviceprovider)

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Inthetablebelow,asummaryofkeypointsforthissetofgaps/challengesispresented.Informationprovidedbykeyinformantsaboutexistingstrengthsandefforts,andsuggestionsforaddressingchallengesisalsoincluded.

TransitionsIntermsofgapsandchallengesinaccessingandreceivingmentalhealthservicesandsupports,afinalthemeistransitions;thatis,children,youthandfamiliestransitioningfromoneserviceoragegrouptoanother.Thesearetimeswhenservicesmaybelackingornotcoordinated,andwhenpeoplecouldinadvertentlyget“droppedout”ofthesystem.Oneintervieweenotedthatanytimeoftransitionispotentiallyaweaklink.Someparticularlyproblematictransitionsdescribedbykeyinformantsareoutlinedbelow.

TransitionsfromoneagencyorservicetoanotherTransitionsfromoneagencyorservicetoanothercanbeproblematic.Forexample,ifachild/youth/familyisseenbyoneagency,butthenisreferredtoanotheragency,therearefewmechanismsinplacetomakesurethattransitionactuallyoccursandthatnecessaryinformationis

Table6.Summary.Gaps/challenges,strengths,andpossibleresponsesrelatedto:Supportswhilewaitingfor,andbeyond‘treatment’Keygaps/challenges• Longwaitlistsforclinicalcare,orfailuretoqualifyforAHS’sCAAMHPprogram,ornotillenoughfor

hospitaladmissionmeansthatfamiliesareoftenleftontheirowntocopewithchild/youthMHconcernsthatcanbeextremelystressfulandchallengingtomanage(e.g.,suicidal;self-harming;violent/aggressive)andcansignificantlyimpactthewholefamily

Existingstrengths/effortsunderwayasidentifiedbykeyinformants• CMHA’sPeerSupportSchool,peersupporters,RecoveryCollege• DistressCentre’sConnecTeen• Anumberoforganizationshavewalk-inclinicsandsinglesessionclinicsthatpeoplemightaccessto

talkaboutcopingstrategiesandnextsteps

Possibleresponsesasidentifiedbykeyinformants• Expansionofexistingfamilyandyouthpeersupportservices;inclusionofnaturalsupports• Mentalhealthsupportsforparentsandfamiliesasawhole• E-mentalhealthsupports• Moresinglesessionandwalkinclinics• Integratedfamily/youthserviceshubs• Psychosocialandothernon-clinicalsupports–e.g.,sports,recreation,arts• Engagechildren/youth/familiesindefiningissuesanddesigningservices/supports

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sharedappropriately.Thefamilyessentiallywindsupretellingtheirstoryoverandoveragain.Someintervieweesnotedthatinverycomplexcases,theymightdomoreofa“warm”handoff–thatis,introducingthechild/youth/familytothereceivingagencyandsharingrelevantinformation.However,thiswasnotedtobetheexception,ratherthanthenorm.

Transitionsbetweenacutecareandcommunity-basedservicesThesecond,andwidelycitedproblematictransitioniswhenchildren/youth/familiesreceivingcarefromcommunity-basedNGOswindupbeingadmittedtoAHSmentalhealthandaddictionprograms,ortohospital,andthenwhentheyaretransferredoutoftheAHSsystembacktocommunity-basedcareprovidedbyNGOs.ThisisdepictedinFigure3below.

Figure3:Transitionsbetweenacutecareandcommunity-basedservicesYouthandfamiliesalsodescribedthechallengestheyexperiencedatthesetransitionpoints.MuchofthiswasdescribedearlierinthecontextoftransitionsintoandoutoftheED.Serviceproviderscertainlyrecognizedthechallengesthatchildren,youthandtheirfamiliesexperiencedatthesetransitionpoints:

• Transi(onfromcommunitybasedcareintoAHSservices

CommunityBasedNGOCare

• AdmissiontoAHSCAAMHPPortohospital• Nocommunica(onbetweencommunitybasedprovidersandAHSproviders• CommunityassessmentsmayberepeatedbyAHS

AHSBasedCare• DischargeoutofAHSservicesandreferraltocommunitybasedservices• Informa(onisnotalwayssharedwithcommunityservices

CommunityBasedNGOCare

Disconnect

Disconnect

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“WehaveongoingstruggleswithdischargingpatientswhoareinexistingprogramswithinAHSforfearthatifwedischargethem,wedon’tthinkthey’regoingtogetwhattheyneedinthecommunity.So,we’llkeepthemlongerinanacutecaresite…Again,ifthatnaturalsortofhandoffwasthere,theywouldfeelmoreliketheycoulddischargethatpatient–knowingthere’ssupportsoutthereandthosesupportsarewellsupported.”(Serviceprovider)

“Ifyouknowhowtoaccessservices,onceyouknowhowtodothat,there’sarealdisconnectbetweengovernmentserviceslikeAlbertaChildren’sHospitalandcommunitybasedresources…there’sadisconnectbetweengrassrootsorganizationswhowanttoworkwithmentalhealthversusprofessionalsinagovernmentsetting.…There’salotofmisconceptionaboutthecommunityfromthegovernmentendofit–iftheyreferout,theyonlywanttorefertoclinicallytrainedpeople.There’sadevaluingofcommunitypartnersasfarasusingthemforsupport.”(Serviceprovider)“Oneoftheproblemswithinstitutionsistheinformationdoesn’tgobacktothepeoplewhodealwiththefamilyandchildeveryday-suchasschools.Notthatyoushouldshareallinformation,butyoushouldsharecertainlyplansforhelpingthekid.”(Serviceprovider)

Oneintervieweedescribedalackoftrustbetweencommunity-basedNGOsand“Health”andthe

associatedlackofcommunicationandsharingofinformation.Sheobservedthatthisisn’tanintentionalthing,butmoreofanoversight.Anothersimilarlyspokeoftrustissuesintermsofwhetherornototheragencieswouldtreattheirclientsappropriately.“Theotherfactoriswedon’ttrust-Healthdoesn’ttrustthoseofusthatareinthecommunity…Mystaffcouldhavebeeninvolvedinacaseforonetothreetofourmonths.Wedecideweneedanassessmentorsomerespitecareorthere’smedicalinterventionthat’srequiredandthechildgetsadmittedtoChildren’s.Wearenever,everconsultedbyHealthforaconsultationormeeting.It’sasifourworkdoesn’texist.Andoftentimesthefamilyfeelscaughtbetweentheirrelationshipwiththeclinician

“WehaveongoingstruggleswithdischargingpatientswhoareinexistingprogramswithinAHSforfearthatifwedischargethem,we

don’tthinkthey’regoingtogetwhattheyneedinthecommunity.So,we’llkeepthemlongerinanacutecaresite…Again,ifthatnaturalsortofhandoffwasthere,theywouldfeelmoreliketheycoulddischargethatpatient–knowingthere’ssupportsoutthereandthose

supportsarewellsupported.”(Serviceprovider)

“Theotherfactoriswedon’ttrust-Healthdoesn’ttrustthoseofusthatareinthecommunity…Mystaff

couldhavebeeninvolvedinacaseforonetothreetofourmonths.Wedecideweneedanassessmentor

somerespitecareorthere’smedicalinterventionthat’srequiredandthechildgetsadmittedtoChildren’s.Wearenever,everconsultedbyHealthforaconsultationor

meeting.It’sasifourworkdoesn’texist.”(Serviceprovider)

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inthecommunityandworriesthatiftheydon’tdowhattheteaminthehospitalsays,they’regoingtoloseaccesstoservicesthere.Sotheysaygoodbyetous.Sothat’saproblembecausewhataboutcontinuityofcare?”(Serviceprovider)

“Wewillhaveourpreferred[agencies]thatwewillabsolutelyworkwithbecauseweknowthem.Weknowtheirreputation.Weknowthatifwehavetohandoffoneofourclientstosomeone,they’regoingtogetappropriateservice,butI’mtellingyou–it’sadigdeep;it’sadeepdigtofindthatconnectionandtoactuallybesuccessfulwithit…We’rejustalltryingtoflybytheseatofourpantsandmakethebestdecisionstoguideourclients…It’sabout,‘Oh,myGod,this14-yearoldtrulydoesneedhospitalization.HowdoImakethathappenwithouthimgettingbouncedoutofemergencyandsenthometoafamilythatisreallystrugglingwithhowtocareforthechildwho’sinanacutementalhealthcrisis?’”(Serviceprovider)

TransitioningfromadolescentmentalhealthservicestoadultservicesAnotherwidelycitedtransitionissuewasthatofmovingfromadolescentmentalhealthservicesintoadultservices.Anumberofchallengesareassociatedwiththistransition,includingdifferentphilosophiesofcarebetweenyouthandadultservices;fewerresourcesandsupportsintheadultsystem;and,changesintheroleoftheparent,issuesofconsentandsharingofinformation.Thisisparticularlydifficultforyouthandyoungadultswhohavecomplexissuesandinvolvementinmultiplesystems.Theymaybeinvolvedinthechildwelfaresystem,orthejusticesystem;theymaybepermanentwardsoftheprovinceortheymayhavesignificanthealthissuesthathaveexcludedthemfrommoretraditionalwaysofaccessingservices.Whiletherearesomeprogramsinplacetosupportyoungadultsinthistransition,theytendtohavelongwaitlists.AHSinterviewees,forexample,notedforexample,aone-yearwaitinglistforemergingadulttreatmentservices;Hull’sBridgingtheGapprogramhasapproximately100peopleonthewaitinglist.

“Inthebestcasescenario,youngadultsareverywellsupportedwithlotsofwraparoundsandfamilyengagement.Andthentheyturn18andthey’retechnicallyadults,buttheydon’tnecessarilyfitintotheadultworldintermsoftheirfunctioningortheresourcesthattheyneed.Sowehaveanumberofemergingadulttreatmentserviceswithin[AHS]butthey’revery,verystretchedintermsofthedemandintothatservice.Theyhaveayear-ishwaitlist.Averylongtimeandfolksthatarereallystruggling.”(Serviceprovider)

“We’rejustalltryingtoflybytheseatofourpantsandmakethebestdecisionstoguideourclients…It’sabout,‘Oh,myGod,this14-yearoldtrulydoesneedhospitalization.HowdoImake

thathappenwithouthimgettingbouncedoutof

emergencyandsenthometoafamilythatisreallystrugglingwithhowtocareforthechild

who’sinanacutementalhealthcrisis?’”(Serviceprovider)

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“Evenif[youngadults]metthecriteriaforserviceinthechildandyouthsystem,theynolongermeetthecriteriaintheadultsystem.Sothatcanbeagap…Again,asyougetintotheadultsystem,thecriteriaforservicenarrows.Youneedtobeexperiencingmoreextremeproblemsinordertoaccessservices.”(Serviceprovider)

“Whenyoutransitionfrombeinginchildmentalhealthsupportsintoadultmentalhealthsupports.It’salmostnightandday.Yougetdroppedinstantly,almostandit’s,‘Figureitout’”.(Serviceprovider)“Ouryoungpeoplewhoare16to24…maybecomingoutoftheirchildhoodyearswithsomebehaviouralmentalhealth,addictionsanddependingonthefamilysystemorotherresourcesandsupports–theseareoftentimesmarginalizedgroupsthatverymuchneedtobeattendedtoortheyfallintoourhealthcaresystemorourjusticesystemorourhomelesspopulation.Justbecauseofinadequateaccesstoresourcesandsupports.”(Serviceprovider)

OtherpotentiallydifficulttransitionIntervieweespointedoutthreeothertransitionpointswherechildren/youthmightfallthroughthecracks.• Transitioningintoadolescence-Agenerallackofservicesforthemiddleyears–ages7to13.One

intervieweenotedalackofservicesforthisagegroup,whichisthetimewhenmanymentalhealthproblemsandillnessesbegintoemerge,otherthanthroughchildinterventionservicesorschoolinterventions.However,thispersonsaidtherearefewyouthworkersinelementaryorjuniorhighschools.Thisisamissedopportunitytocatchemergingissuesearly,andpreventmoreseriousonesdowntheroad.Anotherintervieweenotedthereisaspikeofpresentationsinkidsaged11to13,whichisnotsurprisinggivenchildrenthisageareenteringjuniorhigh,“hormonesarekickingin”,andtheyhavegreateraccesstothebroadercommunityand“thingstheycangetthemselvesintotroublewith”.Thisintervieweeconcluded,“That’sdefinitelyagroupIthinkweneedtoputalotofenergyandeffortinto”.

• Transitionsfromschoolbasedmentalhealthsupportstoclinicalcare–“Idon’tthinkthere’sa

greatpathwaybetweenschoolbasedmentalhealthintomoreclinicalservicesortreatment..there’sstillagap.Peoplehavetowait.Youhavetogoonawaitinglist.It’snotasmoothtransition.”(Serviceprovider)

• Transitionsbetweencommunity-basedresidentialcareandothercommunitysupports–asmall

numberofintervieweesmentionedthatthistransitioncanalsobedifficult.

“Whenyoutransition

frombeinginchildmentalhealthsupportsintoadultmentalhealthsupports.It’salmostlikenightandday.Yougetdropped

instantly,almost,andit’s,‘Figureitout’”(Service

provider)

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Inthetablebelow,asummaryofkeypointsforthissetofgaps/challengesispresented.Informationprovidedbykeyinformantsaboutexistingstrengthsandefforts,andsuggestionsforaddressingchallengesisalsoincluded.

Table7.Summary.Gaps/challenges,strengths,andpossibleresponsesrelatedto:TransitionsKeygaps/challenges• Majorgap–disconnectswhenclientstransitionfromcommunity-basedNGO-providedservicesinto

AHS,andthenbacktocommunity-basedservices–lackoftrust,communicationandinformationsharingbetweenorganizations

• Majorgap-transitionbetweenadolescentMHservicesandadultMHservices(significantdifferencesbetweenadolescentandadultservicesmakethetransitionverydifficult)

• Anothergapinservicesmaybeforchildrenaged7to13• Gap-transitionfromschoolbasedMHprogramstoclinicalMHprograms• Gap–transitionsbetweencommunity-basedresidentialcareandothercommunitysupports

Existingstrengths/effortsunderwayasidentifiedbykeyinformants• RCSDiscurrentlyfundingCONEXandamentalhealthtransitionsposition(workingwithPsychER,

inpatients,schooldivisions,children’sservicesandFSCD–howeverthisisonlyapilot;itisnotannualizedfunding

• ResearchisunderwayintheFacultyofSocialWorkattheUniversityofCalgaryre:useofnavigatorsintransitionsfromadolescenttoadulthealthservices(SusanSamuelsandGinaDimitropoulos)Possibleresponsesasidentifiedbykeyinformants

• BringAHSandcommunity-basedorgstogethertofindwaystoimprovetransitionsandensure“warm”entriesandhand-offsbetweenservices

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SystemissuesPerhapsoneofthestrongestthemesemergingfromthekeyinformantinterviewsisthatcurrently,therereallyisn’ta“system”ofmentalhealthservicesandsupportsinCalgary;rather,peopledescribedthecurrentstateas,“fragmented”,“piecemeal”,and“siloed”.Acommonconcerninparticularwasthelackofintegrationacrossgovernment,non-governmentandprivateorganizationsnotonlyinCalgary,butprovincially.Oneintervieweedescribeditthisway:

“A‘continuum’suggeststhatthereisintentintermsof,andtransitionfromprogramsorfromacuityorfromexpertiseandawebalwayshastheconnectingpointaswellfromwhichthingsradiate.IwouldnotsaythatinCalgaryspecificallyandperhapsevenintheprovince,thatthereisanystructureinplacethatallowsthenon-profit,theprivate,andthepublicsectorsaroundmentalhealthforchildrenandyouthtoactuallyinteractinaveryintentionalmannerforfamilies.”(Serviceprovider)

