Reducing stigma and improving access to mental health care for youth

BC youth have been estimated to have a relatively high—15%—prevalence of mental health disorders.[1] Even more alarmingly, disease onset occurred before 18 years of age in 70% of Canadian adults living with mental illness.[2] Youth are among the most susceptible groups for mental health problems, yet are poorly equipped to recognize disorders and most likely to seek help from each other.[3]

We formed the Healthy Young Minds Project in October 2009. The project’s mission is to “establish a sustainable framework for engaging youth in the discussion of mental health with the aims of reducing stigma and facilitating access to mental health care” through the creation and delivery of workshops in Vancouver high schools. 

The project ran focus groups with teens at a Vancouver high school to find out what youth know about mental health and illness. “We don’t know how they feel,” was one of many frustrated answers to the question, “What is mental health and what does it mean to have a mental illness?”

A qualitative review of our results has revealed that youth understand that mental health is a broad, complicated topic and that they have a great desire to learn—but they have trouble sorting out facts from misinformation. The above quote, in particular, shows that mental illness—at least in peer discussions—is largely viewed as a remote problem that afflicts other people who have foreign, unknown feelings. 

This view may reflect how teenagers see the world, and that part of growing up is realizing that these “others” could very easily be us. The unfortunate reality is that, for some youth, insight may come too late. It may even result in them falling under the radar of mental health service providers.

Ms Williams, a member of the Healthy Young Minds team, recently met a patient, Mr X, during a family practice placement. He was new to the practice and was seeking a physician to help him manage issues related to depression and anxiety. Currently in his mid-30s, he disclosed that he has been suffering silently for more than 10 years, afraid of the stigma an official diagnosis would bring. 

Mr X indicated that his illness limits his social life and prevents engagement in work and school activities. Talking to Ms Williams was the first time he had discussed his problems with anyone in the health care system. Near the end of the interview he seem­ed more relaxed, perhaps relieved, as our colleague thanked him for sharing his story while reassuring him that he is not alone in dealing with these difficulties.

Ms Williams’s encounter illustrates how, despite being severely im­pacted, a person with mental illness can feel alone and afraid to share his experience for many years. Listening to him share his story and serving as the first contact in the health care system was a relieving and humbling experience for a future physician. Coming to the doctor’s office was an important first step, one that Healthy Young Minds would like to see happen earlier in the course of mental illnesses.

Healthy Young Minds aims to increase awareness of mental health and illness so that others like Mr X know that it is okay to admit to having these problems. People with mental health issues should not have to face the barriers of stigma and misinformation while suffering in silence.

We have been inspired early in our medical training by a common passion for reducing disparities and providing young people with the tools to not only access mental health resources, but also to emphasize the importance of addressing mental health through self-care practices. 

One major strength of our project is that it focuses on integrating expert knowledge with what youth already know and would like to know. We are currently compiling and evaluating results from four focus groups with students in grades 9, 10, 11, and 12. These results will complement information from advice from local mental health experts, peer-reviewed literature, and resources from government agencies in the development of pilot mental health workshops for grade 10 students.

In the pilot project this year, we hope to not only stimulate discussion, but also to educate youth on the topics of mental health and self-care practices. We hope that youth will benefit from both the information we will present and from the interaction with positive role models. Above all we believe that education and open discourse are two potent antidotes to the ugliness of stigma. Following our pilot run, the results will be evaluated and the group will be recruiting UBC volunteers to expand the project to more classrooms and ensure its sustainability in future years.

Acknowledgments
The team would like to thank our faculty mentor, Dr Shafik Dharamsi, assistant professor in the UBC Department of Family Practice, and our community mentors, the late Ms Jackie Farquhar, social/emotional learning consultant with the Vancouver School Board, and Mr John Libson, school mental health liaison of Vancouver Coastal Health. This project was funded by the Canadian Federation of Medical Students, the British Columbia Medical Association, and the Social Accountability and Community Engagement Initiative at UBC.

This article has been peer reviewed.

References

1. Waddell C, Shepherd C. Prevalence of mental disorders in children and youth: A research update prepared for the British Columbia Ministry of Children and Family Development. Mental Health Evaluation & Community Consultation Unit 2002, Department of Psychiatry, Faculty of Medicine, University of British Columbia.
2. Mental Health Commission of Canada. Countering Stigma and Discrimination: Operational Plan: Version 3. September 2008. Accessed 26 January 2011. www.mentalhealthcommission.ca/SiteCollectionDocuments/Anti-Stigma/Operational%20Plan%20SD%202008%20sept2908.pdf.
3. Kelly CM, Jorm AF, Wright A. Improving mental health literacy as a strategy to facilitate early intervention for mental disorders. Med J Australia 2007;187:S26-S30.

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Ms Mehta, Ms Williams, Mr Butskiy, Ms Swanson, and Ms Dosani are class of 2013 medical students at the University of British Columbia.