The (hidden secret) Youth Anxiety Epidemic

One of our youth partners just shared this post with me, because it describes their experience with anxiety.

Often the anxiety youth live with on a daily basis is invisible to adults. This post explains why.

High-functioning anxiety sounds like…

You’re not good enough. You’re a bad friend. You’re not good at your job. You’re wasting time. You’re a waste of time. Your boyfriend doesn’t love you. You’re so needy. What are you doing with yourself? Why would you say that? What if they hate it? Why can’t you have your shit together? You’re going to get anxious and because you’re going to get anxious, you’re going to mess everything up. You’re a fraud. Just good at faking it. You’re letting everybody down. No one here likes you.

All the while, it appears perfectly calm.

It’s always looking for the next outlet, something to channel the never-ending energy. Writing. Running. List-making. Mindless tasks (whatever keeps you busy). Doing jumping jacks in the kitchen. Dancing in the living room, pretending it’s for fun, when really it’s a choreographed routine of desperation, trying to tire out the thoughts stuck in your head. 

It’s silent anxiety attacks, hidden by smiles.

It’s always being busy but also always avoiding, so important things don’t get done. It’s letting things pile up rather than admitting you’re overwhelmed or in need of help.

It’s that sharp pang of saying the wrong thing, the one that starts the cycles of thoughts. Because you said too much, and nobody cares, and it makes you never want to speak up again.

Mental Health Rates for Youth in our Region

What is the state of youth mental health on Southern Vancouver Island and in BC?

  • “21% of local [Southern Vancouver Island] students had at least one mental health condition. Females were more likely than males to have at least one condition (25% vs. 16%) and to have multiple conditions (10% vs. 4%)” (South Vancouver Island Results of the 2013 BC Adolescent Health Survey, 2014, p. 4).
  • “Just under half of homeless or street-involved youth [in BC] rated their mental health as good or excellent (49%). Males were more likely than females to rate their mental health as excellent (23% vs. 10%), while females were more likely to rate it as poor (19% vs. 8%)” (Our Communities, Our Youth, 2015, p. 31).
  • “Among youth currently in care [in BC], females rated their mental health more poorly than males (36% vs. 23% of males rated their mental health as fair or poor), which was consistent with the gender difference among all youth who completed the BC AHS. Youth in care were more likely than their peers to report having a mental or emotional health condition (17% vs. 10% of youth not in care)” (We All Have A Role, 2015, p. 20).
  • “Youth [on Southern Vancouver Island] most commonly reported having Depression (10%), Anxiety Disorder (10%), Attention Deficit/Hyperactivity Disorder (ADHD; 7%), and/or an addiction to alcohol or other drugs (2%). Females were more likely to have Depression or Anxiety Disorder, whereas males were more likely to report ADHD. Most students (85%) reported feeling stressed in the past month. Females were three times as likely as males to experience extreme stress that prevented them from functioning properly. Students were also asked the extent to which they felt so sad, discouraged or hopeless that they wondered if anything was worthwhile. Fifty percent reported feeling some level of despair in the past month” (South Vancouver Island Results of the 2013 BC Adolescent Health Survey, 2014, p. 15).
  • “When [Southern Vancouver Island youth] were asked about specific mental health conditions such as depression and anxiety, a higher percentage reported having such a condition than recognized that they had a mental or emotional health condition” (South Vancouver Island Results of the 2013 BC Adolescent Health Survey, 2014, p. 11).
  • “More than two thirds of [homeless and street-involved youth (68%; 62% of males vs. 72% of females) reported having at least one specific mental health condition. Also, 24% reported having a behavioural condition (19% of males vs. 29% of females), and 26% indicated having problems with anger. Youth most commonly reported having been told by a health professional that they had Depression (31% of males vs. 60% of females). Females were also more likely to have Chronic Anxiety Disorder or panic attacks (38% vs.13% of males), Bipolar Disorder (20% vs. 7%), Post-Traumatic Stress Disorder (PTSD; 24% vs. 8%), and an eating disorder (28% vs. 9%). Males were more likely than females to report having Attention Deficit Hyperactivity Disorder (ADHD; 31% vs. 20%). Compared to 2006, a greater percentage of youth reported having Depression (47% vs. 23% in 2006), Chronic Anxiety Disorder or panic attacks (27% vs. 10%), and Schizophrenia (6% vs. 4%). Increases among female youth were also seen in PTSD (24% in 2014 vs. 8% in 2006) and Bipolar Disorder (20% vs. 8%)” (Our Communities, Our Youth, 2015, p. 32).
  • “Males and females with care experience [in BC] were more likely than their peers who were never in care to report extreme levels of stress (20% vs. 9%) and despair (19% vs. 7%) in the past month, to the point where they could not function properly. Youth previously in care were more likely than those currently in care to report these extreme levels” (We All Have A Role, 2015, p. 21).
  • “Most [homeless and street-involved] youth (88%) felt some level of stress in the past month, with 15% of males and 24% of females feeling so stressed that they could not work or deal with things. Youth were also asked the extent to which they felt so sad, discouraged, or hopeless that they wondered if anything was worthwhile. More than 7 in 10 youth (72%) felt this way at least sometimes in the past month, with 1 in 10 reporting feeling so much despair that they could not function properly” (Our Communities, Our Youth, 2015, p. 33).
  • “Youth with [government] care experience [in BC] were more likely than their peers to rate their mental health as fair or poor (as opposed to good or excellent). Those previously in care were more likely than those currently in care to rate their mental health this way.” (We All Have A Role, 2015, p. 19).

