Children’s mental health services have long been described as the “orphan of the orphan” of Canada’s healthcare system. But an integrated system of wellness hubs – a youth-driven “revolution in creating easy access” – is aiming to change that. One funder says it’s a “once in a lifetime” opportunity to make a real difference in people’s lives.
Talk to the people across the country who work on the front lines of the integrated youth services (IYS) movement and they will share the kinds of things you’d expect from experts in their fields – leadership structures, branding strategies, core components. But something else rises to the surface when you talk about youth mental health: every one of the nearly dozen people interviewed for this article, who share more than two centuries of experience working with youth and families between them, has a story. Maybe their daughter was diagnosed a decade too late with a mental health disorder. Maybe they have watched one too many young people die because of a toxic drug supply. When they say they believe in IYS, you hear it in their voices. As one youth at North Simcoe Youth Wellness Hub, in Southern Ontario, puts it, “They are not just doing their jobs, they’re saving lives.”
The fight for a pan-Canadian model for youth mental health services may not be on everyone’s radar, but it should be. Spend an hour with Dr. Jo Henderson and she will tell you why.
Youth need support, and we have an obligation to provide that support.Jo Henderson, CAMH
“Everyone needs to care about young people,” says the director of the Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health at the Centre for Addiction and Mental Health (CAMH) and executive director of Youth Wellness Hubs Ontario (YWHO). “They have some of the highest levels of burden and the least amount of power.” Often, they’re in situations they can’t fix on their own, she says. “They need support, and we have an obligation to provide that support.”
The latest Raising Canada report makes it clear we aren’t doing our job. One-third of Canada’s youth don’t enjoy a safe and healthy childhood, the report notes, listing mental health as one of the top 10 threats to childhood. “Canada has reached a tipping point,” the authors warn, “putting the lives of children and youth – and the future of our country – in jeopardy.”
Learning about how Canada has dropped to the bottom tier of 38 wealthy countries in terms of children’s well-being leads down numerous rabbit holes. Nearly 20 years ago, Senator Michael Kirby described children’s mental health services as “the most neglected piece” of the healthcare system, saying that if mental health services are the orphan of the healthcare system, children’s services are the “orphan of the orphan.” Two years later, a Canadian Paediatric Society report noted that mental health problems were poised to become the next pediatric pandemic. A 2022 report found that Canada is “lagging far behind” on implementing the UN Convention on the Rights of the Child – an agreement signed on to more than 30 years ago. In March 2023, a CBC radio host asked child psychiatrist Tamara Hinz, “Why isn’t this a headline story?” when learning of two-and-a-half-year wait times for youth to receive mental health services. Hinz blamed a “persistently and chronically underfunded” system, circling back to the “orphan child in healthcare.”
That “orphan child” has been a constant backdrop to Henderson’s decades-long career. Asked why it isn’t a headline story, she pauses. Historically, she says, a limited number of voices have been “amplified and empowered to take charge. Children and youth were not seen as members of the community who deserved to have strong voices,” she says. “But, knock on wood, I think that’s changing.”
With IYS, Henderson sees a way forward. What makes this model different from business as usual is the way in which it views and includes youth – as “holistic” beings, she says, as co-creators. A pan-Canadian IYS network defines the model as “a set of guiding principles.” In practice, this means providing help (rapid, no referral necessary) with mental health, substance use, peer support, primary and sexual-health care, social services, and a variety of wellness services under one youth-friendly and inclusive roof. The resulting “youth hub” (for ages roughly 12 to 25) ticks off a lot of fill-the-gap boxes, including what Henderson calls “the age cliff” – when youth transition from youth mental-health services to adult services at 18. Since 2012, IYS has expanded from a few grassroots sites into provincially branded “comprehensive systems of care,” notes a recent Social Research and Demonstration Corporation (SRDC) report.
It makes sense to invest in youth, from an ethical perspective, from a compassion perspective, from a community-strength perspective, and from an economic perspective.Jo Henderson
For Henderson, IYS is a way to right the wrongs of a system “that empowers people who have the most access to the most resources” and passes the ball back to youth. “Transformative change can happen when we stop and listen to youth,” she says, “because they have brilliant ideas. They’re not constrained by 50 years of thinking about things in a particular way.” And this isn’t just about the “right” thing to do: it makes sense to invest in youth, she says, “from an ethical perspective, from a compassion perspective, from a community-strength perspective, and from an economic perspective.”
