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Teens facing addiction and mental illness need services that treat both
May 04, 2012 Andrea Gordon
She was an honours student and competitive soccer player who wrote poetry, played guitar and often had a sketchpad tucked under her arm.
But Caitlin Robb was also a terrified teenager. Her mind raced like a thoroughbred. Her bipolar disorder caused extreme mood swings.
Dabbling in alcohol and pot, she discovered, calmed her jangling nerves. But by the end of high school, she had spiralled into a cycle of binge-drinking and getting high, trying to stop, followed by the inevitable wave of despair when she couldn’t. She developed anorexia, began cutting her arms and legs, and became suicidal.
“It was all about escape . . . and just to take the edge off so I didn’t have to feel,” says Robb, now 24, who lives and works in Stratford and has been in recovery for more than two years. Her parents were desperate to save her. But each time she was ready to accept help there was nowhere to go.
Youth addiction treatment programs couldn’t deal with her complex mental health issues. Neither could eating disorders programs. Mental health centres weren’t willing to handle her substance abuse.
“It was a complete Catch-22. The message I took from it was ‘I’m sorry, you’re too screwed up for us.’ I stopped caring.”
With every failed attempt, her window of willingness for treatment would close. And the cycle would begin again.
The fact that mental illness and addiction are intertwined and exacerbate one another is far from new. But Robb’s experience illustrates the dilemma for youth in Ontario who need treatment for both, known as concurrent disorders. It’s something Robb, now a youth advocate with Children’s Mental Health Ontario, wants to see changed.
Unlike the adult system, youth mental health and addiction services still often function as “two solitudes,” says Dennis Long, executive director of Breakaway Addiction Services for youth in Toronto. Mental health professionals may feel out of their depth dealing with kids who also have drug or alcohol problems and vice versa. But to treat them separately “is absurd,” says Long. “It simply doesn’t work. You really have to address both issues simultaneously because one drives the other. It’s like a dog chasing its tail.”
Breakaway and the George Hull Centre for Children and Families, a local mental health agency, are partners in Clear Directions, one of a few day treatment programs in Toronto for youth with concurrent disorders, which takes eight teens at a time.
Part of the problem is the assortment of agencies and services funded by different provincial ministries and with different mandates.
“We have a fair number of kids whose needs are complex and we don’t serve them well when services are in silos,” says Gordon Floyd, president of Children’s Mental Health Ontario, which represents 85 community-based centres. “We have to better equip organizations to deal with both sides of the diagnosis.”
The prevalence of concurrent disorders is difficult to measure and varies according to setting. But the Centre for Addiction and Mental Health (CAMH) estimates half of young people with mental illness also struggle with substance abuse. Research shows that people with mental illness are at higher risk of addiction than the general population and those with addiction have higher rates of mental health problems.
Further compounding the shortage of treatment for youth is the lack of co-ordination among services, which serve a variety of age ranges, making it a challenge for parents to find the most appropriate help for their kids.
With addiction, for example, there are no withdrawal beds for youth in the Toronto area. Often teens who arrive at mental health centres with drug and alcohol problems are referred to addiction treatment. While they might be lucky enough to find a day program for concurrent disorders, getting one of Ontario’s 103 OHIP-funded beds for residential addiction treatment can take months.
Once they get there, families may downplay underlying mental health problems just to get their child in the door.
In July, CAMH will offer some relief for kids in crisis, when it opens a dozen beds providing 24-hour care for youth with concurrent disorders at its new downtown facility. The beds are the first of their kind in Canada.
Teens age 14 to 18 will stay an average three weeks and as long as six weeks to stabilize, undergo assessments for everything from learning disabilities to attention disorders, and then be moved into CAMH’s day treatment while a net of family and community supports is put in place.
The new beds are designed for acute cases, says Christina Bartha, administrative director of child, youth and family addictions program at CAMH. Teens may come from youth shelters, child welfare or their family homes.
Those in the field say the new unit, which will also operate as a training and research site, is welcome and long overdue. It also reflects a shift towards treatment that addresses not only drug and alcohol dependency but underlying mental health. Increasingly, this kind of treatment also includes families as a critical part of recovery.
Five or 10 years ago, youth concurrent disorders were seldom discussed, says Bartha. “Now it’s on everyone’s radar.”
Failing to treat all the pieces means “we miss an opportunity to have the most benefit in the shortest period of time,” adds Dr. Corine Carlisle, clinical head of youth addictions and concurrent disorders at CAMH.
For some teens, drugs and alcohol are a way to self-medicate symptoms of depression, bipolar, anxiety or ADHD, which may or may not have been diagnosed. The explosion in neuroscience and brain imaging in the past decade has also shed light on another scenario — when drug use triggers psychosis or onset of other mental illnesses by changing the chemistry of the brain.
For Nick Carveth of Toronto, understanding how his drug use was a coping mechanism for anxiety and an undiagnosed obsessive-compulsive disorder was key.
