Health

This is the fourth 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.

“There is not only a clash of history and culture, but practically speaking a yawning gap into which many young people and their families are falling every day around the world. The current system is weakest where it needs to be strongest.” –McGorry et. al.

Popular Belief Five: The health care system is structured to provide necessary services

Reality: One of the most common concerns I have heard from constituents and their families trying to navigate through mental health services, is the difficulty and confusion they have faced in the transition from the youth to adult systems.

Transition-age youth are “young people ages 16 to 24 who are moving from the child and youth to adult mental health system”. When young people reach the age of 19, they ‘age out’ of services provided by Child and Youth Mental Health and the Ministry of Child and Family Development and must move to adult mental health services, which are provided by the Ministry of Health in conjunction with other allied ministries and organizations. However, this transition can often prove confusing and fraught with gaps.

Issues Facing Transitioning Youth

“Once you get to my age [23] there’s nothing” – McCreary Centre Study Youth Participant on the transition from youth to adult services.

Last June, the Select Standing Committee on Children and Youth heard first-hand experiences from experts and youth alike about the many barriers that exist for transition-age youth in our mental health system today. From difficulty navigating services to inconsistencies between service systems to a lack of age-appropriate services and a need for additional supports, each of these things can work alone or in conjunction to further derail a young person transitioning from youth to adult services.

When a young person with mental health problems turns 19, the supports and services that they have been receiving throughout their youth are no longer available to them. When this happens, they must adjust to the abrupt loss of their past relationships with youth service providers and support systems and learn to navigate a new system with new people and new procedures. All this while trying to cope with both the challenges of living with a mental illness as well as the challenges that accompany any youth entering into adulthood. These realities can make it extremely arduous and frightening for a transitioning young person.

To further exacerbate this transition, the youth and adult mental health systems can prove exceedingly disjointed. Young people can find that services and supports that were available to them under the youth system may not have an equivalent under the adult system. When a comparable support does exist, the individual may not qualify for similar services as an adult due to differences in eligibility criteria. In fact, almost 50% of child and youth mental health practitioners have indicated that ineligibility was the greatest barrier for young people moving into the adult system, and 64% agreed that eligibility requirements hindered transition planning.

Furthermore, the lack of appropriate services to support this age group can leave many transition-aged youth feeling out of place and may even prevent them from accessing supports and services in the future. With pediatric services often aimed at a younger age group and adult services often aimed at an older-adult age group, it can be hard for these young people to find age-appropriate services that meet their needs.

Closing the Gaps

“It felt like I was asked to build the wall of China, without giving me the tools, without telling me the specific steps to take.” – McCreary Centre Study Youth Participant on the transition from youth to adult services.

With statistics showing that transition-aged youth are one of the largest demographics faced with mental health challenges, it is disheartening to know that our young people continue to be faced with these barriers day-in and day-out. Advocacy groups, mental health professionals and those living with mental health challenges work tirelessly to break down these barriers and have provided a number of first-hand and evidence-based ideas for improving the transition from youth to adult services.

These ideas include steps such as: extending youth services beyond 19 years of age and implementing a more gradual transition process; providing individual support workers to help youth develop a transition plan and navigate the system; improving information sharing and communication between service providers; and providing youth with the skills and techniques needed to reduce, and hopefully prevent, the need to transition into adult services all together.

It is time for government to take genuine steps towards mending these gaps and ensuring that no more youth fall through the cracks of a system that has been put in place to support them.

Weekly Action item

This week’s action item encourages you to get involved in child and youth mental health supports and services in your own community – Volunteer.

There are a number of local organizations throughout B.C. that work hard to provide youth in their community with the supports they need to achieve and maintain a positive mental well-being. The scope and variety of organizations and volunteer opportunities will vary greatly from region to region. Some options include your local Canadian Mental Health Association branch, Big Brothers and Big Sisters, Boys and Girls Club, or even online resources such as Kids Help Phone, Youth Space, and Youth in BC.