Thislackofintegrationisperhapsmostobviousforchildren/youth/familieswhohavecomplexneeds.Twoserviceproviderintervieweesspokeatlengthofstrugglingtofindprogramsthataddressanumberofcomplexneedsinacoordinatedway.Onenotedtheremightbeaplacetogoforaddictionshelp,oraplaceforhelpwithemotionalregulation,andaplacefortrauma

symptomsandchildabuse,buttheseareallseparateservicesthatarenotoperatinginanorganized,integratedorcoordinatedway.Thisbecomesveryconfusingforyouthandtheirparents:

“Thisbecomesveryconfusingfortheyouthandtheirparentstryingtonavigateallofthis.Theyalreadyhaveaverycomplexchildandnowthey’retryingtomakesenseofalloftheseservices.Eachservicemayhaveaparticularthingthattheycanaddress.Thereisn’toneprogramorbodythatcouldtakechargeandoverseethis.Someservicesaretryingtodothis–forexampletheCONEXprogramofferedbyCalgaryAreaRegionalCollaborativeServiceDelivery(RCSD),whichbringsagenciestogetherforcaseconferencing,butthisprogramhassomeveryspecificinclusioncriteriawhichthenpresentsbarriersforthosenotmeetingthecriteria.”(Serviceprovider)

Anotherintervieweespokeoftheneedtostructurechildren’sservicesasajointarrangementinwhichmultipledepartmentsareinvolvedandco-located-whichshouldideallyavoidthesiloingandthe,“that’syourchildissue,notmychildissue”.Thispersonnotedhowdifficultitisforprofessionalstomanagethiscomplexity,letalonefamilies:

“A‘continuum’suggeststhatthereisintentintermsof,andtransitionfromprogramsorfromacuityorfrom

expertiseandawebalwayshastheconnectingpointaswellfromwhichthingsradiate.IwouldnotsaythatinCalgaryspecificallyandperhapsevenintheprovince,thatthereisanystructureinplacethatallowsthenon-profit,theprivate,andthepublicsectorsaroundmentalhealthforchildrenandyouthtoactuallyinteractina

veryintentionalmannerforfamilies.”(Serviceprovider)

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“Insomeinstances,yourealizekidsmayhitonfiveorsixdifferentsystemsatonceandyourealizeveryquickly–whathappenstherewhenyouhavedifferentfundingstreamsordifferentwaysinwhichneedsaremanaged–theserviceproviderortheclinicianendsupbeingthecasemanagerofallthesesystems.That’satrainedprofessional.Imagineaparentorguardiantryingtogeteverybodyonthesamepage….AsignificantamountofonusseemstobeputonthefamiliestodothisinmanyinstancesandIthinkgivenwhatmanyareexperiencingandinsomeinstancesintermsoftheday-to-daychallengesofsomeoftheirchildren–puttingthatadditionalburdenonthemtofigureoutwheretocallandwhotospeakwithandwaitinglistsandallthosekindsofthings…Ithinkit’s…we’reallbusyinthisworld.Forsomeofthemitalmostbecomestheirfulltimejoboftryingtomanagethesesystems.”(Serviceprovider)

Theissueofnavigationtohelpfamiliesfindtheirwaythroughallofthissurfacedanumberoftimes.Therearedifferentunderstandingsofwhat“navigation”mightlooklikeandforwhom.Itwasconsistentlynotedthatthereareresourcingrequirementsthataccompanynavigation,andalsothatnavigatorswouldsimilarlystrugglewithallthefragmentationinthesystem:

“Theconceptof[anavigator]makessense–it’showmuchresourcesarepeoplepreparedtoprovidetothesekindsofindividuals...Again,youneedtohaveawarenessoftheprogramsandservices,butyoualsoneedtounderstandallthesedifferentprogramsandservicesactandreacttooneanother…that’salsotheknowledgeandexpertiseyouneedtohaveaswell.”(Serviceprovider)“Children’smentalhealthiscomplicated…Itcouldbeeasierwithservicenavigation,exceptthatthosepeoplewouldhavetodealwiththekindsofthingswe’vebeendealingwithforever,whichisdifferentmandates,turfprotection,peoplesayingtheycan’tdothisandtheycan’tdothat…oftenpeoplejustbegintogetfrustratedbecauseit’sbasicallythelargersystemsthatarenotcommunicating.TheMinistryofChildren’sServicesdoesnottalkwiththepartofHealthwherethey’retalkingaboutchildren’smentalhealth,whereverthatis.”(Serviceprovider)

Intervieweesalsospokeatlengthaboutthereasonsforfragmentation.Thesearedescribedbelow.

Whysomuchfragmentation?Intervieweesofferedmanyinsightsaboutwhythe“system”issofragmented.Thisincludesitshistoricaldevelopment,lackofmechanismsorabodyforoveralloversightandplanning,lackofsharedlanguageandprinciplesforsupportingpeople,divergentunderstandingsof“mentalhealth”,andthewaythatservicesareresourced.

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HistoricaldevelopmentoftheNGOsectorinCalgarySomeintervieweesattributedfragmentationtothehistoryofnotforprofitsinCalgary,specificallythattherewasneveranyvehicleforcollaborativeplanningorintegration,thereiscompetitionamongstnot-for-profits,andprogramsandservicesweredevelopedinresponsetoneedsastheyaroseinthecommunity,oronmandatesimposedbyfunders.Overseveraldecades,thishasresultedinthecurrentpatchworkofservicesandsupportsthatexiststoday.

“We’restilltryingtoundotheharmcausedbythisfragmentedfundedmodel…that’swhatisbehinditallisthatpeoplehaveaparticularlegalmandatetolookafteraparticularpopulationorissue,whetheritbehealthandmentalhealth,orrehaborimmigrationandsettlementandsoon–thenwe’reallfacingacareertryingtointegratethismessthatstartedbackinthebeginningwhentherewasn’tanintegratedviewaboutwhatwe’retryingtoaccomplish.Andsothemoneydrivesandpopulationsandthemandatesandtermsanditcreatesthatcompetitiveenvironmentbetweentheagenciesaswell.Sowe’rereallynotgettingattheunderlyingproblemthatstartedatthatlevel.”(Serviceprovider)

“Westartedthis‘neverturnanyoneaway’philosophy[decades]ago…sowestartedsaying‘yes’allthetimeregardlessofwhetherornotaprogramhadaparticularmandate.Asaresult,wecreatedprogramstofillgapsthatpeopleseemedtoneed.That’swhywehavethis.Sometimesdonorsaskwhyithastobesocomplicated…Itellthemweactuallycreatedprogramsbecausepeoplesaid,‘Helpme’andwedidn’thavethatprogramsowecreatedsomethingtofillthatgapandthat’swhyit’scomplicated.That’sbecausepeoplearecomplicated.”(Serviceprovider)

NooverallsystemoversightorplanningSeveralintervieweespointedoutthatthereisnobodythatoverseesthebiggerpictureofmentalhealthservicesandsupportsinthecity,andtherearefew,ifanyopportunitiesforpeopletocometogethertodiscussthingsandplantogether,especiallyinrelationtochild/youth/familymentalhealthneeds.TheyalsonotedthereisalackofclarityregardingthescopeofNGOsinthecommunityandofAHSthatcancreateunnecessaryduplication.Someexpressedhopethatthecurrentprojectwouldbeanopportunitytobringpeopletogetherforthesekindsofdiscussions.

“Thereisnopartythathastakenresponsibilityforoverallsystemplanningforsocialandhumanservices–it’snotclearwhereresponsibilityforthatfits–maybethat’stherootcauseforapiecemealsystem?”(Serviceprovider)“There’salackofclarityinthecommunityastowhatpeoples’scopeisandwheredoeseachindividualplayerplayandhowfardotheystretchoutandwheredoothersmaybeoverlaporwherearethegaps.Becausewiththat,especiallyinyouthmentalhealth,there’ssmallgrantfundingthatpopsupandgivespeopletheabilitytodobitsandpiecesandsoalltheselittlethingsaregoingon….WhereisAHS’slineinthesandandthenwhendoesitgointocommunityandwhereiseachcommunityplayer’slineandsowe’renotduplicatingservices;sothatwe’replayingatruepartinthecontinuumandthattherecanbeasmoothhandover.Thisiswhereourwork

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ends,andthenlet’shandyouovertotheseexperts.Butthere’snotalotofclarityinthecommunityaroundthat.”(Serviceprovider)

Itwasalsonotedthateveryorganizationhassomepieceofthechild/youth/familymentalhealthpuzzle,butnottheentirepuzzle,soitisimportanttoworkcollectivelytowardbetteroutcomesforchildren/youth/families,understandinghoweachorganizationcanmakeacontribution.Asoneintervieweenoted:

“Ourfocusistochangethetrajectoryoftheindividualoutcomes–sotryingtoknitallofthistogetherfromanevidence-basedperspectiveyetweonlyhavescopeandcontrolofsmallbitsofit.Again,like,whoisourneighbourandhowcanwe,together,boostmoresupportsandservices.”(Serviceprovider)

Lackofcommonlanguage,principlesand/oraframeworkforcollaborationandintegrationAnothercommonexplanationforthecurrentfragmentationwasthelackofsharedlanguage,principlesand/oraframeworkthatcouldserveasafoundationforanintegratedwebofsupports.Thiswouldenablepeopleacrossagenciesandorganizationstoworkfromthesamepage,althoughitwasrecognizedthatthismaybechallenginggiventhediversityofculturesandperspectives:

“Evenifthereweresomecommonlysharedprinciples…likeafamilyorsystemicorientationcustomerservicemodel–thatwouldmakeadifference…butthere’sevendifferentcultures…andsomepeoplearecominginfromahierarchicalwayof‘knowingbetter’thansomepeople...Iwantallpeopleworkingfromthesamepage.”(Serviceprovider)

Othersspokeoftheneedforasharedvision,whichrequiresorganizationstothinkinacollaborativefashion,ratherthanonlyself-promotion.OneexamplecitedasaneffectivecollaborativeinCalgaryistheCalgaryDomesticViolenceCollective(CDVC):

“FortheCDVC,it’saboutbuildinganewnarrativearounddomesticviolenceandengagingthecommunityatlargeinthepreventionof[DV]–soitisaboutsharedvision,notjustselfinterestofparticularorganizations.”(Serviceprovider)

Suggestedprinciplesforsupportingchildren/youth,familiesandnaturalsupportsIntervieweessuggestedsomeprinciplesthatmightundergirdaframeworkforchild,youthandfamilymentalhealthservicesandsupports.Manyofthesearethesamevaluesthatunderpinfamily-centredandrecoverymodelsofcareandservices.• Abroadandpositivedefinitionofmentalhealthandaholisticapproachthatincludesnotonly

clinicalaspectsbutalsosupportsforlivinganddevelopingwelldespitehavingamentalhealthproblemorillness

• Akind,compassionatehumanbeing-to-humanbeingfocus.

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“Forus,it’saboutahumanbeingtohumanbeingfocusandunderstandingthatanyofus–youknow,lifehitsusall–right?Youdon’tgetoutofitscotfree.”

• Keepingthefamilycoretosupportingkidsandyoungpeopleandusingnaturalsupportsthatkids

haveidentifiedwhereverpossible

o “Ifwe’retalkingaboutchildren’smentalhealth,we’rereallytalkingaboutfamilymentalhealthorfamilyhealth–it’sreallyhowdowecreateenvironmentsandplaceswherefamiliescanhavegreateraccesstothesetypesofservicesandsupportsthatonbehalfoftheirchild.”

o Ensureweusethewordfamily–orevenbetter,mothersandfathers-“becausewhenyouthink‘parents’,peoplethink‘mothers’

• Needstoincludethe“frontend”–mentalhealthpromotion,mentalillnessprevention,earlychildhooddevelopment,earlyidentificationandinterventionforproblems,andthesocialdeterminantsofhealth

• Shouldalignwithprovincialdirections(i.e.,ValuingMentalHealthNextSteps)

Divergentunderstandingsof“mentalhealth”Akeyaspectregardingthelackofacommonlanguageandprinciplesisdivergentviewsandunderstandingsof“mentalhealth”.Someintervieweesreferenced“mentalhealth”purelyinclinicalterms,asindiagnosablementalillnesses.Othersreferenced“mentalhealth”inmuchbroadertermsandinapositivesenseasinmentalwellbeing,resilienceandflourishing.Thechallengeisthathow“mentalhealth”isdefinedshapeswhatisconsideredtobewithinthelegitimatepurviewof“mentalhealth”servicesandsupports.Thosewithanillness,clinicalorientationwilltendtofocusmoreondiagnosisandtreatment,whilethoseadoptingabroaderandpositiveviewof“mentalhealth”willtendtoembracealargerarrayofservicesandsupportsthatincludemultipledimensionsof“health”-spiritual,social,emotional,financialandsoon.Thetwopositionsarenotmutuallyexclusive;rather,bothareessentialifthedesireisacomprehensivesystemofsupports.

“Mentalhealth–overall,I’vekindofcomefromtheschoolof,insomeways,modernthought,reallythatit’sallaboutmentalwellnessandthatprimarycareandmanyotherthings,socialandenvironmentalandcommunity,allfeedintothat…butforyouthinparticular,orachildtobementallywell,alotofthingshavetocomeintoplay.”(Serviceprovider)

“You’vegotamedicalmodellookingatthechildbutnotthecontextandthenacommunitymodelthat’slookingatthecontextwiththechild.Totallydifferentframesofthought…It’slikeanalientalkingtoagiraffe–differentlanguages.”(Serviceprovider)

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“Whenwethinkmentalillnessormentalhealth–inaclinicalsettinglikeahospital,theirperceptionofthecommunityandwhatthecommunityisdoing,isn’tholisticinthatway.Andthevalueofwhatyoucanputinplacefromdifferentagencyworkerstodothatworkandtodosomesocio-emotionallearning,whichalsobuildsmentalhealth,Idon’tthinkthatthere’sanacceptanceoracknowledgmentthatthat’simportantaswell.That’sabarrier.”(Serviceprovider)

ResourcingResourcingofmentalhealthservicesandsupportsalsosurfacedasanimportantfactorunderlyingthecurrentstateofaffairs.Twothemesemergedfromthedatahere:thefirstisthatmentalhealthservicesareunderfunded;thesecondrelatestothewaythatNGOsarefunded.

AlackofresourcesAhandfulofserviceproviderintervieweesnotethatmentalhealthisunderfunded.Thislackofresourcingalsoplacesstrainonorganizations,includingstaffwhoareoverworked.WhilegovernmentandNGOorganizationsalikeworktothebestoftheirabilitytooperateefficientlyandeffectively,alotmorecouldbedonewithadditionaldollars:

“Mentalhealthisunderfunded–thebigchallengeisactuallyaresourcechallenge.[Mentalhealth]isunderfundedandsoI’malwaysreluctanttoprovidesuggestionsaroundnavigatingprogramsandserviceswhen–that’sgreatinprinciple,butifyoudon’thavetheprogramsandservicesoryouhavehugewaitinglistsoryoudon’thavesupportsinplacesthatfamiliescouldadequatelyaccess,thenthoseareallthingsthataresignificantimpedimentsrightfromtheword‘go’.”(Serviceprovider)

“You’vegotamedicalmodellookingatthechildbutnotthecontextandthenacommunitymodelthat’s

lookingatthecontextwiththechild.Totallydifferentframesof

thought…It’slikeanalientalkingtoagiraffe–differentlanguages.”

