Putting the focus back on the patient

An article published in the December 1st edition of The Chronicle Herald:

IWK hopes to whittle down wait for youth mental health services

By John McPhee, Health Reporter

Add value and keep it simple.

It sounds like a business marketing pitch but actually it sums up an increasingly popular system for treating young mental health patients.

Two child psychiatrists from Britain have been working with staff at the IWK Health Centre in Halifax this week to see if the Choice and Partnership Approach will work there.

About 1,100 people are on the waiting list for child and adolescent mental health services at the IWK Health Centre in Halifax. That wait can be as long as 18 months, compared with the standard acceptable wait of about a month.

"They’ve noticed some of their systems haven’t helped users as well as they would like," Steve Kingsbury [pictured], a child and adolescent psychiatrist based in London, said in an interview Tuesday during a break in the training session at a Halifax hotel.

"How you organize services (and) the paperwork you have to do? And I don’t think they could see any way of doing it better until they heard about this."

Kingsbury and Ann York, who also works in London, have taken the "reduce bureaucracy and focus on the patient" message to 11 countries in the past six years. They and other clinicians came up with the system as a way of tackling long wait times and unacceptable outcomes, York said.

"The central premise is how to design services to make things better for the young person and their family, a better experience and more effective for them. All the things we then do organizationally and clinically are around having them at the heart of it."

The usual treatment approach would see a doctor do a thorough assessment of the patient. But recommendations are often made based solely on such assessments, without finding out what makes sense to the family or the child or what they want, the doctors said.

The question of wants, not needs, is crucial to the Choice and Partnership Approach. If the patient is asked what they want, the list is usually short and can be addressed right away by giving the patient and family goals to work on at home.

"They wouldn’t be put on a waiting list for something," York said. "They would go away with an appointment in their hands to see somebody with the right skills to help them with the goals they wanted."

This method has reduced wait times at their London clinics from a year to several weeks. Similar successes have been reported in the countries where they have trained staff and managers. Those countries include the United Kingdom, Australia, New Zealand and Belgium.

York and Kingsbury came to Nova Scotia on the recommendation of a doctor now working in Halifax who underwent the training in New Zealand.

The IWK couldn’t provide an exact cost of the three-day session, but York and Kingsbury said they don’t charge full consultant’s rates. Rather they are paid the equivalent of what they would earn as clinicians in London. It is their first visit to Canada and they combined the working sessions with their vacation.

"It’s not our day job," joked York, who said they continue to work full-time as psychiatrists and devote an average of one day a month to their consultant work.

Sharon Clarke, clinical leader for mental health services at the IWK, said she was impressed by the Choice and Partnership Approach just from reading the material on the website.

"The exciting part for me is that they’re taking a business approach, in the sense of lean thinking, and using these ideas of demand and capacity to really be able to have an accurate assessment of what the needs are in the system — to put people in the right places, to do the right job at the right time."

The IWK will begin using the system in wait list interventions in January and it will be fully implemented by April.

(jmcphee@herald.ca)

Image credit


Also see:

The Choice and Partnership Approach Website

Evaluation Of The Choice And Partnership Approach In Child And Adolescent Mental Health Services In England

Mental illness leading cause of disability in youth

An article posted on June 6th by CNN.com:

Mental health problems such as depression account for nearly half of all disability among young people between the ages of 10 and 24, according to a new study from the World Health Organization (WHO).

Researchers looked at data from 191 countries and estimated the number of years of good health lost to disability resulting from disease and injury (known as disability-adjusted life years). Among adolescents and young adults, 45 percent of disability was related to depression, bipolar illness, schizophrenia, and other mental disorders, including alcohol abuse.

Health.com: 10 subtle signs of bipolar disorder

Dr. John S. Santelli, M.D., a professor of population and family health at Columbia University's Mailman School of Public Health, in New York City, says that, fortunately, mental health issues at the root of a young person’s disability generally respond to prevention, early detection, and treatment.

