UPDATE: This article has been featured in The Advocate.
Dear People of British Columbia (BC),
Right now, here in BC, many children and youth are struggling with their mental health. To make matters worse, the Mental Health Commission of Canada estimates that only 1 in 5 children who have a clinically significant mental illness receive the mental health care they need. These service shortfalls are a terrible injustice, and they have existed for decades. Even before the COVID-19 pandemic, the mental health needs of young people across Canada were high. Today, more than 2 years later, the pandemic has negatively impacted the mental health of many young people, especially those who were already the most vulnerable (e.g. people with existing mental and physical health conditions).
Experts in the field of child development and mental health have warned governments and the public for more than 50 years that we need to improve the mental health care system for children and youth. In 1970, a book called "One Million Children" was published in Canada. This book was the result of more than 3 years of research across the country. The researchers concluded that more than one million Canadian children were struggling with "emotional or learning disorders" for which they did not receive adequate care. Today, the situation for children with mental health problems is very similar, if not even worse. In 2006, the Senate of Canada warned that children's unmet needs for mental health care would "bankrupt our health care system." In 2021, UNICEF declared children's mental health an international priority. They stated, "We can wait no longer. We cannot fail another generation. The time to act is now."
Why is children's mental health so important? Because mental illnesses are just as common as physical illnesses, and they also cause significant suffering and impairment. Childhood mental illnesses can negatively impact a child's development, their learning, their relationships with others, their family, and their future potential. Just like physical illnesses, mental illnesses tend to persist or get worse over time when a child does not receive timely, appropriate mental health care. Lack of treatment can also lead to devastating problems in the long-term, such as higher rates of severe mental illnesses, life-threatening physical illnesses, homelessness, and suicide as well as lower academic achievement, graduation rates, and likelihood of employment.
The impacts of childhood mental illness on families, society, and the Canadian economy are immense. These costs are estimated to exceed $15 Billion (CAD) every year, and are borne by families, the school system, the health care system, the justice system, and the Canadian economy. Furthermore, the majority of adulthood mental illnesses are preceded by mental health problems in childhood. Adulthood mental illnesses also create tremendous costs for Canadian society, through disability payments, reduced economic productivity, more time off work, and earlier retirement.
Apart from the cost in dollars, the costs in human lives are immeasurable. For instance, the opioid overdose emergency has killed more British Columbians than COVID-19. While this crisis has many different causes, we know from research and boots-0n-the-ground health care workers that most people struggling with addictions and substance use disorders have a history of childhood adversity and mental illness. On November 1st, 2022, the Select Standing Committee on Health made a number of recommendations to the BC Government in order to address this crisis. Among the recommendations, they urge a commitment to improving the mental health of children and youth:
Fortunately, we have more than 50 years of research on effective ways to promote mental health, prevent mental illnesses, and intervene early when children need treatment. Research has shown that these strategies produce high returns on investment, or ROIs. For every $1 we spend on these strategies, we can expect to see a return of $2 to $5 over the long term. In other words, we do not have to pay for mental health care; it pays for itself. When we invest in improving the mental health of children and youth, it protects their health and well-being, it reduces costs to family and society, and it improves lifelong productivity and contribution to the economy.
As it stands, the current mental health service shortfalls for children and youth in BC violate children’s rights (read more here). The rights of children outlined in the "Convention on the Rights of the Child" (particularly Articles 3, 6, and 24) are the law in Canada. Therefore, there is a strong legal justification for improving the mental health care system for children and youth in BC, as well as the economic rationale presented above.
Schools play a vital role in promoting and protecting child and youth mental health. For many young people, the first mental health care professional they meet is their school counsellor. Since school-based counsellors work inside the school building, and since their services are free, they are the most accessible and most equitable service in BC. Furthermore, research shows that improving access to school-based counsellors benefits students' mental health as well as improving graduation rates and reducing disciplinary problems. Despite this evidence, right now, as per the terms in the Collective Agreement, the current school counsellor to student ratio in BC is 693 to 1. This ratio is a travesty, and it is also more than 20 years old. It simply does not reflect the current level of mental health needs today.
So, what can we do about the problem? We can use research data and existing mental health strategies to guide our actions to improve the mental health care system. The 5 recommended actions below are informed by these research data and plans:
Make a political commitment to investing in children’s mental health in British Columbia,
Reduce the student to school counsellor ratio across BC to 250 to 1, to align with standards determined by competent authorities (the current ratio is 693 to 1),
Enhance the capacity of Child & Youth Mental Health to meet the needs of the population,
Enhance the capacity of primary care to meet child and youth mental health needs within every community, and
Integrate every system that cares for and protects children in to one, easy to navigate system (Integrated Child & Youth Teams are a strategy currently being employed in BC to address this issue).
Every person in BC can advocate for these changes. Please, share this information with your family, friends, and colleagues. Reach out to your Member of Legislative assembly by writing them an e-mail and/or letter (click here to find your MLA). Tell them about the current state of children's mental health care in BC and insist that they make a commitment to protecting our children. Please, do not wait. The time to act is now.
Sincerely,
William Nicholls-Allison
P.S. - below, you can download a one-page summary of the information in this article and a reference list. There are also links to four mental health strategies for Canada and British Columbia.