Access to child and youth mental health services in BC: Barriers, recommendations, and strategies for improvement

Abstract

This report summarizes a literature review for the Ministry for Children and Family Development (MCFD) focusing on strategies for improving access to Child and Youth Mental Health (CYMH) services, supports, and treatment. Research consisted of a review of publicly available academic, grey, and policy literature produced since 2011, in order to answer two research questions: 1) What are the barriers to accessing CYMH services in BC, and what steps have been taken to overcome them? a. What are the system-level barriers to accessing CYMH services in BC? b. What strategies have been recommended to address these barriers? c. How have these strategies been implemented? 2) Where barriers remain, what strategies can be used to address them? The literature review is organized into two sections. The first is a review of reported system-level barriers, recommendations, and actions related to improving access to CYMH services in the BC context. The second is a scoping review of academic and grey literature describing and assessing evidence for various strategies for improving access to CYMH services. Access improvement strategies can be divided into service management strategies including waitlist management, increasing engagement, centralized intake, and collaborative care; and service delivery strategies including brief therapy, technology-based delivery methods, and emerging delivery models. Additionally, there is a brief discussion of literature regarding the implementation of two child and youth mental health service transformation models, the Choice and Partnership Approach (CAPA) and Australia’s National Youth Mental Health Foundation, also known as headspace. An appendix consisting of an annotated bibliography of access improvement literature is included. Results of the literature review indicate that barriers to accessing mental health services for children, youth, and families are identified in reviews such as those commissioned by Government (e.g., Berland, 2008), by oversight bodies (e.g., Representative for Children and Youth, 2013), and by parliamentary committees (e.g., Select Standing Committee on Children and Youth, 2016). System-level barriers to CYMH services in BC include long wait times, a fragmented system that is difficult to navigate, and services that are inadequate, inappropriate, or nonexistent in some areas. Consistent with Government’s strategic plans (e.g., Ministry of Health Services, & Ministry of Children and Family Development, 2010), MCFD has taken steps to improve access to CYMH services, including opening walk-in intake clinics, developing an online inventory and map of services, supporting direct system navigation and peer support, expanding the use of videoconferencing services, and developing Youth to Adult Mental Health Transition Protocols. These initiatives align with many of the formal recommendations from the Select Standing Committee on Children and Youth and the Representative for Children and Youth. Research in child and youth mental health services is not well developed, and while there are many strategies in use, few have been shown to be effective in improving access. The approaches that show the most promise include collaborative care, centralized intake, brief therapy, peer support, some computerized CBT programs, and offering tele-mental health via telephone or videoconferencing. The CAPA service transformation model has demonstrated success in reducing wait times, and the headspace model has improved access for many groups of young people, but not all. Many of the strategies identified in the literature as having the potential to positively impact access to child and youth mental health services have been more extensively researched in the context of primary care and/or adult mental health care; additional research into the efficacy of their application in child and youth mental health contexts is needed before the evidence base will be strong enough to inform policy decisions.