"There’s much better behavioral treatments, there’s much better pharmacological treatments as well," says Santelli, who wrote an editorial accompanying the study, which was published in the journal The Lancet. "We know what to do. We just need to do it."

Health.com: 9 ways you can help someone who's depressed

The study was the first ever to look at the international burden of disability in young people. Worldwide, the researchers estimated, disability claimed about 236 million healthy years from this group, which includes both estimated and actual years of life lost to illness and premature death.

After mental disorders, accidental injuries were the second largest cause of disability, accounting for 12 percent, followed by communicable diseases (including HIV, malaria, and tuberculosis) at 10 percent.

The top risk factors for disability were drug and alcohol use, unsafe sex, failure to use birth control, and iron deficiency, a common sign of malnutrition.

Health.com: Myths about safe sex and sexual health

"Youth is considered to be a time of good health," says one of the study's authors, Fiona M. Gore, a WHO researcher in Geneva, Switzerland. However, she says, "important health factors and risk factors for disease in later life emerge in these years "

The study revealed some regional and socioeconomic differences. Compared to the world as a whole, for instance, mental disorders account for a greater proportion of disability in the U.S., in Europe, and in nations with high per-capita income. On the other hand, disability due to injuries and communicable diseases was lower in those countries than worldwide.

"There is a need to focus on prevention strategies and on health promotion of noncommunicable and nonfatal causes of disease in young people," Gore says.

Also see:

Global burden of disease in young people aged 10—24 years: a systematic analysis

Mental Disorders Leading Cause of Disability in World's Youth

New mental health curriculum guide targets high schools

An October 26th posting by the Dalhousie University Medical School:

By Margo Wheaton

Dealing with a mental health disorder can be overwhelming, especially for adolescents. At a time when fitting in feels crucial, it can be hard for a teen to admit how down she is or how alone he feels.

Although it’s estimated that mental health problems affect one in five young people in Canada, early diagnosis and treatment of conditions such as depression, bipolar disorder, schizophrenia, bulimia and anxiety disorders remains elusive. As a result, many young people aren’t receiving the help they need.



Dr. Stan Kutcher [pictured], a professor in the Department of Psychiatry at Dalhousie University's Faculty of Medicine and the holder of the Sun Life Financial Chair in Adolescent Mental Health, has a group that has been working to change that.

Through a partnership with the Canadian Mental Health Association, Kutcher and his team at the IWK Health Centre have developed the Mental Health and High School Curriculum Guide, an innovative learning resource for secondary school teachers. The guide represents a component of the first expert-reviewed comprehensive school-based mental health program in the country and combines collaborative learning strategies with interactive multimedia tools.

The goal? To increase mental health awareness and literacy in students, teachers, and families.

According to Kutcher, who is this year’s recipient of the J.M. Cleghorn Award for Excellence in Leadership in Clinical Research, early identification of mental disorders in adolescents is key: “The data is very clear. We know that early identification and early effective treatment has profound short and long term positive outcomes not only in terms of the disorder but in terms of secondary prevention.”

He notes that identifying mental disorders in adolescence can help prevent substance abuse and social-vocational problems and stresses that failure to identify and treat mental illness in teenagers can have dire consequences: “Jail has become the new mental hospital for kids. We have to intervene earlier.”

By equipping schools with the most current resources in mental health and education along with the tools to facilitate dialogue in the classroom, teachers and students alike will be in a better position to see mental health problems for what they are and know there’s no shame in seeking help.

The curriculum guide, which consists of lesson plans, student-friendly activities and audiovisual resources, has already been successfully field-tested at Forest Heights Community School and will be further evaluated in two Digby schools early in the new year. A national launch of the program will take place in the next few months.

The curriculum resource is part of a larger framework called Pathways to Care, a collaborative, inter-disciplinary approach to adolescent mental health that’s been developed by the Sun Life team as part of its mission to disseminate the most current scientific information available. Other resources include a number of creative, interactive and user-friendly materials specifically for parents, siblings, healthcare providers and, of course, for teens themselves.

