Seeing the Possibilities: The Need for a Mental Health Focus Amongst Street-Involved Youth


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This presentation provides insight on the need for a mental health focus amongst street involved youth.

Elizabeth McCay, RN, PhD
John Langley, MD, FRCP(c)
Andria Aiello, RN, MN
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Seeing the Possibilities: The Need for a Mental Health Focus Amongst Street-Involved Youth

  1. 1. Seeing the Possibilities: The Need for a Mental Health Focus Amongst Street-Involved Youth<br />Presented by:<br /> Elizabeth McCay, RN, PhD <br />John Langley, MD, FRCP(c)<br />Andria Aiello, RN, MN<br />March 9, 2010<br />1<br />
  2. 2. Mental Health Needs of Transitional Street YouthFunded by The Wellesley Institute & Ryerson UniversityElizabeth McCay, John Langley, Heather Beanlands, Linda Cooper, Karen Bach, Colin Dart, Carol Howes, Susan Miner & Patricia Robinson<br />March 9, 2010<br />2<br />
  3. 3. Welcome<br />Questions: Use the Q&A window<br />Technical Issues: Jennifer will try to assist you. Please note, if you are having trouble with the teleconference, please call 1-866-736-1413.<br />Content Questions: These will be addressed, time-allowing, at the end of the presentation, or after the session (via e-mail).<br />Feedback<br />Complete the quick true/false quiz while you wait<br />After the session: Take a minute to tell us what you think using our exit poll<br />March 9, 2010<br />3<br />
  4. 4. Study Objectives<br />To undertake a comprehensive assessment of mental health needs. <br />To provide direction for the development of interventions targeted to the mental health of street-involved youth.<br />To make policy recommendations with regard to the mental health needs of street youth.<br />March 9, 2010<br />4<br />
  5. 5. Homeless Youth<br /><ul><li>20% of youth experience significant symptoms of mental illness.
  6. 6. Underestimate of rate for homeless youth
  7. 7. In Toronto 6,900 youth (16-24) and 4,779 children (under 16) used shelters (2002)
  8. 8. Unique features of inner city youth: homelessness, poverty, addictions, trauma</li></ul>March 9, 2010<br />5<br />
  9. 9. Homeless Youth<br /><ul><li>Mental illness may be either a risk factor for homelessness or be in response to the stressors associated with homelessness
  10. 10. Stressors: exposure to violence, pressure to participate in survival sex and/or drug use (Kipke, et al., 1997; Smart & Adlaf, 1991; & Morrell-Bellai, et al., 2000) </li></ul>March 9, 2010<br />6<br />
  11. 11. Street-Involved Youth:Urgent Mental Health Needs<br /><ul><li>Life on the street can create a downward spiral leading to drug abuse and survival sex (Slesnick et al., 2007), as well as chronic homelessness and suicide (Kidd & Kral, 2002).
  12. 12. The rate of suicide for street youth is at least 10.3 times the national average among Canadian youth (Hwang, 2001).</li></ul> <br />March 9, 2010<br />7<br />
  13. 13. Quantitative Methods<br /><ul><li>Cross-sectional, correlational design</li></ul> 90-120 minute interview session <br /><ul><li>Completion of series of questionnaires and interviews:
  14. 14. Socio-demographic data
  15. 15. Psychological Symptoms: Depression (CES-D), Positive & Negative Syndrome scale (PANSS), Psychological Symptoms (SCL-90), Hopelessness (HS), Substance Abuse (MAST), Suicidality DSI-SS, Self-harm Inventory (SHI), Juvenile Victimization Questionnaire (JVQ)
  16. 16. Strengths: Resilience (RS) & Rosenberg Self-esteem Scale (RSE)</li></ul>March 9, 2010<br />8<br />
  18. 18. Quantitative FindingsCharacteristics of Participants, N=70<br /><ul><li>48 Males; 21 Females; 1 Transgendered
  19. 19. Mean Age 20.21, 16-24
  20. 20. 44 youth lived in shelter or transitional housing; 14 on the street; remainder were in unstable housing.
