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When Mikayla needed help most, she was one of children and youth waiting for community mental health services in Ontario.

The final insult came when Mikayla turned 18 this year and no longer qualified for the services she had spent years waiting for. After a tangle of failures and missed opportunities that are the fault of no one person or hospital, the system spat Mikayla out the other side as an adult, no better off — perhaps even worse off — than when she first sought care at age 12.

While Ontario has made some important moves — this year’s provincial budget for mental health and addictions, with additional funding recently announced to expand the number of youth wellness hubs that offer services including therapy, recreational facilities and food banks — the situation remains dire.

With this lack of timely treatment in the community, young people are increasingly turning to emergency departments in times of crisis. During the first 28 months of the COVID-19 pandemic, ER visits for self-harm in Ontario children ages 10 to 17 increased by 29 per cent above expected levels, while hospitalizations jumped by 72 per cent, at the University of º£½ÇÉçÇø¹ÙÍøand the Sunnybrook Research Institute.

Mental health disorders were the for hospitalization among children and youth ages 5 to 17 for the year ending in March 2022.

“The need is exploding,” said Purnima Sundar, executive director of the Knowledge Institute on Child and Youth Mental Health and Addictions, but there aren’t enough workers to handle all the kids presenting with mental health problems.

After languishing for months or years on wait-lists, vulnerable youth who turn 18 find themselves back at the beginning of adult wait-lists for the same services.

The Mental Health Commission of Canada that mental illness affects more than one million children and youth in the country but less than 20 per cent receive appropriate treatment as they transition into the adult system.

Unable to find work, some end up homeless or in jail. Or worse.

“If I didn’t have the option of living with my parents,” Mikayla said, “I’d be back in the hospital, in a shelter or on the streets.”

On the wall in Mikayla’s bedroom hang pictures that remind her of happier times.

There’s a family photo of a hike along the Ausable River Valley Trail, near London. A picture from a Grade 8 trip to Niagara Falls. An image of Stewie the parrot.

In a basket in the corner sits a collection of startlingly lifelike baby dolls, reminders of when Mikayla dreamed of becoming a neonatal nurse. That dream was put on hold when she left school last year, halfway through Grade 11, because of her mental health.

Above her headboard, the words “Jesus Saves” in white type on a black background are surrounded by a square frame. A silver cross engraved with the word “Saviour” hangs around her neck.

During those first visits to hospital when Mikayla was 12, Jeannie and Mike were left with the impression their young daughter would grow out of her problems. Jeannie says doctors told them Mikayla had “traits” of borderline personality disorder, but she was offered no long-term treatment plan: No cognitive behavioural therapy. No regular sessions with a psychiatrist. None of the things they now know might have helped at that age.

“We thought it was behavioural so that’s how we treated it,” Jeannie said. “But we were really on our own.”

Feeling lost and adrift is common for young people and their families navigating the mental health system, says Dr. Khrista Boylan, a child and adolescent psychiatrist at McMaster Children’s Hospital.

“It’s so complicated and families do get caught up in the system,” she said.

Unsure of where to turn after Mikayla became ill, Jeannie and Mike first looked to Mike’s work benefits, which covered just three therapy sessions for Mikayla with a social worker; the family would have to pay $250 per session after that.

That ended when the social worker, with whom Mikayla had begun to bond, moved away.

Two years later, in 2019, the family received more crushing news: Jeannie had breast cancer and needed a double mastectomy.

Mikayla became depressed. She began having intrusive thoughts that told her something bad would happen to her mother if she didn’t hurt herself.

By 17, she had started swallowing metal objects, including batteries, magnets and razor blades. It was an urge she could not control. Giving into it brought relief, while ignoring it gave her intense anxiety.

“Even when I didn’t want to do it, I had to,” Mikayla said.

Mikayla became a regular visitor to the Children’s Hospital emergency department. Twice, the police brought her in after she went to bridges near her home and threatened to jump into the Thames River.

In one five-month period, she underwent at least 11 endoscopies to attempt to remove metal objects that she had swallowed.

If ER staff believed Mikayla was in imminent danger, they would admit her, but for a maximum of three days, her mother said. Mikayla also visited the hospital on her own if she felt the urge to self-harm or to speak to a doctor about her mental state.