By educating the most important people in a child’s life about mental health, the model cuts across sectors and emphasizes the importance of community connections as a gateway to early detection and treatment.

Kutcher notes that “what we’re doing in the schools here is really cutting edge” and is very appreciative of support from the Provincial Department of Education, the Schools Plus Program, school boards, schools, educators and others without whom the work could not be successful. He points out that the Mental Health Commission of Canada has identified school mental health as a national priority and he envisions it as a major area of investment and development over the next decade.

“We’re now developing national and international linkages in school mental health and I think that we’re well positioned to take a leadership role. I’m hopeful that the province will continue to work very closely with us as we move that agenda forward.”


Media enquiries:

Allison Gerrard, Dalhousie Medical School, (902) 494.1789 / (902) 222.1917, allison.gerrard@dal.ca

Photo credit

Much more must be done

A letter to the editor published in yesterday's edition of The Chronicle Herald:

The Feb. 9 story "Family tried to get teen murder suspect psychiatric help" reports that the family of the young man charged tried to obtain psychiatric care prior to the tragic event. It is often the shocking that draws attention to the commonplace. We need to do more, much more.

Parents, youth and health providers have known for a long time now that rapid, efficent access to effective, high-quality mental health care is a problem. We need to do much better to ensure that those who need care immediately receive high-quality care immediately. That may mean redesigning our health system. That may mean addressing mental health literacy in schools and in the community. That may mean better training in the diagnosis and treatment of mental disorders for all health providers.

One in five young people has a mental disorder requiring professional treatment. If the prevalence of heart disease in youth was that high, would there not be a heart clinic on every corner? Yet those in most need of mental health care do not receive it. What is wrong with this picture? Enough is enough. It is time to fix the problem!

Dr. Stan Kutcher [pictured]
Sun Life Financial Chair in Adolescent Mental Health
Dalhousie University

Mental-health program for Digby schools gains national attention

An article published in today's edition of The Chronicle Herald:

By Brian Medel, Yarmouth Bureau

Digby County proponents of an adolescent mental-health curriculum being included in area high schools have received national attention.

The Mental Health Commission of Canada has asked if they can use a local program in a new national anti-stigma campaign.

"We’re very excited about being part of this campaign," John Roswell, the co-ordinator of the Digby Clare Mental Health Volunteers, said Tuesday.

"Our mandate is to promote the mental health of Digby County residents and we are trying to overcome the prejudice and discrimination faced by people with mental illness in our community.

"We have been focusing on adolescent mental health in particular and this is one of the areas the commission is concentrating on."

Mr. Roswell said his group has been working for several months to introduce information about mental health and illness into the curriculum of Digby County high schools. It now looks like the program will begin during the 2010-2011 school year.

"The (Canadian) Mental Health Commission will be helping us measure the effectiveness of our program," said Mr. Roswell.

The Digby County group has also joined forces with the Sun Life Financial Chair of Adolescent Mental Health at Dalhousie University and the IWK Health Centre to help with their project.

Dr. Stan Kutcher, an adolescent mental health expert at Dalhousie University’s school of medicine, spoke to Digby County teachers Tuesday, providing information on mental health and disease.

Mr. Roswell said 80 per cent of all psychiatric disorders emerge in adolescence and it would be good for people to have some understanding of them.

"Mental illnesses affect more people, directly or indirectly, than any physical illness," he said, adding that 83 per cent of Digby County high school students surveyed by his association recently said they knew someone with a mental illness.

And yet mental illness is something people don’t like to talk about, said Mr. Roswell.

"We’re trying to overcome that by creating a dialogue in our community. We’re trying to help people see that it’s OK to admit that you might have a mental illness."

Conference: Youth Mental Health and the Justice System

Please click on the image to magnify it.