(Serviceprovider)

“Mentalhealthisunderfunded–thebigchallengeisactuallyaresourcechallenge.[Mentalhealth]isunderfundedandsoI’malwaysreluctanttoprovidesuggestionsaroundnavigatingprogramsandserviceswhen–that’sgreatinprinciple,butifyou

don’thavetheprogramsandservicesoryouhavehugewaitinglistsoryoudon’thavesupportsinplacesthatfamiliescould

adequatelyaccess,thenthoseareallthingsthataresignificantimpedimentsrightfrom

theword‘go’.”(Serviceprovider)

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“LackofresourcesisdefinitelysomethingIhear,notonlyinternallyfromallofourstaffbutweworkinalotofcommunity-basedresources…it’sthenumberoneissuethatpeoplesayisabarriertomentalhealthforanypopulationandsoweknowinternallythatlackofresourcesrequiresmystafftocarrywayheaviercaseloadsthanisprobablygoodforthemortheirpatientsanditcreateslongwaitinglists.”(Serviceprovider)

Otherssimilarlynotedthatdemandfortheirservices,despiteeffortstostreamlineandimproveflow,isoutstrippingresourcesandaddingtowaittimes.Thisisanimportantmattertoattendto,saidoneinterviewee,giventhatthereisalargecohortofchildrengoingthroughthesystemnowwhowillsoonbecomeadolescents,furtherincreasingthedemandonbothAHSandcommunity-basedservices.

“Despiteallofourbestefforts,westillhavewaitlists.Mostofourserviceshavegonethrough[processimprovement]programstomakethemmoreefficient...butthedemandisoutstrippingourresources.”(Serviceprovider)

Thewaythatnon-governmentalorganizationsarefundedThereisalimitedpoolofresourcestosupporttheNGOsthatareprovidingmentalhealthservicesandsupportsinthecommunity,andintougheconomictimesthispoolshrinks.NGOsaredependentonongoingfundingtosupporttheirprograms.Thecurrentsystemrequiresthattheseorganizationsrelyonthesamepoolofresources,whichcanresultincompetitionratherthancollaboration.Howcanfundersencouragepartnershipsbetweenthesecommunityorganizations?

“[We]needmoreconversationaboutfundingstructuresforcommunityorganizations,inordertoenablelesscompetitionandmorecollaboration.Howdowedothis?Ifallyourenergygoesintosurvivalandcompetition,thenthereisnothingleftforcollaborativeinnovation”.(Serviceprovider)

Additionalissuesdescribedbyserviceprovidersincludedthefollowing:• NGOsaresubjecttothechangingprioritiesoffunders.Onepersondescribedthisas,”thelistof

whatImustdobasedonwhatfunderswant”.Whateverfundersdecidetofundmakesorganizationsshiftwhattheyaredoing.Thiscaninfluenceinclusionandexclusioncriteriaforprogramming.Oneserviceprovidergavetheexampleofshiftingprogrammingtoadifferentagegroup.Also,givenfunderpriorities,NGOsmayalsonothavethelatitudetotakeonadditionalsupportsthatwouldbeadvantageoustothepeopletheyservebecausetheyarerestrictedtothemandatesoftheirfundingenvelopes.

“So,FunderXhasanewideaaboutsomething–itallhastoappearinourdocumentation.”(Serviceprovider)

“Thewayourfundingisprovided,oftentimesalotofprogramsandservicesdon’thavethelatitudetolookatotherresourceoptions.Justbecausetheirmandateistoprovideparenteducation,that’swhatthey’regoingtodo,evenrecognizingthere’ssomechildrenandfamilies

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thatmaybenefitfromsomethingelse-but,that’snotwhattheirmandateis.”(Serviceprovider)

• NGOshavemanymasters–theyrelyuponnumerousfunders,eachofwhichhasadifferent

mandate.Oneorganizationreportedhavingover90contractswithdifferentfunders:“Wearefundedinawholevarietyofdifferentwaysbyabunchofdifferentfunders…andofcourseallofthesepeoplehavedifferentmandatesrelatedtotheirfunding.”

• Shortfundingcyclesinhibitinnovationandlearning,especiallyintermsofmentalhealth

promotion,mentalillnesspreventionandearlyintervention.Thesekindsofinterventionsrequiretimeto“wrestle”withanddeterminewhatworksbestforchildrenandyouth.Alotofcreativityandenergygoesintoprojectsbutthenthefundingendsprematurely.Theresultisthatthereisadearthoflongitudinaloutcomeresearchbecausetherearen’ttheresourcestobearthisout.

“Totrulyunderstandtheimpactoftheseprogramsrequiresyearsoffundingandtheabilitytoseeandwereallydon’tseemtohavemanyfundingorgovernmentalentitiesthatwanttolookbeyondthreeorfouryearsandfrequently,peoplearegivengrantsorgivenfundingtodevelopprogramsandservicesandalotofenergygoesinandalotofcreativityalotofoutsideoftheboxthinkingandthenyougettoyearthreeanditslike‘Oh,well,thankyou.Yourpilotisnowdoneandwe’reontootherthings’.AndIthinkfundersneedtorecognizeandappreciatethatsomeofthethingsthatwe’retryingtodoherearegoingtotaketimeandtheyneedtohaveafundingstructurethatsupportsthat...fundersneedtothinkandfundlongterm…Manyprogramslongtodemonstrateorprovebeyondathreeyearcyclethattheycanhaveanimpactorameasuredimpactonaddressingmanyoftheseissues.”(Serviceprovider)

Anassociatedissueisaroundoutcomesrequiredbyfunders,particularlyinrelationtomentalhealthpromotion.

“Wedoafairamountofworkinmentalhealthpromotionandeducation…butfindingoutcomesthatfunderswillwanttofundisdifficult.”(Serviceprovider)

• Ideally,funderswouldcollaborateandcoordinatewitheachotherinordertoreduceduplication

ofeffortforNGOs.ItwassaidthattherearethreemajorfundersinCalgary,andthatNGOsoftenfindthemselvescompletingnumerousapplicationsthataskthesamethings.ItwassuggestedthatacommonintakeprocesswouldhelpNGOsbyeliminatingduplicationofeffortincompletingfundingapplications.

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“Wouldn’titbegreatiftherewasacentralizedfundingintakesystemfortheUnitedWay,CalgaryFoundationandtheCityofCalgary…we’redoingthesethreedifferentapplicationsthatreallykindofaskthesamething….Couldtheyallworktogetherandhaveonepotthattheycouldcode?There’sallsortsofopportunitiesaroundthat.”(Serviceprovider)

Capacity–qualityofsupportsandprofessionaldevelopmentOnelastthemerelatedtosystemissuesisconcernnotonlyaboutaccesstoservices,butalsoaboutthequalityofservicesandtheimportanceofongoingprofessionaldevelopmentforthoseworkingwithchildren,youthandfamilies.Inthefaceofscarceresources,thisisnotsomethingthatcanbeforgotten.Asoneorganizationalleadernoted:“Thoseworkingwithfamiliesneededucationandprofessionaldevelopmenttobeeffective.”Asmallnumberofintervieweesspecificallyreferencedprofessionaldevelopmentregardingnewknowledgeaboutbrainscience–howadversechildhoodeventsshapethebrain,andtheimportanceofnurturingrelationshipsandtraumainformedcare.Onesuggestionwastofundprofessionaldevelopmentworkshopsaroundthisresearch.Otherssaidthatasdemandgrowsforclinicalservices,morechildrenandyouthwithacutementalhealthissuesarebeingtreatedinthecommunity,andthiswillgrow,possiblyresultingintheneedforthoseincommunityorganizationstobuildcapacityforaddressingthishigherlevelofacuity.Inthetablebelow,asummaryofkeypointsforthissetofgaps/challengesispresented.Informationprovidedbykeyinformantsaboutexistingstrengthsandefforts,andsuggestionsforaddressingchallengesisalsoincluded.

Table8.Summary.Gaps/challenges,strengths,andpossibleresponsesrelatedto:SystemissuesKeygaps/challenges• Noplanned,integratedcontinuumofservicesandsupports;afragmented,patchworkofprograms

andservicesthataren’twellconnectedtooneanother=poorcontinuityofcareandaddedstressforfamilieso Forthoserequiringmultiplesupports–nosingleplacewheretheseareoffered;separate

servicesthatdon’toperateinanintegratedorcoordinatedwayàconfusinganddifficultforfamiliestonavigate

• Insufficientmechanismsforintegrationandcoordinationofserviceso Noshared,long-termvisiono Lackofcommonlanguage–divergentunderstandingsoftheterm“mentalhealth”and

appropriateactionstoaddressit;disconnectbetweenbiomedical,clinicalmodelsthatfocusonclinicaldiagnosisandtreatment(where“mentalhealth”reallymeans“mentalillness”),andbroaderholistic,socio-ecologicalmodelsthatconsiderthechild/youthincontextandarebasedinabroaderviewof“health”and“wellbeing”

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o Multiplesectorsinvolved,buttheyrarelyspeaktoeachother;jurisdictionalissuesabout“whoownswhat”

o Somedegreeofmistrustacrossorgso Nodefinedforumforpeople(i.e.,publicsectorandNGOs)tocometogethertodiscussissues,

plantogether,etc.• Resourcing–scarcityofresources;currentfundingmechanismsforNGOspromotecompetition

ratherthancollaboration• Concernsaboutqualityofservice/care

o Arepeopleusingevidenceinformedpractice/leadingpractices?o Ispracticeinformedbybrainscience,traumainformedcare?

Existingstrengths/effortsunderwayasidentifiedbykeyinformants• TheCalgaryCouncilforAddictionandMentalHealth(CCAMH),forwhichCMHAisabackbone

organization,includesbothNGOandgovernmentsectormembersPossibleresponsesasidentifiedbykeyinformants

• Strongagreementre:needtodevelopacommonframeworkforchild/youth/familyMHservicesandsupports,oratleastacommonunderstandingofwhat“mentalhealth”isandprinciplesforMHservicesandsupports–intervieweesidentifiedanumberofprinciples

• Developacontinuum/matrix–whatistheidealpathwaytowardwellbeing?Howwouldpeopleideallymovethroughthispathway?

• StrengthenrelationshipsandenhancecollaborationacrossorgsthatsupporttheMHneedsofchildren/youth/families;AHSandcommunityorgsneedtoworkcollectivelytogetanunderstandingofeachotherandtherolestheyplay–maybeworktogethertopilotsomething

• CouldCalgaryorganizationsworkcollaborativelytosupportgovernmentinmovingtheValuingMentalHealthplanforwardinCalgary?DevelopalocalValuingMentalHealthplanandseekgovernmentfunding?

• IstheCalgaryCouncilforAddictionandMentalHealth(CCAMH)apossibleforumforbringingorgstogethertoworkonissues?

• Fundprofessionaldevelopmentre:brainscience,traumainformedcare,patient/familycentredcare,useofACEStool,etc.

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ServiceprovidersuggestionsregardingpotentialrolesfortheUnitedWayFinally,serviceproviderkeyinformantswereaskedtosuggestpotentialrolesfortheUnitedWayCalgaryandAreatomoveforwardwithaddressingsomeofthegapsandchallengesidentifiedinthisreview.Almostallsaidakeyrolecouldbeasaconvener–anorganizationthatwouldbringplayerstogethertotalkabout,supportsystemplanningandtakeactiontoimprovethewebofcommunity-basedmentalhealthservicesandsupportsforchildren,youthandfamiliesinCalgary.WhiletheUnitedWaymaynottaketheleadindirectingthework,itcouldhavean“eyeonthebigpicture”andhelppeopletothinktogetherabouthowthesystemcouldbebetterintegrated,functionalandfamilycentred.

“Conveningbutwithaclearpurpose-notonthetreatmentendbutrather,theUnitedWayisgoodatthebroadcommunityinitiatives–shouldbefocusingonchildandyouthmentalhealthandthecommunityinvolvementinthat–couldbringfunderstogetheraroundchildandyouthmentalhealthtoseewhattheycouldfundtogether.”(Serviceprovider)“TheUnitedWayhastheadvantageofbeingabletoviewacrosssectors,soisagoodconvener.”(Serviceprovider)“There’saconvenerroleforanorganizationlikeUnitedWay,togetapulseonthecommunity…butthereisalso[arolerelatedto]advocacyandleveragewiththeGovernmentofAlbertabecausethatiswherethemoneyliesintermsofbeingabletomorefullyaddressthementalhealthneedsofourchildren,youthandadultsinourcommunities.”(Serviceprovider)

SomecautionsfortheUnitedWaywerealsooffered,includingtheimportanceof“workingwith”agenciesandexercisingcautionbeforejumpingintoaddressgapssoastosupportastrongercontinuumofcareratherthanstartingsomethingnew.Itwasalsosuggestedthatwhateverworkisdoneshouldalignwiththedirectiontheprovincewillbetaking:

“IftheUnitedWaytakessomethingoninrelationtochildmentalhealth…needtoexercisecautionbeforejustjumpingintoaddressgaps–sotheUnitedWayneedstoapplyafairamountofdiligenceto“workingwith”inordertosupportastrongercontinuumofcareratherthanstartingsomethingnew.”(Serviceprovider)“It’sfabulousthattheUnitedWay[isdoingthiswork],butIreallywantthemtobealignedwiththedirectionthatourprovincemightdevelop.”(Serviceprovider)

StrengthsThefocustothispointhasbeenthe“badnews”–thegaps,challengesthatexistinthe“system”today,resultinginaratherone-sidedpicture.Inreality,intervieweesspoketothericharrayofmentalhealthservicesandsupportsforCalgary’schildren,youthandfamilies.And,thereisagreatdealofinnovationunderway.Anumberofinterviewees,forexample,spokeofAHS’sCAAMHPprograminglowingterms,describingtheprogramasinnovativeandprogressive.Itwassimilarlynotedthattherearemany

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excellentcommunity-basedNGOprogramsandservices.ThroughouttheFindingssectionabove,existingstrengthsandactionsunderwaytoaddressgapsandchallengeshavebeenbrieflylistedinthetablesattheendofeachsection.Theselistsareonlyamicrocosmofwhatlikelyactuallyexists–givenitwasnotwithinthescopeofthisprojecttoconductacomprehensivereviewofexistingstrengthsandprograms.Thiscapacityalsoincludesastrongandshareddesiretodobetterforchildren,youthandfamiliesinCalgary,andtoworktogethertodoso.Somekeypointsinclude:• Amongstallparticipantsinthisreview,thereisastrongandsharedpassionforchild,youthand

familymentalwellbeing.• Thereisalsoasharedpassionforabettersystemofsupports/servicesforchildren,youthand

families• Thereisamplegoodwillanddesiretoworktogethermorecollaboratively• Peopleareexcitedaboutthisprojectandeagertoparticipate-manysimplysaid,“Howcanwe

help?”• Manyideaswereofferedformovingforward

Allofthisequatestoapowerfulbaseforchange.Inthesectionbelow,aninterestingAdvisoryGroupdiscussion,demonstrativeofthesepoints,isdescribed.

AdvisoryGroupdiscussionMarch14,2018:Theneedforsystemdisruption

“Theinventionofthelightbulbdidnotcomefromthequalityimprovementofcandles.”(OrenHarari)

TheAdvisoryGroupforthisprojectwasbroughttogetherforasecondtimeonMarch14,2018to:1)reviewandvalidate(ornot)thefindingsoftheinquiry,and2)talkaboutpossibleactionsthatmightaddresssomeoftheidentifiedgapsandchallenges.Thefollowingstrategicquestionwasposedtoguidethisdiscussion:

“Whatgap(s)(ifaddressed)andpotentialactions(ifimplemented)wouldhavethegreatestimpactonimprovingthementalwellbeingofchildren/youth/familiesinCalgary?”

Thediscussionwasconductedintwophases.Inbothphases,theAdvisoryGroupwasgiventimetoreflectandwritetheirthoughtsonaworksheetbeforelaunchingintoagroupdiscussion.Theseworksheetswerecollectedattheendoftheworkshop.Themesthatemergedfromtheworksheetsandthediscussionarebrieflydescribedhere.

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GapandChallenges:WheretofocusInthefirstphase,thegroupwasaskedtoidentifywhichofthegapsandchallengesshouldbefocusedon(i.e.,whichmostimpactsthestrategicquestion?).Ratherthanchoosingspecificgapsorchallenges,aninterestingdiscussionensued.Itwasnotedbymanythattheseproblemshavebeeninexistencefordecadesandthat,ratherthan“tinkeringaroundtheedges”,itistimeto“blowthingsup”or,“startamovement”,oratleastintroducesomedegreeofdisruptioninthesysteminordertomakerealchangeandprogress.

