Canadian response to need for transformation of youth mental health services: ACCESS Open Minds (Esprits ouverts)

Abstract

Aim Youth mental health is of paramount significance to society globally. Given early onset of mental disorders and the inadequate access to appropriate services, a meaningful service transformation, based on globally recognized principles, is necessary. The aim of this paper is to describe a national Canadian project designed to achieve transformation of mental health services and to evaluate the impact of such transformation on individual and system related outcomes. Method We describe a model for transformation of services for youth with mental health and substance abuse problems across 14 geographically, linguistically and culturally diverse sites, including large and small urban, rural, First Nations and Inuit communities as well as homeless youth and a post‐secondary educational setting. The principles guiding service transformation and objectives are identical across all sites but the method to achieve them varies depending on prevailing resources, culture, geography and the population to be served and how each community can best utilize the extra resources for transformation. Results Each site is engaged in community mapping of services followed by training, active stakeholder engagement with youth and families, early case identification initiatives, providing rapid access (within 72 hours) to an assessment of the presenting problems, facilitating connection to an appropriate service within 30 days (if required) with no transition based on age within the 11 to 25 age group and a structured evaluation to track outcomes over the period of the study. Conclusions Service transformation that is likely to achieve substantial change involves very detailed and carefully orchestrated processes guided by a set of values, principles, clear objectives, training and evaluation. The evidence gathered from this project can form the basis for scaling up youth mental health services in Canada across a variety of environments.

Transforming youth mental health services in a large urban centre: ACCESS Open Minds Edmonton

“…Encouragingly, youth‐friendly interventions at early stages of need offer long‐term benefits for outcomes (Clark & Unruh, ). It is in this context that the ACCESS Open Minds (ACCESS OM) initiative has facilitated service transformation around five common objectives in different contexts across Canada (Malla et al, ). Here, we describe how efforts towards these objectives have manifested in service and system transformation in a large urban centre in Edmonton, Alberta.…”

Foreword: The real world of implementing early intervention services for young people, their families and their communities

“…Context—let alone culture—is often lost in the language of scaling up and service implementation. This supplement provides a rare and invaluable insight into how key principles of early intervention can be honoured, and yet flexibly adapted, to meet the needs of diverse communities in a nationwide service transformation program: in this instance via the work of ACCESS Open Minds/Esprits ouverts (Malla et al, ; http://www.accessopenminds.ca) in Canada.…”

“…The establishment of the ACCESS OM network and details regarding the overall structure and process of service transformation across six provinces and one territory has been described previously (Malla et al, ). The service transformation is centred around five objectives of (a) increased early detection and intervention, (b) rapid access (including a target of 72 hours), (c) timely appropriate care where needed, (d) continuing care, which removes the artificial transition normally imposed at 18 years between child‐adolescent and adult services; and (e) meaningful involvement of youth and family in service planning and delivery.…”

“…In the Editorial that follows (Iyer, Boksa & Joober, 2019), some of the principal investigators of the ACCESS OM project comment in greater detail about the differences and similarities across the seven contextual sites and how each site has, or has not, met the challenges posed by their particular context. The supplement also includes several commentaries from members of the three national councils—Youth, Family and Carers, and Indigenous—who help form and strengthen the governance structure of ACCESS OM (Malla et al, ). Each of these councils represents key stakeholders for service transformation across the pan‐Canadian ACCESS OM network, and each site has its own representation of youth and family and carers for service planning and delivery locally.…”

Improving mental health services for homeless youth in downtown Montreal, Canada: Partnership between a local network and ACCESS Esprits ouverts (Open Minds), a National Services Transformation Research Initiative

“…To further improve access to and quality of its mental health services, RIPAJ partnered with the national youth mental health services research project, ACCESS Esprits ouverts (ACCESS EO), to create ACCESS Esprits ouverts RIPAJ (ACCESS EO RIPAJ) in 2014. The five key objectives of ACCESS EO are early identification; rapid access to an initial evaluation; provision of appropriate care within 30 days; continuity of care beyond the age of 18 years and youth and family engagement (Malla et al, ).…”