For further information, please click here.

Teens to learn about mental health

An article published in today's edition of The Chronicle Herald:

Pilot project could be coming to Digby County high schools in new year

By Brian Medel, Yarmouth Bureau

High school curriculum designed to teach students about mental illness may be coming to Digby County classrooms in January as a pilot project.

"This is new," said John Roswell, one of the program co-ordinators with the Digby-Clare Mental Health Volunteers Association.

"We hope to do it during the 2009-2010 school year, hopefully beginning in January," Mr. Roswell said about the project that will be conducted in four local high schools.

He hopes the curriculum will someday be included in all Nova Scotia high schools.

The curriculum was prepared by Dr. Stan Kutcher [pictured] in co-operation with the Canadian Mental Health Association.

"This is really a wonderful opportunity," said Dr. Kutcher, an adolescent mental health expert at Dalhousie University’s school of medicine.

The course will give students information on how the brain works and tell them how to maintain good mental health. Suicide prevention and depression will also be discussed, Dr. Kutcher said Tuesday.

He’ll help teachers better understand mental illness and the new curriculum in special workshops that will be held before the start of the course.

"They’ve been very enthusiastic about this," said Dr. Kutcher.

Next week, staff from the Education and Health departments, along with representatives from local school boards and health authority, will gather in Digby to talk about the new high school course and how it will be implemented.

"We’re not quite sure where it will fit . . . that’s part of what this discussion is going to be about," said Mr. Roswell. "We hope to make (it) a larger project . . . an overall approach to addressing adolescent mental health.

"We’re trying to create a dialogue around this issue in the community and make it OK for people to talk about mental health and mental illness."

Mr. Roswell said 80 per cent of all psychiatric disorders emerge in adolescence. He had mental illness as a young person but was undiagnosed until the age of 40.

"My life would have been so much different had I been diagnosed as a teenager," he said.

More than meds & beds

A letter to the editor published in yesterday's edition of The Chronicle Herald:

Re: "Suicide prevention: Time to get on with what works" by Stan Kutcher (Sept. 12).

Lack of treatment was acceptable in children’s mental health when we didn’t know the difference. However, it is totally unacceptable when the knowledge and proof of improved capability of sustaining a productive life is within a proper treatment plan, but lacks the dollars and commitment to provide it. All children deserve proper treatment without prejudice and stigma over their mental health issues!

It is time for the torture, neglect and abuse to stop. It is time for psychiatrists to stop delivering inadequate treatment proposals to parents and caregivers for their mentally ill children, because the province does not support the mental health needs of its young people, or perhaps, the hospital itself covers its inadequacy.

It is time for our government to invest more dollars into treatment facilities, with not just meds and beds, but with the educated, experienced staff and specialized treatment programs when prescribed. It is time for our children’s hospital to invest in a psychiatric unit and all existing mental health treatment programs, an art therapy program, music therapy program, "in house" psychologists and "on-call psychologists" when in-patient youth are in trauma episodes.

Actually, it is past time!

Sherry Beck Ramey, New Germany

Evergreen Child and Youth Mental Health Survey

Posted yesterday on the Teen Mental Health Blog:

Evergreen Child and Youth Mental Health

View more documents from Dr. stan Kutcher.

Canada has a proud history of valuing health care as part of the fabric of this country and a basic right for all citizens. However, despite our commitment to overall health care, our attention to mental health care is overdue.

In Canada, approximately 1 in 5 children and adolescents experience some form of mental disorder. Most major mental disorders begin prior to the age of 25, making this period a critical time for the promotion and treatment of mental health problems.

One of the key initiatives of the Mental Health Commission of Canada is to develop a Mental Health Strategy for Canada. As part of the strategy the Child and Youth Advisory Committee of the Mental Health Commission of Canada will support the development of a framework specific to the needs of child and youth mental health.

We need your help!!

We invite all Canadians to share their thoughts and opinions in an online survey about values and principles relating to child and youth mental health.