Self-harm & Suicidality

  • “In the past year, 8% of local males and 22% of females reported cutting or injuring themselves on purpose without trying to kill themselves” (South Vancouver Island Results of the 2013 BC Adolescent Health Survey, 2014, p. 16).
  • Among Southern Vancouver Island youth, “eight percent of males and 15% of females seriously thought about killing themselves in the past year…, 4% of males and 7% of females reported attempting suicide in the past year” (South Vancouver Island Results of the 2013 BC Adolescent Health Survey, 2014, p. 16).
  • “Males and females in care [in BC] in the past year were more likely than their peers without this experience to have cut or injured themselves on purpose without trying to kill themselves during that time period (31% vs,. 15%) and to have done so multiple times (24% vs. 10%). They were also more likely to have seriously thought about suicide in the past year (19% vs. 6%).” (We All Have A Role, 2015, p. 22).
  • “Youth who had previously been in care [in BC] were more likely than those currently in care to have self-harmed, seriously thought about killing themselves, or to have attempted suicide in the past 12 months” (We All Have A Role, 2015, p. 22).
  • “Forty-five percent of [homeless or street-involved] youth (23% of males vs. 61% of females) cut or injured themselves on purpose without trying to kill themselves (self-harmed) in the past year. The percentage of males who had ever self-harmed was similar to 2006, while females were more likely to have done so (75% in 2014 vs. 55% in 2006)” (Our Communities, Our Youth, 2015, p. 33).
  • Homeless or street-involved “youth most commonly reported that they most recently self-harmed because they felt lonely or depressed. Among youth who self-harmed, females were more likely to indicate self-harming because they felt lonely or depressed (80% vs. 53% of males), stressed (62% vs. 40%), or because they wanted to feel in control (34% vs. 12%)” (Our Communities, Our Youth, 2015, p. 34).
  • Among homeless and street-involved youth 68% “(62% of males vs. 72% of females) reported having at least one mental health condition, 42% had seriously considered suicide in the past year, and almost a third (31%) had attempted suicide” (Our Communities, Our Youth, 2015, p. 8).



2016 Healthy Schools Forum

The 2nd annual Healthy Schools Forum for the capital region of British Columbia occurred on May 27, 2016. This day-long event was co-hosted by School Districts 61, 62, 63 and 64, Island Health, and the Child and Youth Health Network.

285 people, including a large contingent of youth, gathered at the University of Victoria in Lekwungen, and W̱SÁNEĆ territory to foster collaboration and share knowledge about evidence-informed and school-centred approaches to promoting mental health for young people in the capital region.

The day included dialogue between local thought leaders called From Evidence to Action, in which Maureen Dockendorf  from the Ministry of Education), Dr. Kim Schonert-Reichl from the Human Early Learning Partnership University of British Columbia, and Scott Stinson, from the Saanich School District discussed ‘what we know makes a difference and opportunities to strengthen our efforts’ as people who care about the health and well-being of children and youth.