The casual marijuana habit he began in early high school progressed to a cocaine addiction by grade 12. He dropped out and was miserable, wanting to quit but not knowing how. He tried abstinence-based programs but found he needed an approach that also helped him manage his mental health.
He found it at the REACH (Recovery and Education for Adolescents Choosing Health) program run by CAMH, a harm-reduction day treatment and high school program for youth with substance abuse and mental illness.
“I see those things as so inextricably linked,” says Carveth, 22, who just finished his second year as a Ryerson University student in social work.
Recognizing the link helped him feel there were factors driving his behaviour “and not that I was just a bad person.”
Youth residential addiction centres like Pine River Institute northwest of Toronto and Portage, in Elora, screen and address mental health issues. But the wait list for Portage averages two to four months, and it can take up to a year to get one of the 29 funded beds at Pine River, which also has seven private beds.
“It’s important to treat the whole person,” says psychologist Victoria Creighton, director of clinical programs at Pine River. “If you only treat the symptoms, then something else will pop up.”
She says 95 per cent of clients arrive at the therapeutic centre with a mental health diagnosis. Their lives are in an uproar but once they are away from the chaos, first in the wilderness and then at Pine River’s rural campus, many of those mental health conditions become manageable.
“I think just about everyone we see has some form of co-occurring disorder, but it’s the severity you have to take into account,” adds Peter Vamos, psychologist and executive director of Portage.
Those with serious mental illness need to be treated and stabilized so they can use cognitive and behavioural tools to address their addiction. Those at the other end of the spectrum don’t necessarily need specialized mental health services, he says.
The more pressing issues, says Vamos, are the shortage of beds for addicted youth, wait times and a fragmented system that is difficult for families to navigate.
For Caitlin Robb, the lack of services meant her mental health deteriorated and her addiction worsened. She became hooked on benzodiazepines and crystal meth. Then, just over two years ago, her parents paid for her to stay five months at a private treatment centre in Manitoba, where she began to understand the factors that were driving her behaviour, and to learn healthy ways to cope.
Focusing on her mental health and addiction together was the only answer, she says. “Because if you just take one coping strategy away from me, I’m just going to turn to another.”
Another turning point came at around the same time, when her social worker connected her with the Youth Action Committee, a group of young advocates with Children’s Mental Health Ontario who educate the public by sharing their personal experience and lobby for changes in the system.
At the agency’s 2009 annual meeting, Robb stood up and told her story for the first time. Since then she has spoken to local groups in Stratford, addressed hundreds at two more annual meetings, and appeared on Canada AM to talk about mental health.
“I have a story to tell and people actually listen,” she says. “I want to make a difference.”
May 04, 2012 Andrea Gordon
She was an honours student and competitive soccer player who wrote poetry, played guitar and often had a sketchpad tucked under her arm.
But Caitlin Robb was also a terrified teenager. Her mind raced like a thoroughbred. Her bipolar disorder caused extreme mood swings.
Dabbling in alcohol and pot, she discovered, calmed her jangling nerves. But by the end of high school, she had spiralled into a cycle of binge-drinking and getting high, trying to stop, followed by the inevitable wave of despair when she couldn’t. She developed anorexia, began cutting her arms and legs, and became suicidal.
“It was all about escape . . . and just to take the edge off so I didn’t have to feel,” says Robb, now 24, who lives and works in Stratford and has been in recovery for more than two years. Her parents were desperate to save her. But each time she was ready to accept help there was nowhere to go.
Youth addiction treatment programs couldn’t deal with her complex mental health issues. Neither could eating disorders programs. Mental health centres weren’t willing to handle her substance abuse.
“It was a complete Catch-22. The message I took from it was ‘I’m sorry, you’re too screwed up for us.’ I stopped caring.”
With every failed attempt, her window of willingness for treatment would close. And the cycle would begin again.
The fact that mental illness and addiction are intertwined and exacerbate one another is far from new. But Robb’s experience illustrates the dilemma for youth in Ontario who need treatment for both, known as concurrent disorders. It’s something Robb, now a youth advocate with Children’s Mental Health Ontario, wants to see changed.
Unlike the adult system, youth mental health and addiction services still often function as “two solitudes,” says Dennis Long, executive director of Breakaway Addiction Services for youth in Toronto. Mental health professionals may feel out of their depth dealing with kids who also have drug or alcohol problems and vice versa. But to treat them separately “is absurd,” says Long. “It simply doesn’t work. You really have to address both issues simultaneously because one drives the other. It’s like a dog chasing its tail.”
Breakaway and the George Hull Centre for Children and Families, a local mental health agency, are partners in Clear Directions, one of a few day treatment programs in Toronto for youth with concurrent disorders, which takes eight teens at a time.
Part of the problem is the assortment of agencies and services funded by different provincial ministries and with different mandates.
“We have a fair number of kids whose needs are complex and we don’t serve them well when services are in silos,” says Gordon Floyd, president of Children’s Mental Health Ontario, which represents 85 community-based centres. “We have to better equip organizations to deal with both sides of the diagnosis.”
