Canadian hospitals stretched as self-harming teens seek help

Mental health services are strained as a growing number of teens show up at emergency rooms across Canada with self-inflicted injuries and suicidal thoughts, say pediatric psychiatrists.

"We're seeing twice as many kids as we were 10 years ago," said Dr. Hazen Gandy, division chief of community-based psychiatry at the Children's Hospital of Eastern Ontario in Ottawa.

"Commonly it's cutting," he said of kids typically aged 12 to 17 who slash their arms, thighs or bellies with everything from razor blades to the sharp edges of protractors.

"It could be burning themselves. It could be bruising themselves by repeatedly banging their fist against the wall. It's a way of kind of giving the body a whole different set of inputs that allows them not to feel so awful inside."

Self-harming is a symptom of deeper issues such as anxiety or depression that stem from complex causes, Gandy said. But what's clear is how climbing caseloads are affecting the health system, he said.

"One of my greatest concerns is that as these services are stressed, greater numbers of mental health providers are now themselves showing wear and tear and are on the verge of burnout," said Gandy. He has practised in Ottawa for 20 years and says he has seen wait times grow to eight to 10 months for outpatient services.

"This is an issue across the country."

Rise in self-inflicted wounds

The hospital says recent statistics show an unprecedented spike in ER visits for kids in mental health crises. In 2012-13, it reported that 2,900 children and teens under 18 sought help — up 64 per cent since 2009-10 and the highest number of pediatric emergency mental health visits in Ontario.

Doctors say they are not only seeing a distressing rise in the number of kids seeking help for self-inflicted wounds, but many specialists report that they don't have the hallmarks of a psychiatric disorder. That is leaving doctors with no clear answers as to why they're seeing so many more kids with these kinds of injuries.

Dr. Kathleen Pajer, chief of psychiatry at the IWK Health Centre in Halifax, says she has watched the number of kids with self-inflicted wounds or suicidal thoughts rise steadily in her ER and colleagues in Canada and the U.S. are seeing the same trend.

They kind of go from pretty average, functioning kids to suddenly they can't cope. They can't manage. They're depressed. They're presenting to emergency departments, hopeless.- Dr. Hazen Gandy, Children's Hospital of Eastern Ontario

"A lot of kids don't really meet the criteria for these disorders," she said. "Instead, they seem to be suffering an existential crisis that is sort of, 'I'm empty, I don't know who I am, I don't know where I'm going, I don't have any grounding and I don't know how to manage my negative feelings."'

She suspects there are many factors that may drive teens to hurt themselves. Families are more fragmented, kids in her area appear to be smoking more marijuana and many don't have the skills to deal with stress, conflict or loss, she says.

Gandy agrees and said both girls and boys who show up at the hospital often share a troubling trait: they lack coping skills.

"They don't actually experience a lot of adverse events in their lives," he said of those who enjoy increasingly affluent upbringings with supportive parents.

When something does go wrong — like a breakup, a death or poor grades — many young people are completely thrown, Gandy said.

"They kind of go from pretty average, functioning kids to suddenly they can't cope. They can't manage. They're depressed. They're presenting to emergency departments, hopeless."

Psych consultations on children

Dr. Laurence Katz, a professor of psychiatry at the University of Manitoba who also sees patients at the children's hospital in Winnipeg, agreed that many kids don't have the skills to manage their emotions.

They sometimes turn to self-harm as a result, he said.

"We've had a five-fold increase in the number of psychiatric consultations being done at our children's hospital emergency room in the last 10 and 15 years," he said.

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"We're all trying to figure out (why) we've all got this large increase in presentations to our emergency rooms and we don't have answers to that."

He uses a method of treatment called dialectical behaviour therapy, which helps give kids alternative ways of coping so they don't harm themselves.

Many kids also say they've been bullied on social media, but they also appear to be using it as a way to share information on how to self-harm, Pajer said.

She said kids seek related advice online without parents or teachers knowing, contributing to a contagion effect for those struggling to cope with stress or, sometimes, to fit in with others who are cutting.

'Almost a fad to cut now'

Kim St. John, divisional head of child and adolescent psychiatry at the Janeway children's hospital in St. John's, N.L., said the number of children arriving for mental health help has soared over her 25-year career.

"We would probably get maybe two or three in a week maximum," she said. "Now we're getting several in a night."

Many of the young people that I see that cut do it to belong to a group or to stay within a group. They post it on Facebook.- Kim St. John, Janeway children's hospital

The province's largest health authority, Eastern Health, started tracking mental health statistics in 2012. Those results so far suggest the number of youth who arrived at the Janeway emergency department for depression, suicidal thoughts or self-harm jumped to 418 last year from 280 in 2012.

"It has become almost a fad to cut now," St. John said. "And many of the young people that I see that cut do it to belong to a group or to stay within a group. They post it on Facebook."

Bullying in the schoolyard is different than the sort of virtual pile-ons that happen as kids feel emboldened to say things online that they would never say face-to-face, she added.

"Personally, I would love to see that access to social media was significantly restricted until adulthood."

The fallout includes crowded wait rooms and longer waiting lists for outpatient care, doctors say.

Katz said even though demand for adolescent mental heath services has increased, resources have not.

"If a child needs to be contained in a safe place within a hospital then we do that, but it's clearly overburdening our hospital beds," he said.

"There is definitely increased demand and that's creating a crisis in the system."