TAKE THE SURVEY NOW

The survey [please click here] will take about 30 minutes to complete (but you can save your answers and come back to it at any time).

It is important that we get the thoughts and opinions from as many different people as possible. Please pass this information along to your network, family, friends, or anyone who you think should join this consultation.

Diagnostic Challenges in Adolescent Schizophrenia

From Medscape Psychiatry & Mental Health, October 15, 2008:

Both overdiagnosis and misdiagnosis plague early onset schizophrenia. Dr. Robert Findling [pictured] outlines the challenges in his latest video blog.

Photograph of Dr. Findling courtesy of Case Western Reserve University.

Doctor confronts mental health stigma

From the August 30th edition of The Edmonton Journal:

Gov't pledges $50M to improve service to young people at risk

By Alexandra Zabjek

EDMONTON - Raj Sherman stood on the side of a highway, staring at the approaching headlights, then deliberately stepped in front of an oncoming car.

He was 16 years old, the child of an immigrant family in small-town British Columbia, where many children's parents either worked two jobs or didn't work at all.

Luckily, that night the car swerved and just grazed his side. He later told his family the bruises were from sports injuries and told his teachers he had hurt himself at work.

Now parliamentary assistant to [Alberta] Health Minister Ron Liepert, Sherman recounted the story Friday morning at a funding announcement where his government pledged to pump $50 million into children's mental health services over the next three years.

"The reason you have to tell these stories is to break down the stigma about mental health," Sherman said of his experiences.

The funding plan sets benchmarks for how long it should take for children to receive mental-health services in the province -- those in crisis should receive care within 24 hours, those with less urgent cases within two weeks, and those with scheduled visits within 30 days.

To read the entire article, click here.

Photograph of Dr. Raj Sherman by Candace Elliott, The Edmonton Journal.

Three cheers for outspoken health bureaucrat

From the August 28th edition of The Chronicle Herald:

By Marilla Stephenson (pictured)

CHERYL DOIRON is one of those bureaucrats who, happily for us, is more concerned about doing the right thing than she is with fawning over her political masters.

That’s why the deputy health minister is on the top of my Three Cheers list for her honest assessment of the dismal state of mental health services in Nova Scotia.

Even better, Doiron’s explosive missive was delivered in public, damn the torpedoes and other potential consequences.

She is exactly the kind of bureaucrat Nova Scotia could use more of.

At the Canadian Mental Health Association’s national conference in Dartmouth last weekend, Doiron issued a plea for mental health organizations and the public to push harder to have politicians direct more money into mental health services.

"It’s very hard to get it to be the primary issue, particularly for politicians who are making budget decisions . . . because they are not getting the same pressure about mental health as they get about cancer and coronary disease and diabetes," Doiron told delegates in a speech.

"We, working from the opportunity we have within government, organizations such as (the national association) and the Nova Scotia (association) and other groups, and all of us, collectively need to be doing something much more significant to make this a burning-bridge issue for decision-makers."

Doiron’s primary concern is the long wait times for psychiatric care for people suffering from mental illness, especially children. She noted that while spending for mental illness by her department has increased in recent years, the percentage has decreased in proportion to the total health-care budget.

To read the entire article, click here (as of February 8th, 2010, the entire article is no longer available).

Photograph of Marilla Stephenson courtesy of The Chronicle Herald.

Continual struggle

A letter to the editor published in today's The Chronicle Herald:

Re: "A passionate call for mental health services" (Aug. 23).

It is disheartening to see the continual struggle for the mind and brain to be given equal treatment to the heart, cancer and pancreas. This state risks institutionalizing the stigma described in Michael Kirby’s Senate report "Out of the Shadows at Last."

A wait of six to 12 months for a child or youth feels like a lifetime. Lest children’s mental health service is kept as the "orphan’s orphan," we would like to note a few points.

