We are currently in a children’s mental health crisis.
1 in 8 children in British Columbia (BC) have a clinically-significant mental health disorder, which equals 95,000 children across the province, or 1,500 in Victoria City alone81,84. Less than 44% of these children will receive any form of care, while less than 20% will receive the appropriate treatment5,25,60,96. Can you imagine if there were 1,500 children with cancer in Victoria right now, yet only 300 of them received the appropriate treatment? We would be outraged and take action to protect children. We should do the same for their mental health. Even more concerning is the fact that these figures fail to capture the thousands of children who are struggling with their mental health but do not meet the criteria for a mental health disorder.
Mental illness impacts every area of a child’s life88,96,99. If treatment is delayed or absent, then mental illness typically progresses into more severe forms, causing impairment and suffering into adulthood58,94,95. The consequences of untreated childhood mental illness and trauma may include lower school engagement, academic achievement, and likelihood of graduation; increased incidence of physical health conditions such as cancer, diabetes, and heart disease; and increased risk of homelessness, severe mental illness, and suicide4,12,24,29,32,33,34,42,43,45,46,54,64,65,67,71,74,75,77,85,97.
In 1970, a pan-Canadian team of researchers found more than one million children had unmet needs for mental health and learning support26. This group urged governments to make sweeping changes, concluding with the words “We [cannot] afford to do it later [than now]. One million children look to us for help. We cannot fail them” (p. 471).
Experts have been warning us for more than 50 years and, despite their pleas, not enough has changed. In 2019, the BC Ministry of Mental Health and Addictions6 stated “The trend that should make all of us take notice is the growing number of children and youth experiencing [mental health] challenges… the number of students reporting a mental health condition has risen [in Females from 15% → 23%; Males 5% →>8%; and] the rate was 43% among non-binary youth. More alarming is that 17% of [all] students reported they had seriously considered suicide in the past year” (p. 5).
COVID-19 arrived amid high child mental health needs coupled with longstanding service shortfalls5,96. During the pandemic, there have been extraordinary increases in hospital admissions for mental health crises, many children and families report their mental health has declined, and countless children have lost a loved one15,16,17,28,35,36,57,68,73,81,89. Because children are vulnerable to the impacts of stress during sensitive developmental periods, researchers have warned that continued failures to meet children’s mental health needs will lead to greater harm in the future22,27,81,96.
Given this context, it was shocking when, on March 4th, 2022, School District 61 proposed to reduce the number of school counsellors in the district by 8 full-time positions38. This proposed change would reverse previous efforts to increase mental health supports for students in the district by returning to the school counsellor ratio stated in the Provincial Collective Agreement; that ratio is 693 students to 1 school counsellor7.
How could such an out of touch proposition be put forward during a children’s mental health crisis, a global pandemic, and an opioid overdose emergency? Less than one year before the announcement, a 12-year-old girl died of an overdose in Victoria41; she was one of 31 school-aged people who fatally overdosed in BC that year13.
Families, teachers, and the public protested9,10, and they won. When the proposed changed was defeated, there was general relief; however, it was disturbing that such a proposition was considered at all, since school counsellors have such a critical role in children’s mental health.
School counsellors are BC Certified Teachers and mental health professionals with master’s degree-level training. They provide a wide range of services intended to support all students’ learning and well-being. Epidemiological research shows most mental health disorders begin in childhood or adolescence, with the most common disorders beginning earliest (e.g. anxiety, behavioural, and mood disorders)1,45,46,49,76. This means school counsellors are uniquely positioned to identify and intervene, preventing the early stages of illness from progressing into more severe, costly, and life-threatening problems such as major mental illness, substance use, suicide, and violence.
School counsellors are the first mental health professionals most children ever meet, and research shows more than 80% of children who receive mental health care do so inside their school81,93. Because school counsellors work within the community, and because their services are free, they have the potential to be the most accessible mental health service in BC, so long as school counsellor ratios conform with evidence-based standards.
