Access to Mental Health Services

This is the third in a seven week series examining the topic of child and youth mental health in B.C. As this is a complex and multifaceted topic, I will be narrowing my focus to a few popular beliefs and areas of concern that I have witnessed in my role as MLA. The purpose of this series is to debunk these beliefs, increase awareness of these concerns, end the stigma of mental health in our society and provide opportunities for you to impact what is happening in your community.

“The mental health system for children and youth in B.C. is actually not a system at all, but rather a patchwork of services that is inconsistent from region to region and community to community. It is confusing for youth, their families and even the professionals who serve them and, therefore, actually getting the required services is often near impossible.” – Still Waiting: First-Hand Experiences with Youth Mental Health Services in B.C.

Popular Belief Four: Mental Health Services are available and accessible

Reality: Research shows that young people aged 12 to 25 have the highest incidence of mental health challenges across the lifespan, however their access to services remains the poorest of all age groups. While almost a third of Canadians seeking mental health care report their needs unmet, the rate is even higher for children and youth.

Firsthand experiences of families and youth struggling with mental illness paint a picture of a broken and inconsistent system that provides delayed and heavily restricted access to services for a small subgroup of people with severe and complex disorders. Further compounding these issues is the artificial boundary that youth hit when they turn 18 and must transition into a new, and equally disjointed, adult system.

In order to address issues relating to the accessibility of youth mental health services in B.C., we must first understand how these services are delivered.

Who Provides Services?

A 2013 report by the Office of the Representative of Children and Youth examined how youth mental health services are provided throughout the province:

In BC, the Ministry of Children and Family Development (MCFD) and the Ministry of Health (MoH) have operational responsibility for the main streams of publicly funded mental health services for youth. With principal responsibility for community mental health services falling to MCFD and the MoH taking responsibility for primary care delivered by family doctors, specialized inpatient mental health care, and acute care in hospitals run by regional health authorities and the Provincial Health Services Authority (PHSA).

Geographically, these services are delivered by five regional health authorities, the PHSA and MCFD’s 13 service delivery areas. Each health authority is responsible for the development and delivery of its own community- and hospital-based mental health services and programs – this responsibility includes establishing policies, standards and protocols consistent with legislation, provincial policies and standards. In addition, each hospital within a region is responsible for its own operating policies.

Although policies and standards for the delivery of community mental health services are the responsibility of MCFD’s provincial office, each of MCFD’s regions determines how these policies and standards are implemented within the region and without accountability mechanisms back to the provincial office. As a result, MCFD delivers components of child and youth mental health services in a variety of ways across the province, and manages and operates them under a variety of structures.

Furthermore, the MOH identifies family doctors as the foundation of primary healthcare for all British Columbians. This means that individuals with a family doctor should be able to go to that doctor if they believe they have a mental health problem and should expect the doctor to assess the situation, manage the problem and, if necessary, refer them to specialized care. However, this is often not the case as GPs and Paediatricians themselves have reportedly identified that there’s a massive knowledge gap in this area and they do not have the expertise needed to properly address mental health issues.

Mending the System

Given the number of agencies involved in the delivery of youth mental health services, and the apparent lack of oversight and accountability, it is no wonder these shortfalls exist. A number of recommendations for mending these gaps and service access issues have been provided by both experts and those with first-hand experience navigating the system.

One of the recurring recommendations has been a call for a Minister of State for Youth Mental Health or a Minister of Youth Health. This person would act as a single point of accountability to address the needs of youth with mental health problems in B.C.

Other recommendations have included calls for increased government funding – according to a 2008 report mental illness constitutes more than 15% of the burden of disease in Canada yet receives less than 6% of healthcare dollars. As well as a comprehensive youth mental health plan – one which includes performance measures, targets and outcomes, and regular reporting to the public, decision-makers and service providers.

It is clear that the current system for managing and delivering child and youth mental health services in B.C. is unnecessarily convoluted and extremely disjointed. By redesigning our youth mental health system to incorporate age-appropriate, easy-to-access services that not only address the unique circumstances faced by transition-aged youth, but also aim to reduce the need for transition into adult services all together, we can provide our young people with the supports that they both need and deserve.

Weekly Action Item

Building on the last two action items, this week I am asking you to take this knowledge and share your new understanding of mental health with someone else – Inform Others. This can be a friend, a family member, a colleague, anyone you wish. You can share a story, share some resources or even just share this series. You can do this in person, on the phone, by email or over social media. Whatever the method and however large the scope, just get talking.