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By: Sean O'Malley, Senior Writer, CAMH

For much of her childhood living in a rural community in southern Ontario, Melanie Asselin felt like any other small town kid.  But around the time she turned 12, life began to change. She started to become more withdrawn. Her grades at school began to suffer.  She started losing her appetite.

"I had no idea what I was going through," says Melanie, now 23 and completing a master's degree in social work. "Mental health was something no one in my town talked about and my family didn't talk about it. So when I began to experience symptoms of depression and anxiety it was a new experience for all us."

Unfortunately for Melanie, it was also a new experience for her family doctor, who did not feel they had the right expertise to offer a diagnosis or treatment and instead put her on a waiting list to see a specialist.

"They did what they knew best and referred me to a psychiatrist instead. But that's a big, scary word for a young person to hear. It took a lot of courage for me to tell my family doctor, 'I'm having feelings of depression,' and it was hard for them to just look at you and say, 'Ok, now we have to wait.' I understand why my doctor was hesitant to give medication to a child, but I couldn't help but feel I was alone and waiting was my only option."

It would be another nine months—one of the darkest times in her young life—before she finally began receiving the mental health treatment she needed.

Thanks to a new online tool developed by the Cundill Centre for Child and Youth Depression at the Centre for Addiction and Mental Health (CAMH), the hope is that other young people will not have to wait as long as Melanie did when they seek help. Created by clinician scientists, youth engagement advisors like Melanie and other mental health experts, the Cundill Centre Online Tool for the Treatment of Youth Depression summarizes best care practices for supporting youth with depression, including diagnosis and medication guidelines. It is directed toward primary care physicians, family doctors, school counsellors, social workers, pediatricians and other front-line youth care providers.

"The [COVID-19] pandemic has exposed chronic stresses and strains in the youth mental health system, and as a result we've seen significant increases in youth mental health issues, particularly depression," says Dr. Peter Szatmari, Director of Cundill Centre. "Depression is a very significant challenge, one of the most common mental health challenges that kids experience. The rates are going up and have very serious long-term consequences if it's not treated adequately."

Unfortunately, there is no standardized treatment for youth depression in Canada. The Cundill Centre worked with health teams across Ontario to identify and share best practices with respect to screening, prevention, and treatment of child and youth depression.

"All of us were just doing whatever we thought was the right thing to do, not based on any evidence. Children and youth were receiving different advice depending on who they saw," says Dr. Karin Euler, a family physician with the Georgian Bay Family Health Team, which collaborated with CAMH to contextualize the online tool for their practice. "We weren't unified in our response to how we should manage depression. Children and youth deserve the best treatment possible, and the best treatment possible is based on evidence and good clinical practice guidelines."

The tool includes an overview of depression in youth, including a video simulation of a virtual assessment, as well as links to other assessment tools. The full content can be reviewed in under 20 minutes and is freely available to primary care clinicians in all parts of Canada and was recently also launched for practitioners in the UK, India, South Africa and other regions worldwide.

Zara Uddin, who served as a youth advisor on the online tool, feels optimistic about how it will facilitate better care. She also had a message for her peers struggling with depression: "[Young people should] reach out for help, especially from a physician or counsellor. Depression can be highly treatable, and they can feel better. Sometimes, you just need to ask for help."

"I think there is a role for all primary care providers—including pharmacists—to be really proactive and ask their young patients about their wellness and not just their physical health," says Melanie. "When I was younger I wish someone had asked me, 'How are you doing? How are you really doing? It's hard for young people to develop the courage or even know the right words to bring that up. So if someone with more authority like our family doctor can take that initiative and ask you first, it can open that door."

Access other depression care resources for young people, their caregivers and clinicians here.