From crisis to care: Transforming mental health pathways for Black youth in Ontario
How culturally adapted models are reshaping access, treatment, and outcomes

Mental health and addiction disorders such as depression and anxiety are among the leading causes of disability worldwide, yet the burden is not shared equally in Canada. For many youth, access to care is shaped less by clinical need and more by social and structural factors, resulting in uneven pathways into the mental health system.

Black individuals living in Canada are three times more likely to be admitted to a psychiatric hospital compared to the general population. For Black youth, these disparities are even more pronounced:

• Black youth are four times more likely to enter the mental health system through the emergency department.
• They often wait 16 weeks for help compared to about 8 weeks for white youth.
• Approximately 50% of Black youth entering the mental health system report police involvement at first point of contact.

These findings suggest that for many families, the “front door” to mental health care is often not a clinic, but a crisis response, frequently involving emergency departments or police contact.

Understanding why these disparities exist has been a central focus of CIHR-supported research led by Dr. Kwame McKenzie, CEO of the Wellesley Institute and Senior Scientist at the Centre for Addiction and Mental Health (CAMH). His work spans more than 30 years, beginning at the Institute of Psychiatry in London, United Kingdom, and later continuing in Canada.

While his early research focused on the biology and genetics of mental illness, the evidence increasingly pointed in a different direction. “We discovered that social determinants, especially racism, showed a clear association with an increased risk of psychosis,” explains Dr. McKenzie. “It wasn’t just biology; it was the environment.”

While his early research focused on the biology and genetics of mental illness, the evidence increasingly pointed in a different direction. “We discovered that social determinants, especially racism, showed a clear association with an increased risk of psychosis,” explains Dr. McKenzie. “It wasn’t just biology; it was the environment.”

Dr. McKenzie focuses on translating research evidence into practice. He spearheaded the development of AMANI, meaning peace in Swahili. AMANI is an equity-centred, community-based model designed to create new pathways into mental health care for Black youth. Rather than relying on crisis-driven entry points, it connects young people to culturally responsive care—such as counselling, psychiatry, and group therapy—earlier in their journey.

Building on this work, Dr. McKenzie and collaborators also adapted Cognitive Behavioural Therapy (CBT) for Black populations in Ontario through culturally adapted CBT (CA-CBT). This approach modifies traditional CBT frameworks to better reflect cultural context, lived experience, and structural realities affecting mental health.

The impact of culturally adapted care is increasingly reflected in both patient experience and system outcomes. When care reflects a patient’s lived experience, youth report approximately 30% higher satisfaction and are twice as likely to complete treatment.

Across Canada, the AMANI model, CA-CBT training, and community-based mental health education for immigrants and refugees have been implemented in clinical and community settings. Together, these initiatives have reached tens of thousands of people through training programs and direct service delivery.

Rather than a single program, this work reflects a broader CIHR-supported health research ecosystem, where innovations are developed through research, tested in practice, and then adapted by clinicians and community partners across different settings.

For Dr. McKenzie, the goal is not only to improve individual programs, but to reshape how the health system defines access and quality. “Equitable care means Canadians can move from province to province and still get high-quality, specialized care,” he says.

The direction is clear. Mental health care in Canada is shifting from a model focused primarily on treating illness to one that also designs systems capable of preventing inequity and improving recovery from the outset.

At a glance

Issue

Systemic barriers contribute to Black youth waiting about twice as long for mental health care and being four times more likely to enter the mental health care system through emergency departments or police involvement.

Research

Dr. Kwame McKenzie identifies racism and social determinants of health as key drivers of severe mental illness, including psychosis. His work highlights the need for culturally adapted and community-based approaches to care. By integrating these approaches into Ontario’s mental health system, access shifted away from crisis responses toward earlier support in community settings. As a result, emergency department visits and hospital admissions among Black youth dropped, while engagement and treatment completion improved.