  21. 21. Almost two-thirds of the youth were physical abused & almost one-fourth were sexual abused.
  22. 22. 34% of the youth expressed some level of suicidal ideation (DSI-SS>1).
  23. 23. 24% reported using mental health services</li></ul>March 9, 2010<br />10<br />
  24. 24. Summary of Quantitative Findings<br /><ul><li>High levels of depression, suicidality, and, mental health symptomatology as measured by the CES-D, DSSI-SS and SCL-90.
  25. 25. Moderate levels of resilience and self-esteem as measured by the Resilience Scale and Rosenberg Self-esteem Scale.
  26. 26. Identity and relationship issues.
  27. 27. Risk factors related to abuse, use of drugs & alcohol, as well as self harm.</li></ul>March 9, 2010<br />11<br />
  29. 29. Qualitative FindingsHearing our Participants Stories<br />10 individual interviews (60 to 90 minutes) (N=9) <br /> & focus groups<br />THEMES<br /><ul><li>Surviving Life on the Street
  30. 30. Living with Mental Health Challenges
  31. 31. Finding Strength in the Midst of Challenge: The Emergence of Resilience
  32. 32. Seeking Supportive Relationships</li></ul>March 9, 2010<br />13<br />
  34. 34. Surviving Life on the Street<br /><ul><li>Most frequent explanation for Being without a home was unstable home environments; included abuse, deprivation & issues re drug abuse. </li></ul>“I was in foster homes from the age of 2...I went through 7 different foster homes…My parents...they didn’t used to take care of me, just used to sit there, like that I used to be locked up at night all the time” (Brian)<br />March 9, 2010<br />15<br />
  35. 35. Surviving Life on the Street<br />Life on the Street was portrayed as violent, frightening and intimidating; Barriers to Services (i.e. lack of service on the weekend, not having a place)<br />“If you are intimidated by the people out there you’re going to get the crap kicked out of you.” (Lisa)<br />March 9, 2010<br />16<br />
  36. 36. Surviving Life on the Street<br />Perception of stigma was pervasive; sense of shame; negative labels e.g. “squeegee kids”.<br />Doubly Stigmatized<br />“There is a big stigma attached to being a youth living on the streets…and having a mental problem… people look down on you saying - you suffer from depression, you aren’t able to do this… you have to be at home collecting ODSP because you aren’t fit to work” (Fred)<br />March 9, 2010<br />17<br />
  38. 38. Living with Mental Health Challenges<br /><ul><li>Participants described a myriad of mental health challenges (e.g. –depression, bipolar, substance abuse).
  39. 39. High levels of mental health symptoms reported in qualitative interviews mirror quantitative findings.
  40. 40. One third (N=70) of youth stated they were living with pre-existing illnesses.</li></ul>March 9, 2010<br />19<br />
  41. 41. Living with Mental Health Challenges<br /><ul><li>Perception of a direct link between:</li></ul>pre-existing illness/issues & homelessness<br /> the stress of being homeless and mental health issues<br />“I have depression, well obviously or I think I have depression…according to my doctor… It’s more conditional than anything... If you have no job, if you have no money, and you are stuck here and on the street and its freezing, you are going to be really depressed.” (Rob)<br />March 9, 2010<br />20<br />
  42. 42.
  43. 43. Living with Mental Health Challenges <br /><ul><li>For some almost impossible to escape a desperate sense of unhappiness; urgent need for mental health intervention. </li></ul>“I’ve been at rock bottom numerous times. I’ve had two suicide attempts, I use to self-harm, I used to be a cutter… I hear people saying, ‘I tried to commit suicide and it’s changed my life.’ Trying to commit suicide and failing didn’t change my life. It just made me want to do it faster…” (Fred)<br />March 9, 2010<br />22<br />
  44. 44. Living with Mental Health Challenges<br />Skepticism related to psychiatric treatment; specifically receiving a diagnosis and the use of prescribed medication. <br />“... They need to stop giving people medication, like is a cover up. I have been on Prozac. I don’t know they are making me sleep, they are making me happy, right, I would feel fine and…think alright I am better and I would get off of it. Then it would just be depressing you know. People should just screw all the pills…” (Sue) <br />March 9, 2010<br />23<br />
  45. 45. Living with Mental Health Challenges<br /><ul><li>Juxta-positioning of feeling both despairing optimistic.</li></ul>“…in a way I am happy with myself and in a way I am not. I am sleeping on the sidewalks, you know. Honestly I don’t like that… It brings me down because I know I am a better person…I want to get that depression out of me. I want to be able to look back and say, Hey I made it. I made it through hard times. Now I know I can achieve anything.” (Don) <br />March 9, 2010<br />24<br />
  47. 47.
