This paper analyzes how young adults in Ontario experience elevated risks of mental health issues like depression and anxiety, and have poorer health outcomes due to the combination. In order to identify the issue, research into the experience of those with chronic conditions was used to examine why there is an increase and how best to manage it in the future. By looking at how chronic conditions and mental health are managed within Ontario and the systems which are currently in place, it is clear that there is a need for new and more robust management systems. Separating the care of chronic conditions and mental health in order to focus on a singular issue at a time has created a system where those with chronic conditions feel worse about their health care experience and have poorer health outcomes. Although those with chronic conditions are likely to experience depression and anxiety due to their condition, the current system for managing chronic conditions is adding to the increase in rates of depression and other mental health issues. Going forward, a new system must be put into place to support the mental health of those with chronic conditions in addition to their physical health. 

In Ontario, young adults with chronic conditions experience highly elevated rates of depression and anxiety, yet there is a clear lack of support systems in place to deal with this increase. A community-driven approach needs to be implemented to support the mental health of Ontarian’s with chronic conditions while improving access to mental health care facilities. The burden of care needs to be shifted away from patients and towards professionals who can diagnose and support these issues. The clear link between chronic conditions and mental health has not been addressed and without properly addressing the need for this link, complications arise in the care of chronic conditions. In order to better support Ontarians, there needs to be a clear understanding that chronic conditions and mental health must be addressed as a whole and not separately. The system that is currently in place creates gaps in the care of those dealing which chronic conditions, and must be adapted in order to improve the quality of life for all Ontarians. By creating new systems and supports, those with chronic conditions can receive the care they need to manage their condition and mental health without putting additional strain on the systems which are currently in place. 
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The issue with chronic conditions is that they affect everyone differently, caring for a chronic condition can be a complicated system that people need to navigate as they seek care. Because of how complicated these conditions can be, receiving the care a person needs can be a challenge, and often times mental health gets overlooked. According to the Canadian Mental Health Association of Ontario, those dealing with a chronic condition experience a mental health issue like depression at a rate of between 9.3–11.4% vs those without a chronic condition at 2.8% (CMHA 2008b, figure. 1). This means that those suffering from chronic conditions are four times more susceptible to a mental illness like depression than those without a chronic condition. This increase does not just affect the older individuals with chronic conditions, young adults with the same condition can experience more detrimental effects to their mental health and everyday lives. The younger you are when diagnosed with a chronic condition the more likely it is to impact your ability to reach expected life milestones, meaning that the same condition can have a more dramatic and lasting effect on young adults (Wilson, C. & Stock, J., 2019, para. 22). Being unable to reach expected life milestones like owning your own home, getting married and being self-sufficient can have a dramatic impact on ones feelings of self worth and importance, and this affects the young adult population unlike most other groups dealing with chronic conditions.  
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The increased rates of depression and other mental health issues also leads to other complications with care of chronic conditions. Depression can undermine the motivation for self-care, like compliance with medications, eating well and exercising (CMHA, 2008a, para. 36). Managing a chronic condition and mental health issues like depression in tandem can be an extremely complicated and difficult task for the patient and medical professionals within the current system. In addition, co-existing mental illness and chronic conditions result in poorer health outcomes and higher mortality rates than when either condition is dealt with on its own (CMHA 2008a, para. 32). It can become extremely difficult for someone to manage their conditions when faced with a mental illness, creating issues which need to be addressed in order to properly care for everyone. 
When you are trying to manage a chronic condition, understanding how it will affect you and what to look out for. If you have never been experienced a mental health issue, you may not be able to understand the difference between symptoms of your condition and those of a mental health issue like depression. Due to an increased risk of depression and other mental health issues, they can compound the problems faced by someone with a chronic condition. It is also important to note that not all conditions act the same on someone, and care needs to be taking to address the specific symptoms as well as the toll on their everyday life. 
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Within Canada and Ontario, care for chronic conditions is usually specialized. In addition to a family doctor, you may see a number of different doctors to get all of the care needed, all of which need to be in communication with one another in order to deliver care. The issue is these doctors may not always be in communication, they may be located in other cities or regions and have access to different hospitals and tools. This complicates the care of dealing with chronic conditions because there needs to be a direct line of communication, and for issues related to mental health, that link is missing. Within Canada and Ontario, mental health and chronic conditions are dealt with separately from one another (CMHA, 2008a, para. 21). Due to this separation between the care of chronic conditions and mental illness, the communication link is missing and the care which is needed can become more complicated. 
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According to the Canadian Mental Health Association of Ontario, depression is common among those with chronic conditions. It is frequently undiagnosed by health care practitioners who are tasked with managing chronic conditions (CMHA 2008b, para. 36). This can happen for several reasons, but typically health care practitioners tasked with managing chronic conditions are specialists in their fields, and are often focused on treating the symptoms rather than the person as a whole. This leads to increased rates of depression and mental health issues because the focus is on solving the core issue and not any of the other problems which may arise. Compounding the issue, primary care doctors are not trained in how to detect and manage mental health issues within patients. Although there are Canadian guidelines in place to assist with mental health, they are not linked to the management of chronic conditions (CMHA 2008b, para. 27). 