Dr Richard Stanwick, Cheif Medical Health Officer for Island Health also spoke on the subject of Connectedness Across our Communities.

Each participant was also able to attend 4 of 12 Roundtable sessions that each illustrated a promising practice in the promotion of mental health and resiliency in children and youth in our region.

The following documents provide more information about the forum:


Healthy Schools

We are busy preparing for the next whole network meeting of Child & Youth Health Network on May 27th at the University of Victoria.

We have an auditorium and 11 break-out rooms booked because we’re expecting a crowd!

Please save the date~.

For the first time, our whole network meeting will be hosted by one of the ‘constellations‘ (working groups) of the network: Healthy Schools.

The first Healthy Schools event took place on May 27th in 2015 and focused on Promoting the Mental Health of our Children & Youth.

Find the background materials from that event here:

The Impacts of Hetero-normativity & Cis-normativity on Youth Mental Health

This week our youth partners presented at the CYMHSU Collaborative Learning Session in Vancouver.

Their presentation was titled The Impacts of Hetero-normativity & Cis-normativity on Youth Mental Health.

First question:

Q: What’s Cis?

A: Identifying as the gender you were assigned at birth.

The youth were speaking from experience. About the impacts of prejudice and discrimination on the mental health of LGBTQ+ youth.


Hetero-normativity & Cis-normativity: What’s the problem?

Here’s what the youth told the doctors, clinicians, practitioners and parents in their workshop:

LGBTQ+ identity doesn’t cause mental health problems, yet LGBTQ+ youth have extraordinarily high rates of depression, anxiety, self-harm, suicide and substance use.


This video helps to answer that question:

The youth explained that LGBTQ+ youth face increased vulnerability due to:

  • Loss of supports: rejection by family, friends and community;
  • Burden of keeping their a secret identity;
  • Bullying and violence;
  • Discrimination/hetero-normatavity/genderism;
  • The coming out process;
  • Internalized homophobia;
  • Being confused/not knowing how they identify/feeling uncomfortable in their gender; &
  • Pathologization by the medical/psychiatric community.

They shared fresh (2015) statistics from the Canada-wide Transgender Youth Health Survey:

  • Almost half of trans youth reported feeling stressed to the point that they could not do their work or deal with things during the last 30 days;
  • More than half of trans youth reported they had hurt themselves on purpose in the last year; &
  • 65% of trans youth had seriously considered suicide, more than a third had attempted suicide at least once, and nearly 1 in 10 had attempted suicide 4 or more times.

They asked us: Does it make sense that they, as LGBTQ+ youth, face approximately 14 times the risk of suicide and substance abuse than their heterosexual and cisgender peers, when mental health problems, substance use and suicide are not side-effects of having a minority sexual identity or gender orientation?

They are side-effects of prejudice and discrimination.

What’s the Solution?

Our youth partners are saying that it would be really helpful if we could start by making space for who they are.

Sounds like a reasonable request!

They offered an initial strategy:

Start with Language

Youth who have a non-binary gender identity may prefer different pronouns than he or she, but most of us are unfamiliar with gender-neutral pronouns and feel awkward using them.

The youth recommended that we embrace the awkwardness and practice: “because you know what? It’s way more awkward to have people ignore your gender identity. It’s so awkward it causes self-harm and suicide. So really, embracing a little awkwardness while you get used to using some new words is worth it!

They shared some of the pronouns that transgender people may prefer including: They/them; Xe/xir; Ze/Mer; Ve; Ney and Yo.

If that list is overwhelming, they said that most transgender people are fine with ‘they/them’ as gender-neutral pronouns. The key is to ask: “Is there a gender pronoun you prefer?“.

Just ask!

They also offered two tips for pronoun usage:

  1. Never make assumptions about a person’s gender identity; &
  2. If you slip up and use the wrong pronoun, just correct yourself & move on.

Our Bad

Personal Recovery Outcome Measure

Measuring RecoveryLast week Dr Skye Barbic presented on the Personal Recovery Outcome Measure (PROM) at Island Community Mental Health.

The PROM questionnaire is designed for people who are recovering from mental illness. But it can be used by everyone.