That’s when hospital staff told the family they should do their best to keep Mikayla away from the ER unless absolutely necessary.

London Health Sciences Centre, which operates London’s Children’s Hospital, told the Star it could not comment on specific patient cases, but said that, like many hospitals across Canada, it has an escalating number of young people showing up at its ER in crisis.

Jeannie doesn’t blame the hospital. After all, she says, it was only doing what it was designed to do: provide acute care to stabilize patients until they are well enough to go home.

Jeannie began having weekly conference calls to discuss Mikayla’s care with staff from provincial and community agencies, and Children’s Hospital supervisors. During one call, Mikayla phoned her mom from Walmart and said she had overdosed on Tylenol. The agency staff heard the conversation and phoned 911.

Finally, Mikayla was admitted to hospital for a long-term stay. For that to happen “my daughter literally almost had to die,” Jeannie said.

The hospital stay meant Mikayla could be monitored around the clock, but it was only a temporary solution.

While Mikayla spent her days in a hospital room, Jeannie searched for residential treatment facilities.

Jeannie looked at Sunnybrook’s Frederick W. Thompson Anxiety Disorders Centre, Canada’s first intensive residential treatment program for severe obsessive compulsive disorder, which Mikayla had recently been diagnosed with. But there were two problems: Mikayla would have to go three months without harming herself — the longest she had ever gone was one week — and the wait-list was 18 months, Jeannie said.

“How am I supposed to get her harm-free if I can’t get her into a facility that would help her?” Jeannie said. “Nobody could give me an answer.”

Then, some good news. Parkwood Institute, a hospital site run by St. Joseph’s Health Care London for those with severe and persistent mental illness, agreed to take Mikayla. While Parkwood doesn’t treat OCD exclusively, it did have a team of psychiatrists and psychologists who could work with Mikayla to nail down her diagnoses.

At Parkwood, Mikayla saw a psychiatrist and psychologist about twice a week and visited the on-site gym. Most of her time was spent sitting in her room building Lego castles, drawing or watching YouTube, she said. She has mixed feelings about the treatment she received.

Once, when she was on 24-hour watch after swallowing a razor, she managed to swallow another razor she had smuggled in. Mikayla said the nurses put her in a small locked room alone for three days over the weekend. She was instructed to go to the bathroom in a cardboard “hat,” which staff took away when they delivered her medication twice a day, she said.

“I was pretty much begging on my knees please let me out,” she recalled. “In solitary, how are you supposed to get better?”

(In a statement, St. Joseph’s Health Care London told the Star it has a policy of “least restraint,” including the use of seclusion: “At times, the team is required to take action to ensure that a patient, or others, are safe.”)

At Parkwood, Mikayla’s doctors gave her a new diagnosis that included borderline personality disorder, a mental illness that makes it difficult to regulate emotions, and a major depressive disorder. They did not think she had OCD.

In some ways, it was a relief to finally learn what was afflicting her. But the diagnoses, at 18, came far too late in what she and her mom call a “hellish” experience that could have been more bearable had they been given better guidance and support from the moment Mikayla’s symptoms began as a preteen.

After four months at Parkwood, Mikayla reached the milestone of becoming harm-free for 30 days and asked to have her involuntary status revoked.

It has been five weeks since Mikayla moved back home. With her new-found freedom comes another hurdle: now that she is 18, she no longer qualifies for any of the services in the child and youth mental health system she was waiting for, such as group homes for young people.

She sees a psychiatrist from Parkwood as an outpatient every two to three weeks — much less than what she feels she needs.

Ontario Works, which provides financial assistance, rejected her application because she’s living in her parents’ home. These days, she spends most of her time watching YouTube or riding the bus.

“I’m worried it could be any day where things just go back to how they were before,” she said.

Parkwood found a group home able to provide Mikayla with coping strategies for independent living. But even if she gets in, she can only stay for three months.

And there’s a five-month wait.

If you are thinking of suicide or know someone who is, there is help. Resources are available online at or you can connect to the national suicide prevention helpline at 1-833-456-4566, or the Kids Help Phone at 1-800-668-6868.