What is the system challenge?

In many Canadian communities, there has been a dramatic increase in the number of youth seeking care for mental health challenges. Between 2006-2007 and 2013-2014, Canadian hospitals reported a 45% increase in emergency department visits related to mental disorders among children and youth (age 5 to 24).[i] Canada’s youth suicide rate is the third highest in the industrialized world. In addition, mental disorders are ranked as the second highest hospital care expenditure among Canadian youth, surpassed only by injuries.[ii] Increasing demand for care has placed a strain on affected youth and their families, stretched community resources, and lengthened wait times for treatment.i

[i] Canadian Institute for Health Information. (2015). Care for Children and Youth with Mental Disorders. Retrieved from https://secure.cihi.ca/free_pr...

[ii] Canadian Mental Health Association. (n.d.). Fast Facts about Mental Illness. Retrieved from http://www.cmha.ca/media/fast-...

What are we doing about it?

System stakeholders in the London area collectively recognized an opportunity to work together to improve care for youth with mental health and addiction needs as they transition to community-based care from the emergency department, and between community agencies. Together, they established an Emergency Department to Community Services Youth Transition Protocol to ensure youth with mental health and addiction needs are supported to reach the appropriate service in a timely manner and avoid unnecessary use of the emergency department. The intervention includes:

  1. Procedures to share essential information, including information relating to screening and/or assessment, client needs and services involved.
  2. Designating a contact person at each agency who is clearly identified to the client and family, and who will ensure a successful transition.
  3. Developing a resource, Be Safe, which includes a resource and support toolkit designed to help youth and families manage mental health and addiction crises and identify local supports. The toolkit includes both a mobile application and paper-based version, and was developed in partnership with local youth.
?What's this?

Full Implementation

The intervention was implemented by the London Service Collaborative with help from the Provincial System Support Program at the Centre for Addiction and Mental Health. Having successfully implemented the Emergency Department to Community Services Youth Transitions Protocol, the intervention is now self-sustained under the guidance of an Oversight Committee.

The Be Safe app has been replicated in multiple sites around the Province with information about local resources.

How do we know it works?


number of youth referred to community services from the ER between the project's initial implementation and Sept. 2015


number of downloads of Be Safe in Canada as of May 2016

In order to be relevent we need (youth) at all of our tables . . . planning, development, implementation, and evaluation.

— Adult Service Collaborative member

As a member of the London Service Collaborative, I learned a lot about making change at the system level.

— Youth Service Collaborative member

The Be Safe resource was so successful in the London-Middlesex community that it has since expanded to multiple communities across the province.

Who was involved?

The Service Collaborative brought together over 50 members including youth, service providers, children’s mental health and addiction workers and physicians.

Next Steps

The Oversight Committee continues to monitor the Youth Transitions Protocol, identifying where action is needed to support sustainability. For example, changes to the Protocol are being considered as a response to changes within the hospital.


For more information, please contact

Beth Powell, Regional Implementation Coordinator