It's a frigid November day in downtown Edmonton. The temperature has sunk to -15 C, but a brisk wind makes it feel even colder.
Office workers and students with backpacks scurry along the frozen sidewalks, their hoods pulled tightly around their faces.
Inside the Bill Rees YMCA, a handful of young people lounge about, some munching on snacks while they wait to see a counsellor at the ACCESS Open Minds clinic, which runs weekday afternoons.
This innovative national addictions and mental health program is aimed at those aged 11 to 25, but most who show up looking for help are in their late teens or early 20s.
It's a relaxed atmosphere today, at least on the surface. The waiting area feels like a college student dorm, with comfy sofas to sit on and a big-screen TV at one end, which sits unused.
In a small meeting room down the hall, Dr. Adam Abba-Aji, the lead psychiatrist and a co-investigator for the program's two sites in Edmonton, chats with Katherine Hay.
There are no big desks or bright overhead lights, just comfortable armchairs and stuffed pillows. The implicit message: relax, you are safe and welcome here.
"As you can see, this is more homey than a typical hospital or clinic environment. I don't sit behind a desk here," says Abba-Aji, a faculty member in the U of A's Department of Psychiatry.
"We're trying to create a more relaxed atmosphere so patients feel comfortable sharing information with us. We want them to see this place as a sanctuary. They don't need an appointment. We're trying to change the way mental illness is perceived by young adults."
That message is echoed by Hay, who oversees all young adult community programs in the city for Alberta Health Services, including ACCESS Open Minds.
"Our intention is to create a really positive, welcoming, non-judgemental space for our clients," says Hay, whose easy laugh and casual manner radiates warmth and friendliness.
"So even if they're not in need of really intensive psychiatric interventions right now, they'll know where to come in future if they need more help."
More than 700 young people struggling with mental health or addictions issues have visited the ACCESS Open Minds clinics in Edmonton since the program kicked off in April, says Abba-Aji.
"Access Open Minds does focus on early psychosis, but early psychosis can take many forms and have many causes. It can be schizophrenia, it can be a bipolar illness, it could be depression or it could be drugs," says Dr. Pierre Chue, AHS's addictions and mental health chief for the Edmonton zone.
"All of those things can play a role in terms of developing early psychotic symptoms. So ACCESS Open Minds is both a screening system and a service, as well as a triage to other services, if they're required."
Before the program was launched, there was no obvious place for troubled young people to go for help because the youth mental health system was fragmented. Many, struggling with untreated psychoses or addictions to alcohol, opioids or methamphetamines, simply wound up in hospital emergency wards.
"That's not normally the best place for them. So they'd either struggle along or try to connect with family or friends, or maybe counsellors at school, or try to figure it out on their own," says Hay.
"And then they'd probably deteriorate over time and wind up going to the hospital emergency. So we're really trying to change that."
The YMCA clinic in downtown Edmonton is the largest of the 14 ACCESS Open Minds sites in Canada, which span six provinces and one territory.
The goal in all sites is to arrange a mental health assessment within 72 hours for all those seeking help, followed by facilitated access to any required support services within 30 days, if possible.
"I'm one of five addictions counsellors on the young adult team. Everyone takes turns attending the ACCESS clinic and being part of the intake process," explains Clay Hoffman, who works with AHS.
"It's an open-door policy here. People coming in are looking for a point of contact to receive services, whether it's for mental health and addictions - the two primary ones - or things like housing or employment support. We're the first point of contact to get the process going."
The ACCESS Open Minds program is based on five key pillars: Early identification, Rapid access, Appropriate care, Continuity of care beyond age 18, and Youth and Family Engagement.
"One of the real risk factors for young people is that all of our services are based around this strange idea that at 18 you become an adult, so your service providers are all supposed to change at age 18 as well," explains Hay.
"That creates a big risk factor for individuals who are accessing addiction and mental health services. Everything they had working suddenly may change to an adult system where things are very different. So that's why our program goes up to age 25."
ACCESS Open Minds is supported by $25 million in funding, through 2020, from the Canadian Institutes of Health Research (CIHR) and the Graham Boeckh Foundation.
The program's goal: to harness research-based evidence to fundamentally improve the way young people suffering from mental illness are cared for in Canada.
Those are worthy sentiments, of course. But it's only when one hears about the real-world experiences of actual patients that the value of these clinics becomes clear.
"I'll tell you about one patient I saw here" says Abba-Aji.
When a local news show reported plans to launch the ACCESS Open Minds program, the patient showed up at the Bill Rees YMCA to ask about it. "We hadn't really started the program at that point, but he kept coming until he met Steve, one of our counsellors," says Abba-Aji.
"Steve linked him with support services, he's now off the street, and for more than a year he has not been readmitted to hospital. He just can't stop talking about this program, and through him, two other people he recommended have also come here for help."