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 www.wellesleyinstitute.com Follow us on twitter @wellesleyWI

1. 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 1

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 March 9, 2010 2

3. 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 3

4. 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. March 9, 2010 4

6. Underestimate of rate for homeless youth

7. In Toronto 6,900 youth (16-24) and 4,779 children (under 16) used shelters (2002)

8. Unique features of inner city youth: homelessness, poverty, addictions, traumaMarch 9, 2010 5

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) March 9, 2010 6

12. The rate of suicide for street youth is at least 10.3 times the national average among Canadian youth (Hwang, 2001). March 9, 2010 7

14. Socio-demographic data

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. Strengths: Resilience (RS) & Rosenberg Self-esteem Scale (RSE)March 9, 2010 8

17. QUANTITATIVE FINDINGS

19. Mean Age 20.21, 16-24

20. 44 youth lived in shelter or transitional housing; 14 on the street; remainder were in unstable housing.

21. Almost two-thirds of the youth were physical abused & almost one-fourth were sexual abused.

22. 34% of the youth expressed some level of suicidal ideation (DSI-SS>1).

23. 24% reported using mental health servicesMarch 9, 2010 10

25. Moderate levels of resilience and self-esteem as measured by the Resilience Scale and Rosenberg Self-esteem Scale.

26. Identity and relationship issues.

27. Risk factors related to abuse, use of drugs & alcohol, as well as self harm.March 9, 2010 11

28. QUALITATIVEFINDINGS

30. Living with Mental Health Challenges

31. Finding Strength in the Midst of Challenge: The Emergence of Resilience

32. Seeking Supportive RelationshipsMarch 9, 2010 13

33. SURVIVING LIFE ON THE STREET

35. Surviving Life on the Street 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 16

36. Surviving Life on the Street 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 17

37. LIVING WITH MENTAL HEALTH CHALLENGES

39. High levels of mental health symptoms reported in qualitative interviews mirror quantitative findings.

40. One third (N=70) of youth stated they were living with pre-existing illnesses.March 9, 2010 19

44. Living with Mental Health Challenges 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 23

46. FINDING STRENGTH IN THE MIDST OF CHALLENGE: THE EMERGENCE OF RESILIENCE

52. SEEKING SUPPORTIVE RELATIONSHIPS

55. Specific relationships included: supportive connections with family; the understanding of friends who were also street-involved; and relationships with staff.March 9, 2010 33

59. ParticipatoryAction Research (PAR) Dissemination Project

63. Provided safe space to listen to participants’ stories & allowed youth to take the lead

65. 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

68. Participant One Photos www.streetinvolvedyouth.ca

72. Participant Two Photos www.streetinvolvedyouth.ca

79. Multi-component programs (build on strengths, address distress, self harm, crisis response)

80. Simultaneously address hope & despair

81. Target prevention; repair existing relationships where possible

82. Decrease stigma & build acceptance in the community.March 9, 2010 55

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)