  48. 48. Finding Strength in the Midst of Challenge: The Emergence of Resilience<br /><ul><li>Discontented with their current life circumstances; feeling obstacles to a better life could be overcome.</li></ul>“There is more to life than drugs and alcohol. There is a whole different life out there and I want to explore it…life is hell and you’ve got to work around it. And there are going to be many obstacles in life and just got to deal with what obstacles come about you, that is the way I look at life…”(Don)<br />March 9, 2010<br />27<br />
  49. 49. Finding Strength in the Midst of Challenge: The Emergence of Resilience<br /><ul><li>Youth expressed goals for the future reflective of their development as young adults.</li></ul>“One of my biggest long-term goals is to…well graduate high school and save enough money to pay for tuition for university to start my career I guess, that is one of my long-term goals, and just to you know, be there for as many people as I can without having to actually sacrifice my needs and goals.” (Fred)<br />March 9, 2010<br />28<br />
  50. 50. Finding Strength in the Midst of Challenge: The Emergence of Resilience<br /><ul><li> Skills and attributes: learn from past experience, engage in positive coping strategies (e.g. – choosing the right friends, thinking positively & helping others) and pursue goals.</li></ul>“So like now I am like I have to do something or I am going to die. I have learned to choose my friends, I’ve learned to tell people like friends from real friends. …Real friends…don’t want anything from you and don’t use you.” (Sue)<br />March 9, 2010<br />29<br />
  51. 51. Finding Strength in the Midst of Challenge: The Emergence of Resilience<br /><ul><li>Idea of helping others provided motivation to keep going; offering hope that there would not be the same degree of suffering for youth in the future. </li></ul>“That is one thing, I like talking with people, so if I can get my story out there, because…me saying something could click inside of you guys, and you guys could go out and change something and help out a vast majority of people, right, so you know, helping one person out, you help out…more in the long run, right. ” (Fred) <br />March 9, 2010<br />30<br />
  53. 53.
  54. 54. Seeking Supportive Relationships<br /><ul><li>Virtually all of the participants in the qualitative interviews identified the centrality of supportive relationships in becoming mentally healthy and strong.
  55. 55. Specific relationships included: supportive connections with family; the understanding of friends who were also street-involved; and relationships with staff.</li></ul>March 9, 2010<br />33<br />
  56. 56. Seeking Supportive Relationships<br /><ul><li>Some relationships with friends were described as feeling like family. </li></ul>“I normally am a good friend, if I meet someone on the street that I have gone to school with or something, I will keep an eye out for them, teach them what I know… We are all on big happy family. We watch each other backs while we are out here.” (Erica) <br />March 9, 2010<br />34<br />
  57. 57. Seeking Supportive Relationships<br /><ul><li>Importance of positive caring relationships with staff was emphasized .</li></ul>Yeah, someone showing interest. Yeah that means a lot, means lot…There is a client-and-staff barrier. They are just here for a job and not here to help people. There are a couple of people who kind of care. I don’t know, it means a lot when someone takes you to the side and asks you what’s wrong. (Rob) <br />March 9, 2010<br />35<br />
  58. 58. Seeking Supportive Relationships<br /><ul><li>The capacity to see “staff” as friends -consistent with development in young adulthood. </li></ul>“Like I get along with the staff very well, we are all good friends now. Whenever I keep coming here, it’s like they give me an extra push ahead. You know I can succeed in something later on, They are also pushing me forward to achieve what I want and without all the support and pushing…I’d probably be still sitting on the sidewalk…, you know.”(Don)<br />March 9, 2010<br />36<br />
  59. 59. ParticipatoryAction Research (PAR) Dissemination Project<br />
