Until relatively recently, the issue of children’s mental health was largely swept under the rug.
While awareness surrounding children’s mental health disorders has grown, Dr. Peter Szatmari is well aware that more can be done.
Szatmari is heading up a project that will bring about greater collaboration between The Hospital for Sick Children (SickKids), the Centre for Addiction and Mental Health (CAMH) and the University of Toronto and aims to boost access to – and the efficiency of – the delivery of services for children and youth with mental health disorders.
The Child and Youth Mental Health Collaborative, as it is known, will focus on integrating clinical care to ensure children and youth receive the best in evidence-based treatments, training future mental health practitioners to fill gaps in services and developing a research program to look into child and youth mental illness and addictions.
The fact that such a position exists represents a massive and much-needed shift in focus in the field of child and youth mental health.
“It wasn’t long ago that child and adolescent psychiatry was thought of as the orphan of an orphan – nobody took it seriously,” Szatmari said.
“Now we have more of an idea that what happens early in life – from zero to 18 – has a profound influence not only on physical health but also mental health throughout a person’s lifetime.”
Part of the problem was that, until recently, many were quick to dismiss children dealing with mental health disorders out of hand. The prevalence of mental health conditions among children and youth was not known, meaning that children who acted out were simply considered bad seeds.
“Now we know enough to say this kid is in distress as opposed to this is a bad kid, he’s spoiled, he’s wanting attention and misbehaving to get it,” Szatmari said.
Indeed, mental health disorders are increasingly being acknowledged as a leading contributor to child and youth crime.
Common conditions affecting children and adolescents include depression, anxiety, attention deficit-hyperactivity disorder and behavioural disorders, as well as neurodevelopmental disorders such as learning disabilities and autism spectrum disorders.
There are a variety of factors that can contribute to mental health disorders in children, including living in poverty or being in families where conflict is prevalent or where the parents themselves have mental health disorders.
While his new position heading up the integrated Child and Youth Mental Health Collaborative takes into account child and youth mental health at three downtown organizations, Szatmari noted the dearth of services available is a nationwide issue.
“We’re pretty confident that the rate of mental health disorders (characterized by chronic symptoms that cause significant impairment in a child’s ability to function) among children and youth is about 15 per cent,” he said.
“We see mental health challenges (in which symptoms are transient or chronic but do not cause significant impairment) in one in five. Only about one-quarter of these children get services.”
Szatmari estimated that only 10 new people are trained in child and youth psychiatry every year, many of those being trained at the University of Toronto and winding up at SickKids or CAMH.
Given Canada’s size and status as a health care leader and estimates suggesting that 1.2 million children and youth across Canada are affected by mental illness each year, not enough is being done to ensure all children and youth have the services they need.
“Right now, the wait lists are way too long,” Szatmari said.
“You have kids who are in distress, who are suffering, who are suicidal or not going to school – they can’t wait a year. They need access right away.”
While Toronto is relatively well-served in that area with SickKids, CAMH and other mental health services, those in more rural communities are not so fortunate. Northern Ontario, for instance, has the equivalent of only 2.5 full-time child psychiatrists. Szatmari pointed to SickKids’ telepsychiatry line, where children in rural communities can teleconference with psychiatrists in urban centres as a step in the right direction.
He said more help is on the way for children and adolescents across the province.
“Certainly, the Ontario government has put a child and youth mental health strategy front and centre,” Szatmari said.
“They’re making radical moves to make sure the system is not fragmented, but they’re just starting that process.”
Szatmari himself is just starting with his own mandate, having taken on his new role at the beginning of March. He plans on conducting a ‘listening tour’ where he will speak with mental health service providers and caregivers, doctors and families to see where there are gaps that need addressing and what can be done to address them.
“My job will be to weave together what I hear with what we know about children’s mental health disorders,” he said.