It is also important to remember that promoting and supporting the mental well-being of youth can be done in a variety of settings through out our communities and is not limited to organizations that deal directly with mental health. For example, you could volunteer at a local youth drop-in centre, your local community association or community centre, at a school, with a youth sports group or any other youth-involved organization or group.

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.

This is the second 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.

“Health is not simply the absence of disease; it is something positive…” – Harry Sigerist, Medicine and Human Welfare

Popular Belief Three: Mental Illness is the Issue

Reality: If you pay close attention to many conversations about ‘mental health’ you will probably notice that surprisingly the focus is not actually on health.  Most often when we refer to mental health we are really meaning mental illness.

This type of discourse in which mental health and mental illness are used interchangeably not only pairs negative connotations with the concept of mental health, but also brings people to believe that the issue is simply about treating mental illness. When in fact the larger, more encompassing issue is mental health and well-being.

The World Health Organization (WHO) defines Health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Moreover, 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.” Each of these definitions stress the positive dimensions of health and mental health. Just as health is not merely the absence of disease, mental health is not merely the lack of a mental disorder – it is the presence of mental well-being.

Yet the Mental Health System as currently structured puts primary emphasis on treating and managing medically diagnosed mental disorders. The majority of resources are channelled into reactive approaches to illness, with little attention given to mental health promotion and/or illness prevention.  

What are the implications of this illness-oriented system for youth mental health?

A survey conducted by the McCreary Centre Society found that when asked to define mental health, young people with first-hand experiences of mental health challenges defined it in terms of mental illness rather than in terms of mental wellness.They associated mental health with disorders and negative life experiences or traumatic events.

Interestingly, despite their own negative associations with mental health, some survey participants noted that for people who had not experienced such challenges, mental health would likely refer to one’s well-being. Likewise, when youth who were no longer experiencing acute mental health challenges defined mental health, they did so from this positive framework – describing mental health as a component to a balanced healthy lifestyle.

The fact that so many youth facing mental health challenges pair such negative meaning with the concept of mental health – and have such adverse experiences with mental health supports and services – is a statement of how our mental health system is failing to address the true needs of our young people.

Switching the Focus

Historically, the common approach of our healthcare system has been a focus on the biomedical diagnosis of disease, concerning itself primarily with the illness and not necessarily the individual as a whole. While more holistic models have gained acceptance over the last few decades, the biomedical model continues to be the dominant lens in healthcare today. But this model only addresses part of the problem.

Mental health and mental ill-health are not just biological issues, just as they are not just psychological issues or social issues or environmental issues. Rather, mental health and ill-health are often by-products of interactions between all of these components. Similarly, an individual’s ability to seek support for their mental health challenges is often dependent on the relationships between these same components.

It is precisely this reason that we need to stop approaching mental health and mental ill-health through such a narrow viewpoint. We need to look beyond the labels on the medical chart and stop basing treatment plans merely on medical diagnoses. We need to stop putting sole emphasis on getting rid of an individual’s mental illness and instead focus on how we can provide them with the support and tools they need to live a full and meaningful life. In other words, we need to stop treating the illness and start treating the individual.

By changing the emphasis of our mental health system from one of mental illness to one of mental well-being, and shifting the focus of support services from treating the disease to treating the individual, we can start to shift the way society and those facing these challenges view mental health. While simultaneously fostering feelings of autonomy, meaning and empowerment in the youth facing mental health challenges head-on.  

Weekly Action Item

Armed with a better understanding of mental health and mental health challenges perhaps you might wish to acknowledge your own mental health needs. As the Canadian Mental Health Association points out, “staying mentally healthy is like staying physically fit – it requires a little effort every day.” That’s why this weeks action item is to set aside some time to assess and address your own mental health needs.

This will look different for everybody. Mental health is about striking a balance in all aspects of your life: social, physical, spiritual, economic and mental. Reaching a balance is a learning process and everyone’s personal balance will be unique. Even when a balance has been reached, your challenge will be to stay mentally healthy by keeping that balance.

While some people may be able to reach and maintain this balance on their own, others may require the support of family, friends and/or professionals.  To help you with this process, here is a link to the Canadian Mental Health Association’s website where you will find some suggestions to help you strike and keep your balance.

