Comprehensive Children’s Mental Health Indicators

It’s a wonderful thing when you find a paper that proactively answers your specific research question!

Creating Comprehensive Children’s Mental Health Indicators for British Columbia is a paper like that.

Our Question

What data sources are available and what criteria should we use to select comprehensive indicators to track the mental health of young people in the capital region over time?

This Paper Answers:

The Data Sources used to select indicators for this study can be found on pages 16-18 and the indicators on pages 19-22.

But the whole paper is worth a read. Or two.

Here’s just a little of what this paper offers:

“Mental health—or social and emotional well-being—is fundamental to human development and essential for all children to flourish. Yet at any given time, an estimated 14% of children (or 800,000 in Canada) experience mental disorders causing significant symptoms and impairment, exacerbating matters, clinical treatment services still reach fewer than 25% of these children despite substantial public investments in health care. Meanwhile, there are almost no investments in programs that could address determinants and prevent problems. Consequently, mental disorders unnecessarily persist throughout the lifespan, with adverse outcomes ranging from reduced educational and occupational chances to increased mortality. The associated economic burden is now estimated to exceed $51 billion in Canada annually, urgently underscoring the need to better address mental health starting in childhood. To address children’s mental health adequately, a new comprehensive population health approach is needed—promoting healthy development for all children and preventing disorders in children at risk, in addition to providing effective treatment for children with established problems and disorders.”

“Canada urgently requires a population health approach to children’s mental health—promoting health and preventing disorders, in addition to providing treatment. Underpinning this approach, indicators could enable population monitoring, thereby informing ongoing public investments.”

“Strategically, monitoring could also raise public awareness about the importance of children’s mental health—understanding that ‘what gets counted, counts.'”

“A population health approach for children’s mental health—promoting health and preventing disorders, in addition to providing treatment—requires a correspondingly broad framework encompassing concepts central to the social and emotional well-being of the entire population of children. Therefore we propose a comprehensive framework that covers: major developmental stages; determinants and contexts; mental health status and related developmental domains; and a wide range of intervention approaches.”

Population Health Framework for Children's Mental Health
Gratitude to Charlotte Waddell, Cody A. Shepherd, and Alice Chen from Simon Fraser and Michael H. Boyle from McMaster for all the work that went into this project and for reporting the results so we could learn from them.

Ecological Determinants of Health

The Canadian Public Health Association has just released a discussion paper on the Ecological Determinants of Health. Find it here.

Wellness WheelThis document relates to the current work of the Shared Measurement constellation of the Child & Youth Health Network. Partners in the Shared Measurement constellation are currently defining each of the 8 domains identified as core to our Common Agenda.

We have wondered about about whether we should include any ecological measures in the ‘environment’ domain.

Though ecological systems are not our target (social systems are) if we really want to ensure that children & youth thrive in the long term, we cannot pretend that ‘ecological determinants of health’ are not going to be increasingly relevant to young people’s well-being.

Not only their future well-being, as ecological impacts became more pervasive, but their current well-being: if young people see adults committing to improving the health of our ecological systems, they may experience less nihilism about the state of the world they are inheriting.

Including an ecological measure in the Child & Youth Health Network would also be a way to engage all of the people in our community, including those who are passionate about the environment.

But at the same time, if it is not a system we are targeting, is appropriate for us to try to measure it?

Though this document doesn’t provide example indicators, it advocates for their development (the following excerpt is from p. 26):

The Public Health Agency of Canada, the Canadian Institutes for Health Information, and Statistics Canada should develop and test a set of indicators of the ecological determinants of health to be used to monitor and report on these issues across all four orders of government (i.e., federal, provincial, municipal and First Nations) and to guide more comprehensive impact assessments of the ecological, social, health and economic impacts of major public policies and private sector developments.

