About the Provincial System Support Program Supports Ontario’s Comprehensive Mental Health and Addictions Strategy, through system interventions. Provides capacity and expertise in: knowledge exchange information management implementation coaching equity and engagement evaluation JG

JG We work with CAMH clinical, research and public policy to share evidence. We work to translate the work of our colleagues in CAMH’s Institute for Mental Health Policy Research.

Early Years 12/29/2018

Mental Health and Addiction Treatment for Children: Early Years One in five children and youth has an identifiable mental health disorder; five out of six will never get the help they need. The onset of many mental health conditions occurs during childhood or early adulthood (Kessler et al., 2005). Gandhi et al. (2016) found increasing trends of emergency room and office based visits for both mental health and substance use among Ontario children and youth aged 10-24 from 2006-2011. Gandi et al. (2016) was a population based, repeated annual cross-sectional study. 12/29/2018

Mental Health and Addiction Treatment for Children Community based mental health and substance use service providers serving adolescents and youth currently do not thoroughly assess for co-occurring problems or utilize evidence based practice to address youth with multiple problems. Bukstein and Horner (2010) found that more than half of youth in substance use treatment who have concurrent mental health diagnoses, have three or more psychiatric disorders. Most commonly, conduct, anxiety and depressive (mood) disorders co-occur with problematic substance use in youth (Schwartz et al, 2007). 12/29/2018

School Age Youth 12/29/2018

Ontario Student Drug Use and Health Survey (OSDUHS) Family life, school life Drug use & related harm indicators Drug perceptions, context Mental & physical health indicators Antisocial behaviours Violence, bullying, cyberbullying Gambling activities & problems Video gaming & problems A repeated, cross-sectional, anonymous survey Surveys students in grades 7 to 12 in Ontario’s publicly-funded schools Includes drug use, mental health, physical health, bullying, gambling, & other risk behaviours Conducted every two years since 1977 Longest ongoing student survey in Canada and one of the longest in the world Some objectives of the OSDUHS are to provide trustworthy and timely data regarding: ● current alcohol, tobacco, and other drug use by students, including trends since 1977; ● current mental health, physical health, and well-being indicators, and trends since 1991; ● population and sub-population changes in health indicators over time (including a focus on grade, region and sex); ● risk and protective factors that correlate with these indicators; ● the uptake of risk behaviours and problems during adolescence, which affect the burden of disease in adults; and ● emerging issues facing today’s youth, such as use of emerging drugs or new forms of risk behaviours.

% students reporting past year drug use (2015) As this Table shows, the mostly commonly used drug is alcohol, with 46% of students in grades 7 through 12 reporting use (excluding just a sip to try it) during the 12 months before the survey. Consumption of highly caffeinated energy drinks is also quite prevalent, with about one-third of students reporting past year use, followed by cannabis, with 21.3% reporting past year use. About 12% report using electronic cigarettes (with or without nicotine), which is a higher prevalence than regular tobacco cigarettes (9%). One-in-ten students report the nonmedical (NM) use of prescription opioid pain relievers, such as codeine, Percocet, Percodan, Demerol, or Tylenol #3 in the past year. The remaining drugs are used by less than 10% of students.

Frequency of drug use in the past year among users When we examine the number of times past year users used an illicit drug during the 12 months before the survey (excluding alcohol, cigarettes, high caffeine) we can see that use of most drugs, with the exception of cannabis, is very infrequent (represented by the size of the white bars). However the use of drugs such as Salvia divinorum and LSD is quite high with 68 and 66% of students having tried these drugs once or twice in the past year.

Regional differences in past year drug use There are regional differences in past year use of several drugs. In Northern Ontario we see higher rates of cigarette use, alcohol, and binge drinking than the Provincial average. In Toronto we see lower rates of alcohol and smokeless tobacco use, but higher rates of inhalants.

Drinking alcohol drinking significantly increases with grade students in Toronto are least likely to drink, whereas students in the North are most likely

Nonmedical opioid pain reliever use significantly increases with grade (13% of 12th graders use) no significant regional differences

As this Table shows, the mostly commonly used drug is alcohol, with 46% of students in grades 7 through 12 reporting use (excluding just a sip to try it) during the 12 months before the survey. Consumption of highly caffeinated energy drinks is also quite prevalent, with about one-third of students reporting past year use, followed by cannabis, with 21.3% reporting past year use. About 12% report using electronic cigarettes (with or without nicotine), which is a higher prevalence than regular tobacco cigarettes (9%). One-in-ten students report the nonmedical (NM) use of prescription opioid pain relievers, such as codeine, Percocet, Percodan, Demerol, or Tylenol #3 in the past year. The remaining drugs are used by less than 10% of students.

Seeking Support for Mental Health Concerns One in five (21%) students reported visiting a mental health care professional at least once in the past year. Females are more likely to seek mental health counselling. More than one quarter of students (28%) reported wanting to talk to someone but not knowing where to go. Females (39%) are twice as likely as males (19%) to report an unmet needs for mental health support. Significantly more students (21%) reported visiting a health care professional for mental health in the past year compared to 1999 (12%), the first year of monitoring. An additional 3% of students reported seeking telephone or internet counselling. 12/29/2018

Self Reported Mental Health and Psychological Distress One in six (17%) students rate their mental health as fair or poor, significantly higher than 2007, the first year of monitoring (11%). Females (23%) are significantly more likely than males (10%) to report fair or poor mental health. 34% of student experience moderate to serious levels of psychological distress; 14% met criteria for serious levels of psychological distress. 7% of students report low self esteem, significantly higher among females (10%) than males (5%) Both moderate to serious and serious levels of psychological distress were significantly higher than in 2013, the first year of monitoring. 12/29/2018

Suicidal Ideation and Suicide Attempts 1 in 8 students (12%) reported having serious thoughts about suicide in the past year. This represents an estimated 113,500 students. Females are twice as likely to report suicidal ideation. 3% reported a suicide attempt in the past year. 12/29/2018

Internalizing and Externalizing Problems by Sex

Coexisting Problems OSDUHS examines the co-occurrence of substance use, mental health and antisocial behavior problems, specifically: Moderate to serious psychological distress (K9 Screener) Antisocial behavior (3+ of 9 antisocial acts) Hazardous/harmful drinking (AUDIT) Drug use problem (CRAFFT) 12/29/2018

% Classified as Having 3 or 4 Problems 12/29/2018

Transitional Age Youth 12/29/2018

2013 CAMH Monitor (18-29) 17% of individuals age 18-29 experienced elevated levels of distress according to the GHQ12. Elevated distress declined with age. 12% reported fair or poor mental health. Reports of suicidal ideation were 2.7x times higher among individuals age 18- 29 (5%) compared to those 55 and older (2%). 7% of young adults reported nonmedical use of prescription opioids 12/29/2018

Young Adults and Alcohol Use (18-29) 36% of 18-29 year olds reported exceeding the low risk drinking guidelines, weekly binge drinking (13%) and harmful/hazardous drinking (31%). Age was significantly related to reporting at least one symptom of dependence according the AUDIT and this age group demonstrated the highest percentage at 13%. 12/29/2018

Questions and Discussion 22

For more information, contact: Tamar Meyer Provincial System Support Program Centre for Addiction and Mental Health tamar.meyer@camh.ca