THE PARAMEDICS radioed in the details to the rural Ontario hospital: female teenager, intentional overdose, ETA five minutes. The patient’s mother arrived with her, wearing a look I had grown all too familiar with — bewilderment, incredulity, fear. When I’d taken the job as an emergency- department clerk, I’d steeled myself for blood and guts, for car accidents and broken bones. But I wasn’t prepared for the sheer number of cases like this one.
After the girl was out of medical danger, the emergency physician asked me to contact the attending psychiatrist, who would speak with the girl and try to find out what had triggered her suicide attempt. Beyond this consultation, however, the patient and her family would be largely on their own, left to navigate a fragmented system that has allowed too many young people to fall through the cracks.
Last June, researchers from the Children’s Hospital of Eastern Ontario, the University of Ottawa, and McGill University released a study about emergency-department visits by Ontario adolescents between 2003 and 2017. Beginning in 2009, the number of adolescents presenting for self-harm increased sharply, more than doubling between then and 2017. Visits for mental health issues, such as anxiety, depression, and suicidal ideation, rose 78 percent over the same eight-year period. Mental health professionals report children as young as seven or eight expressing a desire to take their own lives.
Across the country, the situation is similarly dire. In BC, almost one in five of the province’s students reported having seriously considered suicide in the past year, according to a survey by the youth health nonprofit McCreary Centre Society. And, according to Judy Darcy, BC’s minister of mental health and addictions, Indigenous youth in the province are dying of suicide at a rate four to five times higher than their non-Indigenous peers.
Dina Kulik, a Toronto pediatrician, experiences the youth mental health crisis first-hand during every emergency-department shift she works. Her caseload regularly includes children whose parents have just discovered fresh cuts on their arms, young people escorted by police after sending suicidal texts and barricading their bedrooms, or unconscious teens wheeled in by ambulance crews after intentionally overdosing on prescription medication.
When she isn’t working in the emergency department, Kulik runs a primary-care and consulting practice at Kidcrew, a multi-specialty pediatric clinic, where she discovers still more young people wrestling with suicidal thoughts. Each visit, patients are given a questionnaire that looks at many different aspects of their lives, including mental health, bullying, and overall safety. “It’s eye-opening,” says Kulik of the survey results. “The vast majority of the parents bringing these kids have no idea their kid is struggling. They never heard the child complain.”
There are many other young people struggling with suicidality who do not seek emergency care or share their mental state with physicians — meaning they’re missed in studies, which often focus on emergency- room visits and inpatient admissions. According to Katherine Hay, president and CEO of Kids Help Phone — which collects real-time data on youth suicidality across Canada — the number of young people calling to seek help for suicidal thoughts has increased by 110 percent over the past four years. Hay estimates that her team intervenes in an average of eight adolescent suicide attempts per day.
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