At 17, Brianne Moore found herself sitting alone in hospital, in a psychiatrist’s office. “The room wasn’t very well lit,” she recalls. “It was dark and fit the tone. I remember shaking a lot. I remember sitting up tall waiting for what the doctor would say. It was scary.”
Moore, now 19, started showing signs of anxiety when she was just 3 years old. Nothing was done; the hope was that she could grow out of it. But by age 13, she was feeling depressed, and by 16, she began to see a counsellor. Moore continued to struggle until a suicide attempt drove her to reach out for more intensive help at the Children’s Hospital of Eastern Ontario, in Ottawa.
While there, she was diagnosed with borderline personality disorder, as well as an eating disorder, anxiety, and depression. But instead of receiving a course of treatment, Moore says she left the hospital “with no answers.” She was told was to sit tight for six to 12 months, when therapy could start.
Her experience would be much different today: wait times at CHEO and at the Royal Ottawa Mental Health Centre are practically nonexistent. It’s the result a new program called Choice and Partnerships Approach, or CAPA, which was introduced in March of 2016.
“By summer, we had no wait lists,” says Gail Beck, clinical director for the Royal’s youth program. “A young person with a referral can be seen within two weeks. If it is more urgent than that, we can see someone within a couple of days.”
Before CAPA came to CHEO and the Royal, children and youth under 18 experiencing depression, anxiety, ADHD, and eating disorders had to wait for an available psychiatrist. Now, patients are given what’s called a “choice appointment.” Instead of initially seeing a psychiatrist, patients meet with a clinician — an umbrella term that also includes psychologists, nurses, social workers, and professionals like occupational therapists — to discuss the most challenging problem.
“There are not as many psychiatrists as there are clinicians,” Beck says, and bringing them into the program has reduced a major source of bottlenecks. And not everyone wants to see a psychiatrist — especially teenagers. A social worker or a psychologist might offer skills that are a better fit for a young person’s treatment goals. So CAPA not only improves efficiency, but also quality of care.
Clinicians help families understand what kinds of treatments are available and what risks might be involved, then assist them in choosing a plan to meet their goals most quickly. Instead of feeling dragged through a one-sided diagnostic interview, the session unfolds like a conversation that empowers both the youth and the family. In their first session, clinicians work with patients to identify at least one action that can address the problem. For a child with a temper, for example, the family may commit to writing out who said what after a tantrum and look for why the aggression escalated. Or the child might decide to attend a problem-solving program offered in the community.
“The diagnosis is a little less important,” says Kathleen Pajer, chief of psychiatry at the Children’s Hospital of Eastern Ontario, who first learned about CAPA in 2011, when she worked at a pediatric and women’s hospital in Halifax. “A kid might be aggressive, for example. There could be four or five different diagnoses to cause aggression. We first just need to figure out how to attack the aggression.” Though a psychiatric diagnosis may be an important component of the treatment down the road, Pajer says families first need a plan on the spot — something that they can start implementing right away.
Moore says that approach would have made a difference in her own treatment. “If you have something to do, it is tremendously helpful,” she says. “For me, it was finding things that I enjoy,” like volunteering in high schools and community centres to promote mental health and resiliency. Being passionate about something, she says, is helpful for getting through the feelings of hopelessness.
CAPA is working: at the IWK Health Centre in Halifax, where Pajer first pioneered the model in North America, wait times for the mental health program have dropped from over seven months to under 10 weeks. At the Children’s Hospital of Eastern Ontario, where she brought the program in 2014, one in four patients typically has no need to return to the hospital after the first appointment, instead improving on their own or with support from a community agency.
Patients who do need extra help attend “partnership” sessions, a word used in CAPA to emphasize collaboration. If a child’s aggression is rooted in depression, the partnership may include cognitive behaviour therapy. If a teenager is anxious and having significant trouble attending school, she or he could be steered into a program at that offers curriculum along with treatment, or to a mental health treatment unit in one of the local high schools.
Having made their way from the Maritimes to the nation’s capital, CAPA-like strategies are now being implemented in hospitals across Ontario. Corine Carlisle, a psychiatrist at the CAMH in Toronto, is having success with group orientation sessions, usually held within a week of referral, that offer a variety of treatment options. Carlisle’s program encourages youth to set their own treatment goals, and families are connected with community resources as close to home as possible. To further reduce barriers, patients don’t need a doctor’s note. Youth can refer themselves for treatment at the right time for them — when they are ready and motivated.
Kim Moran, executive director of Children’s Mental Health Ontario, says she is encouraged by CAPA’s success. She adds that several Ontario community-based mental health agencies are looking at similar models, but more needs to be done. According to data collected in November 2016 by roughly 90 children’s mental health centres in Ontario, more than 12,000 troubled children and teens wait up to a year and a half to receive treatment in the community. The longest waits are still in Ottawa.
In part, Moran says, that’s because community agencies don’t have the resources to deal with the demand. So Pajer, who says she is “on a personal mission to get things fixed,” is working alongside community mental health agencies and hospitals in eastern Ontario to expand the use of CAPA where services are lacking.
Moore, who shares her own struggles with mental health at public speaking events, says that while she’s glad the stigma surrounding mental illness has diminished, it’s crucial to address access problems. “When I was unwell and knew I needed help, all I wanted in the world was to receive treatment and get better,” she says. “If we can do that for other youth in the future — and faster — that would be amazing.”
Rebecca Fortin is a 2017 Global Journalism Fellow with the Munk School of Global Affairs with expertise in public health promotion.
May we have a moment of your time?
Our public funding only covers some of the cost of producing high-quality, balanced content. We depend on the generosity of people who believe we all should have access to accurate, fair journalism. Caring people just like you!
Get Current Affairs & Documentaries email updates in your inbox every morning.