If she closes her eyes, Gillian Mulvale can still see the rugged beauty of one of Canada’s most pristine natural landscapes. During her first trip to Yukon in May 2013, the DeGroote Assistant Professor basked in the brightness of the sun during long days, and was surprised by warmer weather than what she had left behind in Ontario. She also recognized how easy it could be to feel isolated.
Mulvale was visiting Whitehorse, the capital, more than 5,000 kilometres from her office at Burlington’s Ron Joyce Centre. An expert in health policy and management, she was on hand to co-lead an unprecedented study into child and youth mental health with Dr. Stan Kutcher of Dalhousie University. Their work was being conducted in a territory roughly the size of Spain, but with a total population of less than 38,000 people.
The ultimate goal was to propose a framework for reallocating resources and retraining staff to better serve children and youth suffering from mental disorders – particularly those in remote and rural areas outside of Whitehorse, with little or no access to adequate care. Mental disorders include conditions such as psychosis, bipolar disorders, depression, anxiety disorders, ADHD, anorexia, and bulimia. At any given time, 10-15 per cent of the population of children and youth in Canada will experience a mental disorder.
“For any child receiving treatment for a mental disorder, think about how overwhelming that whole process can be,” Mulvale offers. “Then that is compounded, if you need to be flown from a northern community to Whitehorse to be properly assessed. If you’re admitted to hospital, which can happen when you’re suicidal, you’re suddenly away from your family and they can’t come and visit you. It can be a very frightening experience.”
During a second visit in October 2013, she travelled to communities of just several hundred people and experienced first-hand the difficulties faced by visiting counsellors from Whitehorse, including travelling long distances, professional isolation, and lack of anonymity for people sharing stories of mental health system experiences.
Mulvale heard about the difficulties of accessing services, particularly in rural and remote communities, with some youth and families facing intense challenges as a legacy of residential school policies. The researchers also heard about the need for better coordination of existing services, and the desire for culturally appropriate services for First Nations youth and families.
Over the course of an intense week of face-to-face data-gathering in October 2013, Mulvale and her colleagues conducted individual interviews and focus groups in Whitehorse and surrounding communities to collect feedback from nearly 100 stakeholders – including young people with mental disorders, family members, service providers, and government policy makers – to assess prevalent issues, capture the diversity of perspectives, and build support for the process.
By comparison, many qualitative studies would be considered “robust” with 20-25 interviews, depending on the topic, Mulvale says. Those interviewed in Yukon were asked about strengths and gaps in current services, and how the government could implement and provide a more comprehensive range of services.
The resulting Child and Youth Mental Health and Addictions Framework for the Yukon helped inform the territory’s new Yukon Mental Wellness Strategy, released in May 2016. The Strategy prioritizes implementation of the Child and Youth Framework for the first two years of its 10-year implementation plan, and adopts its core values and comprehensive approach, including broad stakeholder engagement as a basis for transforming child and adult mental health and addictions services.
The 15-page Framework was a collaborative effort, with input from researchers at McMaster (including DeGroote Associate Professors Glen Randall, Patricia Wakefield, and Christopher Longo) and Dalhousie Universities, along with Yukon Health & Social Services; Kwanlin Dün First Nation; and the Council of Yukon First Nations. The new plan was also informed by the experiences of other jurisdictions facing similar challenges, as well as Evergreen, Canada’s national child and youth mental health framework, released in 2010.
“Gillian and her team provided a valuable stimulus to Yukon through their research into the provision of children’s mental health services,” says Cathy Stannard, Director, Community Health Programs in Yukon’s Dept. of Health & Social Services. “Their efforts, and subsequent report, provided direction not only for children’s services, but rather provided a roadmap of how to best provide services in rural and remote areas, for people of all age groups and differing levels of mental health problems. Yukon has significantly benefited from McMaster’s investment, and the dividends will be reaped for years to come.”
One of the major changes moving forward involves the implementation of a “cascading” model of service delivery that will allow more services to be offered within rural, isolated communities. Whitehorse will offer basic, advanced, and enhanced services; regional hubs will offer basic and advanced services; while smaller communities will offer basic services, some for the first time ever. Existing staff across a range of health and human services will be re-trained to fit the new service model, and referrals to larger centres will take place as required. The long-term hope is that flying young and vulnerable patients into Whitehorse will decrease substantially.
For Mulvale, simply opening a dialogue and gaining trust was a major milestone during the completion of the Framework. “We were out there trying to build trust, trying to build relations, and really engaging people,” she explains. “It helped to have a neutral group to come in, establish trust, and collect information.”
In the years ahead, the feedback offered by Mulvale and her team will slowly be transformed into policy. The largest remaining challenge, she explains, is ensuring subsequent governments keep pushing for better and more efficient mental health resources for young people. Still, Mulvale is confident her team’s work will have a major impact in the region.
“I know we’ve done something important here,” she says. “I know our work has the ability to change people’s lives for the better. For any researcher, that feeling is so rewarding.”
Gillian Mulvale is an assistant professor of health policy and management at McMaster University’s DeGroote School of Business and a member of CHEPA. She holds a PhD in health research methodology from McMaster University, an MA in economics from Western University and a post-graduate diploma in health services and policy research. Mulvale researches issues in mental health policy and service delivery, through the lens of health policy analysis and health economics, to support the development of coordinated, person-centred and recovery-oriented care.