“Weneedtoblowthingsup.Allofourtraining,models,perspectives,teachingsarenottruths–theyarewaystoorganizeourthinkingthatoftencreatebarrierstothebestcare…theyareconstrainingourthinking…everytimeweaddrules,weserveclientslesswell.Howarewegoingtomeettheneedofpeoplewithoutthejargonandacademicphilosophies?Weneedtoberesponsiveandflexible,notboundbyconstrainedwaysofthinking.”“IfIwasinUnitedWay’s,shoes,I’dbeasking,‘Howdoweshowupinapositivelydisruptivewayasafunder?’Ratherthantinkerwithnavigatorsandsoon,whydon’twesupportpeopletonavigatetheirownwayversusmakingtheformalsystemmoreexplicit?...How[dowe]createamovementandhaveyouthandfamiliestakethelead?’UnitedWay’smandateisnotaboutfundingclinicalservices,sohowdotheyplayinthisspacethatcomplementsthis?So,what’sthenewspace?”

Itwassuggestedalsothatthinkingatthispointneedstobemorestrategicthantactical–thatis,itisimportanttostepbackandre-envisionhowthingsoughttowork,topeelawayjargonandmodelsandfocusonwhatchildren/youth/familiesandtheirnaturalsupportsreallyneed.Asthepreviousquotesillustrate,thiskindofre-envisioningneedstobedonecollaborativelywithyouthandfamilies,asit’snotpossibletodeterminewhattheyneedwithouthavingtheirexperienceandinsightsatthetable.Someofthefundamentalprinciplesandwaysofworkingthatwouldguidethisstrategicshiftemergingthroughthisdiscussionandincludedthefollowing.Thesearecloselyalignedwiththeliteratureonfamilycentredcare/servicesandarecoveryapproach.• Thefocusshouldbeonhumanbeingssupportingotherhumanbeingsinahumaneand

compassionatemanner.Anexplorationofwhataccessibleandcompassionateservicesmightlooklikeisneeded.“It’sabouthumanityhere–it’sabouttalkingtohumanbeings.”

“Weneedtoblowthingsup.Allofourtraining,models,

perspectives,teachingsarenottruths–theyarewaysto

organizeourthinkingthatoftencreatebarrierstothebest

care…theyareconstrainingourthinking…everytimeweadd

rules,weserveclientslesswell.Howarewegoingtomeettheneedofpeoplewithoutthe

jargonandacademicphilosophies?Weneedtoberesponsiveandflexible,not

boundbyconstrainedwaysofthinking.”

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• Thechild,youthandfamilyneedstobeatthecentreofcare,andservicesshouldbeorganized

withthemnotforthem.“It’sfamilies’experienceofwhattheyneedthatissoimportant.”

• Thefocusshouldbeonwellbeing,notillness.Children,youthandfamiliesmayhaveclinicalneedsthatrequiretreatment,butthesupportsandservicesthatpromotechild,youthandfamilywellbeingencompassmorethanthis,andinvolvenaturalandpeersupports.Notallofthiscanorshouldcomefromfundedagencies.Thefocusshouldbeonsupportingpeopleontheirjourneytowellbeing,drawinguponandbuildingtheirownstrengthsandnaturalsupportsasmuchaspossible,butalso,workingwithpeersupportsandagenciestohelpmeettheirneeds.Thisiscongruentwithafamily-centredapproach.

o “It’smeetingpeoplewheretheyareat,listeningandthenworkingwiththemand

supportingthemtostartsomewhere.”

o “Weneedtomoveawayfromjargon,“mustdo’s”andfigureoutwhatweneedtodo.Howcanweorganize/constructservicestomeetthevaryingneedsofthepeoplewesee?”

• Differentchildrenandyouthwillhavedifferentneedsanddifferentlevelsofcomplexity,and

thusthepathwaytheytakewillbedifferent.Forexample,thepathwayforayouthexperiencingtheirfirstpsychoticepisodewillbedifferentfromayouthwhoisanxiousaboutrelationshipsatschool.

• Thefocusshouldbeon“everydoorbeingtherightdoor”andthesystemplayersbeingableto

findwaystoworktogether.Itisnecessarytodevelopstrongtransitionalprocessesacrossorganizations–forexample,expectationofwarmentriesandhandoffsintransitions.

• Weshouldbuildontherecoveryframingandsupportindividualandfamilystrengthsandcapacitydevelopment;buildontheDIY(doityourself)conceptwhereinformationandsupportshelpkeepfamiliesoutoftheformalsystem;takeanapproachthatisnotreliantuponphysiciansbutbuildspeerandnaturalsupports.o Somecautionswereexpressedaboutthe“doityourself”language.Somepeoplefeltmore

comfortablewithlanguagesuchas“familycentred”,whichincorporatesmanyoftheprinciplesdescribedaboveandincludestheconceptsofbuildingonstrengths,andagency.Ultimatelyitisaboutworkingwithyouthandfamilies,supportingthemontheirjourney,notabandoningthem.

• Systemcollaboration,culturechangeacrossthesystemthatisperson/familycentredismuch

biggerthanitsounds.Integratedplanningisrequired,thatinvolvesboththegovernmentfunded

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andnot-profitorganizations.Itwasalsonotedthattheprivatesector(e.g.,privatepsychologists)shouldalsobeinvolved.

o “Basedontoday’sconversation,itseemsthatweneedtorethinkthesystem,

particularlysothatgovernmentandnonprofitorgsaremuchmoreintegrated,playingtotheirstrengths,offeringseamless,“warm”experiencestoyouthandfamilies.Cananintegratedplanningprocessbestartedwiththeultimateoutcomethatyouthandfamiliesgetindividualizedsupportbasedontheirneeds,thatinvolvestheirnaturalsupportnetwork?”

Howtogetthere:PriorityactionsInthissecondphaseofdiscussion,AdvisoryGroupmemberswereaskedtoconsiderwhathademergedthroughthephaseonediscussionandreflectonwhatsomepriorityactionsmightbe:“Whatwouldhelpustomoveforwardwithaddressingsomeofthechallengesraisedanddiscussedinphase1?”Theneedforalargeshift,ratherthancontinuingtotinkerattheedgeswasfrontofmind.Thegroupwasaskedtoconsiderthesecriteria,astheyconsideredpriorityactions.

SomeguidingcriteriaØ Isitdo-able?Ø Isitcommunity-based?Ø Doesitaddressmorethanoneidentifiedgaporchallenge?Ø Doesithavesynergywithworkunderway?Ø Istheresomeexcitementaroundthispossibleaction?Ø Isthereevidencetosupportthisaction?Ø Isthereanopportunityforcollaboration,andinparticularbetweenAHSandcommunity-

basednon-profitagencies?Ø Ofthepossibleactionstoaddressthisgap/challenge–whichoneswouldhavethe

“biggestbangforthebuck”?

Priorityactionsthatparticipantswroteontheirworksheets,andthendiscussed,fellintofouroverarchingandinterconnectedthemes.Thesearebrieflydescribedbelow.1. Systemredesignandintegration.Buildingontheearlierdiscussion,groupmembersdescribedit

beingimportanttotakeactionsthatwouldshakethingsup,thattherewasaneedforsomesystemicchangeandaphilosophicalshift.Thiswouldrequireinpart:flexingofboundaries;reducinggatekeeping;andthebridgingofclinical,NGOandpeeroptions.Thedevelopmentofsomearchetypaladdictionandmentalhealthstoriescoulddrivethischange.Ifwecanshiftfromidentifyingchildrenandyouthaspatients,perhapsthechallengeswithinformationsharingwillbereduced.

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Somefeltthatonewayofaddressingoftheserequiredchanges,wouldbetobuildontheconceptofan“integratedyouthserviceshubslocatedinthebroadercommunitythatbringhealth,mentalhealth,socialservicesandcommunityservicestogetherinaninclusivecommunitiesframe”.Thishasthepotentialtodevelopcommonexpectationsforallsystemstohavearole;normalizeshelpseekingandbroadercommunityconnectionsandparticipation;andisco-createdwithyouth.Workingonthedevelopmentofanintegratedserviceshub,wouldbeonewayofaddressingaconcernexpressedbysomeaboutfocusingsolelystrategically;wherethereisadangerof“alotoftalkandnoaction”,asthisquoteillustrates.

“Sometimestakingthelongview–anintegratedsystem–canmeanthatpeopletalkalotbutdon’tmoveforwardbecauseultimatelythesystemistoohardtoreallychange.Whatmotivatesreal,effectivechange?Maybeacombinationofalong-termfocusonsystemdisruptionandchangeandshort-termwinnablestrategies.”

2. Access.Thestrongthemeemergingfromkeyinformantinterviewsabouthowchallengingitisfor

youngpeopleandtheirfamiliestofindtheservicesandsupportstheyneedandthenaccessthem,wasagainastrongthemeinthisworkshop.Thisisnotdistinctfromtheconceptofanintegratedsystem,butratherisakeydimensionofsuchasystem.Anumberofideasweredescribedanddiscussedspecificallyaroundaccess,including:

• Pullingtogethersomesortofcommunity-widecommunicationsplan/programtoletschools/doctorsandothersknowwhatisavailable,andhavethismarketedinawaythatallserviceproviderscanconnectin

• Creatinga“DIYvirtualmentalhealthsystem”• Integratingtele-psychiatryintoawalk-incommunityservicehub,withtwo-wayconnection

tohospitals• Creatingmultiplepointsofentrythatareclient/familycentred,wherethereisashared

cultureamongstserviceproviderstoincreasecollaboration,informationsharing,andtheuseoftechnology

• Shiftingperspectivesaboutaccessandhowsystemswork.Forexample,itwasnotedthattherecouldbeapolicyof“nowaitlists”(i.e.“someonewillseeyoutoday”)ornextdaysupport,whichhasbeensuccessfulinOntario

• Ensuringtherearemanypathsordoorsinthatfitthehopesandexpectationsofchildren,youthandfamilies;thereisaneedtodecreasethefrustrationandlossofhopeduetopooraccessibility

• Optimizingtheuseoftechnologytoimproveaccessandnavigation;oneideasharedwastodevelopaninteractiveapp,likeOpenTable,whereonecanbookanappointmentorconversationinrealtimewithaclosingloop:“Wouldyoulikeustocallyou,textyou,emailyou?Isthereanyoneelseyouwouldliketobring?”

• Incorporatingmoreconversationsandlisteningintothewayagencieswork;thisiscriticallyimportantwhenpeopleareinitiallyreachingoutforhelp

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“Peoplewanttoknowtheycancalloneplaceandhaveacompassionate,caringhumanbeingontheotherend…havingtheopportunitytotalkwithahumanbeingforaslongastheywant.Theveryactofbeing“heard”isaninterventioninitself.”

Again,acommonthemethatresurfacedmanytimesinthisdiscussionwasthatimprovingaccessrequiresabigphilosophicalshift,whichwillrequirecreativityandthinkingcollaborativelywithyouthandfamilies:“Whatdotheyneedandwhen?”

3. Navigation,andtransitionsandbetweenservicesandsystems.Similartotheissueofaccess,

navigationandtransitionsbetweenservicesandsystems,aspartofanintegrated,family-centredapproach,emergedintheworkshopdiscussionasanimportantpiecetoaddress.Thenotionofwarmentriesandhandoffstohelppeopletransitiontootherservicesandsupports,dominated.Withrespecttoamoretargetedaction,itwassuggestedthatonethingthatcouldbedoneisto“supportsomethingcollectivelyaroundtransition”.Therewasrecognitionthatdoingsomeworkontransitionshasthepotentialtogreatlyimprovethenavigationexperienceforyouthandfamilies,andthatthereisalreadyworkunderwaythatcouldbeleveraged(e.g.,RCSDwork;researchbeingconductedattheUniversityofCalgary).Participantsnotedthatmovingforwardhererequiresawilltochange,andpeopleworkinginservicesmustbewillingto“gobeyondtheirmandate”.

Thereweremixedperspectivesaroundhowbesttoenhancenavigation.Somefeltthatdevelopinganavigationservicewherenavigatorsworkwithchildren,youthandfamilieswithmorecomplexneeds,andthatbuildsyouthandfamilynavigationabilities,wouldbeuseful.Usingtechnologytosupportnavigatorswithinthesystemsandnavigationwasfelttobeanimportantcomponentofthiswork.Forexample,theideaofdevelopingaphoneapp,describedunder“Access”below,wouldbecriticalhere.

However,therewassomeconcernexpressedthataddingnavigatorscouldleadtoagencystafftofeelthiswasnotpartoftheirjob.Also,fundingofnavigatorsmighthaveanegativeimpactoncommunity-basedservicesifitresultsindecreasedfundingforotherneededsupportsandservices.Asoneparticipantnoted,“Weneednavigation,butnotattheexpenseofsustainableclinicalcareforchildrenyouthandtheirnaturalsupports.Bothareessentialanditmustbefamilycentred.Servicesneedtobegrownandsustained.”

4. Collaborativeandintegratedplanningacrossorganizations.Keepingattopofmindthecautionof

“alltalkandnoaction”,groupmembersthoughtthatbringingNGOandgovernmentorganizationstogetherforcollaborativeandintegratedplanningisrequiredinordertoachieveanintegratedcontinuumofmentalhealthservicesandsupportsforchildren,youthandtheirfamilies-onethatisunderpinnedbysomecommonprinciplesandwaysofworking.Again,thisworkneedstobedonecollaborativelywithyouthandfamiliesandtheprivatesectoraswell.

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Systemintegrationisrequiredtoensurethatfamiliesdon’thavetodo,asonepersonwrote,“ALL“thework”ofcallingsomanyentrypoints”.Somegroupmembersreferredtothisasalmost“inhumane”.Theuseoftechnologytoincreaseawarenessofservicesandsupports,andpotentiallyincreaseaccessandimprovenavigation,wasdescribedasanopportunityto“forceustocollaborate”andhasthepotentialtotransformserviceslongterm.SomefeltthisintegratedplanningmightbeagoodfitwiththeworkoftheCalgaryCouncilonAddictionsandMentalHealth.

Thisintegratedplanningshouldalsoincludeafocusoneducationandmentalhealthpromotion,“supportingmentalhealthpromotionactivitieswhereexpertisealreadyexists”,aswellasprovidingmore“opportunitiesforcommunitytotakeoncontractsforpreventionandpromotion.”Communitydevelopment,alongwithpeersupport,wasnotedtobe“animportantchange-makerforchildren,youth,families.”Itwasalsonotedthatitwillbenecessarytogettoaplacewhereservicesprovidedbycommunity-basedNGOsarevaluedashighlyasmoregovernmentfundedservices.Asoneparticipantnoted,“Weneedtogetridofthestigmaofworthandeffectivenessofcommunityservicesversusgovernment”.

Theideasdescribedunderaccess,navigationandtransitionscouldallbebuiltuponthroughthiscollaborativeplanningeffort.Participantsframedsomeadditionalquestionsthatmightbeaddressedinsuchaplanningprocess:

• Arewesurewehaveenoughoftheright,affordableservicesavailableforyouthandtheirfamilieswhentheyneedit?Doweneedtorethink,addmoreresources?

• Whyarethereservicesthatcontinuetobeavailableandarenotbeingused?• Canwepromotewhatmentalwellbeingcould/shouldlooklike?• Canweknittogetherthepatchworkofwonderful/effectiveservicesthatexist?• CanweproposeamentalhealthandaddictionsvisionforCalgary?

Finally,theAdvisoryGroupmembersagreedthereisawillingnesstoact.Itwasrecognizedthatthestatusquoisnottenable,notforyouthandfamilies,norforthepeopleprovidingtheservicesandsupports.“Everyonearoundthetableappearstobepassionateabouttheideasaroundimprovements.”Nevertheless,thereisnoexpectationthattheprocesswillbeeasy.Tobetrulydisruptive,andtomakethephilosophicalshiftsrequired,therewillneedtobesometoleranceforaninnovation–failure-learningcycle.Therewassomeconcernthategosandfearmaygetintheway,andrecognitionthatthiscanonlysucceedifthereisleadershipfrom,andpartnershipbetweenfunders,andacommitmenttoworkacrosssectors.Thechangemanagementrequiredwillhavetobeacknowledgedandstewarded.

