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Winter 2011/12 | Vol 15 No 2

A view from CAMH

Dr. Kwame McKenzie

My first job as a full-fledged psychiatrist was with a team called Antenna in London, England. The team was set up by two psychiatric nurses to serve youth between 16 and 25. We provided assertive community treatment and first episode, crisis and case management, using a team and community development approach to help improve the lives of people with mental health issues in a very challenging inner-city district.

Before Antenna launched, a community group was formed to help decide on the program’s focus. The group wanted services for this particular age group because it seemed that services which started at age 18 led to youth dropping out of care. The group suggested that one of the team’s nurses serve as a community development worker to liaise with other youth services and to help them work with our clients. The group also recommended that our case managers work intensively with hospital wards to ensure a smooth transition between outpatient and inpatient care. Another suggestion was that rather than wait until youth turned 25, Antenna should work with other mental health teams so that clients could transition when they were ready for the care they needed.

Ultimately, the community group identified transitions as important; the service listened; and the outcome data are among the best for any service of this type. Taking care at transitions is common sense.

Fast forward a couple of decades to the present and the issue of transition-aged youth is again in the spotlight: In Ontario, $257 million have been granted toward child and youth mental health services. The Canadian Psychiatric Association has recognized child psychiatry as a separate specialty. The Centre for Addiction and Mental Health will soon open new inpatient beds for youth with concurrent disorders, backed by an outpatient day program. Youth mental health has become the focus of renewed interest and optimism in the media and in the political realm. So it’s a good time to take a look at our practices.

If up to 70 per cent of adult mental health problems have their origins in childhood, then taking a life course approach to mental health services makes sense. But we have to ask: Is it useful to build silos such as child and youth, adult and geriatric psychiatry? Is chronological age, rather than need, what we should consider when we look at how services are organized? Should youth and adult services merge into teams like Antenna that specialize in dealing with transitions? The answers may not be what you think.

Kwame McKenzie, MD, MRCPSYCH (UK)
Executive editor, CrossCurrents;
Director of Social Aetiology of Mental Illness, CIHR Training Centre (SAMI);
Deputy director, Schizophrenia Program, CAMH;
Clinical director, Health Equity, CAMH;
Senior scientist, Social Equity and Health Research Section, CAMH;
Professor of psychiatry, University of Toronto