SPOR Impact

Ontario Ministry of Health and Long-Term Care: SPOR IMPACT Grants

What We Know

Health services on-reserve have the capacity to deliver health promotion, prevention, early intervention, and counselling, [12] yet many youth present to mental health clinics at medium to high risk of mental health crisis. Thus, there is an inherent mismatch between the mental health needs of First Nations youth and the scope and capacity of services on-reserve. Since intensive or specialist-based treatment is not available on-reserve, youth are forced to leave their communities to seek treatment hundreds of kilometers from home, away from family support. To achieve better fit and improve outcomes, we must identify youth earlier – when their mental health needs are emergent rather than urgent. A multi-faceted approach is necessary, to support youth in crisis while turning some attention upstream, to population health promotion and secondary prevention.

What We Know

Health services on-reserve have the capacity to deliver health promotion, prevention, early intervention, and counselling, [12] yet many youth present to mental health clinics at medium to high risk of mental health crisis. Thus, there is an inherent mismatch between the mental health needs of First Nations youth and the scope and capacity of services on-reserve. Since intensive or specialist-based treatment is not available on-reserve, youth are forced to leave their communities to seek treatment hundreds of kilometers from home, away from family support. To achieve better fit and improve outcomes, we must identify youth earlier – when their mental health needs are emergent rather than urgent. A multi-faceted approach is necessary, to support youth in crisis while turning some attention upstream, to population health promotion and secondary prevention.

Project Details

Focus on Prevention Our goal is to evaluate the impact of a new screening and triage process to identify and support youth earlier in their illness trajectory. It also supports Canada’s National Aboriginal Youth Suicide Prevention Strategy, to “develop and carry out locally-driven community plans for preventing suicide in First Nations and Inuit communities”, [13] and is in line with the Ottawa Charter for Health Promotion’s recommendation to focus upstream on population-based health promotion. [14] Prevention strategies are critical in isolated communities and school-based screening is a recommended best-practice for harm reduction. [15, 16] Secondary prevention is most effective in high risk populations and is effective for youth. [17, 18] The Ontario government took action by funding 80 new Child and Youth Mental Health and Addictions Workers to support First Nations youth in 2014. However, there is no process in place to identify at-risk youth on-reserve that is efficient, culturally appropriate, and feasible in isolated First Nations with limited resources.

Framework

We are guided by the First Nations Mental Wellness Continuum Framework, [19] shown in Appendix Figure 2. The Framework articulates essential services, beginning with “Health Promotion, Prevention, Community Development, and Education” and “Early Identification and Intervention”. [19] The social determinants of health (SDOH) [20-22] also play a pivotal role. Our intervention impacts intermediate determinants [23] by enhancing the social safety net and health services system.