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.

Rights of mentally ill youth must be a national priority

From the March 20th edition of The Chronicle Herald:

By Dr. Stan Kutcher, Dr. Simon Davidson and Dr. Ian Manion

According to the World Health Organization, mental disorders contribute almost one-third of the global burden of disease during adolescent years. In Canada, between 15 and 20 per cent of youth suffer from a mental disorder that would benefit from appropriate care. Early and effective identification and intervention for young people suffering from mental illness is essential because as many as half of all lifetime cases onset before 14 years of age and 75 per cent by age 24. Although effective treatments for many of these disorders are known, they are often not provided to young people who need them.

Furthermore, there may be insufficient attention being paid to fundamental human rights of some young people who are suffering from mental disorders. According to the United Nations Declaration of the Rights of the Child – 1959 (to which Canada is a signatory), "no child shall be subjected to torture or other cruel, inhuman or degrading treatment or punishment." This declaration goes on to state that "the child who is physically, mentally or socially handicapped shall be given the special treatment, education and care required by his particular condition."

The UN resolution [Principles for the] Protection of Persons with Mental Illness and the Improvement of Mental Health Care, 1991, states: "All persons with a mental illness, or who are being treated as such persons, shall be treated with humanity and respect for the inherent dignity of the human person."

The Canada Health Act (1985) similarly seeks to protect and promote the physical and mental well-being of all Canadians. The rights to protect young people with mental disorders are in place, but the shortcomings fall within the enforcement and provision of these rights.

There is a critical situation of mental health care for young people in Canada, resulting from stigma, lack of easily available mental health care, lack of health providers trained in mental health competencies, complexities of addressing multiple needs of the mentally ill, and chronic underfunding of mental health services, among many other things.

Due to substantial gaps in appropriate mental health care, many young people are being placed in detention facilities simply because there is nowhere else to go. Behaviours rooted in mental disorders are being punished rather than being treated. Alarmingly, some observers have noted that youth detention centres may be the newly emerging youth mental health care system.

Identified as the "orphan of the orphan" in the Kirby Commission Report (2006), child and youth mental health care is not high on many provincial or federal government agendas. The recent establishment of the Mental Health Commission of Canada is a step in the right direction.

If 15 to 20 per cent of our young people suffered from cardiac disease, there would be a national campaign for the treatment of heart problems in every community. Yet, only one in five of young Canadians requiring mental health care receive it. And the provided "care" is not necessarily effective or consistent with the recognition of the human rights of those who receive it.

Clearly, the situation must change. 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. Current human resources are inadequate to meet child and youth mental health care needs, and traditional means of providing specialist care by single professionals, as compared to multidisciplinary teams, may impede accessibility to mental health care for young people.

Providers of mental health services may require upgrading of clinical training, as substantial changes in the understanding of the development and treatment of mental disorders in young people have been made in the last decade. These advancements have yet to be fully translated into treatment approaches. Although research funding into child and youth mental health care through the Canadian Institutes of Health Research has increased over the last five years, enhanced and targeted funding is needed to allow for the further identification of the most effective treatments and delivery systems.

Mental health care for young Canadians is a right, not a privilege. It must be provided in a manner that is equally based on the best available scientific evidence, the developmentally unique needs of children and youth, and recognition of the principles of the human rights of the child and of those suffering with mental disorders.

It is a tragedy that young people expecting appropriate mental health care are treated in a manner that offends their basic humanity. It is a tragedy that young people suffering from mental disorders do not have the right to care provided in a way that adheres to developmental issues. And it is a tragedy that young people suffering from a mental disorder do not have the right to care based on best scientific evidence.

Children and youth must work in collaboration with their primary care givers to advocate for appropriate care and systematic change at the government level. The time for talking has passed. It is time for provincial and federal governments to do what is right by putting child and youth mental health on the federal-provincial health agenda as a national health priority.

Dr. Stan Kutcher is Sun Life Financial Chair in adolescent mental health and director, World Health Organization Collaborating Centre in Mental Health, Dalhousie University and the IWK Health Centre. Dr. Simon Davidson is executive director, planning and development, and Dr. Ian Manion is executive director, operations, at the Provincial Centre of Excellence for Child and Youth Mental Health, Children’s Hospital of Eastern Ontario.

Also see:
Mentally ill youth: meeting service needs

Standards for Mental Health Services in Nova Scotia. Revised and Approved March 22, 2004.

Photograph of Dr. Stan Kutcher courtesy of the IWK Health Centre.