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DiscussionThroughthecourseofthisproject,manychallengesandgapshavebeenidentifiedinCalgary’scurrentarrayofmentalhealthservicesandsupportsforchildren,youth,families/naturalsupports.Someofthefindings,particularlytheexperiencesofyouthandfamilies,aredisturbing.But,thesearenotnewchallenges–somenotedthesystemhasbeenlikethisfordecades.ThiswasechoedattheBrainTrust2meeting,hostedbyAlbertaHealthServicesinFebruaryofthisyear.Afterhearingaboutthetraumaticexperiencesofyouthandfamiliesaccessingemergencydepartmentsformentalhealthconcerns,thegeneralconsensusofmeetingparticipants(mostlyserviceproviders)was,“thisisn’tnew”.Furthermore,otherinquiries,andmostrecently,theAlbertaGovernment’sValuingMentalHealth(VMH)inquiry,havegeneratedstrikinglysimilarfindingsandrecommendationsforaction.TheValuingMentalHealthreview,forexample,identifiedchildren,youthandfamiliesasanunderservedandprioritypopulationforaction.Someofmostrelevantfindingsandrecommendedactionsfromthisworkinclude14:

• Albertansneedtobeabletoaccesstherightcarewhenandwheretheyneedit;o Onewayistoincreaseawareness,amongstprofessionalsandindividualsaboutthe

servicesthatareavailable;anotherwayistohelppeoplenavigatethesystemo Theprimaryhealthcaresystemmustbesupportedandchallengedtoincreaseits

capacitytoprovidetheseservices• Onceinthesystem,individualsneedtobeabletomovefromoneservicetoanotherwithease;

thisrequiresacoordinated,integratedsystemwithbettercollaborationbetweenhospitalandcommunityandprimaryhealthcareservices

Similarly,recommendedactionsoutlinedintheMentalHealthCommissionofCanada’sMentalHealthStrategyforCanada:AYouthPerspective15,basedonanextensivenation-wideconsultationprocess,arealsohighlycongruentwiththisreview.Someoftherecommendedactionsthataremostcongruentwithfindingsinthisreviewinclude:

• Givepeopleaccesstotherightservice,treatmentsandsupportwhenandwheretheyneedthem

• Giveprimarycarealargerroleinmentalhealth• Makementalhealthservicesmorereadilyavailableinthecommunity

14GovernmentofAlberta.2015.ValuingMentalHealth:ReportoftheAlbertaMentalHealthReviewCommittee2015.Author.14GovernmentofAlberta.2017.ValuingMentalHealthNextSteps.Author.15MentalHealthCommissionofCanada.2016.TheMentalHealthStrategyforCanada:AYouthPerspective.Author.Retrievedfrom:https://www.mentalhealthcommission.ca/sites/default/files/2016-07/Youth_Strategy_Eng_2016.pdf

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• Givepeoplelivingwithcomplexmentalhealthissuesbetteraccesstothespecializedservicesandtreatmentstheyneed

• Includepeersupportasanessentialpartofmentalhealthservices• Improvementalhealthservicesforimmigrants,refugees,ethno-culturalandracializedgroups• Meetmentalhealthneedsrelatedtogenderandsexualorientation-• WorkwithFirstNations,InuitandMetispeoplestomeettheirdistinctmentalhealthneeds

whilerespectingtheiruniqueexperiences,rightsandcultures• Improvementalhealthbyimprovingpeoples’livingconditions

TheneedforaphilosophicalshiftWhatisinteresting,differentandexcitingaboutthisreviewofservicesandsupportsinCalgaryisthattheAdvisoryGroupmembers,allleadersofkeymentalhealth-relatedserviceagenciesandorganizations,havecalledfordisruptionandaphilosophicalshift,whichisnotsomethingdiscussedintheValuingMentalHealthreview16.Whiletheideaofdisruptionmaybeembeddedinthatwork,itisnotexplicitlystatedthatthevaluesandprinciplesuponwhichmentalhealthservicesandsupportsaregroundedneedtobescrutinizedandre-considered.Throughthecourseofthisproject,culminatingwiththeAdvisoryGroupmeetingonMarch14,therehasbeenaconsistentcallforre-thinkingthecurrentsystemintermsofwhatitistryingtoachieve,andhow.AdvisoryGroupmembershavearticulatedaveryclearneedanddesirefortransformativechange,notjust“tinkeringaroundtheedges”.Thisisamassiveshiftanditwillbedifficulttoachieve,butitseemstoholdgreatpromiseforchangeandabetterwayofdoingthings.Ifchangeeffortssimplycontinuetobegroundedinoldwaysofthinking,thenthe“system”willkeepbehavingasithasforthepastseveraldecades.Specifically,AdvisoryGroupmembersandkeyinformantshaveidentifiedaneedforaphilosophicalshift,essentiallyfromaclinical,biomedical,diseaseandtreatmentfocusedcollectionofservicestoabroaderandpositiveunderstandingof“mentalhealth”andwhatpeopleneedtofunctionandlivewell,whetherornottheyhaveamentalhealthproblemorillness,andtakinganapproachthatiscentredonchildren,youthandfamilies.Thefollowingshiftswereconsistentlysuggested17:

• Thefocusshouldbeonthefundamental“technology”ofhealthcare:humanbeingssupportingandservingotherhumanbeingsinakindandcompassionatemanner.

• Thefocusshouldbeonthewholefamilyandtheirnaturalsupports;notjusttheindividualchild

oryouth.

16TheMHCC’sfocusonrecoveryandwellbeing,however,ismoreconsistentwithideassurfacinginthisreview17Recognizingthatmanyorganizationsmayalreadybeworkingintheseways

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• Thefocusshouldbeonwhatchildren,youth,familiesandtheirnaturalsupportsneedtofunctionwellontheirjourneytowellbeing.Therewillalwaysbeaneedfordiagnosisandtreatmentforacertainproportionofthepopulation,buttobetterservefamilies,thesystemneedstoembraceamoreholisticapproachthatconsidersthewholeperson/familyincontextandfocusesonwhattheyneedtobewellandtomanagewellatthepresenttime.

• Thefocusshouldalsobeonprovidingsupportstochildrenandyouthandfamiliesbeforethey

needtousetheformalsystem–information,peersupport,sports,recreationalactivitiesandsoon,andmentalhealthpromotionandmentalillnesspreventioneffortscanbepowerfultoolshere.

• Thefocusshouldbeonstrengthsandbuildingcapacity–helpingchildren,youthandfamiliesto

helpthemselves,butnotnecessarilyonlybythemselves;rather,withthesupportofmanyeasilyaccessiblepeopleandsupportstohelpthemalongtheway.Forpeopletofeelempowered,theymustbeabletoaccessthesupportstheyneedwhentheyneedthem.Thereneedstobeanappropriatebalancebetweenprofessionalcareandself-help/empowerment.

Personandfamily-centredcare,mentalhealthpromotionandrecovery:Inspirationforare-designedsystem?Theseideasarehighlycongruentwiththenotionsofpersonandfamily-centredcare,mentalhealthpromotionandrecovery–couldtheseapproachesbetheinspirationforare-designedsystem?

Personandfamily-centredcareandservicesSomeAdvisoryGroupmembersspecificallyreferencedfamilycentredcareindiscussionsandsomearealreadyworkinginthismanner.And,aprincipleoftheValuingMentalHealthreviewis,that“aperson-andfamily-centeredapproachisusedtoaddressaddictionandmentalillness18”.Acoreconceptofthisapproachisrecognizingthatchildrenandyouthlivein,andaresupportedbyfamiliesandothernaturalsupportsintheircommunities,andthatitisnecessarytomeetpeoplewheretheyareatandtoworkinpartnershipwiththesefamiliessotheycanoptimallysupporttheirchildren.Beyondprovidingchildren,youthandfamilieswithusefulinformationandsupport,familycentredcareinvolvestrulylisteningtochildren,youthandfamiliesaboutwhatishappening,thingstheyhavealreadytried,andwhatmightbehelptheminthecurrentmoment.Ultimately,familycentredcareinvolvesdevelopingacollaborativerelationshipbetweenserviceprovidersandyouthandfamilies-onethatisbasedonmutualtrustandrespectcharacterizedby“workingwith”,ratherthan“doingfor”.

MentalhealthpromotionMentalhealthpromotion(MHP),likeitsparent-healthpromotion,isoftenmisunderstoodassimplytheprovisionofeducationabout“beinghealthy”.Whilethismaybepartofahealthpromotingapproach,themoreimportantaspectsofareitsfoundationalprinciples.Theseincludeaholisticandpositive

18GovernmentofAlberta.2015.ValuingMentalHealth:ReportoftheAlbertaMentalHealthReviewCommittee2015.Author.,pg.10.

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conceptualizationof“health”(including,forexample,mental,emotional,spiritual,intellectual,social/relationalandphysicaldimensions)andperhaps,mostimportantly,supportingpeopletotakecontrolovertheirownlives(e.g.,selfdeterminationandempowerment).MHPstartswherepeopleareatandwalksbesidethemtosupporttheirneeds–again,“workingwith”ratherthan”doingfor”.Itsfoundationsareequity,socialjustice,andcollaborativeandmulti-sectoralactiononthesocialdeterminantsofhealth.Boththepersonandfamilycentredapproachtoservicedeliveryandtherecoverymodelarealignedwiththeconceptsembeddedinmentalhealthpromotion.

RecoveryThenotionofrecoverywasbrieflydescribedearlierinthisreport.Weraiseithereagainbecauseitishighlyresonantwiththedesiredphilosophicalshiftandbecausethereisastrongprecedenttobaseamentalhealthsystemontheconcept.Theterm,“recovery”doesnotimply“cure”ofamentalillness;ratheritimpliesthatpeoplewithamentalillnesscanalsoenjoyagoodlevelofwellbeingandtheabilitytobehappyandliveafulfillinglife,justlikesomeonelivingwithdiabetesorsomeotherchronicillness.Whilepeoplemaystillrequirediagnosesandtreatments,thisisonlyapartoftheirlives.Thestrongprecedentforbasingamentalhealthsystemorframework/continuumontheconceptofrecoverycomesfromtheMentalHealthCommissionofCanada’sMentalHealthStrategyforCanada,whichisgroundedinmentalhealthandrecoveryterminology.Akeyfocusisonchildrenandyouthbecomingresilientandattainingthebestmentalhealthpossible.Thesecondstrategicdirectionis,“Focusthementalhealthsystemonrecoveryandwellbeingforpeopleofallagesandprotecttherightsofpeoplewithmentalhealthissues19”.Unfortunately,theseapproachestodatehavegenerallygottenlostinthehealthsystem.(Somenotforprofitsseemtohaveabetterhandleonthis,however.)Althoughfamilycentredcarehasastrongevidencebaseandhasbeenconsidereda“bestpractice”inchildhealthfordecades,ithasbeenslowertotakerootinchildandyouthmentalhealthsettings20.Itwouldseemthataparadigmshiftisrequiredwherefamiliesareviewedasapartofthesolution,ratherthanaspartoftheproblem.Similarly,mentalhealthpromotionisextremelyunderfunded,despiteitspotentialtoreducetheincidenceandseverityofaddictionsandmentalillnesses.TheValuingMentalHealth(VMH)inquiryfoundthatmentalhealthpromotionaccountsforonly0.1percentofhealthcarecosts.Andfinally,intermsofrecovery,theconceptdoesn’tseemtobeontheradarinAlberta,withsomeimportantexceptionssuchasCMHACalgary,whichisstronglyorientedtothisapproach.And,theMHCCnotesthatwhilerecoveryshouldbeatthecentreofmentalhealthreform,itisnot:

19MentalHealthCommissionofCanada.2016.TheMentalHealthStrategyforCanada:AYouthPerspective.Author,pg.10.Retrievedfrom:https://www.mentalhealthcommission.ca/sites/default/files/2016-07/Youth_Strategy_Eng_2016.pdf20MacKeanG.,SpraginsW.,L’HeureuxL.,PoppJ.,WilkesC.&LiptonH.(2012).AdvancingFamily-CentredCareinChildandAdolescentMentalHealth:ACriticalReviewoftheLiterature.HealthcareQuarterly(Vol.15–SpecialIssue),64-75.

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“Eventoday,ourmentalhealthsystemisstillnotfocusedenoughonthefullrangeofservices,treatmentsandsupportsthatpromoterecoveryandwellbeing21.”

Aboutaligningwithprovincialdirections:ValuingMentalHealthNextStepsSomeparticipantsinthisreviewexpressedconcernthatwhatevercomesofthisworkshouldalignwithprovincialdirections,particularlytheValuingMentalHealthNextStepswork.Indeed,onesuggestionwasthatauniqueCalgaryversionoftheVMHNextStepsplancouldbedeveloped.Thismightbetheprocessofdevelopingacontinuum/frameworkforchild/youth/familymentalhealthservices,forexample.However,akeychallengeisidentifyingandresourcingconcreteandimplementableactions.TheVMHreportoutlinesanumberofprinciplesthatarehighlyresonantwithfindingsfromthisinquiry,plussomeothers.Anoverarchingprincipleisthat,“individualsareseeninaholisticway,wherepreventionisapriorityandearlyinterventionleadstobettertreatmentandrecovery’”.22Otherstatedprinciplesincludethefollowing:

• Aperson-andfamily-centredapproachisusedtoaddressaddictionandmentalillness.• Thesocialdeterminantsofhealthplayasignificantroleinprevention,treatment,stabilization

andrecoveryfromaddictionandmentalillness.• Theculturaldiversityofindividuals,caregiversandfamiliesisrespectedandwelcomedin

addressingmentalhealthissues.• Albertansareheardandplayanactiveroleininfluencingimprovementstoservices.• Albertanshaveequitableaccesstoqualityservicesregardlessofgeography,diversityor

economicstatus23.

AconcernexpressedbysomekeyinformantsisthattherearefewresourcesattachedtotheVMHwork,andthereappearstobechallengeswithcoordinationontheground.AnotherconcernwasthatVMHmaynothaveastrongenoughcommunity-governmentalliancetobesuccessfulandthatmoreadvocacyisneeded–includingastrongNGOvoiceattheVMHtablestoshow,forexample,thecostsavingsthatcouldbeachievedthroughintegratedactionsbetweenNGOsandgovernmentorganizations.Thismaybeparticularlyimportantinthefaceofacomingelectionandapotentialchangeofgovernment.Assuch,theremaycertainlybeadvantagesforCalgarycommunity-basedNGOstoensuretheyhaveavoiceattheVMHtables.ThiscouldsimultaneouslysupporttheworkofVMHandactionsarisingoutofthisUnitedWayinquiry.

21MentalHealthCommissionofCanada.2016.TheMentalHealthStrategyforCanada:AYouthPerspective.Author,pg.10.22GovernmentofAlberta.2015.ValuingMentalHealth:ReportoftheAlbertaMentalHealthReviewCommittee2015.Author,pg.10.23GovernmentofAlberta.2015.ValuingMentalHealth:ReportoftheAlbertaMentalHealthReviewCommittee2015.Author,pg.10.