Specifically, to:

  • Identify health indicators for conditions plausibly related to ecological change for use within impact assessments and as early-warning or sentinel conditions to be monitored;
  • Revise the core set of indicators of health used in Canada to include indicators to measure key ecological determinants of health, the socio-ecological system and sentinel health conditions associated with ecological change;
  • Ensure that public health reports at all levels include indicators of ecological determinants of health in routine reports, and report specifically on them on a regular basis, reflecting local, regional, provincial, national, indigenous and global contexts; and
  • Assure that as much effort and profile are applied to the collection and publication of data on the state of the environment as on the state of the economy.

A Child & Youth Mental Health Epidemic (& a solution~)

beach youth“According to the most recent information from the Mental Health Commission of Canada, more than one million, or 23 per cent of Canadians aged nine to 19, are living with a mental illness. And by some estimates, a staggering three out of four young people who have mental-health issues do not receive the help they need. At almost every turn, they encounter barriers to accessing timely and appropriate care, ranging from a lack of resources to their own reluctance to seek help due to shame, embarrassment or fear of prejudice.”

This quote from an article titled “To improve mental health, tackle problems early” from the Globe & Mail this week.

So what do we do?

A small group of youth age 15-17 who are partners in the Child & Youth Health Network have a vision…

A Youth Resource Hub

Their idea is simple: we come together create a place where youth can go & no matter what they are looking for, they can get support.

A one-stop shop.

From a professional standpoint we would frame this in terms of mental health services. The youth are fine with this, but they are clear that, for them, a resource hub would address the whole person: mind/body/spirit.

So whether a youth is

  • lonely;
  • worried about ‘a friend’s’ suicidal ideation;
  • needs help with creating a resume;
  • has a weird & embarrassing rash;
  • is getting bullied;
  • needs help with coming out;
  • doesn’t know where they will sleep that night;
  • is worried about their parent; or
  • needs time to build trust and relationships before sharing what they are grappling with…

there is a youth-friendly place they can go where youth-friendly people will not leave until the youth is safe & a plan is in place.

That is their vision.

Other features of the hub that are important to these youth:

  • A food garden where youth are welcome, can find fresh food to eat, learn how to grow food and can access indirect, low-pressure counselling from a counsellor~gardener.
  • All kinds of services onsite, including (perhaps) a branch of the youth clinic, a branch of the Victoria Regional Library (designed for youth), a café (where youth can get job & life skills + affordable healthy food), mental health/addictions/counselling services, & a place to offer workshops/groups.
  • Youth- & adult-led groups & workshops for youth on subjects that matter to youth: gender identity, sexuality, spirituality, etc.
  • That the hub be intentionally designed to be safe for all youth, including those that may be young/sheltered. Not just an emphasis on street involved/homeless youth.

Turns out, other communities have already embraced this model. The Globe & Mail article explains:

“Such a big problem requires big solutions, especially as more young people, freed from the discrimination of previous generations, speak out and seek help. While we’ve seen increased attention and funding from various levels of government (from community boards to federal agencies), we will be left with a patchwork of initiatives unless concrete steps are taken to improve access to diagnosis and provide funding for treatment nationwide. A few initiatives under way are worthy of national attention.

Dismantling silos

One of the boldest of these initiatives seeks to radically change how young people receive mental-health treatment with the ambitious goal of driving down waiting times. Modelled after Australia’s Headspace National Youth Mental Health Foundation, the ACCESS Canada project aims to provide one-stop hubs where youth can seek the various services they need.”

What about the cost of not finding a way to effectively support children & youth who are struggling with their mental health?

“Untreated, [children & youth] risk failing at school, floundering at work, getting into trouble with the law, facing homelessness, being repeatedly hospitalized or dying by suicide.

The Mental Health Commission reports the total cost of addressing mental-health problems and illnesses over the next 30 years is expected to exceed $2.5-trillion. Yet some of these costs could be prevented. An estimated 70 per cent of mental-health problems emerge in childhood or adolescence and evidence shows the earlier they’re tackled, the better the chances of positive outcomes.”