Most mental disorders in adults begin in children and youth. Parity of resources, clinicians and research funding for child and youth mental health is even more dramatically unbalanced than for adults. Many of the problems in childhood have long-term consequences for adult functioning and multiple service problems and needs. In a knowledge-based economy, without helping all children and youth reach their optimal mental health, we sacrifice the economic health of our society.

We applaud Deputy Health Minister Cheryl Doiron’s alert to society that we must all attend to mental health, and in particular we support the need to bring services for the minds and brains of children and youth up to par with other systems and organs of the body.

Margaret Steele, MD, President,

Wade Junek, MD, President-Elect,

Canadian Academy of Child and Adolescent Psychiatry

A passionate call for mental health services

From today's edition of The Chronicle Herald:

By John Gillis, Health Reporter

Deputy minister makes rare appeal for public support

Nova Scotia’s deputy health minister called on mental health organizations and the public Friday to help her light a fire under politicians to do more to help people with mental illnesses.

In a passionate off-the-cuff speech at the opening of the Canadian Mental Health Association’s national conference in Dartmouth, Cheryl Doiron said her department has put more money into mental health services over the years, but spending has declined as a proportion of the overall health budget.

"It’s very hard to get it to be the primary issue, particularly for politicians who are making budget decisions . . . because they are not getting the same pressure about mental health as they get about cancer and coronary disease and diabetes," she said.

"We, working from the opportunity we have within government, organizations such as (the national association) and the Nova Scotia (association) and other groups, and all of us collectively need to be doing something much more significant to make this a burning bridge issue for decision makers."

Mental health spending accounts for just over 3.5 per cent of the $3.2-billion provincial health budget.

Ms. Doiron said the relatively small amount of funding for those services means the province is failing to provide "absolutely essential help" to children and others.

She gave the example of an adolescent mental health program at the IWK Health Centre. The in-patient treatment lasts 12 to 18 months. But the 13- to 19-year-olds who might benefit from the intensive program have to wait that long just to be admitted.

Ms. Doiron said she pleaded the case to cabinet and was able to secure extra funding of $1.5 million this year and about $2 million in subsequent years to expand to 18 beds from 12.

An enduring bias against people with mental illness means people are often reluctant to speak about their conditions, and society doesn’t know they should be treated just like people with physical ailments, Toronto psychiatrist David Goldbloom told the conference in his keynote address.

"I think one of the challenges around mental illness is that its unique properties include affecting our thinking, our moods and our behaviour: the very dimensions that define us as individuals," he said. "That makes it a lot tougher to separate the illness from the person."

And while growing numbers of people report in surveys that they have had direct experience with mental illness, either personally or through a friend or relative, the perception that people with mental illnesses are dangerous or violent has increased, Dr. Goldbloom said.

That attitude is exemplified by reporting on events such as the recent beheading of a passenger on a Greyhound bus and crime dramas like CSI and Law and Order, he said.

"The reality of mental illness, its mundane reality, is virtually never depicted," he said. "The same applies to the newspapers, because somebody recovering from mental illness or somebody simply making a great adaptation to mental illness is about as newsworthy as a plane landing safely at the airport."

Dr. Goldbloom said research shows that negative perceptions are formed very early, so young children should be a focus of efforts to erase stigmatization.

Workplaces should be another major target, he said.

Finding and keeping meaningful work goes a long way toward helping a person with mental illness develop a sense of self and social connections; mental illness is the leading cause of short-term disability keeping people out of the workforce, Dr. Goldbloom said.

The Mental Health Commission of Canada, of which he is vice-chairman, says mental illness drains $51 billion from the Canadian economy each year.

But there is hope that negative attitudes can be broken down, Dr. Goldbloom said.

He recalled that when he was an intern in the early 1980s, hospital staff were "terrified" of the gay men who appeared with symptoms of what was later identified as HIV/AIDS, only touching them with triple-gloved hands.