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ThoughtsaboutmovingforwardAkeydynamictoaddresswhenmovingforwardisbuildingmutuallyrespectfulandtrustingrelationshipsamongstplayers.ThisthemeemergedstronglyfromtheMarch14workshopwiththeAdvisoryGroup;andasnotedinthe“Findings”section,thereappearstobealongstandingtension,particularlybetweencommunity-basedNGOsandAHS.Muchofthismaybeduetolackoftime,andlackofopportunitiestocometogetherandlearnmoreaboutwhateachotherdoes,therespectivechallengestheyface,andsoon.Giventhatcollaborativeactiondependsonmutuallyrespectfulandtrustingrelationships,thiswillbefoundationaltowhateverworkisundertaken.Somepeoplethoughtthatworkingonsmallprojectstogethermightbeafruitfulwaytobeginthisprocess.Anotherconsiderationiswhowillleadtheprocessofmovingforwardwiththiswork?Akeyfindingofthisreviewwasthatfragmentationofservicesisdueinparttotheabsenceofagrouporbodythathasoversightofchild,youth,andfamilymentalhealthservicesandsupportsinCalgary,andthatregularlybringsstakeholderstogethertoplan.IntervieweesalmostunanimouslydescribedtheUnitedWayasanidealconvener–ofbringingpeopletogether–but,isthereaneedforanotherbodytoleadtheprocess,to“seethebigpicture”,topullthingstogether,andperhapseventocommunicateasone,unifiedvoicetogovernment?ItwassuggestedthattheCalgaryCoalitionforAddictionandMentalHealth,whichincludesNGOsandgovernmentorganizations,couldbeapotentialleaderinthiswork.AnotherconsiderationintermsofleadershiphastodowithfundingagenciesinCalgary,andcurrentfundingmodelsthattendtofostercompetitionratherthancollaboration.Tosupportpartnerships,collaborativeaction,integrationandinnovation,theremaybeaneedforfunderstoexplorealternatefundingmodels.Inthenextandfinalsectionofthisreport,somepossiblepathwaysformovingforwardarepresented.

Pathwaysformovingforward:SomepossibilitiesBasedonthefindingspresentedherein,thereareanumberofpotentialpathwaysthattheUnitedWaycouldtakeinmovingforward.Someofthesepathwayswilldisruptcurrentwaysofworking;othersmayaddresspressingissuesinthemoreimmediateterm;andsomemaydoboth.Themostimportantfactorherewillbeengagingstakeholders,includingchildren,youth,familiesandtheirnaturalsupports,alongsideNGOs,governmentandprivatesectorgroupsintheprocess.Inthissection,someideasforaction,groundedinthefindingsofthisreview,arebrieflydescribed.Whereverrelevant,actionsbeingtakenundertheVMHNextStepsbannerthatareinplaceinCalgaryalreadyorthatcouldbeaugmented/leveragedareidentifiedbelow.(SeeAppendixCforatablecomparingchallengesidentifiedinthisreviewwithactionsoutlinedintheValuingMentalHealthNextStepsdocument.)

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DisruptiveactionsTheterm“disruptive”isusedheretoimplyactionsthatdisturbthestatusquoorwayofdoingthings,andinsodoing,resultinchange.Therearemanywaystodisruptasystem–adoptinganewphilosophicalstanceorapproachforexample;orintroducingnewideas,innovations,programs,approachesthatchangetheusualwayof“doingbusiness”;changingthewaypeopleinteractandworktogether;engagingsystemusersinredesignefforts;and,soon.ManyofthesuggestionsputforwardbykeyinformantsandAdvisoryGroupmembersaresynonymouswithsuchdisruptions.Aphilosophicalshiftandsystemredesignareatthetopofthelistandrepresentthegreatestdisruption.Anumberofotheractionsthathaveenergyaroundthemandthatwouldsupportthisshiftincludeinnovationstoaddressaccessandtransitionissuesandtobettersupportchildren,youthandfamilies.Thesearedescribedbelow.Note,however,thattheintentisnottoprescribeanyparticularaction;rather,itisoutlinewhathasbeensuggestedandwherethereseemstobethemostenergyforaction.Whatispresentedbelowismerelyastartingpointfordialogueanddeliberation.Therearemanyotherpossibilities.

Buildanewfoundation:DevelopanintegratedcontinuumorframeworkformentalhealthservicesandsupportsthatisgroundedinaphilosophicalshiftThemostdisruptiveapproachismakingthephilosophicalshiftandre-designingtocreateanintegratedsystemthatisfocusedonmeetingthementalhealthneedsofchildren,youthandfamilies.Animportant“disruptionwithinthedisruption”istheintegralinvolvementofchildren,youth,andfamiliesinthisprocess–“nothingforuswithoutus”.Thisisthestartingpointforasystemgroundedinwhattheyneed.Therearemanywaystoapproachthisandcarefulconsiderationwillberequiredtofindthemostpromisingway(s)forward.Differentperspectiveshavebeensharedaboutthis,includingthefollowing:

• “Startsmall”withsimpleonedayintegrated,cross-agencyplanningmeetings• Createacoordinationtablethatbringsagenciestogethertofindwaystoimprovecoordination• Bringcasemanagersfromcommunity-basedNGOsandAHS(andotherrelevantgovernment

organizations)togethertodiscusstheirapproachestocasemanagement(itwasthoughtthatthisprocesswouldhelppeoplefromboth“sides”understandtheapproachestheytake,andthechallengestheyexperience)

• BringpeoplefromNGOsandAHStogether,alongwithyouthandfamilies(i.e.,peoplewithlivedexperience)totalkabouthowthingscurrentlywork,perhapsusingsomeexamples

• Conveneasmall,cross-organizationalgrouptopilotsomethingnew,evaluateandfine-tuneit,thenscaleitup

• Achieveagreementonwhat“mentalhealth”means,andidentifysharedprinciplesforservingCalgary’sfamilies;or,tostartwithafulloutcomprehensivevisioninganddesign

• Engageinafull-outprocesstodevelopan“ideal”continuumorframeworkofmentalhealthservicesandsupportsforchildren,youthandfamiliesinCalgary

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Whetherstartingonbigorsmallactions,highlyskilledfacilitationwillberequiredtobringstakeholderstogether-ideally,children/youth/families,NGOs,governmentorganizations(notjusthealth,butothersectorsaswell),andtheprivatesector(e.g.,privatepsychologists)inaconstructivespace.TheUnitedWayisdevelopingaco-designlab,whichmaybeanexcellentvehicleforthiswork.

Disruptionstoaddresskeyissues:Access,transitions,andbettersupportsforchildren,youth,andfamiliesAnumberofinnovativeactionsoutlinedbyparticipantsinthisreviewcouldaddressseveralidentifiedchallengessimultaneously.Theseinclude:integratedservicehubs,peersupport,ande-mentalhealth.Eachisbrieflydescribedbelow.1. Experimentwithintegratedservicehubsorsimilarapproachesthatenablerapidaccessto

multipleservicesandsupports.Thereviewrevealedagreatdealofenergy,enthusiasmandactionaroundtheconceptofintegratedyouthservicehubs,basedontheoriginalheadspacemodeldevelopedinAustraliaandnowbeingadoptedindifferentformsinmanyothercountries,includinginAlberta.Integratedhubsareunderstoodas,“theintegrationofhealthandsocialservicesunderoneroofinayouth-friendlyenvironment24”.Thesehubsmayaddressaccessandintegrationissues,inparticular.Betterintegrationofservicesandsystems(“Actinpartnership:Createanintegratedsystem)isacorestrategyoutlinedinVMHNextStepsdocument.Oneoftheactionsoutlinedunderthisstrategyis:“Implementacommunity-basedservicehubmodelwhereservicesarejointlyplannedanddeliveredbymultiplesectorsthroughonelocation,eitherphysicallyorvirtually.Servicesincludehousing,physicalandmentalhealthservices,primaryhealthcare,addictionservices,justice,socialservices,school-basedservices,etc.25”BasedontheValuingMentalHealthreview,PolicyWiseforChildren&FamilieshasbeencontractedtoassistintheimplementationoftwotofourCommunity-BasedMentalHealthServiceHubsforYouthinAlberta’sruralcommunities.OthereffortsunderwayinAlbertainclude:• Edmonton–twoACCESSOpenMindsresearchprojectsareunderway;thesearecommunity

spacesthatcanactasaportalforhelp-seekingyouth• Camrose–hasanintegratedserviceshub• UnitedWayCalgaryCommunityHubs(partnershipwithCityofCalgary,RotaryClubofCalgary)

–inBowness,GreaterForestLawn,NorthofMcKnight,Sunalta,VillageSquareandVistaHeights(notaspecificfocusonchild/youthmentalhealthperse;mayalsoservebroaderneedsre:mentalhealthpromotionatcommunitylevel)

• SomeexistingCalgaryorganizationsthatoperatelikeintegratedhubsinclude:o TheAlexYouthHealthCentreandFamilyHealthCentre

24Salt,V.,Parker,N.,Ramage,K.,&Scott,C.2017.Community-basedmentalhealthserviceshubsforyouthenvironmentalscan.Edmonton:PolicyWiseforChildren&Families,pg.3.25GovernmentofAlberta.2017.ValuingMentalHealthNextSteps.Author,pg.9.

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o SheldonKennedyChildAdvocacyCentre-co-located,multi-disciplinarywraparoundsupportsforchildrenexperiencingseverechildabuse

• CMHACalgarywillbehostingaforumre:integratedservicedeliveryhubsonApril11,2018.Thisforumwillbringtogetherlocalagencieswithworldleadersinintegratedservicehubs.

• Anothersuggestedpossibilitywastopilotasinglepointofentrymodel;• TheCalgaryDomesticViolenceCollectiveisworkingoncoordinationalongtheservicespectrum

asanareaforfocusin2018-2020.Thegoalistobringleadersindomestic/sexualviolencetogethertoensureacoordinatedapproachandtoidentifyandfillgapsinservice.Theremaybeanopportunitytolearnfromthisgroupintermsofdoingthiscoordinationwork“ontheground”.

2. ExpandyouthandfamilypeersupportinCalgary.Giventhatpeerscanhelpaddressanumberofissuesincluding,providingsupportswhenpeoplefirstbegintoexperienceissues;servingasafirstcontactinagencies;workinginemergencyroomsandinpatientunitstosupportpeoplethroughtheprocess;andsoon.Peerscaninteractwithyouthandfamiliesinmanywaysincludinginperson,throughtexts,e-mailsandtelephoneandthuscanbehighlyaccessibleforpeople.Thus,theyhavegreatpotentialtohelpyouthandfamiliescopewithissuesbeforetheyneedtoaccessformalservices;theycanbeasupportwhilepeoplearewaitingforappointmentsandtreatment;theycansupportpeoplethroughthejourneyandmaketheexperienceforchildren,youthandfamiliesamorehumaneandcomfortingone.Peersupportisanintegralcomponentofintegratedservicehubs,sothereisanopportunitytoexpandthepeersupportthroughtheactionoutlinedaboveaswell.PeersupportisalsoakeyrecommendationoftheMHCC:

“Peersupportworksbecausepeoplewhohaveexperiencewithmentalhealthissuescanofferencouragementandhopetoeachother–oftenreducinghospitalization,providingsocialsupportandimprovingqualityoflife.Itcanalsoconnectfamiliesexperiencingsimilarsituations,helpingthembetterunderstandthementalhealthsystemandimprovingtheirabilitytotakecareoftheirlovedone’sneeds.26”

Asdescribedpreviously,theCMHACalgaryisplayingaleadershiproleinadvancingpeersupportthroughtheirPeerSupportSchool,sothereisanopportunitytoexpand,augment,leverage–broaderemploymentofpeersupportersthroughoutthecity.Itisalsorecognizedthatseveralotheragenciesemploypeersupporters;itwouldbefruitfultobringthesegroupstogethertotalkaboutmutuallybeneficialopportunitiesforstrengtheningpeersupportservicesforchild,youthandfamilymentalhealthinCalgary.

26MentalHealthCommissionofCanada.2016.TheMentalHealthStrategyforCanada:AYouthPerspective.Author,pg.16.Retrievedfrom:https://www.mentalhealthcommission.ca/sites/default/files/2016-07/Youth_Strategy_Eng_2016.pdf

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TheValuingMentalHealthNextStepsdocumentincludesanactionre:examiningpotentialmodelsforusingvolunteerpeermentorsas“navigators”betweenhealthandcommunitysettings.

3. Implemente-mentalhealthsolutionstosupportyouthandfamilies.Manyintervieweesreferenced

variouse-mentalhealthsolutionstosomeofthegapsandchallengesidentifiedherein,yetAlbertawasnotedtobe“waybehindtheeight-ball”inthisarena.ThismaybeabouttochangegiventhatAHS’sAddictionandMentalHealthStrategicClinicalNetworkandpartnersrecentlyreceivedaCanadianInstitutesofHealthResearch(CIHR)researchgranttoteste-mentalhealthforadolescentsandyoungadultsexperiencingthethreemostcommonlyoccurringmentalillnessesinyouthandyoungadultsunder25:anxiety,mood,andsubstancedisorders.Theprojectwillinvolvee-mentalhealthinnovationsincludingpeer-to-peerandfamilysupport;internet-basedcognitivebehaviouraltherapy;and,internet-basedscreeningforalcoholconsumption.BeyondtheCIHRgrant,therearemanyotherpotentialapplicationsfore-mentalhealth.Oneexampleisaphoneapptoimproveaccessandnavigation,forexample.Astartingpointforthisworkmaybetoconsultwiththosewhohaveconductedresearchabouttheuseandeffectivenessofvariouse-mentalhealthtechnologies,andseektoidentifythoseapproachesthatmayeffectivelyaddressvariouschallengesaddressedherein.Animportantreminderwouldbetoensurethatyouthinparticularareinvolvedintheseprocessessincetheywouldlikelybetheprimaryusersofthesetechnologies.TheValuingMentalHealthNextStepsdocumentincludesanactionfore-mentalhealth:“Developvirtualtechnology-basedsolutionstohelppeopleaccesstools,informationandtreatmenttoaddressaddictionandmentalhealthissues”.

Somelessdisruptivebutpotentiallyimpactfulshort-terminterventionsTherearemanyotherpossibleandlessdisruptiveactionsandpathways;manyhavebeenoutlinedinthesummarytablesinthe“Findings”sectionofthisreport.Threethatseemtohavegoodpromisearebrieflydescribedbelow.

1. Access–increaseawarenessaboutwhatservicesareavailableandhowtoaccessthem.Somepossibilitiesincludetargetedsocialmarketingcampaigns(customizedapproachesfordifferentgroups,suchasyouth,families,serviceproviders,primarycarephysicians,clinics/networks,schools).Acautionisthatincreasedawarenesswouldideallyresultinincreaseddemandforservices.Otherstrategiestoincreaseservicesneedtobeconsideredintandemwiththisintervention.TheValuingMentalHealthNextStepsdocumentincludesanactionrelatedtoincreasingawarenessofexistingsupports:“Createandmaintainauser-friendlycomprehensivelistingof

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publiclyandprivatelyfundedaddictionandmentalhealthservicesavailableinAlberta.27”SomeworkisunderwayinAlbertatoexpand211services.

2. Access–increasethenumberofsingle-sessionandwalkinmentalhealthservicesforyouthandfamilies,andtestnewwaysofreducingwaitlists.AnumberofagenciesinCalgaryhavefoundwaystoincreaseaccessthrough,forexample,theuseofdetaileddatatoanticipateresourceneedsandeliminatewaitlists;walkinclinics;single-sessionclinics;theuseofanintakeandengagementteamwherethefirstcontactwithaclientisviewedasaninterventioninitself;anapproachof“screeningpeopleinratherthanout;andbarrier-freecounseling.Lessonscanbelearnedfromtheseorganizations.Itmaybehelpfultoconveneadialogueamongstagenciestosharepracticesthatcouldhelpreducewaitlistsandproviderapidaccesstosupports.

3. Transitions-begintomovetowardan“everydooristherightdoor”approach,andmorewarmentriesandhand-offsacrossthewebofmentalhealthservicesandsupportsinCalgary.Oneapproachmightbetoconvenemeetingswithstakeholderstotalkabouthowthismightwork,andperhapsdevelopapilotproject.Thismightbesomethingthatasmallgroupofactorscomestogethertoworkon,pilot,refineandscaleup.