Preliminary data from ACCESS Open Minds (a national research and evaluation network initiated in 2014) demonstrate the “first ever example of the potential of a pan-Canadian network to transform mental health care,” with early results showing a 70.5% decrease in youth-reported distress and fewer emergency room visits. At one Edmonton site, for every dollar invested in the project, $10 in service costs were avoided.
Henderson describes YWHO (Ontario’s IYS brand) as a one-stop shop where you can get everything from a coffee to a condom. In the International Journal of Integrated Care, she describes YWHO in terms of Urie Bronfenbrenner’s bioecological systems theory, saying that establishing an interconnected system such as IYS is “complex and dynamic, influenced by political, economic, and social factors.”
When Henderson talks to young people about YWHO, she asks them a simple question: “If I take you up in a plane and you parachute and land anywhere in the province of Ontario and you want to go for a coffee, where would you go?” Some say Tim Horton’s or Starbucks; in Northern Ontario, they might say Robin’s Donuts. Then she asks, “What if I drop you out of the plane in that same community and you’re feeling completely overwhelmed. You don’t know what to do. You don’t know how to cope. You’re really stuck. Where would you go?”
“We have no system of care in Ontario,” Henderson says. “There is not one organization for young people you can name.” And that is what YWHO is trying to do, she says. “We want every young person in the province of Ontario to know that in their community there’s a youth hub they can go to and when they walk through the door, someone who likes young people will say, ‘How can I help you? What’s up?’ Then we figure it out as a system. That’s a systemic approach.”
YWHO (Ontario): ‘The right services, at the right time, in the right place’
Ask the youth of Palmerston, Ontario, where they’d go once their parachute touched ground and they’ll point you in the direction of Main Street. In the town of less than 3,000, The Grove-YWHO, one of seven Grove sites in Wellington County and Guelph (and part of the expanding, provincewide 30-site YWHO network), is the place to go. Seventeen-year-old Nadia (the youth interviewed for this piece are referred to by first name only) says that most of the young people she knows come “every single day.” Subway provides a bit of competition, but The Grove has a reputation for being “warm, welcoming, inviting.” She likes the “very cool” welcome sign in various languages (the product of a youth-led equity, diversity, inclusion, and Indigenous reconciliation framework) and sometimes attends activities such as cupcake making or the weekly Chillax and Snax, but it’s more than that: The Grove “gave me hope,” she says.
A year ago, Nadia found herself “super stressed” and in need of housing. Not only did The Grove act as guardians, so she could sign a lease, and assist with financial aspects; they took her grocery shopping, helped her decorate, provided her with a safety plan. “I’m very thankful and grateful,” she says. Nadia’s experience at The Grove, and a lifetime of experience in the social service system, has made her want to give back: “Honestly, one of the main reasons I want to do social work is that I don’t want to see more kids growing up the way that I did.”
When Henderson came to the Rotary Club of Guelph to speak about a new model of care, Cyndy Dearden thought, “‘Hallelujah! There’s a model out there that actually treats youth like they’re the centre.’” Her experience trying to navigate the system for one of her daughters was “the real motivator behind getting involved with The Grove, because if I couldn’t navigate it as a mature mom who is a professional who can navigate just about any system, I don’t know how a 20-year-old is supposed to do it.”
Dearden, who is now The Grove’s executive director, says her experience helps her to “see things that other people might not see.” The Grove team’s philosophy is “You don’t turn anyone away,” and Dearden tells the story of a man in his late 40s walking in just before Christmas whose best friend had just died by suicide. “We welcome him in, we sit down, we talk to him, and get him the support that he needs.”