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Not only are health care practitioners not trained to deal with the management and detection of mental health issues, the current system limits the interaction and time a patient has with their doctor. In addition to short appointment times, diagnostic overshadowing focuses the conversation on the chronic condition and not the patient as a whole (CMHA, 2008a, para. 27). Because chronic conditions and mental health issues often share similar symptoms, it can be difficult for health care practitioners to accurately diagnose a mental health issue in addition to the underlying chronic illness. Primary care doctors are not trained in detecting mental health issues and depression, and patients may not realize they are experiencing issues because they may relate it to a symptom of their condition. These issues make detecting and talking about mental health issues complicated for patients and can often go undiagnosed. 
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The lack of connection between specialists and mental health care services, and focus on dealing with one issue at a time rather than the individual as a whole has lead to sicker Canadians feeling worse about their care. Not only are they feeling worse about their care, but those with a chronic condition have a higher dependency on health care services. As the focus continues to stay on one issue at a time, other complications in their care can continue to arise. Sicker Canadians and those dealing witch chronic conditions have a less positive perception of their own care and the system as a whole, only 48% rated their quality of care as good compared to 76% of the general population (Health Council of Canada, 2001, pg. 8). These same Canadians also feel less engaged in their own care, according to the Health Council of Canada 58% feel they do not have enough time with their doctors and 72% say their doctors are less likely to explain things in a way they can understand. 
When people feel like they are disconnected from their care and that they do not have enough time to fully understand all of the issues they are facing, it can become extremely complicated to manage and sort out their conditions. It is oftentimes expected that your health care practitioner will be able to understand and solve the issue you are facing, especially when you have a chronic illness. However, because not all health care practitioners are trained to detect and manage mental health issues when dealing with a chronic condition, if it goes unnoticed, care can become complicated. Finding mental health care is also put in the hands of the patient, because they are expected to set up appointments with their primary care doctors specifically about the issue of mental health and not their condition as a whole. 
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Proper care and services around mental health and depression are needed for Ontarians who are dealing with chronic illness. It is well known that mental health issues like depression are more common among those dealing with chronic conditions and that not diagnosing these issues can have a detrimental impact on the outcome of those which chronic conditions. Within Ontario, nearly 1 in 3 psychiatrists see very few outpatients and 20% see two or fewer new patients a month (Rudoler et al. 2019, pg. 1). With so few psychiatrists in Ontario receiving new patients it can be challenging for anyone to receive support for a mental illness, this makes it even more challenging for those dealing with a chronic illness. Because there is a lack of connection between specialized health care practitioners and mental health services, even though people with chronic conditions are already deep in Ontarios medical system they do not necessarily have easier access to care. In 2017 alone approximately 4.9 million Canadians aged 15+ felt they needed mental health care, over 1 million felt that their needs were only partially meet and around 600,000 felt their needs were unmet (StatCan, 2017). Being within the medical system does not mean you will receive better access to care, and because there is such a high need for mental health services finding access can be almost impossible. 
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In addition to a challenge in just being able to access mental health care, there is also a cost associated with receiving some care. Although most psychiatrists are covered under the Ontario Health Insurance Plan (OHIP), psychologists, counsellors and therapists are not (Settlement 2019, para. 3-5). With only a small part of the mental health chain being covered by OHIP it adds to the challenge of those dealing with chronic illness. When dealing with a chronic condition, there are other costs which need to be considered. Despite OHIP and Canada’s universal coverage, one in eight Canadians with a chronic condition did not see a doctor, skipped a recommended test or treatment due to concerns over cost (Health Council of Canada 2011, pg. 7). Ontarians with a chronic condition need to consider the costs of receiving care and treatment, which can make it very challenging to seek and receive additional mental health supports. Because cost is an issue in receiving some of these mental health services, it has been found that the people who end up receiving the care are from a higher income-level (Bartam & Stewart 2019, pg. 1). 
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Ontarians with chronic illness are faced with a system which has little to no capacity to support mental health service needs, no line of communication between primary care doctors and support networks, and incurring additional expense which may be detrimental to other areas of their lives. Looking at the services provided by organizations like the Canadians Mental Health Association and their branches in Ontario, there are no programs built specifically for those with chronic conditions. Due to the system in Ontario pushing for issues like mental health and medical illness to be talked about and managed separately, there has never been a foundation for those who have chronic illnesses to rally together for support services. This puts them at a unique disadvantage, there is no clear path for someone to access care for a mental illness when dealing with chronic conditions. Like all other Canadians they must reach out to services using the same process regardless of the clear links between chronic illness and increased rates of depression and other mental health issues. 

When Ontarians with chronic conditions need to consider the costs and benefits of receiving mental health care which they need, there is a clear issue with the system. People with a chronic condition are already at a higher risk of getting a mental illness like depression and because of the system in place currently it can easily go undiagnosed. In order to address these issues, real steps need to be taken in order to address cost, communication and care for all Ontarians with chronic conditions. Managing both a chronic condition and mental illness at the same time leads to poorer health outcomes, and it is important to understand that without proper training and care the situation will continue to decline. By creating an organization or group dedicated to supporting and caring for all Ontarians with chronic conditions from a whole body outlook and not one issue at a time, real improvement in quality of life can happen. It is important that the focus of an organization like this isn’t on just creating change in small ways, but pushing for a dramatic shift in the way we think about chronic conditions and mental health care. These issues can not be seen as separate from one another, and the impact that they have on peoples lives needs to become something that is known by all. To fully address and support the care of everyone, an approach based around understanding and activism is needed. Those who have been recently diagnosed with a chronic condition need to understand the system is working to help them, and all services should be laid out right away. All of the information shows there are links between chronic conditions and mental health and that new services are needed. In order to address this need there needs to be a push for change within the medical and governmental systems we currently have.