ConcludingremarksManykeyinformantsandAdvisoryGroupmembersforthisinquiryexpressedappreciationtotheUnitedWayforanopportunitytoparticipate.Somesaidtheyarerarelyaskedfortheirinputandsowereverypleasedtobeincludedinthiswork.AdvisoryGroupmemberssaidtheyenjoyedtheopportunitytocometogetherandtalkaboutissuesandchallengesthattheyshare,andbegintothinkaboutsolutions.Theimportantworknowistonurtureandgrowthegoodwillandenthusiasmgeneratedinthisproject.Therearenoeasyanswersandnosimplesolutions.Alotmorediscussionisneeded.OneAdvisoryGroupmembermadethefollowingcommentsattheMarch14meeting:

“IfIwasinUnitedWay’sshoes,I’dbeasking,“Howdoweshowupinapositivelydisruptivewayasafunder…howdowecreateamovementandhaveyouthandfamiliestakethelead?UnitedWay’smandateisnotaboutfundingclinicalservices,sohowdotheyplayinthisspacethatcomplementsthis?”So,what’sthenewspace?”

ThesearegoodquestionsfortheUnitedWaytoconsider.Perhapsthroughthisinquiry,theprocessofpositivedisruptionhasalreadybegun.Thenewspacemightbeonethatbringseveryonetogether,andespeciallychildren,youthandfamilies,torethinkasystemthatservestheirneeds.

27GovernmentofAlberta.2017.ValuingMentalHealthNextSteps.Author,pg.9.

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AppendixA:Compilationofsummarytables

Table2.Summary.Gaps/challenges,strengths,andpossibleresponsesrelatedto:Servicesandsupportsfoundationaltochild,youthandfamilymentalwellbeingKeygaps/challenges• Insufficientattentiontothepromotionofmentalwellbeing,resilience,thepreventionofmental

healthproblems,andearlyidentification/earlyinterventionforemergingmentalhealthordevelopmentalissues

• Earlychildhooddevelopmentiscrucialandacoreopportunitytopromotementalwellbeing,preventmentalhealthproblems,identifyissuesandinterveneearly;ECMapstudy:manychildreninCalgaryarenotgettingthesupporttheyneedduringtheircrucialearlyyears

• Thereareextremelylongwaitlistsinthepublicsectorforpsychosocial,psychoeducationalandotherkindsofassessmentswhichmeanschildrenmaynotgetaccesstothesupportstheyneedinatimelymanner

• Morepreventativeworkisrequiredtobolsterchild/youth/familymentalwellbeingsotheydon’trequireformalservices/supportsinthefirstplace;or,wherethereisaneednotyetrequiringclinicalcare–thereisgreatpotentialfortractioninthisarea

Existingstrengths/effortsunderwayasidentifiedbykeyinformants• First2000DaysNetwork–enablingcollectiveactiontoimproveearlychildhooddevelopment

outcomes• AHS’s“EarlyYears”book–allnewparentsreceivethisbook;hasrecentlybeenupdatedtointegrate

newknowledgere:brainscience• AHSandAlbertaEducation–comprehensiveschoolhealthinitiativesthroughoutAlberta• AHS–MentalHealthCapacityBuildinginschools–workingwithmorethan180schoolsre:positive

mentalhealth• BurnsMemorialFund–workthatiscongruentwithmentalhealthpromotion–Children’sFundgoals

relatedtochilddevelopment(healthy,safe,accesstooptimalhealthcare;readyforschool,experiencessuccessandgraduates;opportunitytoparticipateinrecreationalactivitiestohelpthemdiscovertheirtalents);movingtowardgreaterfocusonsocial-emotionallearning;FamiliesMovingForwardProgram;workre:naturalsupports

• Carya–numerouspositivementalhealthpromotionandmentalillnesspreventionprogramsthataddressriskandprotectivefactorsforchildren/youth/families(e.g.,selfesteem,copingskills,selfconfidence,relationships,creativity);parentresilience,youthandcommunityengagement)

• CouncilofChampionsforChildrenandYouth–lookingatbuildingresilience• TheAlex–numerousinitiativesaimedatpreventingcrisis–mentalillnessprevention;theAlex

CommunityBus• CUPS–Servicesfocusedonresilience;supportsforlowincomeCalgarians• ChangeinMindinitiative(PalixFoundationandtheAllianceforStrongFamiliesandCommunities

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(US)CUPSandBigBrothers,BigSistersCalgaryareparticipating–initiativetointegratebrainscienceconceptsintoaction)

• UnitedWay,CalgaryandArea–AllinforYouth,EnoughforEveryonePovertyReductionStrategy• AlbertaChildren’sHospitalresourcelibraryre:child/youthmentalhealth• AHS–doingworkregardingmentalhealthliteracy–educationaboutmentalhealthissuesand

illnesses;communityeducationservices• School-basedmentalhealthservices/supports(significantinvestmenthere)

o ComprehensiveSchoolHealth-AHSo MentalHealthCapacityBuildinginitiative–AHSo PolicyWiseandtheAHSMaternalNewbornChildandYouthSCN-basedona

recommendationfromValuingMentalHealth,currentlyexaminingmentalhealthsupportsforchildrenandyouthinschools

o SafeandCaringSchools-AlbertaEducation–promotionofpositivementalhealth;socio-emotionallearning;healthy,respectfulrelationships;

o MentalhealthliteracyProject–AHSo Smiles–basedonDr.StanKutcher’smentalhealthliteracyprogram–forGrade9-10

students(AHS)o UnitedWay–AllinForYoutho Secondaryeducationworkre:mentalhealth

§ UniversityofCalgary-CampusMentalHealthStrategy§ AlbertaGovernmentworkre:post-secondarymentalhealth

Possibleresponsesasidentifiedbykeyinformants

• Focusonbuildingresilienceandstrengtheningprotectivefactorsforchildren,youth,families,naturalsupports,communities

• Parenteducationbasedonnewbrainsciencewouldbebeneficialforallparents• RevisitparentingandotherECDprogramminginAlberta–aretheybasedonbrainscience?• AHSCAAMHPPprogramisdoingsomeworkwithdaycareoperators,communityprovidersaround

increasingmentalhealthcapacity–talkingabouttheimpactsoftraumaandmentalhealth• Workwithdaycarestoincrease/applyknowledgeofbrainscience;helpthemtoidentifyissuesearly

andreferappropriately(linktoworkbyMuttartFoundation’s“WellAhead”initiative–workingwithdaycares)

• Explorechildcareconsultationservices(re:childdevelopment,screening,earlyintervention)forchildcare/daycaresettings(e.g.,Ontariomodel)

• Screeningandearlyintervention-Exploreissuesre:timelyassessmentfordevelopmentaldelay,learningdisabilities,socio-emotional/behaviouralissues;implementstrategiestoreducewaitlistsfortheseassessmentsandexpediteaccesstoappropriatesupports

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Table3.Summary.Gaps/challenges,strengths,andpossibleresponsesrelatedto:Gettingin–AccessingMHservicesandsupportsKeygaps/challenges• Lackofawarenessofwhat’sneededandwhat’savailable

o Families/youthmaynotknowwhatsupportstheyneed,whattoaskfor,ormaybeunsureaboutwhattheyshouldshare

o Familiesandyouthdon’tknowwheretofindsupportsàtheywindupintheERasalastresort

o Serviceprovidersarealsochallengedtokeeptrackofalltheavailableservicesandtheirinclusion/exclusioncriteria;primarycarephysiciansmaysimplyopttosendtotheER

• Exclusioncriteriaornarrowinclusioncriterialimitaccess• Lengthywaitlistsforclinicalsupports;and,costs,hoursandlocationofservices=barrierstoaccess• Acurrentlackofcapacityinprimaryhealthcarere:child/youth/familymentalhealthissues/illnesses• Children/youthnotillenoughforadmissiontohospitalorAHS’sCAAMHPprogram–wheredothey

goforhelp?• Anumberofunderservedgroups/populationswhoareathigherriskforproblemsandalsooffalling

throughthecracks:o Children/youthwithASD,FASD,otherdevelopmentalandbehaviouralissueso LGBTQ2S,andparticularlytransgenderyoutho Youthinvolvedwiththejusticesystemo Familiesandyouthlivinginpovertyand/orwhoarehomelesso Youthwithaddictionso Newcomers(refugee,immigrantfamilies);familiesforwhomEnglishisasecondlanguageo Indigenousfamilies

Existingstrengths/effortsunderwayasidentifiedbykeyinformants• Calgaryis“rich”inmentalhealthservicesandsupports;manythatoffere-therapy,telephone,text,

chat,andwalk-inservices;othersoffersingle-sessionvisitstohelppeoplecopeandmakeaplanformovingforwardwhilewaitingformoreintensivesupport

• CalgaryCounselingCentrehaseliminatedwaitlistsbyusingdatatocustomizesupportsforclientsandpredictresourcerequirements;andbysupervisingstudentsorpost-graduatestudentstoworkwithclients

• Crisiscounselingo Wood’sHomes–24/7crisiscounselingviatelephone,text,livechat&mobileresponseo Wood’sHomes-EastsideFamilyCentre–nochargewalkincounselingforfamilieso KidsHelpPhone(pilotingatextmessagingapproachinManitoba)o DistressCentreConnecTeeno AfterhourscrisissupporttoUofCstudents(Wood’sHomes,CalgaryCounselingCentre,

DistressCentre)

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• Someorganizationsareworkingwithprimarycaretobuildcapacity.AHS,forexample,hasCANReach–afellowshipwithpediatriciansandfamilyphysicianswhichincludesonlinemodulesandofferscontinuingmedicaleducationcreditsPossibleresponsesasidentifiedbykeyinformants

• Morepreventativeworktosupportchildren/youthandbolstertheirmentalwellbeingsotheydon’tgetintocrisisinthefirstplace

• Morementalhealthliteracytrainingforthegeneralpublicandyouth;educationforparents/youth• Increasepublic/family/youthawarenessaboutwhere/howtoaccessservices–marketingcampaign,

brandingstrategy• Findwaystoreducewaittimes–rethinktraditionalapproaches• E-mentalhealth(e.g.,appsorsocialmediaforfindingservices)• BuildMHcapacityinprimarycare• Increasethenumberofsinglesessionandwalkinclinics;Ontariorequiresallfundedmentalhealth

serviceproviderstoofferwalk-inclinics• Expandpeersupportservices(phone,online,in-person)• Locateserviceswherechildren/youth/familiesgather–e.g.shoppingmalls,leisurecentres• Implementcommunity-basedintegratedservicehubs/one-stop-shops;exploreorganizationsthat

arecurrentlyoperatinginthiskindofmanner(e.g.,TheAlex)

Table4.Summary.Gaps/challenges,strengths,andpossibleresponsesrelatedto:AssessmentKeygaps/challenges• Whatkindsofassessmentsareneededandwhen?Howmanychildren/youthactuallyneedafull,

multidisciplinaryassessment–theseareexpensiveandtherearewaitlists.Whenwouldalessintense,rapidapproachbemoreappropriate,andwhatwouldthatlooklike?

• Itcantakeyearstogetaninitialassessment• Noagreementonaparticulartypeofscreening/assessmenttoidentifytheunderlyingtraumaand

howtheissuegetsframed;differentapproaches=differentrecommendationsforcare/treatment• TraumaisnotaddressedintheDSMyetitisahugedrivingfactorinrelationtoclinicalseverity–

diagnosissystemismissingabigpartoftheintensityofneed• Needtodoabetterjobofmatchingtheserviceneedwithwhatthechild/youth/familyneeds• ThereareadvantagesanddisadvantagesofhavingaformaldiagnosisExistingstrengths/effortsunderwayasidentifiedbykeyinformants• TheACESscreeningtoolbeingisusedbyAHSCAAMHPP• Somecommunity-basedNGOshaveasofterapproachtoassessment,beginningwith“justlistening”

andhavingagentleconversationPossibleresponsesasidentifiedbykeyinformants

• Workcollaborativelytoreviewassessmentprocesses-co-createarapidandappropriateassessmenttooloraone-stoptriageservice

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Table5.Summary.Gaps/challenges,strengths,andpossibleresponsesrelatedto:SupportsforthewholefamilyKeygaps/challenges• “Parentsareinalotofpain”• Children/youth/familieswanttobehaveavoice/belistenedto,andbeunderstoodasexperts

regardingtheirownhealth,experiencesandneeds;theyneedandexpectservices/supportstobeprovidedinanempathetic,caring,respectfulandsafeenvironment,yetthisdoesnotalwaysoccur

• Parental/caregivermentalhealthiscrucial;anintergenerationalapproachisimportant,andsupportingparentswiththeirownmentalhealthneeds–aholistic,familycenteredapproach

Existingstrengths/effortsunderwayasidentifiedbykeyinformants• CatholicFamilyServices–intakeprocessasanintervention–thevalueoftalkingwithpeopleina

compassionatemannerforaslongastheywant(withhighlypositivefeedbackfromclients)• CMHA–youthandfamilypeersupporters

Possibleresponsesasidentifiedbykeyinformants• Familyandyouthpeersupport;inclusionofnaturalsupports• Engagechildren/youth/familiesindefiningissuesanddesigningservices/supports• Mentalhealthsupportsforparentsandfamiliesasawhole• E-mentalhealthsupports• Singlesessionandwalkinclinics• Integratedservicehubs• Psychosocialandothernon-clinicalsupports–e.g.,sports,recreation,arts

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Table6.Summary.Gaps/challenges,strengths,andpossibleresponsesrelatedto:Supportswhilewaitingfor,andbeyond‘treatment’Keygaps/challenges• Longwaitlistsforclinicalcare,orfailuretoqualifyforAHS’sCAAMHPprogram,ornotillenoughfor

hospitaladmissionmeansthatfamiliesareoftenleftontheirowntocopewithchild/youthMHconcernsthatcanbeextremelystressfulandchallengingtomanage(e.g.,suicidal;self-harming;violent/aggressive)andcansignificantlyimpactthewholefamily“

Existingstrengths/effortsunderwayasidentifiedbykeyinformants• CMHA’sPeerSupportSchool,peersupporters,RecoveryCollege• DistressCentre’sConnecTeen• Anumberoforganizationshavewalk-inclinicsandsinglesessionclinicsthatpeoplemightaccessto

talkaboutcopingstrategiesandnextsteps

Possibleresponsesasidentifiedbykeyinformants• Expansionofexistingfamilyandyouthpeersupportservices;inclusionofnaturalsupports• Mentalhealthsupportsforparentsandfamiliesasawhole• E-mentalhealthsupports• Moresinglesessionandwalkinclinics• Integratedfamily/youthserviceshubs• Psychosocialandothernon-clinicalsupports–e.g.,sports,recreation,arts• Engagechildren/youth/familiesindefiningissuesanddesigningservices/supports

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Table7.Summary.Gaps/challenges,strengths,andpossibleresponsesrelatedto:TransitionsKeygaps/challenges• Majorgap–disconnectswhenclientstransitionfromcommunity-basedNGO-providedservicesinto

AHS,andthenbacktocommunity-basedservices–lackofcommunicationandinformationsharingbetweenorgs

• Majorgap-transitionbetweenadolescentMHservicesandadultMHservices(significantdifferencesbetweenadolescentandadultservicesmakethetransitionverydifficult)

• Anothergapinservicesisforchildrenaged7to13• Gap-transitionfromschoolbasedMHprogramstoclinicalMHprogramsExistingstrengths/effortsunderwayasidentifiedbykeyinformants• RCSDiscurrentlyfundingCONEXandamentalhealthtransitionsposition(workingwithPsychER,

inpatients,schooldivisions,children’sservicesandFSCD–howeverthisisonlyapilot;itisnotannualizedfunding

• ResearchisunderwayintheFacultyofSocialWorkattheUniversityofCalgaryre:useofnavigatorsintransitionsfromadolescenttoadulthealthservices(SusanSamuelsandGinaDimitropoulos)Possibleresponsesasidentifiedbykeyinformants

• BringAHSandcommunity-basedorgstogethertofindwaystoimprovetransitionsandensure“warm”entriesandhand-offsbetweenservices

Table8.Summary.Gaps/challenges,strengths,andpossibleresponsesrelatedto:SystemissuesKeygaps/challenges• Noplanned,integratedcontinuumofservices&supports;afragmented,patchworkofprogramsand

servicesthataren’twellconnectedtooneanother=poorcontinuityofcareandaddedstressforfamilieso Forthoserequiringmultiplesupports–nosingleplacewheretheseareoffered;separate

servicesthatdon’toperateinanintegratedorcoordinatedwayàconfusinganddifficultforfamiliestonavigate

• Insufficientmechanismsforintegrationandcoordinationofserviceso Noshared,long-termvisiono Lackofcommonlanguage–divergentunderstandingsoftheterm“mentalhealth”and

appropriateactionstoaddressit;disconnectbetweenbiomedical,clinicalmodelsthatfocusonclinicaldiagnosisandtreatment(where“mentalhealth”reallymeans“mentalillness”),andbroaderholistic,socio-ecologicalmodelsthatconsiderthechild/youthincontextandarebasedinabroaderviewof“health”and“wellbeing”

o Multiplesectorsinvolved,buttheyrarelyspeaktoeachother;jurisdictionalissuesabout“whoownswhat”

o Somedegreeofmistrustacrossorgso Nodefinedforumforpeople(i.e.,publicsectorandNGOs)tocometogethertodiscussissues,

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plantogether,etc.• Resourcing–scarcityofresources;currentfundingmechanismsforNGOspromotecompetition

ratherthancollaboration• Concernsaboutqualityofservice/care

o Arepeopleusingevidenceinformedpractice/leadingpractices?o Ispracticeinformedbybrainscience,traumainformedcare?