  60. 60. ParticipatoryActionResearch<br /><ul><li>Collaborative partnership between participants & researchers that allows voice of participants to be heard along with a focus on improving life circumstances</li></ul>(Speziale & Carpenter, 2003)<br />
  61. 61. The Goal<br /><ul><li>To engage street-involved youth in a self-identified strategy to represent their ideas regarding what it means to be mentally & emotionally healthy</li></li></ul><li>The Participants<br /><ul><li>Four participants recruited from one of our community agencies in Toronto</li></ul>Two participants completed project to produce final product<br />Two participants could not complete project since we were unable to contact them <br />
  62. 62. The Collaborative Process<br /><ul><li>July 2007 – Winter 2008
  63. 63. Provided safe space to listen to participants’ stories & allowed youth to take the lead
  64. 64. Weekly meetings to identify focus of project</li></li></ul><li>Building on the Focus Groups<br /><ul><li>Themes regarding meaning of mental & emotional health, identified from 2 focus groups, were used to provide direction to youth who volunteered for PAR project
  65. 65. Themes included:</li></ul>Knowing yourself<br />Recognizing self worth<br />Being stable, adaptable, positive, and balanced within society & among other people<br />Trying to cope and get through everyday, knowing that you will be okay<br />
  66. 66. Photovoice<br /><ul><li>Photovoice project identified</li></ul>Youth chose to take photographs & create voice media project to capture meaning of mental & emotional health from perspective of street youth<br />
  67. 67. Photovoice<br /><ul><li>Each participant provided with digital camera & asked to:</li></ul>Take photographs that reflected their perceived meaning of mental & emotional health<br />Digitally record a narration that reflected their personal story or the meaning behind their photographs<br />
  68. 68. Participant One<br />Photos<br /><br />
  69. 69.
  70. 70.
  71. 71.
  72. 72. Participant Two<br />Photos<br /><br />
  73. 73.
  74. 74.
  75. 75. What the Participants Had to Say About the Project…<br /><ul><li>Theme #1: Participant Engagement</li></ul>“I felt like this place needed some kind of direction…And honestly, like I gotta say, I think I kinda made this thing happen…There was one point I sat there and then at that point it completely changed the direction where we were going to”<br /><ul><li>Theme #2: Belonging, Involvement & Empowerment</li></ul>“It just gives you some, like, stability…It’s just nice to know you’re a part of something…you’re impacting something”<br />
  76. 76. What the Participants Had to Say About the Project…<br /><ul><li>Theme #3: Photography as a Way to Express Emotions & Connect with Others</li></ul>“I just thought photography was a good way to, ah, express, ah, inner emotions”<br />”Somebody can go through my set of pictures and say those are some good pictures…This guy’s just like me…we’re not that different”<br /><ul><li>Theme #4: Group Environment</li></ul>“You guys were just very easygoing, which makes us more willing to come”<br />
  77. 77. What the Participants Had to Say About the Project…<br /><ul><li>Theme #5: Youth Speaking for Themselves</li></ul>“We could give them a different point of view, instead of always saying there are all these older people who are trying to speak for us, and…”<br />“Instead of it being told that there are seven thousand youths on the street this year, you can get some of those youths and get them to, like, show what they go through…we’re not bad people and we’re just in a bad situation”<br />
  78. 78. FUTURE DIRECTIONS<br /><ul><li>Urgent Need for Acceptable Mental Health Services (non-stigmatizing; accepting; peer support).
  79. 79. Multi-component programs (build on strengths, address distress, self harm, crisis response)
  80. 80. Simultaneously address hope & despair
  81. 81. Target prevention; repair existing relationships where possible
  82. 82. Decrease stigma & build acceptance in the community.</li></ul>March 9, 2010<br />55<br />
  83. 83. Achieving things is going to make me a better person. It is going to make me realize that no matter what obstacle this world is going to throw at me I am going to get around it, or crawl under it, I don’t care, I am going to find a way around it, you know. (Youth Participant)<br />