Updates

Representatives from the Children’s Health Policy Centre were proud to address the 50th Annual Banff International Conference on Behavioural Science, March 18 to 21, 2018. The theme was, “What are Ideal Children’s Mental Health Services?”

CHPC director Charlotte Waddell (adjacent), delivered the closing plenary address on the topic, “Improving Children’s Mental Health: The Policy Opportunities in Canada.” In her 50-minute presentation, Waddell covered a host of topics for the broad-ranging audience that included everyone from well-known academics to graduate students.

Waddell’s key messages included five points:

• It’s important not to focus on one age group at the expense of others. The responsibility facing children’s mental health policymakers encompasses all young people from before birth to early adulthood.

• There are considerable challenges in providing services for all ages and all disorders. “We are currently reaching only 30% of children with mental health disorders,” Waddell said, citing a recent systematic review the CHPC prepared.

• We shouldn’t fall for the argument that there’s not enough money. “Canada spends a lot on healthcare, but if we look at current Canadian spending, most of it is going towards older Canadians,” Waddell said. “We need to have a public conversation about that.”

• It is possible to change spending patterns. This has been demonstrated by spending on autism where funding has increased tenfold over the last 10 years. “It’s a terrific success story for one mental disorder,” Waddell says, adding, “We can learn from that.”

• We need to triple spending on children’s mental health. “That goal is entirely reasonable,” according to Waddell. She adds that new spending should cover both prevention and treatment, and should go towards effective or proven interventions.

Earlier in the conference, the CHPC team also delivered a three-hour workshop titled, “Research-policy partnerships in children’s mental health: Lessons from British Columbia.” In it, Nicole Catherine spoke about her experience as Scientific Director and Co-Principal Investigator of the BC Healthy Connections Project, the first Canadian randomized controlled trial evaluating the Nurse-Family Partnership (NFP) program.

Developed nearly 40 years ago by David Olds and colleagues in the US, NFP starts in early pregnancy, before children are born, and involves intensive home visits continuing until children reach their second birthday. The program particularly focuses on girls and young women and their children who are facing disadvantages such as low income.

The BC Healthy Connections Project trial involves close collaborations with BC policymakers in the Ministries of Health and Children and Family Development and in four participating regional Health Authorities. Some 744 children are being reached through the trial, with final results expected in 2020–2021.

In the same workshop, Christine Schwartz spoke about the Children’s Mental Health Research Quarterly, describing a longstanding research-policy-practice partnership with BC’s Ministry of Children and Family Development. She highlighted the methods used to convey research evidence to policymakers, as well as to practitioners and families.

These methods include preparing systematic reviews of evidence on prevention and treatment interventions across a wide array of childhood mental health problems. Evidence is then prepared in user-friendly formats, published free on line, in the Quarterly. Topics are chosen in consultation with policy partners and each issue is accompanied by talks.

The BC child and youth mental health budget should be tripled to ensure help for the estimated 70 per cent of young people with mental disorders who currently receive no effective treatment, according to Charlotte Waddell, director of SFU’s Children’s Health Policy Centre.

Waddell shared her views in an article published recently in the Vancouver Sun.

The system needs more interdisciplinary teams, including psychologists, nurses and social workers, to be available in communities where children live, according to Waddell. But instead, budgets for these services, which are provided for all BC children through the Ministry of Children and Family Development’s Child and Youth Mental Health Branch, have been steadily eroded over the years.

Waddell also said that some common childhood disorders — such as anxiety, behaviour problems, substance misuse and depression — could be avoided if society invested in more preventive programs. There are many such programs that are effective and that can be delivered, in family homes and in schools. (For examples, please see the Centre’s recent publication on preventing childhood depression as well as one on preventing anxiety in children.)

Waddell noted that budgets for autism in both B.C. and Ontario have increased 10-fold over the last decade, mostly due to effective lobbying by parents of autistic children. The same has not been true for budgets for other childhood mental disorders, she said. But these increases for children with autism show that increases are possible.

The story, which ran under the headline “Not enough services for mentally ill kids, says family of struggling boy,” was published in the Dec. 1/17 issue of the Vancouver Sun. A follow-up story appeared on Dec. 4/17 under the headline, ” A mother’s plea: Save unique Richmond school that helped her 7-year-old mentally ill son.”

BC has recently released a new Mental Health Strategy (2017–2020). This is a supplement to Healthy Minds, Healthy People, BC’s existing 10-Year Mental Health Plan (2010–2020) jointly sponsored by the BC Ministries of Health and Children and Family Development.

Of note, the new plan recommits to supporting Nurse-Family Partnership. This intensive public health nursing program supports young, first-time mothers and their children who are living on low-income. Starting prenatally then continuing over the first two years of the child’s life, the program aims to improve children’s mental health and development, while also improving the mother’s life circumstances.

Nurse-Family Partnership is currently undergoing a scientific evaluation known as the BC Healthy Connections Project. The Children’s Health Policy Centre at SFU is leading this randomized controlled trial with more than 700 families — with scientific collaborators at McMaster University, UBC and the University of Victoria. The Project is also being conducted in close collaboration with policy partners in the BC Ministry of Health and the BC Ministry of Children and Family Development, as well as in Fraser, Vancouver Coastal, Island and Interior Health Authorities.

In other news, the plan will also increase the number of community-based child and youth mental health clinicians across the province. It will add up to 120 net new positions to existing services over three years. This will increase access for up to 7,000 children and youth each year on top of the 27,000 who are currently being served.

The new staff will include specialized clinical practitioners, and community support and outreach workers. They will help Indigenous and non-Indigenous children and youth and their families address their mental-health challenges.

Anyone seeking a referral to Nurse-Family Partnership should contact their local Health Authority.

Anyone seeking more information on Child and Youth Mental Health services should contact the Ministry of Children and Family Development.

Funding for childhood mental health in BC should increase three-fold to reach all children with mental disorders. That was one of the key messages from child psychiatrist and CHPC director Charlotte Waddell, in speaking at B4Stage4 event in Victoria, November 29.

Sponsored by the Canadian Mental Health Association, B4Stage4 is a campaign highlighting the difference between cancer and mental health care in Canada. “We don’t wait until stage 4 to intervene for cancer, so why do we wait to treat mental illness and addiction,” the website reads.

In her plenary talk, Waddell delineated the numbers for BC:

• Some 84,000 children ages four to 17 — or nearly 13% of children — are estimated to have mental disorders at any given time

• But only 30 % receive the specialized treatment they need

•This means that some 70% — about 58,000 — are not being treated

Waddell emphasized that it is unthinkable that we would ask 70% of BC children with cancer to go without treatment. So we can no longer allow this to continue for children with mental health problems.

Waddell also pointed out that five of the most common mental-health conditions in children and adolescents — anxiety disorders, attention-deficit/hyperactivity disorder, substance misuse, conduct disorder and depression — are also preventable. More information about Waddell’s talk is available in an article in the Times-Colonist.