The World Health Organization (WHO) defines mental health as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”

Clearly we don’t need to be recovering from a debilitating mental illness to be pursuing improved mental health. In fact, the WHO definition for mental health could be the definition for purpose in life.

How it Works

The questionnaire tells a story of recovery, from the very earliest stages of the process to total wellness.

That’s why all of us can use it: wellness is a goal we all share no matter where we are stating from.

This tool quantifies that which can otherwise feel amorphous. It enables a person to track their progress over time, and also enables comparison between people.

There are 30 multiple-choice questions in PROM and they are sequential.

The metaphor Dr Barbic uses to describe measurement of recovery using PROM is a 30-cm ruler. The whole ruler represents total wellness. For any of us.

Almost no one is at 30. All of us are somewhere on the ruler.


Each one of the questions, in order, represents another increment (a centimeter) on the ruler.

By completing the PROM questionnaire we end up with a score. Some number out of the highest possible total of 30.

This score enables you to track changes over time.

If you missed the link earlier in this post,  you can find the questionnaire here.

PROM questionsRecovery

After scoring, the questionnaire enables you to identify areas of strength as well as areas to work on.

Your score also refers you to an intervention opportunity as part of your story of recovery.

So, for example, a score of 16 refers you to statement #16 “I have new interests”.

You could choose to work on something else, but something around 16 might be a good place to start.

Dr Barbic suggested that we look at a range of options, three below and three above our score.

PROM questions 2Implications for Youth

I was curious about whether this questionnaire could be used with youth. Before I could put up my hand to ask, Dr Barbic told us that it can, but that a youth version is currently under development.

One example: Youth don’t care about sleep. But they care very much about intimate relationships. So those statements (#5 & #29) may need to be adjusted in a tool developed for youth.

She’ll have more information in April.

How Common are Behaviour Disorders?

Mental Health QuarterlyThe winter 2016 edition of the Children’s Mental Health Research Quarterly focuses on children’s conduct difficulties and behaviour problems and notes that “30% to 50% of referrals to children’s mental health services are for behaviour problems”

The following are quotes from this edition:

“According to rigorous epidemiological surveys, approximately 2.4% of children meet criteria for oppositional defiant disorder at any given time. Similarly, a review of nine high-quality surveys found that approximately 2.1% of young people meet diagnostic criteria for conduct disorder at any given time. Extrapolating from BC and Canadian population figures, an estimated 30,000 children and youth in BC and 240,000 in Canada are likely experiencing one or both of these conditions at any given time.”

“Policy-makers, practitioners and members of the public can make a difference for young people by enacting and supporting policies that address socio-economic disadvantage, including overall child poverty levels. For example, evaluations of income-supplement programs have suggested that increasing the incomes of poor families by just $5,000 a year for two or three years could produce large improvements in children’s behaviour. And, given that living in poverty poses multiple risks for child well-being, poverty reduction may also avert other risks. For example, family socio-economic disadvantage has also been linked to children having chronically activated stress pathways, with consequent effects on their immune systems.

The available causal evidence also suggests that practitioners may have an added role to play by directly helping parents — given that parenting appears to be another important modifiable factor in the development of children’s behavioural problems”

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.

Child and Youth Mental Health: BC government recommendations

dad43The all-party Select Standing Committee on Children and Youth has issued its unanimous report on child and youth mental health with 23 recommendations to strengthen child and youth mental health services in British Columbia. The committee’s recommendations are the result of two years of work and public consultations with individuals, experts, and organizations involved in the delivery of child and youth mental health services.

The CBC reported that 140,000 children in the province need some form of mental health intervention, but only 25 to 30 per cent of them receive services from the public system, according to Bev Gutray, CEO of Canadian Mental Health Association’s B.C. chapter.

The report is recommending a new Minister for Mental Health “to provide leadership and accountability and more school- and community-based hubs where mental health professionals work together in child- and youth-friendly settings.”

“Children, youth, and their families are suffering as a result of gaps and weaknesses in services,” added deputy chair Doug Donaldson. “The Committee is recommending a coordinated, integrated system where there are ‘one child, one file’ services for children, youth, and young adults that includes targets where assessments occur within 30 days and treatment within the next 30 days.”