Youth and depression: Why it’s crucial to intervene early

From The Vancouver Sun

Shilpa Narayan was 14 years old when the distress she had tried to hide for years erupted into tears after a teacher asked how her day was going.

“I looked at her and I just started crying,” she recalls.

At that moment, thanks to intervention by her teacher, Narayan took the first step toward treatment for the anxiety and depression she had suffered from since the age of 12.

“Everything was scary, everything was daunting,” said Narayan, now 20. “Some days I couldn’t speak. At the end of the day, I felt I had run multiple marathons but hadn’t won any of them.”

Anxiety disorder and depression were clinical terms the teenager didn’t understand at the time. She just knew that she felt overwhelmed.

Narayan’s teacher took her to the school counsellor.

“She probably saved my life at that point,” Narayan said.

But many children and teens suffering from a mental disorder never get help.

According to the Children’s Health Policy Centre at Simon Fraser University, 70 per cent of the estimated 84,000 children and youth in B.C. who suffer from a mental disorder do not receive treatment.

CHPC director Dr. Charlotte Waddell said child and youth mental health need to be a high priority — and early intervention is key.

“If you wait until someone becomes an adult, you’re leaving that young person with sometimes five or 10 years of severe symptoms,” she said.

“That young person has stepped off the developmental pathway that they needed to be on to be able to complete school, the chance of going to university or entering the workforce.”

Studies have found that 50 to 75 per cent of mental disorders start in childhood. Anxiety is common in early childhood, as is depression in the teen years. Suicide is the second leading cause of death among youth across the country, according to the Canadian Mental Health Association.

Narayan can trace her first signs of anxiety and depression back to elementary school.

“I was lost, confused, I was angry at myself because I just knew there was something there and it was bad … I tried to push it away,” she said.

She hid her struggles from her parents and tried to mask what she was feeling by pushing herself into sports and clubs.

“I didn’t want to be trapped in my own thoughts,” she said. “I told myself it was just a phase I would get through.”

But Narayan began to have anxiety attacks and would start shaking in class. Plagued by fears of failure and of disappointing her parents, she felt the stigma of mental illness.

Roxanne Pope, the teacher in whom Narayan confided, said she became worried after noticing the teen’s demeanour had changed.

“She’s usually very outgoing. She started to be withdrawn and started to disclose she was struggling,” said Pope.

Narayan recalled trying to verbalize how she felt when she met with the school counsellor.

“All I could tell her was that I hate the way I’m doing things. I hate myself,” she said.

School counsellors, doctors or nurse practitioners are the first point of contact for many children and youth seeking help, says Waddell. A referral might then be made to a child and youth mental health team run by the Ministry for Children and Family Development.

Cognitive behavioural therapy — which aims to change patterns of thinking and behaviour through one-on-one or group counselling — is the preferred treatment for anxiety and depression. It has more lasting results than medication, which is less effective and can have side-effects, according to the CHPC.

The counselling services offered by the ministry are good, said Waddell, but often they aren’t available or there aren’t enough spaces.

“We simply don’t have enough services on offer,” she said.

Narayan’s school counsellor referred her to community counselling at Surrey’s Pacific Community Resource Centre. The service was free, but the counsellors were graduate students on practicum, meaning they would switch every six months. It made it difficult for Narayan to establish trust.

“I’m having to re-tell everything, because there’s only so much they have in their notebooks,” said Narayan. “No one is at fault in this. It’s just how the system works.”

At one point in high school, she filled out a referral form for a ministry-funded counselling service. She had an intake interview, but was told that her conditions were not severe enough and was put on a nine-month waitlist.

“What is the definition of bad enough? Is it self-harm to the point that you’re in the hospital?” said Narayan.

“If someone is going through the extreme, please take them in. But at the same time, don’t tell someone else that they aren’t bad enough (to receive treatment).”

When medication was suggested to Narayan, she was upset by the idea that she had a chemical imbalance. On her first round of anti-depressants, she suffered side-effects, and when her anxiety mounted she ended up hospitalized.

Child psychiatrist Dr. Matthew Chow said seeing patients wait for treatment spurred him to start Youth Wellness Associates, a youth psychiatry clinic with expedited treatment access times.

“We do have a lot of youth and children who wait on waiting lists or who never get help at all and, as a result, encounter significant disability. Ultimately some, unfortunately, die from their illness through suicide,” said Chow.

At Youth Wellness, which is based at the Three Story Clinic in Vancouver, child and adolescent psychiatrists assess patients within four weeks of referral. They are then referred to other specialists, providers and clinics.

