Children’s Mental Health 1954-2016 – who cares?

David Cawthorpe is a Professor (Adjunct) in the Faculty of Medicine at the University of Calgary, Alberta

 

By the end of this month the 22nd International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP) Congress will have come and gone. As this will have been its second congress hosted in Canada since 1954, it is perhaps time to take stock.

In Istanbul, in 2008, our team got its first whiff of tear gas and we won the 2016 bid; it was the beginning of an exciting journey, wherein the hope was to form a national community around this torch, a mental health Olympics for children and adolescents. Did we succeed? A good question. Regionally, we hoped to gain access for at least 1000 participants who would never otherwise have the opportunity to attend such a world class event. Did we achieve this or will this congress have been just another big business venture? The proof will, no doubt, be in the residual pudding!

And what of innovations in the locale that would showcase our community, the exemplars championing dissemination of the core message and ethos of the Kirby report?  Having more than tripled our budget since 2002, we are hard-pressed to increase access to annual business-as-usual forms of mental health care above 1.8% of the base population of children and youth in our catchment area, in spite of the doubling of the rate of mental disorder.

What of the recent synopses of the national state of affairs regarding youth mental health services and mental health literacy among teachers  and students brought forward by Stan Kutcher, a national champion, if not the lament from my region?

We have implemented Kutcher’s Mental Health Literacy program and have nearly doubled referrals from participating schools, which does not bode well, given the overall failure to increase our baseline per capita capacity above 5%. However, best of all, by changing our paradigm in schools from consultation to education, by  providing teachers not only with the skills to identify mental problems vis a vis Mental Health Literacy implementation in 2013, but by also providing teachers with the supportive micro-interaction skills for students in their classrooms, the 42 school-based mental health staff were able to provide something to an additional 3K (1.5%) children annually via using their face-to-face consults as a venue to teach relevant in situ skills. When the problem goes beyond the bailiwick of the classroom – “who they gonna call?” - You know.

Fortunately, we have also implemented Peter Jensen’s REACH program.  It only took five years to secure funding for a pilot project and we received $200K less than we first requested in 2007. In the present year, it appears that the one hundred community physicians trained in the REACH method have improved the quality of their referrals and refer fewer children to our tertiary emergency departments.

Additionally, and in one fell swoop, beginning in 2015, we have a become trauma-informed division, a process facilitated by the Norlien (now Palix) Foundation, which brought Vince Felitti   north to Alberta many times from the mid-2000s and implemented the Family Wellness Initiative from 2008 to 2014. We implemented the Adverse Childhood Experience (ACEs) questionnaire survey in 2015, finding an average score of 4/10 for all referral-linked surveys. Its simple sum accounted for over 30% of the variance predicted by a raft of clinical and system variables (e.g., Western Canada Wait List Children's Mental Health Priority Criteria Form). Of note, treatment of the child with anxiety and an ACE score of 0 is likely different than that of a child with anxiety and an ACE score of 6.

With these three innovations in hand, almost a decade after conceptualization and an uphill sojourn for pilot funding, we may finally have a chance to influence the mental well-being of the next generation, provided we gently integrate School-Based Mental Health and Mental Health Literacy with the CanREACH program, implement formal two-tiered family group-based and online general service orientation to prepare families for treatment, as well as offer specific education orientation based on presenting concerns to accelerate disposition and goodness of fit.

Most importantly, and based on the most palpable evidence, we need to overcome a possible system-based stigma apparently embedded in our health services. Understanding the close relationship between physical/biomedical and mental disorders is of paramount importance.  To put the seemingly  perpetual crises shaping the demand of child mental health services in perspective, recall the cartoon of the sinking boat being bailed furiously by those in the stern, while those in the prow chortle that they are glad the leak is not in their end of the boat.

IACAPAP 2016 runs from the 18th to the 22nd of September in Calgary

 

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