Access to mental health and addiction services for youth and their families in Ontario: perspectives of parents, youth, and service providers.

BACKGROUND: Canadian youth (aged 16-24) have the highest rates of mental health and addiction concerns across all age groups and the most unmet health care needs. There are many structural barriers that contribute to the unmet mental health care needs of youth including lack of available and appropriate services, high costs, long wait times, fragmented and siloed services, lack of smooth transition between child and adult services, stigma, racism, and discrimination, as well as lack of culturally appropriate treatments. Levesque et al. (2013) developed a framework to better understand health care access and this framework conceptualizes accessibility across five dimensions: (1) approachability, (2) availability, (3) affordability, (4) appropriateness, and (5) acceptability. The purpose of this study was to explore access to addiction and mental health services for youth in Ontario, Canada from the perspectives of youth, parents, and service providers. METHODS: This qualitative study was a university-community partnership exploring the experiences of youth with mental health concerns and their families from the perspectives of youth, caregivers, and service providers. We conducted semi-structured interviews and used thematic analysis to analyze data. RESULTS: The study involved 25 participants (n = 11 parents, n = 4 youth, n = 10 service providers). We identified six themes related to structural barriers impacting access to youth mental health and services: (1) "The biggest barrier in accessing mental health support is where to look," (2) "There's always going to be a waitlist," (3) "I have to have money to be healthy," (4) "They weren't really listening to my issues," (5) "Having more of a welcoming and inclusive system," and (6) "Health laws aren't doing what they need to do." CONCLUSION: Our study identified five structural barriers that map onto the Levesque et al. healthcare access conceptual framework and a sixth structural barrier that is not adequately captured by this model which focuses on policies, procedures, and laws. The findings have implications for policies and service provisions, and underline the urgent need for a mental health strategy that will increase access to care, improve mental health in youth, decrease burden on parents, and reduce inequities in mental health policies and services.

Optimists and Realists: A Latent Class Analysis of Students Graduating from High School during COVID-19 and Impacts on Affect and Well-Being.

The Novel Coronavirus Disease (COVID-19) pandemic has had profound effects on physical and mental health worldwide. Students transitioning out of high school were uniquely impacted at the onset of the pandemic, having missed the opportunity to properly mark the end of their final year in the K-12 school system. The adverse effects of this loss on this population are still unknown. The purpose of the current study was to examine stress, wellbeing, and affect in a sample of 168 students (N = 168; Mage = 17.0, SD = 0.46; 60% female; 40% male) who were completing their final year of high school during the early stages of the pandemic when emergency stay-at-home orders were in place. Participants completed an online survey assessing the impact of COVID-19 on their life satisfaction (pre-COVID19, during COVID-19, and anticipated five years from now), stress, positive affect, and negative affect. Latent class analysis (LCA) was used to create classes of participants based on their responses to the pandemic. A two-subgroup solution provided the best model for the life satisfaction outcome variable. Subgroup 1, optimists, comprised 24% (N = 40) of the sample and reported high life satisfaction ratings one year prior to COVID-19 and a slight decrease in life satisfaction during COVID-19, and they anticipated an increase in life satisfaction 5 years from now. This group was characterized by low stress, low negative affect, and high positive affect during the pandemic. Subgroup 2, realists, comprised 76% of the population (N = 128) and experienced similarly high retrospective ratings of pre-COVID life satisfaction but a larger decrease in life satisfaction during the pandemic and a smaller increase in five years. The realist group was characterized by low positive affect, high stress, and high negative affect during the pandemic. The findings suggest that during the pandemic, certain subsamples of adolescents had greater difficulty in managing this transitional period and experienced changes in mood and well-being (i.e., affect, stress) as compared to other adolescents (i.e., optimists). Future research should investigate the characteristics and coping mechanisms that are instrumental for increasing life satisfaction and positive affect while lowering stress in this population.