Access is limited by school counsellor ratios. Both the BC Teachers’ Federation8 and the American School Counsellors Association3 recommend a ratio of 250 students to 1 school counsellor due to the large body of research indicating lower ratios mean better outcomes for students. In addition to supporting students’ mental health, lower ratios mean improved academic achievement, attendance, graduation rates, post-secondary application rates, and positive school behaviours as well as reduced disciplinary and suspension rates14,18,19,20,21,31,37,51,69,70,82,98.
Lower ratios may also improve recruitment and retention of school counsellors, since they are at risk of burnout and secondary trauma due to the nature of their work56. Research shows lower ratios reduce risk of burnout66. Additionally, when school counsellors are able to spend more time counselling, and less time on non-counselling activities – such as case management, covering classes for absent teachers, paperwork, and supervision2 – then risk of burnout is further reduced59.
BC’s 693 to 1 ratio is put in stark contrast when compared to other regions. For instance, BC has a higher ratio than 49 out of 50 American states, only surpassed by Arizona55.
In Europe, both Croatia and Ireland aim for a 250 to 1 ratio, while Bulgaria and the Russian Federation maintain a 500 to 1 ratio72.
How can BC maintain such a high ratio when it was the first province in Canada to develop a child and youth mental health policy?
Mental health policies for BC and Canada have emphasised the importance of school-based mental health services for children for 20 years6,50,60,95. Furthermore, on November 1st, 2022, the Legislative Assembly of BC53 recommended to “Fund universal access to integrated mental health and substance use supports for children, youth, and young adults, including increasing the number of specialised school counsellors” (p. 12).
The most direct way to increase the number and accessibility of school counsellors is to reduce the ratio to the evidence-based standard of 250 to 1. Not only is the current ratio of 693 to 1 an international embarrassment, but it also perpetuates BC’s historic neglect of children’s mental health needs to a degree that violates children’s rights5. Access to timely, adequately staffed mental health services is a fundamental right of all children81, as described in the Convention on the Rights of the Child90, particularly Articles 3, 6, and 24.
Reducing the ratio and increasing the number of school counsellors will cost money. However, the cost of neglect is far greater than the cost of care. How much does one, full-time school counsellor cost per year? In Victoria, between $68,000 and $99,486 per year, depending on years in service38. How much does childhood mental illness cost per year?
In 2013, researchers estimated the total cost of child mental health problems to range from $14-15 Billion CAD per year76,
In 2018, the Ontario economy lost $421 Million CAD due to parents taking time off work to care for their children struggling with anxiety disorders23,
A single child with untreated conduct disorder costs an estimated $2 Million CAD to society across the lifespan79, and
The estimated economic burden of youth suicides is $725 Million CAD per year83.
Investing in children’s mental health could pay for itself. Studies indicate improving access to effective care for children will reduce overall costs related to mental illness, improve productivity across the lifespan, and produce high returns on investment11,61,80,83,88. For instance:
An anxiety prevention program for children showed net returns of approximately $14,500 CAD per participant over costs80,
Improving access to treatments for anxiety and mood disorders returns approximately $2.3 to $5.7 for every $1 spent24,
Substance use disorder interventions return approximately $4 to $11 for every $1 spent92, and
Treatments for adolescents with behavioural disorders return $7 to $31 for every $1 spent88.
The children of British Columbia deserve better. We have an ethical and legal responsibility to act in the best interests of our children90, just as the Greater Victoria School District Mission Statement declares: We nurture each student’s learning and well-being in a safe, responsive, and inclusive environment; We give each student the opportunity to fulfil their potential; and We stand for the principles of social responsibility and social justice40.
This is an urgent appeal: We must reduce the student to school counsellor ratio in British Columbia to 250 to 1. By doing so, we will take important steps towards guaranteeing access to mental health care for every child and protecting future generations of children in British Columbia.
Please visit this link if you wish to view the references for this article.