Teens with anxiety, psychosis, mood disorders fill day program to capacity

A group of between eight and 10 teenagers arrives at P.E.I.'s Insight youth mental health day treatment program most mornings at 8:15 a.m., and starts the day with breakfast.

"The breakfast is — there's magic to that — it's about welcoming kids through the door and making them feel comfortable," said Dr. Jackie Goodwin, a clinical psychologist and the team lead for the program.

These teenagers all have mood disorders, anxiety disorders or psychosis — and often more than one diagnosis.

The four-month day treatment program isn't their first experience getting help. It's "more intensive treatment on particular cases with complex needs," said Goodwin.

Designed for those aged 13 to 18, teens get referred to the program by a community mental health clinician, youth addictions services, a psychiatrist or a pediatrician, and from there the family meets with the Insight team to determine if it's the right program for them.

Key to that, Goodwin said, is their willingness to participate.

"That youth feel like, 'Yeah, I'm willing to give this a try.' We have had a small group of youth that have said, 'I'm not ready for this.' And that needs to be respected, because readiness for treatment is really important."

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Full to capacity, with a wait list

In the year the program has been operating, of the 45 teens referred to the program, 16 haven't gone past the intake process either because it wasn't the right program for them or because they refused the program. Twenty-nine teens have been admitted, with two teens leaving the program before they completed it.

The program has been full to capacity each time it has run, Goodwin said.

The average wait time from referral to assessment is 40 days, and the average wait time from referral to admission is 66 days.

"Our waits are not arduous because, again, we're not at the first front door, we're at the second level of service," said Goodwin.

A familiar routine

After breakfast, the teens start on group therapy.

"We're checking in how their night's been, how their health is that morning, kind of their goals for the day, etc.," said Goodwin.

"And then depending on the day of the week they go into a variety of different psychotherapy groups. Our psychotherapy groups … would be targeting the particular health symptoms that they are having."

Two hours of each day are spent on academics — and fun is part of the program, too.

"You have to allow youth to be youth and we think that's important," she said. "We plan in activity moments. We also embed trips out into community as part of our treatment schedule, but also to do a lot of rewarding and highlighting how much skill they're developing."

The program runs until just after 3 p.m., mirroring the familiar school model.

On Wednesdays, the youth return to school, which Goodwin said is different for every participant.

"We think it's important not to pull youth completely out of their community connections," she said. "It can be anything from they're back actually in a classroom to they're in a quieter space finishing up material that a teacher needs done."

'A very full year'

Goodwin called the year that Insight has been operating "a very full year," and said she's pleased with what the program has accomplished in that time.

"When people ask me about outcomes or progress in the program my brain immediately gets filled with faces of young people, and it's really their stories that the program's about," she said.

"We recently had our first GED graduate come out of our program whose academic career had been really interrupted with health challenges … We all did a lot of cheering for her."

She said the program has also had teens who have been able to move on to university, and she said many who have gone through the program have made progress with their symptoms.

Shorter hospital stays

Another success she has seen is in length of hospital stay if a participant needs more intensive care.

"Safety is primary. Obviously. If a youth needs to go into hospital we would be facilitating that right down to calling the ER and one of our clinicians going over to assist the youth and the family as they go over to that level of care," Goodwin said.

"What we are seeing though is a trend for the few students we've had go back to hospital that generally their lengths of stay have been shorter, and because we welcome them back in so there's a lot of consultation liaison that goes on between our service and the hospital."

Help returning to the community

There's a weekly group for parents and guardians to participate in as well as individual family consultation.

"Very often parents talk to us about feeling very alone when your child has a complex health need," she said. "Being able to come in, see other families who are working through that same journey and getting support and also critical advice and consultation — many of the parents are saying that that's been a big deal for them."

The youth typically stay with the program for four months. After the four months is up, there's optional aftercare.

"We know there's kind of a dance around returning to community, and there's also some research literature that talks about continued booster sessions being helpful," said Goodwin.

"Graduates of our program can choose whether they would like to continue to get coaching while they're moving into community, so they come in for a weekly evening psychotherapy group, get a lot of support, often with peers they've been in program with, and also the clinicians are very focused on encouraging them to be utilizing the skills they've learned in group."

Of the 17 youth that have completed the program so far, 11 have taken part in the aftercare.

'Increased energy around mental health'

Goodwin said Insight is one piece of the puzzle when it comes to serving the province's needs for youth mental health.

She points to the behavioural support team for children aged four to 12 for kids with moderate to severe disruptive behaviour disorders, which was created around the same time Insight was, as well as the Strength program, a residential and day treatment program for youth aged 15 to 24 with addiction issues.

"I'm heartened by in 20-some-odd years in the field, I'm definitely feeling an increased energy around mental health and addictions," said Goodwin.

"These are all of our kids and all of our family members and asking for good care is important."

This story is part of an ongoing CBC P.E.I. series on mental health services in the province. You can share your experiences with us here.