A Qualitative Investigation of the Positive and Negative Impacts of the COVID-19 Pandemic on Post-Secondary Students’ Mental Health and Well-Being

Evidence suggests that post-secondary students without pre-existing mental health concerns may have experienced worsening mental health during the COVID-19 pandemic, relative to students with pre-existing mental health concerns. To clarify the psychological impacts of the pandemic, and elucidate why differences may exist among students, 20 interviews were conducted with emerging adults enrolled in university. Using directed content analysis, eight themes were identified: three more common among students with pre-existing mental health concerns, three more common among students without pre-existing mental health concerns, and two shared. Although all students experienced novel stressors during the pandemic, students without pre-existing mental health concerns reported greater increases in social and academic isolation, relative to students with pre-existing mental health concerns. Students with pre-existing mental health concerns also leveraged existing coping repertoires, which further supported their ability to manage pandemic-related challenges. Findings highlight how postsecondary institutions can bolster student well-being.

Navigating inequities in the delivery of youth mental health care during the COVID-19 pandemic: perspectives of youth, families, and service providers.

OBJECTIVES: There have been concerns about the adverse effects of the COVID-19 pandemic on Canadian youth (aged 16-24) as they have the highest rates of mental health concerns. The objectives of the present study were to explore the experiences of youth with mental health and/or addiction concerns and their families during the pandemic, and to examine how adequate and equitable mental health services have been for youth and families from the perspectives of youth, parents, and service providers. METHODS: Using a descriptive qualitative research design and a university-community partnership, we conducted individual interviews with youth, parents, and service providers. The study involved a total of 25 participants (n=15 service users, n=10 service providers). Among the service users, 11 participants were parents and four were youth. We used thematic analysis to analyze interview data. RESULTS: The thematic analysis identified three themes in the data: (1) youth mental health concerns have increased, whereas supports have decreased, (2) families end up being the treatment team with increased burden, little support, and lack of recognition, and (3) inadequate and inequitable mental health services for youth and families are amplified during the pandemic. CONCLUSION: At a time when mental health needs were higher, the mental health care system offered less support to youth and their families. For a more equitable response to the pandemic, we need an accessible and integrated mental health care system that shows a commitment to addressing social determinants and reducing health disparities and inequities in access to mental health services.

RéSUMé: OBJECTIFS: Les effets indésirables de la pandémie de COVID-19 sur les jeunes (16 à 24 ans) du Canada suscitent des inquiétudes, car ce sont les jeunes qui présentent les taux les plus élevés de problèmes de santé mentale. Nous avons voulu explorer les expériences de jeunes aux prises avec des problèmes de santé mentale et/ou de toxicomanie et de leurs familles durant la pandémie, et à déterminer si les services de santé mentale sont suffisants et équitables pour les jeunes et leurs familles du point de vue de jeunes, de parents et de prestataires de services. MéTHODE: À l'aide d'un plan de recherche qualitative descriptive et d'un partenariat entre les milieux universitaire et associatif, nous avons mené des entretiens individuels avec des jeunes, des parents et des prestataires de services. Vingt-cinq personnes ont participé à l'étude (n = 15 utilisateurs et utilisatrices de services, n = 10 prestataires de services). Parmi les utilisateurs et utilisatrices de services, 11 étaient des parents et 4 étaient des jeunes. Nous avons eu recours à l'analyse thématique pour analyser les données des entretiens. RéSULTATS: Trois thèmes se sont dégagés de l'analyse thématique des données : 1) les problèmes de santé mentale des jeunes augmentent, tandis que les mesures d'aide diminuent, 2) ce sont les familles qui finissent par constituer l'équipe de traitement, ce qui représente un fardeau accru, peu de soutien et un manque de reconnaissance, et 3) l'insuffisance et l'iniquité des services de santé mentale offerts aux jeunes et à leurs familles ont été amplifiées durant la pandémie. CONCLUSION: Alors que les besoins en santé mentale étaient plus élevés, le système de soins de santé mentale a offert moins de soutien aux jeunes et à leurs familles. Pour une intervention plus équitable face à la pandémie, nous avons besoin d'un système de soins de santé mentale accessible et intégré, manifestement engagé à aborder les déterminants sociaux et à réduire les disparités d'état de santé et les iniquités d'accès aux services de santé mentale.

