Innovations in Mental Health Promotion: Youth Net/Réseau Ado

Ian G Manion PhD CPsych, Simon Davidson MB BCh FRCPC, Christina Norris MA, Sarah Brandon MA, Department of Psychiatry, Children's Hospital of Eastern Ontario; Department of Psychiatry and School of Psychology, University of Ottawa, Ottawa, Ontario

Canadian youth are at a disturbingly high risk for mental illness and mental health problems (1). Furthermore, research has revealed that death by suicide remains the second most common killer of youth in Canada. and that adolescents are the only age group where the rate of suicide is on the rise. It appears that, depending on the methods used. about one of five Canadian children or adolescents has a significant mental health problem or psychiatric disorder (2). The Canadian Youth Mental Health and illness Survey (3) showed that main-stream Canadian youth have significant concerns regarding their own mental health, that they are largely dissatisfied with existing mental health services. and that they are most willing and comfortable to interact among themselves around such issues.

The above findings were the impetus for the development of a regional (Eastern Ontario and Western Québec) youth mental health promotion and mental illness prevention program. Youth Net/Réseau Ado (YN/RA). YN/RA is a bilingual program run by youth, for youth. that strives to promote awareness and increase communication among youth regarding mental health and illness issues, as well as to empower youth to develop connections with a safety net of 'youth4riendly' professionals. Through focus groups, run by young (aged 18 to 25 years old) trained facilitators, YN/RA provides a forum for open discussion of mental health and illness. Its goals are to destigmatize mental illness while promoting good mental health; to facilitate the early identification of mental health concerns and connection to services; and to respect what youth are saying to make present mental health services more youth appropriate.

YN/RA has been developed as an innovative way of combining both macroscopic and microscopic approaches to mental health intervention with youth. At a macroscopic level, youth are connecting with youth to discuss mental health and illness openly. YN/RA also encourages young people to create their own mental health promotion and mental illness prevention initiatives. Such Initiatives might include youth-focused support groups concerning depression, self-esteem or relationship issues; a mental health board game; question and answer boxes; or newsletters (ie, YOUTH FAX. FAX ADO). YN/RA is available to assist with the implementation of such youth-generated programs and offers training to interested youth. YN/RA also supports the translation of traditional and formal mental health and illness information into youth-friendly language or 'youth speak'.

At a microscopic level, YN/RA links adolescents in the most acute need with professionals and more traditional mental health services through a youth-friendly and community-based program. These efforts include screening and identification of youth in focus groups who may be at risk of suicidal behaviour, with strict adherence to a crisis protocol when such situations arise. By showing respect for and being attentive to the youth perspective, YN/RA has gained the trust of youth. This enables YN/RA to serve as the bridge to assist youth with making that first step of reaching out to more formal supports when necessary. An overall objective of the program is to demystify mental health and illness for youth while educating professionals about the flexibility and sensitivity required to serve all youth better. Both the macroscopic and microscopic components of YN/RA are supported by an infrastructure of mental health professionals.
Friends, parents and teachers are usually the first to recognize that an adolescent may be having significant problems (see Table 1 for warning signs of mental illness or suicide).
YN/RA continues to offer focus groups throughout Eastern Ontario and Western Quebec. Youth have provided very positive feedback on the YN/RA philosophy and programs. More formalized evaluation of the impact of this program at both an individual and a community level is being developed. As well. plans to replicate the YN/RA model through satellites in 10 different communities across Canada are underway. We truly believe that, as stated so well in The Health of Canada's Children: A CICH Profile: "It is our responsibility to work with youth to find ways to maintain, enhance and improve their health (including mental health). Not only do our approaches have to move with the times and the changing society, but also with the attitudes and perceived needs of and by our youth (1)."

YN/RA seeks to provide the opportunity for youth to voice their concerns and to respect the role that youth will play in the evolution of mental health services.


TABLE 1: Warning signs for mental illness or suicide
Behavioural signals
  • Marked deterioration in school performance or increase in absenteeism
  • Excessive use of alcohol and/or drugs
  • Marked changes in sleeping and/or eating habits
  • Consistent aggressive or nonaggressive violations of rights of others: opposition to authority, skipping school, thefts, vandalism, etc
  • Withdrawal from friends, family and regular activities Poor appetite, difficulty sleeping
  • Frequent outburat of anger and rage
  • Unusual neglect of personal appearance
  • Uncharacteristic delinquent, thrill seeking or promiscuous behaviour
  • Occurrence of previous suicidal gestures or attempts
  • Self-mutilation
  • Planning for death; making final arrangements; giving away favourite possessions
Physical/psychological symptoms
  • Many physical complaints Iheadaches, stomach aches)
  • Depression shown by continued, prolonged negative mood and attitude or thoughts of death
  • Low energy level, poor concentration, complaints of boredom
  • Loss of enjoyment in what used to be favourite activities
  • Intense fear of becoming obese with no relationship to actual body weight
  • Marked personality change
  • Sudden cheerfulness after prolonged depression may be a manifestation of relief because a decision has been made
Verbal signals
  • Comments about feeling rotten inside, wanting to end things, and soon no longer being a problem for others
  • Nihilistic comments such as "life is meaningless", ."filled with misery", "what's the use of it all?"
  • Verbal or written threats
Adapted from reference 4. It should be noted that there is a group of individuals who may show no signs or very subtle signs before their suicidal behaviour.