"Think of how far it has come in the ensuing 25 years," Dr. Goldbloom said. "It’s really an extraordinary social transformation. Mental illness has not come anywhere near as far as HIV."

Photograph of Cheryl Doiron courtesy of The Canadian Institute for Health Information.

Recognizing the priority of child and youth mental health

From today's edition of The Chronicle Herald:

Canada celebrates its second National Child and Youth Mental Health Day today, during Mental Health Week (May 5-11), to increase awareness about mental health issues facing young people.

The adolescent years are a critical period of adjustment for both youth and families. Young people go through many physical, mental and emotional changes during adolescence. According to the World Health Organization, mental disorders account for almost one-third of diseases among adolescents worldwide. In Canada, between 15 and 20 per cent of youth suffer from a mental disorder that would benefit from appropriate care. However, accurate and up-to-date information on the scope of this issue is lacking in Canada.

Early, effective identification and intervention for young people suffering from mental illness is essential. Half of all lifelong mental disorders onset before 14 years of age and 70 per cent by age 24. Although effective treatments for many of these disorders are known, for a variety of reasons they are often not readily accessible to or accessed by young people who need them.

As parents and community members, it is important to be aware and understand how youth develop, the challenges they face, and the ways we can help them stay as physically and mentally healthy as possible. Parents are usually the first to notice the symptoms of a mental disorder in their child. But frequently they do not know what the problem is or what to do about it. Often, parents are struggling with their own mental health concerns that further tax their ability to help their child.

So figuring out what the problem is and getting the right kind of help in an effective and timely manner would be of value not only to the young people, but also to their parents and family. Talking to youth about the issue of mental health can be difficult, but it is the best way to understand what they are going through and if they need to get help.

At school, mental health problems can be equally challenging for children and adolescents. For many youth, the transition to new academic and social environments can be difficult and create stress that they are ill-equipped to deal with. Additionally, young adolescents may be experimenting with drugs and alcohol and beginning to engage in other risk-taking activity.

Learning to cope with these changes and build resilience is an important part of being successful in school, especially given that some of the most serious forms of mental illness emerge early in adolescence. Most schools do not supply students with the necessary support to help them address this transitional stage. Strong partnerships between schools and service providers can help educators identify and appropriately refer students who may be experiencing mental health problems.

The workplace is another area where the working parent, the parent’s child/family and the employer can contribute to mental health awareness. It is important for working parents to be well informed about mental disorders and treatments so they can advocate for their children and themselves. Enhancing mental health awareness of working parents and their children may promote mental health and well-being, improve early recognition of mental disorders, enhance appropriate early use of health services and lead to better health, social and economic outcomes for all.

The home, school and workplace are all important environments for advancing youth mental health, but none of these environments can hope to succeed without federal and provincial support. The recent establishment of the Mental Health Commission of Canada is a step in the right direction, as is the recent report Reaching for the Top by Dr. Kellie Leitch, which establishes a blueprint of recommendations for child and youth mental health care. But despite these advances, child and youth mental health care is still not high on many provincial or federal government agendas.

In Canada, only four of 10 provinces have created child and youth mental health policies/plans and there is no national child and youth mental health policy. Furthermore, only one in five of Canadian young people requiring mental health care receive it. Clearly the situation must change.

Mental health care for young Canadians is a right, not a privilege. What would happen in this country if only one in five adults needing hip replacements received them? Or how would we react if 15 to 20 percent of our young people suffered from cardiac disease? The access to mental health services and treatment should be no different for children and youth with mental health problems! The time has come to explore legislating access to timely mental health assessment and care based on the rights of children and youth.

Dr. Stan Kutcher is Sun Life Financial chair in adolescent mental health, director WHO Collaborating Center in Mental Health, Dalhousie University and IWK Health Centre. Dr. Simon Davidson and Dr. Ian Manion are on the executive, Provincial Centre of Excellence for Child and Youth Mental Health, Children’s Hospital of Eastern Ontario.