We didn’t invent the wheel; we took an evidence-based model, and we implemented it.Cyndy Dearden, The Grove-YWHO
“We treat people who walk through our doors in a holistic, individualistic way,” Dearden says. That’s the YWHO model. “We didn’t invent the wheel; we took an evidence-based model, and we implemented it.” Introducing a new model can be scary, she says, and initially they concentrated on the people that wanted to work together. “We had naysayers, but, for the most part, everybody has come on board.” They can see that youth are struggling, she says; the numbers speak for themselves. “We’ve got to rewrite the script to help them get through this.” So far, the community has raised nearly $12 million since The Grove sites opened in 2021 (while each hub receives $650,000 from the Ontario Ministry of Health, this “doesn’t go far,” she notes).
The hubs are “hopping,” says Dearden – as in 4,000 visits per month – and she attributes their success to the concept of little sites connecting to a big site. “Jo said, ‘You’ve got to be where the youth are.’ If you just built one huge site in downtown Guelph, you’d be missing a large percentage of youth most in need of services.” Prior to The Grove, youth in these smaller communities had to wait for a parent to drive them to Waterloo or Kitchener, she says, or be “shipped off in a taxi” when they felt vulnerable.
Dearden thinks about how different her daughter’s life would have been if a Grove had existed. “What keeps me going is there’s a need out there. It’s the right thing to do,” she says. “I love the model because it’s based on wellness, not illness.”
Foundry (BC): ‘Support young people in living a good life’
More than 4,000 kilometres away, in Prince George, BC, Toni Carlton, provincial director for community, culture, and connection at Foundry, sees “wellness” as a by-product of social justice. When people think “mental health” they usually think of things like depression, anxiety, psychosis, Carlton says, but the scope is much wider. Youth are also dealing with the impacts of climate change, social justice, systemic racism. “These bigger world issues impact their mental health, and I think we have a responsibility to address that,” she says. For example, the In Plain Sight report shows the impact of widespread racism on Indigenous people seeking healthcare in BC. Carlton, who is a member of the T’Sou-ke Nation, says, “We’ve all known this for a long time, but now others are learning how damaging this can be.” When we address these kinds of inequities and injustices, “we’re supporting wellness,” she says.
These bigger world issues impact their mental health, and I think we have a responsibility to address that.Toni Carlton, Foundry
With Foundry – one of Canada’s first prototypes for IYS, with 15 sites across BC, eight in development, and 12 more on the way – the engagement of young people and families in the development of a centre is “foundational,” Carlton says, and “far more complex and robust than I’ve seen anywhere else,” from the building itself, to governance structures (described as “flattened hierarchies”) and accountability mechanisms. For BC’s 204 Indigenous communities who speak more than 30 languages, this type of engagement advances the Truth and Reconciliation Commission’s Calls for Action. At Foundry, Indigenous youth have been able to “develop a physical presence that reflects their own identities right from the beginning,” Carlton says. The brand design incorporates different colour schemes, types of animals. At the newly opened Foundry Sea to Sky, “visual elements of Squamish identity” are built into the centre, including QR codes to translate words and a Welcome Totem Pole created by the Squamish Nation.
In BC, a province described by its tourism website as “rugged and wild with few towns and roads,” meeting IYS goals, such as being easy to find and providing rapid access to help and services, can be challenging. Carlton, who has lived and worked in northern BC (a region of 600,000 square kilometres and home to the province’s most at-risk populations) for three decades, says that any system operating in the province needs to recognize that “BC is not a monolith.” There is a need to rethink IYS for outside the urban context, she says, and to recognize that sometimes it’s more than services that are needed in these areas – it’s a complete restructuring. Poor (or no) internet connectivity, limited transportation options, and lack of housing (for both youth and potential staff) are just a few barriers.
In the vastness of northern BC, Carlton sees just how far Foundry’s tentacles reach. “What’s been unique about working with rural communities and northern communities is this recognition that their reach is beyond that community,” she says. And as Foundry spreads, so does the reach of IYS. “Twenty years ago, I wasn’t really talking to folks outside of my community, or even outside the organization that I was working in,” she says. “And now we’re talking to folks in Australia, and we’re talking to folks in Ireland, and we’re talking to folks in Ontario, and Nova Scotia. We’re all trying to learn from each other.”
While Vancouver youth might not face the same obstacles to accessing services that northern youth do, multiple systemic barriers exist in the third-least-affordable city in the world.