Existingstrengths/effortsunderwayasidentifiedbykeyinformants• TheCalgaryCouncilforAddictionandMentalHealth(CCAMH),forwhichCMHAisabackbone

organization,includesbothNGOandgovernmentsectormembersPossibleresponsesasidentifiedbykeyinformants

• Strongagreementre:needtodevelopacommonframeworkforchild/youth/familyMHservicesandsupports,oratleastacommonunderstandingofwhat“mentalhealth”isandprinciplesforMHservicesandsupports–intervieweesidentifiedanumberofprinciples

• Developacontinuum/matrix–whatistheidealpathwaytowardwellbeing?Howwouldpeopleideallymovethroughthispathway?

• StrengthenrelationshipsandenhancecollaborationacrossorgsthatsupporttheMHneedsofchildren/youth/families;AHSandcommunityorgsneedtoworkcollectivelytogetanunderstandingofeachotherandtherolestheyplay–maybeworktogethertopilotsomething

• CouldCalgaryorganizationsworkcollaborativelytosupportgovernmentinmovingtheValuingMentalHealthplanforwardinCalgary?DevelopalocalValuingMentalHealthplanandseekgovernmentfunding?

• IstheCalgaryCouncilforAddictionandMentalHealth(CCAMH)apossibleforumforbringingorgstogethertoworkonissues?

• Fundprofessionaldevelopmentre:brainscience,traumainformedcare,patient/familycentredcare,useofACEStool,etc.

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AppendixB:Interviewguides

InterviewguideforserviceprovidersUnitedWayproject:ThestatusofmentalhealthsupportforchildrenandyouthinCalgary

GuideforinitialkeyinformantinterviewsIntroduction- Briefdescriptionoftheproject

o ThisisareviewprojectexaminingmentalhealthsupportsforchildrenandyouthinCalgary.Areasoffocusinclude:

§ Identificationofexistingcommunity-basedmentalhealthsupports§ Identificationofbarrierstoaccess§ Identificationofgaps§ Recommendationsandideasforimprovement

o “ThefindingsandrecommendationswillbeusedinformthefutureworkoftheUnitedWayofCalgaryandpotentialpartnershipopportunitieswithstakeholderstostrengthenthecommunitybasedcontinuumofcareforchildrenandyouth.”

- Anyquestionsforus- PermissiontoaudiotapetheinterviewQuestionsOpening- Couldyoutellmealittleaboutyourrole<withXorganization>?

o Probere:§ Explicitlinktochildandyouthmentalhealthsupportand/orresearch§ Whyinterested/excitedaboutthisproject;whatyouhopewillbeachievedthrough

thisproject?- Whatkindsofchildandyouthmentalhealthservicesorprogramsdoesyourorganization

provide/support/workwithinCalgary?- Arethereparticularcommunitiesorpopulationsthatyouserve/support/workwith(e.g.,children,

youth,“atrisk”–newimmigrants/refugees,poverty,indigenous,homeless,justice-involved,livingwithchronicillnessesordisabilities,LGBTQ,others?)

Currentcontinuum/webofsupportsandflowthroughthese- Howwouldyoudescribethecurrentcontinuumorwebofcommunitymentalhealthsupportsfor

childrenandyouthhereinCalgary?o Probearound:

§ Prettycompleteorfullofholes?Smoothorbumpy?o Wherewouldyousaytheservices/programs/initiativesthatyourorganizationprovidesfitin

thiscontinuum/web?

- Lookingthroughtheeyesofchild,youthandtheirnaturalsupports:Howwouldyoudescribethewaythatpeoplecurrentlymovethroughthiscontinuum/web?

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o Whatkindsofbarrierstoaccessdoyouthinktheyexperience?o Wheredochildrenandyouthfallthroughthecracks/wherearethegaps

§ Probe:aroundwherechildren&youthmayexitthe‘system’prematurelyand/orhaveproblemswithtransitionpoints?

o Doesthiscontinuum/webandanybarriers/gapslookdifferentindifferentcommunities/populations?

- Whatwouldtimelyandseamlessflowlooklike?

o Doesthislookdifferentindifferentcommunities/populations?Ifyes,how.o Whatseemstobeworkingwelloriscurrentlyhelpfulinfacilitatingtimelyandseamless

flow?

- Whomightwetalktoinordertobetterunderstandwhatnavigatingthewebofservices/supportsfeelslikeforchildren,youthandtheirfamilies/naturalsupports?

o Forexample:doyouhaveany(orknowofany)advisorycouncils,boardmembers,youthgroups,thatmightbeinterestedinspeakingwithus?

o Otherideasrehowtomapthisflow,lookingthroughtheeyesofchildren,youthandtheirfamilies/naturalsupports

An‘ideal’Calgarycontinuum/webofsupports- Whatareyourthoughtsaboutwhatanidealcontinuum/webofsupportsforchildrenandyouthin

Calgarymightlooklike?o Probearound

§ Earlyinterventionandpreventioncomponentsofthiscontinuum§ Theconceptofpositivementalhealthandaddressingrisk/protectivefactors

- Doesyourorganization/youuseanykindofmodelorcontinuumofservicesforchild/youthmentalhealth–thatis,somethingthatdepictspromotion/prevention/earlyintervention,treatment,recoveryandsoon?

o Ifyes,couldyoudescribeit?Shareitwithus?- Arethereothergoodcontinua/websinotherplaces,ormodels,thatyouareawareofthatwe

shouldtakealookat?Onemodeloutthere:Acontinuumofneeds-basedservicesandsupportsfromOntario’sPolicyFrameworkonChildandYouthMentalHealth(attached)- Whatareyourthoughtsaboutthisasacontinuum?- Focusingontheyellow,greenandorangecolumns:

o Reflectingbackonthecurrentcontinuum/webinCalgary,andlookingatthefunctionslistedhere,aretherefunctionsthatyou’dsayaremissingornotcurrentlywelldeveloped?

o Thinkingaboutan‘idealcontinuum’forCalgary,arethereimportantfunctionsthatyou’dsayaremissingfromthisparticularcontinuum?

Givenourdiscussionaboutbarriers,gapsandtheidealCalgarycontinuum,wheremighttheUnitedWayofCalgaryandtheirpartnersbestfocustheirefforts?ORReflectingonthisstatementaboutthisproject:“ThefindingsandrecommendationswillbeusedtoinformthefutureworkofUnitedWayofCalgaryandpotentialpartnershipopportunitieswithstakeholderstostrengthenthecommunitybasedcontinuumofcareforchildrenandyouth.”

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- WheremighttheUWandtheirpartnersfocustheireffortsinordertostrengthentheCalgarycommunity-basedcontinuum,andultimatelymakeapositivedifferenceinthelivesofchildren,youthandtheirfamilies?

Closing- AreyouawareofanyexistinginventoriesofCalgary-basedchildandyouthcommunitymental

healthservicesandprograms?- Arethereotherprojects/initiatives(pastorpresent)thatweshouldbeawareof?- Arethereotherpeopleyouwouldrecommendwespeakwith?- Arethereanyresourcesouttherethatyouthinkwouldbeusefulininformingthiswork?- Isthereanythingelsethatyouwanttosay?

InterviewguideforyouthandfamilyUnitedWayProject:Thestatusofmentalhealthsupportforchildren,youthandfamiliesinCalgaryYouthandfamilyexperiencewithmentalhealthsupportsandservices:InterviewguideIntroduction- Thankyouortakingtimetospeakwithus.Wesoappreciateit.- Asyouknow,weareworkingona‘review’projectfortheUnitedWayonmentalhealthsupports

andservicesforchildren,youthandfamiliesintheCalgaryarea- Theywanttohaveabetterunderstandingofwhatcommunity-basedmentalhealthsupportslook

likenow,includinganybarrierstoaccess,actualgapsinservices,andideasforimprovement.o “ThefindingsandrecommendationswillbeusedinformthefutureworkofUnitedWayof

Calgaryandpotentialpartnershipopportunitieswithstakeholderstostrengthenthecommunity-basedcontinuumofcareforchildrenandyouth.”

- WehaveconductedinterviewswithmanyserviceprovidersandsomeresearchershereinCalgary.Nowwereallyneedtounderstandhowyouthandtheirfamilies/friendsexperiencethis‘continuum’ofservicesandsupports.

- That’swhyweneedtospeakwithyou,asweunderstandthatnotonlycanyouspeaktoyourownexperiencesbuttotheexperiencesofthepeopleyousupportthroughyourworkatCMHA

- Questionsforus?- Permissiontoaudio-tapeourconversation?- Finally,couldyouletusknowhowmuchtimeyouhave?Canyouspendhalfanhour?Longer?- 3binsofquestionsQuestionsOpening- CouldyoutellusalittlebitaboutyourrolehereatCMHA?Howlongyou’vebeendoingthis?

- WhatledtoyourinterestindoingthisworkwithCMHA?Child/youth/familyexperienceswithcurrentservicesandsupportsinCalgaryDrawingonanyofyourownexperiencesnavigatingthementalhealthservicesinCalgary,andtheexperiencesofthepeopleyouhavesupportedthroughyourworkatCMHA:- Wheredochildren/youth/familiesORyoungpeoplestrugglemostwithgettingthekindofhelpthey

need?o Barrierstoaccessingservices?o Anyissuesrelatingtoassessmentsofmentalhealthissues/needs?o Gapsinservices?Placeswherechildren/youth/familiesmightfallthroughthecracks?o Challengeswithtransitions(e.g.,fromhometohospitaltohome;toadultservices)?

- Dopeopleturntotheirfamilydoctorforhelpornot?Whatisthisexperiencelike?- AretherethingsthatworkreallywellinCalgary,orservicesthattendtoworkbetterfor

children/youth/familiesORyoungpeopleandtheirfamilies/friends?Istheresomethingwecanbuildon?

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- Couldyousharesomereal-lifeexamples,sowecantrulyunderstandwhatcurrentservicesarelike?

An‘ideal’Calgarycontinuum/webofsupports- Pretendnothingexistednow,andweneededtostartfromscratch.Whatmightanideal

continuum/webofsupportsforchildren,youthandfamiliesinCalgarylooklike?ORanidealservice?

o Probearound§ Howwouldpeopleliketobeabletoaccessservices?§ Whatdoesagoodassessmentprocesslookandfeellike?§ Whatwouldtimelyandseamlessflowacrossserviceslookandfeellike?§ Whatabouttheearlyinterventionandprevention,beforepeoplestartexperiencing

moresevereproblems?§ Whataboutsupportsandservicesforyoungpeoplelivingwithsignificantmental

illness?§ Wheredoespeersupportfitinallofthis?§ Whataboutsupportsforrecovery?§ Other???

- Areyouawareofothercities,provincesorcountriesthatdoabetterjobofsupportingchildrenand

youthdealingwithmentalhealthissues,andtheirfamilies/friends?ORofothermodelsofprovidingservices‘outthere’thatyoufeelarepromising?

o Probearound§ Where/when/howyoungpeopleprefertoaccessservicesandsupport§ Communityhubconcept,andwhatisintegraltomakingthisconceptworkforyoung

people§ E-Mentalhealth(i.e.,onlinesupports,apps,etc.)

- Iftherewasonethingthatcouldbechangedtobettersupportchildren/youthandfamilywith

mentalhealthneedsinCalgary,whatwouldthatbe?Couldyoudescribewhatitwouldlooklike?

Closing- Arethereotherpeopleyouwouldrecommendwespeakwith?- Arethereanyresourcesouttherethatyouthinkweshouldtakealookat?- Isthereanythingelsethatyouwanttosay?

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AppendixC:ChallengesIdentifiedinthisReviewandRelevantValuingMentalHealthNextStepsFindingsfromthisreview

RelevantactionsoutlinedinValuingMentalHealth–NextSteps

Mentalhealthpromotion

Supportlearningenvironmentsthatpromotepositivementalhealthandwellbeinginourschoolsandpost-secondaryinstitutions

- Ideasandconceptsofpositivementalhealth,includingsocial-emotionallearningarefoundincurrentandfutureprogramsofstudy

- Ensuresupports(includingtoolsandresources)thatfocusonstudentpersonalgrowthandwell-beingareavailabletoallAlbertaschoolsandpost-secondaryinstitutions,includingconsultationwithFirstNations

Access–peoplecan’tfindservices

Createandmaintainauser-friendlycomprehensivelistingofpubliclyandprivatelyfundedaddictionandmentalhealthservicesavailableinAlberta.

- ConsiderleveragingAlberta’sexistingHealthLinkandMyHealthplatformsasaninterfaceforthislistingandevaluatetheireffectivenessasaninterface

- CollaboratewiththefederalgovernmentandIndigenousorganizationstocompileasharedlistingofservicesandprogramsavailableonandoffreserveforIndigenouspeople;initiateuseofthelistinginthreehigh-needscommunities

Access–primarycarecapacity

Definetheroleofprimaryhealthcareinaccessingandprovidingaddictionandmentalhealthservices

- Includeservicesandsupportsrelatedtoaddictionandmentalhealth(basedonacommunityhealthneedsassessment)inthebusinessplansofprimarycarenetworks(PCNs)

- ProvideinformationtoAlbertansonthebenefitsofestablishingalong-termrelationshipwithaprimaryhealthcareteamthancanprovideearlyservicesanddirectclientstoothersasneeded

Assessment–screeningtools

ProactivelysupportAlbertanswithadversechildhoodexperiences- EvaluatewhethertheAdverseChildhoodExperiences(ACES)riskassessment

toolshouldbeimplementedinAlberta.- ImplementACEasascreeningtoolinidentifiedsettingsandevaluateits

effectivenessTransitions Developpathwaystoandfromprimaryhealthcaretosupportcoordinationwithin,and

transitionbetweenhealthandcommunitysettings(includingschools)”- Examinepotentialmodelsforusingvolunteerpeermentorsas“navigators”- Developalternativemodelsofcareforpeoplewithaddictionandmentalhealth

issuespresentingtoemergencydepartmentse-Mentalhealth–Accesstoinformationandtreatment

Developvirtual,technologybasedsolutionstohelppeopleaccesstools,informationandtreatmenttoaddressaddictionandmentalhealthissues

- Focusonvulnerableandruralpopulationsfirs- Shareinformationonwebsites,tele-health,mobileapplications,andother

technologies