Peer support program supports youth through mental health and addictions crises in the ED

If you have a health crisis, where do you turn to for help? For many young Canadians, the emergency department (ED) is the first port of call.

Over the last decade, there has been an alarming 100% increase in the number of young adults visiting EDs across Canada with issues related to mental health and substance use. While the ED may not be an ideal environment for youth to receive the support and care they need, it still plays a critical role in crisis intervention as the first point of contact for those needing psychiatric care.

“These patients come to the ED in their time of crisis because we’re open 365 days a year, 24 hours a day. You don’t need an appointment and we never turn anybody away,” said Dr. Bjug Borgundvaag, the Director of the Schwartz/Reisman Emergency Medicine Institute (SREMI) at a virtual webinar on youth mental health. “In speaking with some of these young people, we know that the experience of an ED visit is frightening and very distressing. We also know that they get discharged feeling that their problems were not adequately addressed or resolved. In other words, we have a mismatch between the kind of help our patients are seeking and the kind of care we provide.”

Recognizing this gap in care and the growing trend among young adults visiting the ED for mental health and substance use issues, SREMI has created the RBC Pathway to Peers (P2P) program. Funded by a generous donation from the RBC Foundation and developed in partnership with Stella’s Place, RBC P2P provides real-time, in-person peer support to young adults who visit the ED at the time they need it most. The program is believed to be the first peer support program in Canada where peer support workers with extensive, formalized ED training are incorporated as members of the ED team.

The strength of peer support lies in the social connection: the feeling that “you are not alone”. Peer support workers have lived experiences with mental health and substance use. Using those experiences, they can support others from a place of empathy and deep understanding.

“It’s easy for young people to speak to ED staff and write off their advice and what they say because they do not feel understood. But when you speak with someone who looks like you, talks like you, and has similar experiences, it gives them a credibility that others don’t have,” says Dr. Borgundvaag.

This connection formed through mutual understanding also helps to fight stigma – one of the major barriers that young adults face in getting the care they need, says Yolanda Delmonte, a peer support worker at RBC P2P.

“For young people, the thought of coming to such a public place is very scary. They’re worried about what people are going to think: their parents, friends, classmates – whoever it is. But I think having people with lived experience who are able to talk to them and say ‘I’ve been where you’re at’ helps them feel more comfortable with asking for help in an ED around their mental health or substance use.”

Even for those willing to take the first step in getting the care they need, the fear of the unknown is a huge hurdle. In times like these, RBC P2P peers act as a guide and advocate for youth navigating the health care system.

“Often when a young person comes in, one of the first questions I get is ‘what’s happening? What’s going to happen next?’ Most of the time, young people may not even know what is happening in a hospital or what they’re experiencing with their mental health. So they don’t know how to reach out for care or who they should reach out to,” says Mahalia Dixon, another peer support worker at RBC P2P. “That’s when we can walk them through what support is available to them and reassure them that they are at the helm of their own care. It’s important to remind them that they still have that agency because losing that agency is a huge fear for a lot of young people.”

While peer support does not replace clinical care, it is a great complement to the care that’s already being provided in the ED. Together, the P2P team works with Mount Sinai Hospital’s ED team to provide accessible and inclusive care for all patients.

Since the program’s launch in Mount Sinai Hospital’s ED in May 2020, the RBC P2P team have supported over 600 young adults. The program continues to grow and expand with the vision of one day serving as a template for other hospitals and community programs across Canada.