Canadian street youth: Who are they? What are their needs?

By: Nancy Haley, MD
Homeless youth’, ‘out-of-the-mainstream youth’ and ‘street youth’ are some of the many terms that are used to describe a heterogeneous group of young people who live and work on the streets of urban centres across Canada (1–3). The actual number of street youth in Canada is unknown, and estimates vary from 45,000 to 150,000 youths, depending on the source (4). The youth come from rural, suburban and urban areas, are from all socioeconomic classes and have diverse cultural backgrounds. For different reasons, these adolescents are thrown out of their homes or run away to inner city streets in search of identity, independence or a better life.
Many have suffered emotional, physical and/or sexual trauma or parental neglect during their childhood (5–7). Others have underlying behavioural, emotional or mental health problems, which are often undiagnosed and exacerbated by substance misuse that began in early adolescence (2,7,8). Over time, these teens become increasingly detached from their families, the educational system and society, and adopt a street-involved lifestyle that compromises their personal development, and physical and mental well-being. Many street youth become involved in illicit drug use, survival sex and criminal activities, which further alienate them socially and legally (2,5,7). In Canada, 12% to 26% of street youth have exchanged sex for money, shelter, drugs or other needs, and 17% to 36% of them have injected drugs (9,10).
Living on the streets in an unstable and predatory environment puts these young people at risk of developing many health problems (2,3,7,9–14). Studies carried out among Canadian street youth report high rates of sexually transmitted diseases and blood borne infections; for example, chlamydia infection was found in more than 20% (12), hepatitis B markers in 7% to 9% (9,13), hepatitis C infection in more than 12% (9) and human immunodeficiency virus infection in 1.8% to 2.2% (5,10) of street youth. For many youth, alcohol and/or drug dependency, and mental health problems lead to increased morbidity and premature death. In a cohort of Montreal street youth, severe depression, attempted suicides and drug overdoses were frequent (15). The mortality rate among these youths was 12 times higher than that of other young people their age; suicides and drug and/or alcohol problems were the leading causes of death (15).
What Can Physicians Do To Help These Youth?
Identify youth at risk of marginalization
Many street youth report a long history of serious personal and family problems that began years before they ended up on the streets. Some were living with abusive families, or had parents with addiction and/or mental health problems. Others had unresolved gender identity issues, mental health problems or substance use disorders (1,5,7,8). In early adolescence, most street youth began engaging in multiple risk-taking behaviours, such as truancy, illicit drug use, unsafe sexual activities and delinquency (4,5). Despite the fact that many of these youth were referred to health care, social service or child protection professionals to address overt school or behavioural difficulties, very few disclosed their underlying personal problems (2). Even fewer youth felt that they were given the support that they needed when family or personal problems were identified (2).
Certain behavioural and school problems are known to precede and be associated with substance use and mental health problems (16); family physicians and paediatricians are ideally situated to identify youth at risk of marginalization and to provide early intervention. Multiple risk-taking behaviours and severe mood swings in a child or adolescent should alert caregivers that the child may not just be going through ordinary adolescent ‘angst’ but may be showing signs of more serious problems. Physicians’ privileged relationship with youth during medical visits enables them to learn about a young patient’s personal and family life, and explore the underlying causes of his or her problems. Although such history-taking may often be difficult and time-consuming in a busy clinical practice, it is essential if caregivers are to help youth and their families receive the services that they require. The physician can play a pivotal role by developing an intervention plan for a troubled youth with his or her family, school officials, social services and even the police, that can help him or her avoid further social alienation and ultimately street involvement.
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