The prevalence of concurrent disorders is difficult to measure and varies according to setting. But the Centre for Addiction and Mental Health (CAMH) estimates half of young people with mental illness also struggle with substance abuse. Research shows that people with mental illness are at higher risk of addiction than the general population and those with addiction have higher rates of mental health problems.
Further compounding the shortage of treatment for youth is the lack of co-ordination among services, which serve a variety of age ranges, making it a challenge for parents to find the most appropriate help for their kids.
With addiction, for example, there are no withdrawal beds for youth in the Toronto area. Often teens who arrive at mental health centres with drug and alcohol problems are referred to addiction treatment. While they might be lucky enough to find a day program for concurrent disorders, getting one of Ontario’s 103 OHIP-funded beds for residential addiction treatment can take months.
Once they get there, families may downplay underlying mental health problems just to get their child in the door.
In July, CAMH will offer some relief for kids in crisis, when it opens a dozen beds providing 24-hour care for youth with concurrent disorders at its new downtown facility. The beds are the first of their kind in Canada.
Teens age 14 to 18 will stay an average three weeks and as long as six weeks to stabilize, undergo assessments for everything from learning disabilities to attention disorders, and then be moved into CAMH’s day treatment while a net of family and community supports is put in place.
The new beds are designed for acute cases, says Christina Bartha, administrative director of child, youth and family addictions program at CAMH. Teens may come from youth shelters, child welfare or their family homes.
Those in the field say the new unit, which will also operate as a training and research site, is welcome and long overdue. It also reflects a shift towards treatment that addresses not only drug and alcohol dependency but underlying mental health. Increasingly, this kind of treatment also includes families as a critical part of recovery.
Five or 10 years ago, youth concurrent disorders were seldom discussed, says Bartha. “Now it’s on everyone’s radar.”
Failing to treat all the pieces means “we miss an opportunity to have the most benefit in the shortest period of time,” adds Dr. Corine Carlisle, clinical head of youth addictions and concurrent disorders at CAMH.
For some teens, drugs and alcohol are a way to self-medicate symptoms of depression, bipolar, anxiety or ADHD, which may or may not have been diagnosed. The explosion in neuroscience and brain imaging in the past decade has also shed light on another scenario — when drug use triggers psychosis or onset of other mental illnesses by changing the chemistry of the brain.
For Nick Carveth of Toronto, understanding how his drug use was a coping mechanism for anxiety and an undiagnosed obsessive-compulsive disorder was key.
The casual marijuana habit he began in early high school progressed to a cocaine addiction by grade 12. He dropped out and was miserable, wanting to quit but not knowing how. He tried abstinence-based programs but found he needed an approach that also helped him manage his mental health.
He found it at the REACH (Recovery and Education for Adolescents Choosing Health) program run by CAMH, a harm-reduction day treatment and high school program for youth with substance abuse and mental illness.
“I see those things as so inextricably linked,” says Carveth, 22, who just finished his second year as a Ryerson University student in social work.
Recognizing the link helped him feel there were factors driving his behaviour “and not that I was just a bad person.”
Youth residential addiction centres like Pine River Institute northwest of Toronto and Portage, in Elora, screen and address mental health issues. But the wait list for Portage averages two to four months, and it can take up to a year to get one of the 29 funded beds at Pine River, which also has seven private beds.
“It’s important to treat the whole person,” says psychologist Victoria Creighton, director of clinical programs at Pine River. “If you only treat the symptoms, then something else will pop up.”
She says 95 per cent of clients arrive at the therapeutic centre with a mental health diagnosis. Their lives are in an uproar but once they are away from the chaos, first in the wilderness and then at Pine River’s rural campus, many of those mental health conditions become manageable.
“I think just about everyone we see has some form of co-occurring disorder, but it’s the severity you have to take into account,” adds Peter Vamos, psychologist and executive director of Portage.
Those with serious mental illness need to be treated and stabilized so they can use cognitive and behavioural tools to address their addiction. Those at the other end of the spectrum don’t necessarily need specialized mental health services, he says.
The more pressing issues, says Vamos, are the shortage of beds for addicted youth, wait times and a fragmented system that is difficult for families to navigate.
For Caitlin Robb, the lack of services meant her mental health deteriorated and her addiction worsened. She became hooked on benzodiazepines and crystal meth. Then, just over two years ago, her parents paid for her to stay five months at a private treatment centre in Manitoba, where she began to understand the factors that were driving her behaviour, and to learn healthy ways to cope.
Focusing on her mental health and addiction together was the only answer, she says. “Because if you just take one coping strategy away from me, I’m just going to turn to another.”
Another turning point came at around the same time, when her social worker connected her with the Youth Action Committee, a group of young advocates with Children’s Mental Health Ontario who educate the public by sharing their personal experience and lobby for changes in the system.
At the agency’s 2009 annual meeting, Robb stood up and told her story for the first time. Since then she has spoken to local groups in Stratford, addressed hundreds at two more annual meetings, and appeared on Canada AM to talk about mental health.
“I have a story to tell and people actually listen,” she says. “I want to make a difference.”
