4. Care Across the Lifespan and for Complex Needs

First psychosis and early intervention

Early Psychosis Intervention programs, or EPI, provide specialized assessment, medication treatment, family work and support with education and employment. Fraser Health accepts young people aged 13 to 30 with a first psychotic episode or an early course requiring appropriate treatment; follow-up may continue for up to three years. Northern Health's age range is broader, from 12 to 45. Referrals can come from the family, a physician, another professional or the person themselves. [4, 25, 26]

Illustration (4. Care Across the Lifespan)Zoom

A study by Riedlinger and colleagues, published in 2026, examined the organization of 16 services using 2022 data. Their catchment areas covered approximately 4.36 million residents. Mean fidelity to the model studied was 56.1% of the maximum score. Two services had high fidelity, nine moderate, three low and two very low. Dedicated EPI centres scored higher on average than general mental health and substance use centres. [57]

The clearest gap was between access to contact and the depth of continuing treatment. Most teams could respond and visit at home; psychological work, family education and clinical supervision were much less well supported. These differences shape life after positive symptoms diminish: returning to classes, addressing anxiety and supporting relatives.⁵ [57]

Youth services and the transition to adult care

Child and Youth Mental Health, or CYMH, services belong to the Ministry of Children and Family Development, MCFD. This network provides free, voluntary, specialized care for children and young people under 18. Foundry serves those aged 12 to 24, bringing together mental and physical health care, substance use support, peer support and social services. In the same centre, a young person can discuss anxiety, contraception, education, work or housing difficulties. [58, 59]

The first six Foundry centres recorded 4,783 young people and 35,791 visits from 2015 to 2018. Mental health and substance use care represented 57% of services used, and physical health care 25%. People most often heard about the centre from friends, at 44%, or family, at 22%. 58% of surveyed visitors said they would not have sought help anywhere without Foundry. Girls and young people aged 15 to 19 attended particularly often; boys and the 20-to-24 age group were less represented. [59]

A later study of the network's expansion described 23,749 unique users and 110,145 services across the respective in-person and virtual reporting periods. Virtual care supplemented local centres and made support available at a distance. [60]

Compass supports professionals treating children and young people under 25. In its first five years, from September 2018 to September 2023, 2,336 professionals registered. Family physicians accounted for 34.6% of contacts and paediatricians for 27.5%. Medication was discussed most often, in 60% of contacts; resource coordination in 32%; psychotherapeutic and behavioural interventions in 30%; and diagnostic clarification in approximately one quarter. A single contact could cover several questions. [61]

The provincial protocol for transition between child and adult care covers the period from age 17 to the 21st birthday. Handover includes planning with the young person, identifying the next service and exchanging clinical information. In practice, education, housing, family roles and program eligibility all change during these years. A handover meeting needs to preserve the accumulated knowledge of the illness course, treatment response and effective forms of support. [62]

The perinatal pathway has a separate consultation service. The Provincial Reproductive Mental Health Outpatient Clinic at BC Women's accepts referrals from physicians, nurse practitioners and midwives for pregnancy planning, conditions during pregnancy and up to eight months postpartum. A one-time preconception consultation may address lithium, an antipsychotic, previous postpartum psychosis and a monitoring plan. Continuing work is coordinated with the local team and maternity care. [63]

BC Children's Hospital provides specialized hospital care for children and adolescents: child and adolescent psychiatric units and a psychiatric emergency assessment area complement local services. For planned admission, the team gathers information from school and community providers; before discharge, it coordinates further work with the family, local physicians and CYMH. This cooperation is particularly important when behavioural change simultaneously affects education, family life and safety. [64]

Intellectual disability and autism: supporting adult life

Community Living BC, or CLBC, funds social support for eligible adults aged 19 and over with intellectual disabilities; its Personalized Supports Initiative also covers defined cases of autism and fetal alcohol spectrum disorder with substantial limitations in adaptive functioning. Support may include daytime activities, employment assistance, respite for relatives and accommodation. Health services treat co-occurring psychiatric conditions. [65]

STADD coordination helps young people aged 16 to 24 move into adult services. Families encounter overlapping age boundaries: CYMH serves those under 18; Foundry serves ages 12 to 24; Compass advises professionals caring for people under 25; and CLBC support begins at 19. Transition planning aligns funding, daytime activity, communication and medical follow-up. [58, 59, 61, 66]