Amanda, a youth peer support worker at Foundry, understands such barriers well. “Before Foundry was Foundry,” she says, she was a client at the Granville Street location where she now sits – formerly Inner-City Youth, a 30-minute walk from the Downtown Eastside, the subject of numerous articles and documentaries. This is Foundry’s oldest site and “the smallest and busiest,” she says.
When Amanda “aged out” of the system at 18, Foundry was there to fill the gap. She recalls the sense of connection she felt with her youth peer support worker, who was her age and had similar lived experiences with mental health and addictions. “He was honestly my favourite person on the team,” she says.
From sitting in the client’s chair to working nine to five, Amanda has been able to experience the “whole cycle” of Foundry. Her most valuable skill is the ability to connect with clients, she says, to “meet them where they’re at,” without judgment. “You don’t necessarily know anybody’s story,” she adds.
Foundry has changed Amanda’s life, and in turn she has witnessed it change the lives of her clients, whether it’s a youth who was homeless for eight months who is now in housing or someone going to treatment. With drug toxicity the leading cause of death in BC (six deaths per day), intervention is even more top of mind. Each step toward wellness is cause for celebration, she says: “It’s a big win for the whole team.”
Huddle (Manitoba): ‘The first thing you need to know about us is we’re on your side’
The concept of “team” comes up often in Winnipeg, where Manitoba’s first IYS hub, led by NorWest Community Health since 2017, was added to five new sites in May 2022 to establish the Huddle Manitoba Network. With its small-town vibe and diverse population, a place where “local partnerships evolve and flourish,” the city is well-positioned for interesting collaborations across sectors, says Megan Tate, vice-president of community grants at The Winnipeg Foundation (WF). “Kind of what Huddle is all about, right?”
The “holistic” nature of the IYS movement encapsulates everything WF, founded in 1921, believes in, says Tate: “a Winnipeg where community life flourishes for all,” where Huddle is in itself a community, she says, of young people.
We know that community organizations are stressed and stretched and probably tired of filling out grant proposals and final reports. With Huddle, funders can spend more time on programs and less time filling out forms.Megan Tate, The Winnipeg Foundation
As a funder, Tate appreciates the IYS “funder collaboration” model tied to a backbone organization (WF funds Huddle through the United Way Winnipeg). By dealing collectively with a group of funders, the process is more streamlined, she says. “We know that community organizations are stressed and stretched and probably tired of filling out grant proposals and final reports.” With Huddle, funders can spend “more time on programs and less time filling out forms.”
After more than a century, WF has a “bird’s eye view” of the city, Tate says, and can see how things connect – the connection between access to art and mental health, between the environment and health. At Huddle, all those connections come together, she says. “It’s one thing to read a proposal; it’s another to see it in action and see the space and understand how young people might use the space and hang out there.”
According to Pam Sveinson, executive director of the Manitoba Youth Hubs Initiative, the hubs reflect a youth-driven branding process, promoting a “sense of warmth and welcoming,” of being received into a safe space where youth can be “authentically themselves.” At Huddle Brandon (215 kilometres west of Winnipeg), this means being greeted with a pair of “cozy” hand-knitted slippers, she says. Every Huddle offers a different flavour – whether it’s karaoke and movie nights or cognitive behavioural therapy and community breakfasts.
Sveinson notes that her organization “relied heavily” on input from YWHO and Foundry, in particular the importance of integrating Indigenous cultural programming from the outset. “Youth were telling us that Indigenous wellness is a very important part of their overall wellness journey,” she says. Huddle Ka Ni Kanichihk offers cultural healing activities such as cedar baths, sweat lodges, and community pipe ceremonies. With Winnipeg home to the largest Indigenous population in Canada, Sveinson says it’s “essential” to look at how “we bridge between Indigenous wellness and Western approaches to wellness.”
Philanthropy came to the table and said, ‘This is an interesting idea.’Connie Walker, United Way Winnipeg
Connie Walker, CEO of United Way Winnipeg, says that philanthropy is the bridge that has made all this possible. “It would not have happened without the Graham Boeckh Foundation,” she says. “Philanthropy came to the table and said, ‘This is an interesting idea.’ Government looked at the IYS model, studied it, did their own report that said, ‘We’ve got to change.’”
