North Shore teens in crisis

With the number of teens visiting Lions Gate ER for mental health problems doubling in three years, youth advocates are calling for more services.

ImageDan’s 15-year-old daughter began wearing long-sleeve shirts after she started cutting herself.

Bullies at her high school on the North Shore were relentless, taunting her online, calling her names and physically hurting her.

She spiraled into depression and, not seeing a way out, soon became suicidal.

One particularly bad evening she wound up in Lions Gate ER suffering from extreme anxiety. She waited eight hours to be admitted, says her father, was given Ativan to calm her down and eventually transferred to BC Children’s Hospital for treatment.

After spending three days at the hospital, the diagnosis: Post traumatic stress.

“We wanted to stay away from pills but eventually we had to go there,” Dan tells The Outlook, visibly concerned for his teenage daughter.

Despite several school programs on the North Shore that help with depression, anxiety and other mental health issues, the family decided home schooling was the best option.

While the circumstances vary greatly, cases of teens in crisis have been steadily increasing on the North Shore.

Over a three-year period in 2010, 2011 and 2012, Lions Gate emergency room visits for depression, suicidal thoughts and self-harm have more than doubled for teens.

Noticing an increase in youth mental health problems, Dr. Tom Barnett, a psychiatrist on the North Shore, commissioned a report to show the exact numbers.

In line with his prediction, ER visits have shot up in recent years.

“Our community is not well served in spite of the fact that we have two ministries – Health and the MCFD [Ministry of Children and Family Development] – both running parallel programs in mental health for youth, with parallel bureaucracies and overheads,” says Barnett of what he describes as a complex and often frustrating system parents must navigate on the North Shore.

The report also looks at Richmond Hospital, a facility Barnett says is run much the same as Lions Gate, but doesn’t show the same results. The number of teens with mental health issues remains nearly the same over the three-year period, with a few dips.

Noticing the trend the report outlines, Capilano University communications instructor Michael Markwick ran in the last provincial election as an Independent for West Van-Capilano to advocate for teens on the North Shore with mental health issues.

“There’s been a lot of studying but no action,” he tells The Outlook. “It’s clearly not working for kids on the North Shore, these numbers clearly show that.”

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Dan’s daughter is doing somewhat better now that she’s home-schooled. But with Facebook and other websites, bullying can never be left behind.

Diane, a mother of two boys in North Vancouver with disabilities, knows this well. In her experience even video games, which can be hooked up to the Internet, are targets for bullies who harass other players by making threats and name-calling.

Her younger son, who is eight years old, has suffered from depression and anxiety for a few years.

“He started saying things like ‘I wish I was dead’ and he drew a random person shooting him,” she explains, noting this is an early age for symptoms to start.

After his problems continued, Diane saw no other choice but to transfer him to another school.

Both parents say the wait-list to see a publicly funded counsellor is too long, so they are seeking treatment privately.

And they aren’t surprised the number of teens coming to Lions Gate ER with mental health issues has doubled in the last three years.

To be exact, in 2009/10 92 teens visited the ER, 152 in 2010/11 and 193 in 2011/12. Although lower, the number of children up to 13 years old increased proportionally, from 10 to 13 to 20. A population increase of just over 2 per cent on the North Shore doesn’t account for the jump.

One thing is for certain, these parents insist, there needs to be child psychiatric beds on the North Shore so youth don’t need to go to BC Children’s Hospital, which can further complicate an already traumatizing experience.

Dr. Lance Patrick, the head of psychiatry at Lions Gate Hospital, says the hospital’s new HOpe Centre would ideally have beds for children.

The $62-million acute mental health facility is still under construction and will eventually include a 26-bed inpatient psychiatric unit. This area, however, isn’t specific to children.

“The hospital foundation… raised enough funds to have an extra floor that is available for further development for just these kind of reasons,” Patrick tells The Outlook.

“We’ve been depending on BC Children’s and BC Children’s is really a provincial resource not a secondary care resource.

“Getting access to BC Children’s service is very difficult, it takes time and means the children that need the service aren’t getting it quickly.”

Another option, says Dr. Steve Mathias, Vancouver Coastal Health’s regional youth medical leader, is mobile crisis units similar to those in Vancouver and Richmond. A nurse or social worker, along with support from an on-call doctor, would go into houses to treat patients with mental health problems. This way teens who don’t want to access services at the hospital or in school can get help.

Students on the North Shore have access to school counsellors who are trained to work with mental health issues on a short-term basis, as well as programs that offer support. For some students, however, in-school treatment isn’t enough.

The North Shore’s increase in emergency room visits isn’t a unique problem, says Mathias, but seen in many communities throughout Canada.

“We’re finding increased emergency room utilization across the country for young people looking for mental health support,” he says. “This is something we’ve found in the region — at all the local hospitals the number of visits have gone up — and across the country as well.”

Although exact statistics aren’t readily available, he doesn’t think numbers on the North Shore have gone up disproportionately compared to other places.

“The North Shore is a catchment area for both urban and rural sites so Lions Gate is a hospital where folks all the way up to Bella Bella will come to. It’s a different population, it’s a different set up in terms of services right now.”

Spokespeople for both Vancouver Coastal Health and the Ministry of Children and Family say they are focusing on improving wait-lists and support for parents navigating the system, as well as improving the transition process as teens move to adult mental health services.

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The increasing number of youth with mental health problems on the North Shore won’t be fixed with more money, says Dr. Barnett. The problem, he explains, is a complicated system that leaves parents frustrated and ultimately puts children at risk.

Dan’s daughter was lucky to be transferred to BC Children’s Hospital relatively quickly. Getting patients from the North Shore in for treatment is “extremely difficult,” says Barnett.

With no specific areas for adolescents with mental health issues, some parents are left confused with the system at Lions Gate Hospital.

Currently if a 14-year-old girl, for example, comes to the ER with anxiety, she would be sent to the pediatrics ward to be seen by a different psychiatrist each day. If the girl was two years older, she would be sent to the adult psychiatry ward.

“It’s not locked. The family would need to hire a sitter if she was suicidal,” says Markwick with concern.

Their solution: It’s time to stop studying the problem and find a solution.

“Multiple reviews have not resulted in significant changes, and yet another is scheduled for later this month,” says Barnett, adding positive results won’t be seen without improvements to out-patient and early detection programs. One solution, he says, is to have either the Ministry of Health or MCFD in charge to avoid confusion.

Whatever the solution, Mathias says Vancouver Coastal Health is looking into options.

“We’re committed to solving the issues and having a committed and coordinated approach because right now the emergency room is the point-in-contact for so many youth in crisis,” he says.

But Markwick says change isn’t happening fast enough.

As former chief of staff for the Ontario Human Rights Commission, he is working with several parents on the North Shore to file a complaint under the BC Human Rights Act.

“These kids because of their age and handicap are being denied service available to everyone,” he says.

“It has to be a politically led solution. The Ministry of Health and the Ministry of Children and Family are ultimately responsible.

“A new cabinet is in place so let’s solve this together, but it has to be based on evidence, not politics.”

*Parents’ names have been changed

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