Developmental Disabilities Mental Health Services, or DDMHS, in Fraser and Vancouver Coastal supports people aged 12 and over with intellectual disabilities and mental health or complex behavioural problems. The initial psychiatric assessment usually takes two hours; work with the person and their support network may continue for up to 18 months. Referrals include a current physical examination, agreement from the family physician or nurse practitioner, and a psychological report. The team clarifies the roles of pain, communication difficulties, the environment and mental disorder, and coordinates treatment with the people providing daily support. [67]

Older adults: care at home and long-term care

Fraser Health's community program, mainly for people aged 65 and over, offers assessment, treatment, home visits, consultation in residential and long-term care facilities, and support for relatives. The person, a family member or a professional can make a referral. The team works with primary care; a home visit adds information about nutrition, medication use, mobility and the actual capacity to provide care. [5]

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Vancouver's service accepts older adults with new mental health problems or a longstanding disorder complicated by ageing. People with progressive dementia and complex behavioural and psychological symptoms may receive its care at any age. [68]

The 2025 Canadian guideline on behavioural and psychological symptoms of dementia addresses agitation, depression, anxiety, psychosis, risky sexual behaviour and medication review. Assessment connects a symptom with its course, the environment and its impact on the person and relatives. Pain, sleep disturbance, sensory difficulties and changes in familiar care become part of the clinical picture alongside cognitive impairment. [69]

For a transition to long-term care, the regional service assesses needs and urgency. On 31 March 2025, 7,029 people were on the provincial waiting list; their average elapsed wait was 287 days. During that period, home support, respite for relatives and reassessment of needs constitute a distinct stage of care. [70]

Care developed by Indigenous peoples

The history of residential schools, family separation and discrimination affects trust in health institutions. The independent In Plain Sight review in 2020 surveyed 2,780 Indigenous people and 5,440 health care workers. Among Indigenous respondents, 27% always felt that their needs were taken seriously, compared with 59% of other respondents; 23% reported feeling not at all safe when accessing mental health or substance use services. Stereotyped assumptions of intoxication affected the assessment of pain, neurological symptoms and reasons for seeking care. [71]

FNHA develops its own clinical and cultural pathways. Its Virtual Substance Use and Psychiatry Service provides specialized care to First Nations people and their family members by referral. Elders and traditional knowledge holders may join the support network. Patients can discuss their mental state and treatment in a setting that recognizes their connection with family, community and culture. [72]

In January 2026, the Sts'ailes Éyameth' Health Centre opened, a partnership among the community, FNHA, Fraser Health and the province. In the North Fraser area, the centre combines clinical care with traditional healing practices and welcomes residents of different backgrounds. It provides a concrete way for communities to participate in organizing everyday services. [73]

The scale of need is especially visible in the toxic drug crisis. According to FNHA, 289 First Nations people died in 2025, compared with 433 in 2024; mortality remained 5.4 times higher than among other provincial residents. Almost half of those who died, 49.5%, were under 40. FNHA's response combines harm reduction, clinical treatment, family support and community-led programs. [74]

Métis Nation British Columbia has its own mental health and harm reduction programs. Métis Counselling Connection, launched in 2021, helps MNBC citizens pay for counselling; coordinators assist in finding appropriate care. Inuit eligible for the federal Non-Insured Health Benefits, or NIHB, program have mental health counselling coverage. These pathways complement the regional health network while maintaining connections with their own communities and cultural practices. [75, 76]

Forensic psychiatry

The Forensic Psychiatric Hospital in Coquitlam has 190 beds. It serves people referred through the legal system, including those found unfit to stand trial or NCRMD, not criminally responsible on account of mental disorder. According to the provider, approximately 65% of forensic service clients and patients have concurrent severe mental illness and addiction. The team includes psychiatry, psychology, nursing, social work, occupational therapy and recreation. [77]

Continuing treatment is supported by seven regional clinics in Vancouver, Surrey/Fraser Valley, Victoria, Nanaimo, Kelowna, Kamloops and Prince George. They provide expert assessments, treat mental health and substance use disorders, and deliver opioid agonist treatment. Under a conditional discharge, the BC Review Board sets conditions for residence, supervision and treatment; the regional team supports compliance with them and the person's return to community life. [77]