“And so the stars just aligned,” Walker says. While a lot of this was about dollars, “because that’s what leverages government to change,” she says, “it was also about using their voice and inspiring what’s possible.”
But it’s also about Winnipeg. The city is big enough to have the resources, the expertise, the collective will, but is “small enough that we can get it done because we literally do know each other,” Walker says. “I’ve come to learn that it’s so rooted in relationships. And, you know, that’s really how lives get changed.”
Walker emphasizes that Huddle is a place free of plexiglass, with a program person waiting to fill out your application to see if you qualify. When you hear young people’s stories, she says, “emotions and tears are never far from the surface.”
As a former community public health nurse, Walker has been into people’s homes and witnessed firsthand the “tremendous barriers” youth face. “And really, it’s not that complicated,” she says. “I mean, it is complicated, but it shouldn’t be this complicated to take some of those barriers away and acknowledge that every young person could be anything they want.”
“I’ve never met a young person who aspires to be in a gang, who aspires to use substances, or who aspires to drop out of school, who aspires to be on social assistance,” she says. “No young person is born with those aspirations, nor do their parents have those aspirations for them. We all dream bigger for our kids. And we all dream big as little people.”
Graham Boeckh Foundation: ‘We are transforming mental healthcare in his name’
The thing about mental health is that everyone has a story, says Ian Boeckh, president of the Graham Boeckh Foundation (GBF). “Many people are aware of mental health, both on a personal level actually experienced in their family, but also how much it affects people in society, and affects the trajectory of people’s lives.”
In 1986, Boeckh’s brother Graham died from complications related to schizophrenia at the age of 22. A few years later, the Boeckh family set up a foundation to “improve the lives of people living with, or at risk of, mental illness.” A 1997 McGill Reporter article noted the stigma surrounding mental health at the time, saying, “the family has been very courageous in stepping forward. They’re private people exposing themselves to public scrutiny.”
A decade ago, GBF “embarked on an audacious goal: the transformation of Canada’s youth mental-health care system,” Boeckh recently told the Financial Post. Today, Boeckh says, “I think we are well on our way to having IYS in every community in Canada,” with initiatives currently available or under development in close to 120 communities across the country. The provincial brands (YWHO, Foundry, Huddle, and Aire ouverte in Quebec, where Boeckh lives) are part of “a revolution in creating easy access.”
There’s an opportunity to now go beyond awareness, to really help people and make a difference in their lives.Ian Boeckh, Graham Boeckh Foundation
Boeckh notes that the issues faced by young people and their families across Canada are very similar, but when it comes to different communities’ capacity to help, great differences persist. To become a truly pan-Canadian movement and support all kinds of communities is “really helping to create equity,” he says. What Marg Cox is doing in an underserved community such as Haliburton is “quite extraordinary,” he says, and speaks to the power of IYS. “To have part of this movement in downtown Toronto and Vancouver and Montreal, but include Haliburton County, Inuit villages up in the Arctic, remote First Nations communities, is something that is really critical if we want to have an equitable society.”
Boeckh has visited many of these communities and has seen the impact IYS is making. Communities “feel empowered,” he says, when they’re given this opportunity. As momentum for IYS grows, supporting it becomes easier. “There’s a whole ecosystem now,” he says. This ecosystem includes research initiatives such as IYS-Net, funding partnerships to accelerate IYS sites, and a 30-member Mental Health and Awareness Affinity Group to mobilize philanthropic resources.
Now that we’re seeing awareness about mental health increase, it’s time to take the next step, Boeckh says: “There’s an opportunity to now go beyond awareness, to really help people and make a difference in their lives. This is something that for mental health comes maybe once in a lifetime.”
The artwork that accompanies this piece, just take the book, we don’t have enough time, was created by Taliah Dumas Stephenson using ballpoint pen and alcohol markers. It is an illustration of a washroom building in a Florida state park where you could take and leave a book. The piece references things ending and how a consistent thing doesn’t actually stay in your life as long as you feel it does. She wanted to reflect on how beautiful it can be to look at something from a distance, which is hard sometimes.
This submission was part of a collaboration with Haliburton Youth Wellness Hub to highlight the talent of young artists.