When social isolation is nothing new: A longitudinal study psychological distress during COVID-19 among university students with and without preexisting mental health concerns

The coronavirus disease 2019 (COVID-19) global pandemic has had an unprecedented impact on college and university campuses internationally (e.g., widespread campus closures, transitions to online learning). Postsecondary students, who were already a developmentally vulnerable population, are now facing additional new challenges, which could lead to increased mental health concerns. However, there is a paucity of research on the psychological impacts of COVID-19, or who may be most at risk, among postsecondary students. To address these gaps in the literature, we recontacted a sample of 773 postsecondary students (74% female, Mage = 18.52) who previously completed a survey on student mental health in May 2019, again in May 2020. Students filled out an online survey at both time points, reporting on their recent stressful experiences and mental health. Although we expected that students with preexisting mental health concerns would show increased psychological distress during the pandemic, this hypothesis was not supported. Instead, repeated-measures analyses demonstrated that students with preexisting mental health concerns showed improving or similar mental health during the pandemic (compared with one year prior). In contrast, students without preexisting mental health concerns were more likely to show declining mental health, which coincided with increased social isolation among these students. Our findings underscore that colleges and universities will not only need to continue to support students with preexisting mental health needs but also prioritize early prevention and intervention programming to mitigate the impacts of COVID-19 on students with increasing psychological distress, potentially stemming from increasing social isolation in response to the pandemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved) Abstract (French) La pandemie mondiale du coronavirus 2019 (COVID-19) a eu un impact sans precedent sur les campus universitaires et collegiaux a l'echelle internationale (p. ex., fermetures de campus generalisees, transition vers l'apprentissage en ligne). Les etudiants de niveau postsecondaire, qui forment deja une population vulnerable sur le plan developpemental, font maintenant face a de nouveaux defis supplementaires, ce qui pourrait entrainer une augmentation des inquietudes en matiere de sante mentale. Or, il y a un manque de recherche sur les impacts psychologiques de la COVID-19, ou sur les personnes qui pourraient etre les plus a risque, chez les etudiants de niveau postsecondaire. Afin de combler ces lacunes dans la litterature, nous avons contacte, de nouveau en mai 2020, un echantillon de 773 etudiants de niveau postsecondaire (74 % de sexe feminin, age median = 18,52 ans) qui avaient deja repondu a un sondage en mai 2019 sur la sante mentale des etudiants. Les etudiants ont rempli un sondage en ligne aux deux moments, faisant etat de leurs recentes experiences stressantes et de leur sante mentale. Bien que nous nous attendions a ce que les etudiants ayant des preoccupations preexistantes en matiere de sante mentale montrent une detresse psychologique accrue pendant la pandemie, cette hypothese n'a pas ete appuyee. Au lieu de cela, des analyses repetees ont demontre que les etudiants ayant des problemes preexistants de sante mentale affichaient une amelioration ou une sante mentale similaire pendant la pandemie (comparativement a un an auparavant). En revanche, les etudiants qui n'avaient pas de problemes preexistants de sante mentale etaient plus susceptibles de presenter une diminution de la sante mentale, ce qui coincidait avec un isolement social accru chez ces etudiants. Nos resultats soulignent que les colleges et les universites auront non seulement besoin de continuer a soutenir les etudiants ayant des besoins preexistants en sante mentale, mais aussi de donner la priorite aux programmes de prevention et d'intervention precoces afin d'attenuer les repercussions de la COVID-19 sur les etudiants qui eprouvent une detresse psychologique croissante, pouvant decouler d'un isolement social croissant en reponse a la pandemie. (PsycInfo Database Record (c) 2020 APA, all rights reserved) Impact Statement Public Significance Statement -Although there is mounting concern that students with preexisting mental health concerns may be particularly vulnerable to the psychological impacts of COVID-19, the present study found that students without preexisting mental health concerns had greater increases in psychological distress during the pandemic. Increases in social isolation were unique to students without preexisting mental health concerns (whereas students with preexisting mental health concerns showed no change), which may account for the worsening of their mental health. (PsycInfo Database Record (c) 2020 APA, all rights reserved)