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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

The Inner City Youth Mental Health Program

Helping homeless youth and young adults find their way to wellness

Steve Mathias, MD, FRCPC, and Scott Harrison, RN, BScN, MA, CCHNC

Reprinted from the "Housing" issue of Visions Journal, 2013, 8 (1), pp. 30-31

According to the City of Vancouver’s most recent homelessness count, there are now an estimated 2,200 homeless people living in Vancouver, an increase of 235% since 2002. The street-involved youth population, ages 16 to 24 years, is estimated to be over 700 and growing. Ninety-five percent of these youth originate from within British Columbia; 60% come from outside Metro Vancouver.1

Overwhelmingly, these street-involved youth did not seek or choose to be homeless. Nearly half are foster care ‘graduates’ who have been homeless since leaving or aging out of ministry guardianship or care.2 Many others are estranged from their families of origin because of behavioural issues related to undiagnosed or untreated mental illness. In the vast majority of cases, it was the deterioration of personal relationships with caregivers, rather than economic circumstances, that propelled young people onto the streets.3

Research indicates that street-involved youth face substantial risks for both physical and mental health issues. They have disproportionate rates of HIV, hepatitis C and other sexually transmitted infections.4 Mental illness in this population is eight to 10 times more common2 and their expected lifespan three decades shorter5 than a non-homeless youth population. These youth present with various psychiatric problems, including anxiety, depression, trauma, attachment issues, poor coping patterns and personality disorders, psychosis, acquired brain injuries and substance use.  

The Inner City Youth Mental Health Program: Origin and Current Services

The St. Paul’s Hospital Inner City Youth Mental Health Program (ICYMHP) was founded in 2007 and was specifically designed to work with street-involved youth. The ICYMHP first collaborated with Covenant House Vancouver, but quickly grew to include several other partners, including Coast Mental Health, Broadway Youth Resource Centre, BC Housing, the City of Vancouver, the Vancouver School Board and the Ministry of Social Development.

The ICYMHP aims to prevent the transition of homeless children and youth into the adult cycle of breakdown, non-productivity, lifelong disability and early death. The program aims to do this by providing early intervention and a continuum of comprehensive care. A team of eight psychiatrists, two social workers, an occupational therapist and a psychiatric nurse uses an inter-disciplinary, assertive outreach model to engage youth.

Today, the ICYMHP and its partners strive to address three basic needs of Vancouver’s street youth population: health care, shelter and social support. This is necessary because our youth’s impairments, be it mood, substance use, or cognitive ability actually serve as obstacles in accessing community services such as adult education, employment agencies or even mental health housing. Whether expectations by these services are too high or too specific, our youth simply struggle to successfully engage with them.  ICYMHP case managers advocate and communicate strategies to community services in an effort to improve youth engagement and success. For instance, the Vancouver School Board has assigned a teacher to provide on site classroom time in one of the largest housing sites, facilitating attendance by the youth. Similarly, Coast Mental Health in partnership with ICYMHP, has designed a peer/buddy training program which will see ICYMHP youth trained to become peer mentors.

The ICYMHP and our partners approach youth in an attachment-informed manner. We recognize that the majority of homeless youth distrust caregivers and institutional care providers. The ICYMHP team strives to develop relationships with each youth, focusing on the youth’s goals and dreams of autonomy. Mental health and addiction issues are redefined as obstacles that can be overcome, rather than as deficits or disabilities.

Along with our partners, we provide the needed outreach, one-to-one support and specialized programming required to care for a fairly large group of previously homeless young people. To date, over 400 youth have been assessed by the ICYMHP, and improved adherence to treatment and appointment attendance are both significant gains the program has achieved. The ICYMHP psychiatrists currently see upwards of 80 youth weekly. Through its partnership with BC Housing and Coast Mental Health, the ICYMHP provides case management to 50 youth living in low barrier housing and 10 youth living in subsidized market housing.

ICYMHP Expansion Thanks to a Donation by Silver Wheaton.

The Inner City Youth Mental Health Program has been generously supported by grants from HSBC, the Vancouver Foundation and the St. Paul’s Hospital Foundation.

Additionally, we are excited to announce that on December 14, 2012, Silver Wheaton pledged $1.6 million over three years to become the lead funder of the ICYMHP. This will support the enhancement of services and the expansion of the program into the Downtown Eastside. It is expected that the case management capacity of the ICYMHP will be nearly doubled and that our ability to provide recreational and rehabilitation opportunities will dramatically improve with this generous donation.

For these youth, re-engaging in education, recreation and employment is a key determinant of health. Numerous youth, finally free of mental illness, addiction and trauma, have been able to complete high school, attend post-secondary school or enter the workforce. For others, the cycle of monthly visits to hospital emergency rooms has been broken, or the daily struggle for survival has ended. Many these youth are finally able to see that a life filled with happiness and wellness is possible.

A Youth in the ICYMHP

Jean is now 23 years old. Homeless at the age of 19, when her foster care ended, Jean found herself homeless.  She moved from her home town of Kelowna to Vancouver, where her ex- boyfriend was living with several others in a rented house.  Soon after arriving, she was beaten by her boyfriend and ended up at Covenant House Shelter with nowhere to turn.

By then, Jean was using methamphetamine on a near daily basis and had begun working in the sex trade. When approached by Covenant House staff, she disclosed a lengthy history of self harm, chronic suicidal thoughts and several past attempts. She had struggled with her sexuality and self-identified as a gay woman.

Covenant House staff referred her to the Inner City Youth Mental Health Program where she was seen by a psychiatrist and placed in low barrier housing. After working to decrease her methamphetamine use, she opted to enter the ICYMHP’s Dialectical Behavioural Therapy Program, an intervention designed to help those suffering with self harm, substance use and chronic suicidality.

Over the next year, Jean began making positive changes as she started to set limits with partners engage in healthy social activities, and abstain from methamphetamine.  Jean then was moved to a higher barrier apartment, where drug use was less prevalent, the building was cleaner and dinner was served nightly. After six months of abstinence, she completed her high school diploma and entered a post secondary training program.

Today, she is in school, drug free and has a tremendous outlook on life. She is hoping to move to her own apartment in coming months and continue to explore wellness activities in her community.

About the authors

Steve is Medical Manager of the Inner City Youth Mental Health Program at St. Paul’s Hospital, which he founded in 2007. He has been working with street-involved youth for over 10 years

Scott is Director of Urban Health and HIV/AIDS with Providence Health Care. He is a nurse and midwife with over 20 years of clinical experience working with marginalized communities

  1. Metro Vancouver Regional Steering Committee on Homelessness. (2012, February 28). One step forward: Results of the 2011 Metro Vancouver Homeless Count. Retrieved from
  2. Smith, A., Saewyc, E., Albert, M. et al. (2007). Against the odds: A profile of marginalized and street-involved youth in BC. Vancouver: McCreary Centre Society.
  3. Kidd, S. (2010). Resilience in homeless youth: The key role of self esteem. American Journal of Orthopsychiatry, 78(2), 163-172.
  4. Ferguson, K.M. (2010). A comparison of addiction and transience among street youth. Community Mental Health, 46, 296-307.
  5. Colton, C. & Manderscheid, R. (2006). Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing Chronic Diseases, 3(2), 1-10.


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