Guest Opinion : We Need New Ways to Help Young People with Mental Illness

Written By:  Dr. Kathleen Pajer, chief of psychiatry at Children’s Hospital of Eastern Ontario and Dr. Smita Thatte, clinical director of the youth program at The Royal.


This new normal is rearing its ugly head in hospital emergency departments, doctors’ offices, and community care centres across this country at an accelerated rate. At the Children’s Hospital of Eastern Ontario (CHEO) and at the Royal Ottawa Mental Health Centre’s Youth Program, we are seeing more 16-year-olds battling paranoia and hearing voices; 14-year-olds with severe major depressive disorder or bipolar disorder; 12-year-olds addicted to marijuana and prescription drugs like oxycontin; 10-year-olds with body acceptance issues coupled with mood disorders and anxiety. And the frequency with which young kids are engaging in self-harm is growing at an alarming rate. This last group is particularly difficult to treat because many of them do not meet criteria for our major mental illnesses.

Why is this so?

While we don’t have all the answers, we believe that at least two major factors are at play. First, in today’s world, face-to-face contact has been replaced by screen to screen. In the past, communication, the critical component of forming relationships, was done through talking to people and direct behavioural interactions. As our reliance on computer technology has grown, the amount of time spent in these direct interactions has diminished. The result is a generation of young people who are both connected in a much larger network than ever before, yet isolated — and they feel alone. Second, kids are exposed to readily available drugs that are far more potent and harmful than those that were available even a decade ago. This has made for a dangerous cocktail.

The bottom line is that today’s child and youth mental health issues are not the same as they were years ago and we need to change the way we think about – and treat – mental illness.

This means supplementing the previous approaches – medication and face-to-face individual or group psychotherapy – with new strategies to effect change in children and youth. One such strategy is to use computer technology to reach patients. This is often much more accepted and has the advantage of making treatment more available because it does not depend on physically attending an appointment. If this techno-savvy generation actually relates better to devices than they do to human beings, we need to work within the framework of this new reality: for example, offering cognitive behaviour therapy through a computer program or remotely with a therapist hooked up to an iPad through the Ontario Telemedicine Network.

Emerging data indicate that these types of therapies are at least as effective as traditional face-to-face therapy with kids, and a great deal of mental health research is under way about how best to incorporate technology as a way to connect with disconnected children and youth.

The implications are at once challenging and liberating. With the right programming, treatment could be accessible even to the most remote clients and emergency situations might be managed without a psychiatrist on hand.

While the children and youth need to have secure attachments with caring adults for good mental health, we don’t know if the role of traditional face to face therapy with human interaction is critical in treating today’s mentally ill children and youth. However we do know that we need to find a successful way to connect with them. If kids are connecting through technology, then we have to meet them where they are. We have to rethink the way we initiate social engagement and re-build from the ground up. Bottom line: Today’s kids raised on technology as a primary means of forming relationships may actually have different brains than those of us who have not been raised in this way. And we have to adapt to that.

Second, experimenting with substances such as alcohol, cigarettes, and marijuana has been a part of the adolescent experience for hundreds of years. But the substances available today are more potent, more likely to be contaminated, and are easily obtainable. Moreover, children and youth are routinely introduced to such substances as early as the age of 10 years. When kids start using substances during these pre-pubertal years, this has long-term effects on the way their brains develop. During this time period, our brains are pruning connections that have grown at a very high rate in the earlier years of life. Which connections get pruned is dependent on the environmental input. So the brain of a 14-year-old who is smoking a gram of marijuana a day is pruning connections in a totally different (and we believe maladaptive) way than the student sitting next to him whose brain is pruning connections on the basis of sports and music activities. This same concern applies to the compulsive playing of video games. We need to address this widespread problem of addictive behaviours in our children and youth.

To help children and youth develop their full potential, we are working to develop new treatment strategies. But we cannot be doing this in isolation of each other or without the help of families and patients. That’s why we’ve created the Young Minds Partnership. The brainchild of CHEO and The Royal, this new delivery model will be used to provide specialty psychiatric and mental health care for children from birth to 18 years.

By evolving our partnership and working with the Ministry of Child and Youth Services and other community service providers, parents, and kids, we will change the way we treat mental illness in children and youth. Our goal is to dramatically reduce wait times and shorten our wait lists by better matching treatment plans to kids and improving patient flow through the system. We also know that early intervention can prevent severe mental illness, so we plan to bring services to kids at earlier stages – including children under five – to help curb the rise in self-harm and serious disorders among young people.

At a time when kids are sicker earlier with more complex mental illnesses, when instant connection is leading to acute isolation, when the human brain is embracing touch screens over human touch, and when kids are ingesting more toxic substances or using video games for comfort, it will take all of our combined resources to find new ways to help our young people. Success will depend on cooperation, collaboration and communication between institutions, agencies and individuals.

No one silo can solve this modern-day crisis. Only by working together will we improve the mental wellness of our children and youth — and make new connections that heal.

 

See the original article here.