Seeing the Possibilities Webinar with Beth McCay

Seeing the Possibilities: The Need for a Mental Health Focus Amongst Street-Involved Youth
Presented by:
Elizabeth McCay, RN, PhD
John Langley, MD, FRCP(c)
Andria Aiello, RN, MN
March 9, 2010
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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
March 9, 2010
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Welcome
Questions: Use the Q&A window
Technical Issues: Jennifer will try to assist you. Please note, if you are having trouble with the teleconference, please call 1-866-736-1413.
Content Questions: These will be addressed, time-allowing, at the end of the presentation, or after the session (via e-mail).
Feedback
Complete the quick true/false quiz while you wait
After the session: Take a minute to tell us what you think using our exit poll
March 9, 2010
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Study Objectives
To undertake a comprehensive assessment of mental health needs.
To provide direction for the development of interventions targeted to the mental health of street-involved youth.
To make policy recommendations with regard to the mental health needs of street youth.
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Homeless Youth
20% of youth experience significant symptoms of mental illness.
Underestimate of rate for homeless youth
In Toronto 6,900 youth (16-24) and 4,779 children (under 16) used shelters (2002)
Unique features of inner city youth: homelessness, poverty, addictions, trauma
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Homeless Youth
Mental illness may be either a risk factor for homelessness or be in response to the stressors associated with homelessness
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)
March 9, 2010
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Street-Involved Youth:Urgent Mental Health Needs
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).
The rate of suicide for street youth is at least 10.3 times the national average among Canadian youth (Hwang, 2001).

March 9, 2010
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Quantitative Methods
Cross-sectional, correlational design
90-120 minute interview session
Completion of series of questionnaires and interviews:
Socio-demographic data
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)
Strengths: Resilience (RS) & Rosenberg Self-esteem Scale (RSE)
March 9, 2010
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QUANTITATIVE FINDINGS

Quantitative FindingsCharacteristics of Participants, N=70
48 Males; 21 Females; 1 Transgendered
Mean Age 20.21, 16-24
44 youth lived in shelter or transitional housing; 14 on the street; remainder were in unstable housing.
Almost two-thirds of the youth were physical abused & almost one-fourth were sexual abused.
34% of the youth expressed some level of suicidal ideation (DSI-SS>1).
24% reported using mental health services
March 9, 2010
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Summary of Quantitative Findings
High levels of depression, suicidality, and, mental health symptomatology as measured by the CES-D, DSSI-SS and SCL-90.
Moderate levels of resilience and self-esteem as measured by the Resilience Scale and Rosenberg Self-esteem Scale.
Identity and relationship issues.
Risk factors related to abuse, use of drugs & alcohol, as well as self harm.
March 9, 2010
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QUALITATIVEFINDINGS

Qualitative FindingsHearing our Participants Stories
10 individual interviews (60 to 90 minutes) (N=9)
& focus groups
THEMES
Surviving Life on the Street
Living with Mental Health Challenges
Finding Strength in the Midst of Challenge: The Emergence of Resilience
Seeking Supportive Relationships
March 9, 2010
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SURVIVING LIFE ON THE STREET

Most frequent explanation for Being without a home was unstable home environments; included abuse, deprivation & issues re drug abuse.
“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)
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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)
“If you are intimidated by the people out there you’re going to get the crap kicked out of you.” (Lisa)
March 9, 2010
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Perception of stigma was pervasive; sense of shame; negative labels e.g. “squeegee kids”.
Doubly Stigmatized
“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)
March 9, 2010
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LIVING WITH MENTAL HEALTH CHALLENGES

