Suicide and Systems of Care: What is the Connection? U of T Researchers Seek Input from Parents & Caregivers

Suicide is complex. Researchers like Dr. Toula Kourgiantakis and her colleagues are engaged in research to learn more.

As a social worker and psychotherapist working for more than 25 years with families supporting children, youth, and young adults with mental health concerns, I have become increasingly concerned about the mental health care received by youth and their families. While we know of evidence-informed treatments that are most appropriate for mental health and addiction-related concerns, in my experience these programs are either non-existent, have long waitlists, or very narrow eligibility criteria making it extremely challenging for youth to receive the type of mental health care that they need.

For youth and families from equity-deserving groups, it is even more challenging to find culturally responsive mental health care. Moreover, parents/caregivers are such a critical source of support for their youth, but they often feel excluded from their youth’s treatment and are overburdened with how to support their youth as they advocate for treatment that meets their youth’s needs as they try to navigate a fragmented and sometimes unwelcoming mental health care system. 

I am a researcher in social work at the University of Toronto and continue to work with families whose stories and experiences inform my research. Many of the families I work with have youth with concurrent disorders and complex mental health care needs. While early intervention is optimal, this is most often unavailable. There is also a lack of intensive outpatient treatment programs, as well as inpatient treatment programs. Since the start of the pandemic, the mental health of Canadian youth has declined while substance use has increased. We know that 80-90% of youth who die by suicide have at least one mental health concern (Cash et al., 2009) and substance use disorder is the second most frequent risk factor (Centre for Suicide Prevention, 2022). In Ontario, the rates of mental health visits by youth to emergency departments for reasons related to self-harm or suicidality have significantly increased in the last 10 years (Gardner et al., 2019). 

Over the last 2.5 years, I have heard numerous stories in my clinical practice and through my research studies about serious distress in youth with reduced access to mental health and addiction services. Parents have described the impact of school closures on their youth’s mental health and wellness, increased isolation in their youth, decrease in healthy coping skills, increase in cannabis use and other substances to cope with various symptoms, and lack of resources to support the youth and family. While each youth’s experience is unique, there are common threads across the stories I have been hearing related to youth distress and accessible, available, appropriate, equitable, culturally responsive, and family-focused care (Kourgiantakis et al., 2022). 

There are several studies including the 2021 Ontario Student Drug Use and Health Survey (OSDUHS) that confirm that a high number of Ontario youth are not doing well. The OSDUHS (2021) study found that almost half of Ontario youth in grades 7 – 12 reported moderate to serious distress levels, 20% had self-harming behaviours, and 18% contemplated suicide in the last year. In addition, 42% of youth noted that in the last year, they had experienced at least one time where they would have wanted to speak to someone about their mental health concerns, but they did not know where to turn. 

I was very preoccupied with what I was observing in clinical practice and learning through research about youth mental health, access to care, and suicide and had a few conversations with other researchers, clinicians, and parents about how this could be explored in a research study. We formed a research team with valuable expertise that included (1) Dr. Eunjung Lee, University of Toronto Professor, Associate Dean, Academic, and FIFSW Chair in Mental Health & Health, (2) Dr. Shelley Craig, University of Toronto Professor and Canada Research Chair on Sexual and Gender Minority Youth, (3) Dr. Marjorie Johnston, Associate Professor at Dalhousie University, and (4) Dr. Jonathan Singer, Professor at Loyola University and Past President of the American Association of Suicidology. 

Deborah and David Cooper have also joined our team and they bring professional expertise and lived experiences as parents of a child who died by suicide. David has worked as a grief facilitator at the Toronto Distress Centres and together they have co-authored a book for parents who have experienced the loss of a child to suicide. They are also co-founders of Eli’s Place – a residential treatment program under development in Ontario for young adults coping with mental illness. 

Our team also has two outstanding research assistants: Jori Jones is a Ph.D. student in social work at the University of Toronto and an Advanced Practice Clinical Leader at the Centre for Addiction and Mental Health (CAMH) and Carrie Lau is a student in the Master of Social Work program at the University of Toronto.

As a team, we discussed the importance of professional and peer support for youth and young adults with mental health concerns and suicidal risk. We could see that there were gaps in the research on youth suicide and the type of care a youth received leading up to the suicide. Moreover, there is limited research that highlights the perspectives of parents/caregivers who are among those most affected by a youth’s suicide. 

Parents/caregivers are well positioned to provide information on the “systems of care” that engaged with their youth prior to a suicide. The systems of care include formal and informal support offered to youth through mental health and addiction services, hospitals, primary health clinics, community centres, schools, and religious or spiritual centres. 

Suicide and Systems of Care – flyer to participate in a study for parents who've lost children to suicide.

The aim of our study is to increase our understanding of the systems of care interacting with Ontario youth under the age of 25 who die by suicide from the perspectives of parents/caregivers.

Parents/caregivers who are interested in sharing their insights and experiences participate in a 90-minute interview via Zoom. We hope to hear from a diverse group of Ontario parents and will use this information to generate recommendations that can improve mental health care quality and access, practice guidelines, and suicide prevention.

For more information about this study, please click on this link or feel free to contact me directly
or the Project Coordinator, Jori Jones,

Eli’s Place will be a rural, residential treatment program for young adults with serious mental illness. To learn more about our mission and our proven-effective model click here.

Toula Kourgiantakis | Friend of Eli’s Place

Toula Kourgiantakis, Ph.D., RSW, CCFT is an Assistant Professor, Teaching Stream at the Factor Inwentash School of Social Work University of Toronto. Her research focuses on youth mental health, equity and access to mental health care, as well as family involvement in youth mental health treatment. Toula has more than 25 years of clinical experience as a social worker and family therapist, and she continues to work with youth and families.

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