Depending on where a child or youth lives in the province and even within the Lower Mainland, access to care varies, said Chow.

“Basically, the further east you go, past Boundary Road, the longer the waits get,” he said.

He said as populations have shifted, he’s noticed fewer referrals from Vancouver and increasing demand in Surrey, Langley, Port Coquitlam and Maple Ridge, where there are more young people.

Many of Chow’s patients are intercepted early in their illness or when symptoms are mild to moderate. He said too often the system forces people to wait for treatment until they’re very sick or suicidal.

“It’s a fundamental principle of medicine that the earlier that you can intervene in an illness, the better the outcome will be,” Chow said.

Narayan, now a student at SFU and an advocate for mental health, continues to receive treatment. She credits her ability to get through high school and transition to university to five teachers who banded together to help her navigate the system and get access to care.

They also encouraged her to open up to her parents, who are proud of her advocacy work.

“Living with my anxiety and living with my depression, I find it’ll never get easy for me,” she said. “But I feel like through my life I will learn tools that will help me manage it better. We expect ourselves to turn off the monsters, but how realistic is that? Rather, let’s say, let’s turn down the volume of the monsters.”

Eight years after first experiencing the signs of mental illness, Narayan told her story to an auditorium of Grade 7 girls at Elgin Park Secondary in Surrey. They were the same age she was when her anxiety and depression began.

Naryan asked the group how many felt stressed. Most raised their hands.

“Know that you’re not alone,” she told them.

Ashley MacDonald was hospitalized numerous times as a child due to depression, including a stay in an adult psychiatric ward.
Ashley MacDonald was hospitalized numerous times as a child due to depression, including a six-month stay in an adult psychiatric ward.

Services struggle amid surge in youth reporting mental health issues 

Ashley Macdonald began suffering from symptoms of anxiety in Grade 9, along with depression, an eating disorder and a self-harm addiction. At times she couldn’t get out of bed or eat. 

“It felt like you were very heavy, like you’re just draped over, covered in something thick,” Macdonald said of her depression. 

At crisis points she would call 911 and was hospitalized multiple times — including a six-month stint in an adult psychiatric ward when she was in Grade 12. 

After her health stabilized, she moved into a transitional living program with Options Community Services Society. 

Now 19, Macdonald is able to study and work. She attributes her progress to cognitive-behavioural therapy. 

She’s one of thousands of children and young people in B.C. who have been hospitalized due to mental health issues — and the province’s counsellors and clinicians are struggling to cope.

Canada-wide, emergency department visits for youth who have mental disorders rose 45 per cent between 2006/2007 and 2013/2014, according to the Canadian Institute for Health Information. In-patient hospitalizations increased by 37 per cent in the same period.

According to the Ministry of Health, approximately 3,800 children and youth were hospitalized for mental health and substance-use related reasons in 2013-2014 in B.C.

B.C. Children’s Hospital in Vancouver has 20 beds as part of a provincial in-patient program for children and youth, as well as six beds in a psychiatric emergency unit. In the rest of the province, there are six in Prince George, eight in Kelowna and 10 at Surrey Memorial Hospital. 

Dr. Matthew Chow, a child psychiatrist with the counselling group Youth Wellness Associates in Vancouver, said that due to the lack of beds in youth wards, youth sometimes end up in an adult psychiatric ward.

The stigma of mental illness is evident in how the health system treats patients with mental health disorders compared to, for example, young cancer patients, Chow said.

“We treat them (young cancer patients) really, really well — we do everything in our power to make it a comforting experience because we know it’s scary,” he said. “Yet, in the mental health system, we don’t do that. We have people being put in adult units or being treated by adult specialists, and it’s really frightening for them, and it’s not fair.”

Macdonald still attends counselling and hopes to inspire others to seek help for their mental health struggles. 

“I feel like there’s a lot more people out there who are struggling than what we actually see,” she said. “It’s kind of this big, dark secret out there.” 

She is now a youth representative with the Child & Youth Mental Health and Substance Use collaborative, an initiative funded by Doctors of B.C. and the provincial government to increase timely support for those in need.

The collaborative was established in June 2013 and has since grown to 64 local teams across the province, involving around 2,600 people. 

“It was formed in response to family doctors identifying that children and youth and families did not have sufficient access to mental health and substance use services,” said Valerie Tregillus, project director of the collaborative.

“We were being told by school counsellors and clinicians and doctors that they feel they’re facing a tsunami. I think that there’s no question that there’s underfunding for this high-need population and the return on investment is massive.”

 • Rosemary Newton is a graduate of Langara College’s journalism program and recipient of the 2016 Jeani Read-Michael Mercer Scholarship

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