Participants described a myriad of mental health challenges (e.g. –depression, bipolar, substance abuse).
High levels of mental health symptoms reported in qualitative interviews mirror quantitative findings.
One third (N=70) of youth stated they were living with pre-existing illnesses.
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Perception of a direct link between:
pre-existing illness/issues & homelessness
the stress of being homeless and mental health issues
“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)
March 9, 2010
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For some almost impossible to escape a desperate sense of unhappiness; urgent need for mental health intervention.
“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)
March 9, 2010
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Skepticism related to psychiatric treatment; specifically receiving a diagnosis and the use of prescribed medication.
“... They need to stop giving people medication, like medicine...it 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)
March 9, 2010
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Juxta-positioning of feeling both despairing optimistic.
“…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)
March 9, 2010
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FINDING STRENGTH IN THE MIDST OF CHALLENGE: THE EMERGENCE OF RESILIENCE

Discontented with their current life circumstances; feeling obstacles to a better life could be overcome.
“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)
March 9, 2010
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Youth expressed goals for the future reflective of their development as young adults.
“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)
March 9, 2010
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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.
“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)
March 9, 2010
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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.
“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)
March 9, 2010
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SEEKING SUPPORTIVE RELATIONSHIPS

Virtually all of the participants in the qualitative interviews identified the centrality of supportive relationships in becoming mentally healthy and strong.
Specific relationships included: supportive connections with family; the understanding of friends who were also street-involved; and relationships with staff.
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Some relationships with friends were described as feeling like family.
“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)
March 9, 2010
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Importance of positive caring relationships with staff was emphasized .
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)
March 9, 2010
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The capacity to see “staff” as friends -consistent with development in young adulthood.
“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)
March 9, 2010
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ParticipatoryAction Research (PAR) Dissemination Project

ParticipatoryActionResearch
Collaborative partnership between participants & researchers that allows voice of participants to be heard along with a focus on improving life circumstances
(Speziale & Carpenter, 2003)

The Goal
To engage street-involved youth in a self-identified strategy to represent their ideas regarding what it means to be mentally & emotionally healthy

The Participants
Four participants recruited from one of our community agencies in Toronto
Two participants completed project to produce final product
Two participants could not complete project since we were unable to contact them

The Collaborative Process
July 2007 – Winter 2008
Provided safe space to listen to participants’ stories & allowed youth to take the lead
Weekly meetings to identify focus of project

Building on the Focus Groups
Themes regarding meaning of mental & emotional health, identified from 2 focus groups, were used to provide direction to youth who volunteered for PAR project
Themes included:
Knowing yourself
Recognizing self worth
Being stable, adaptable, positive, and balanced within society & among other people
Trying to cope and get through everyday, knowing that you will be okay

Photovoice
Photovoice project identified
Youth chose to take photographs & create voice media project to capture meaning of mental & emotional health from perspective of street youth

Photovoice
Each participant provided with digital camera & asked to:
Take photographs that reflected their perceived meaning of mental & emotional health
Digitally record a narration that reflected their personal story or the meaning behind their photographs

Participant One
Photos
www.streetinvolvedyouth.ca

Participant Two
Photos
www.streetinvolvedyouth.ca

What the Participants Had to Say About the Project…
Theme #1: Participant Engagement
“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”
Theme #2: Belonging, Involvement & Empowerment
“It just gives you some, like, stability…It’s just nice to know you’re a part of something…you’re impacting something”

Theme #3: Photography as a Way to Express Emotions & Connect with Others
“I just thought photography was a good way to, ah, express, ah, inner emotions”
”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”
Theme #4: Group Environment
“You guys were just very easygoing, which makes us more willing to come”

Theme #5: Youth Speaking for Themselves
“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…”
“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”

FUTURE DIRECTIONS
Urgent Need for Acceptable Mental Health Services (non-stigmatizing; accepting; peer support).
Multi-component programs (build on strengths, address distress, self harm, crisis response)
Simultaneously address hope & despair
Target prevention; repair existing relationships where possible
Decrease stigma & build acceptance in the community.
March 9, 2010
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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)

Seeing the Possibilities Webinar with Beth McCay

by Wellesley Institute on Mar 09, 2010

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