Over the course of the last few months I have been working to raise awareness about the regressive approach British Columbia is taking to fund health care via flat-rate MSP premiums. I’ve been pressuring both the government and the official opposition to support a more progressive approach like that in place in Ontario.

I’ve written about this earlier and tabled a petition in the legislature of 6,662 British Columbians who agreed. Furthermore, during question period, I asked the Minister of Finance if the government would empower the Select Standing Committee on Health to examine innovative, progressive ways of revising how MSP premiums are charged. The Minister responded that he believed the mandate of the committee was sufficiently broad for “members of the committee, and those that they might invite in, to have the kind of conversation that the member is alluding to”.

Following up on the Minister’s response, I formally wrote to the Chair of the Select Standing Committee on April 17 asking two specific questions regarding the possibility of initiating a conversation with respect to the funding of MSP in British Columbia.

I received a response to my letter today.

The response was, to say the least, most disappointing. The Chair of the committee stated that “they consider only those matters that are referred to them by the Legislative Assembly”. Given the Minister’s response to my question during question period, this statement is most perplexing.

What’s even more troubling is that further in the letter, the Chair of the committee states:

“The Committee is currently working to identify potential strategies to ensure the sustainability and improvement of our health care system while ensuring its financial sustainability.”

Moving MSP premium funding from a regressive to a progressive system of funding is precisely one of the key ways we can ensure the financial sustainability of our healthcare system. I am astonished that the Committee has apparently not recognized this.

For those interested, the Select Standing Committee on Health has the following members:

Linda Larson  Liberal, Boundary-Similkameen (Chair)
Judy Darcy  NDP, New Westminster, (Deputy Chair)
Donna Barnett Liberal, Cariboo-Chilcotin
Dr. Doug Bing Liberal, Maple Ridge-Pitt Meadows
Sue Hammell NDP, Surrey-Green Timbers
Richard T. Lee Liberal, Burnaby North
Dr. Darryl Plecas Liberal, Abbotsford South
Jennifer Rice NDP, North Coast
Bill Routley NDP, Cowichan Valley
Dr. Moira Stilwell Liberal, Vancouver-Langara

This is the first in a seven week series that will examine 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.

Over the last two years in my role as MLA it has become apparent that a central challenge we are facing, both locally and provincially, is that of addressing the mental health needs of youth.  Through first hand experiences shared by constituents and the research conducted over a period of several months by my office I have begun to realize how limited the understanding of this issue is. Moreover, I have become concerned about the popular beliefs that underpin conversations and thinking about mental health.

Over the next several weeks I will be releasing a series of posts that will examine the topic of adolescent mental health in our region. My goal with this series is to debunk these dominant beliefs, increase awareness of these areas of concerns, and decrease the stigma of mental health in our society. We will also offer action items that you as individuals can undertake to impact what is happening in your community.

Popular Belief One: Mental Health is not a mainstream issue

Reality: Mental health is as mainstream as any health or social issue in our society today – perhaps more so. It is so mainstream, that you would be hard-pressed to find any individual that has not been impacted by mental health challenges in some way, whether it be directly or indirectly.

According to the Mental Health Commission of Canada (MHCC), by the time people reach 40 years of age, 50% of people in Canada will have had or have a mental illness. But it is not just the people who experience mental health problems that are impacted by them. When we include families and caregivers, mental health problems will impact almost every Canadian at some point throughout their lifetime.

However, challenges related to Mental Health not only put an immeasurable burden on the individuals and families facing them head-on, they also place a heavy weight on society. One study found that in Ontario, the burden of mental illness and addiction is one and a half times higher than all cancers put together and more than seven times that of all infectious diseases.

Similarly, when taking into account health care costs, lost productivity and reductions in health-related quality of life, the economic cost alone of mental health challenges is estimated to be $51 billion per year in Canada.

Popular Belief Two: Mental Health is not a youth issue

Reality: Surpassed only by injuries, mental health challenges in youth are ranked as the second highest hospital care expenditure in Canada.

Today, more than 6.7 million Canadians (1 in 5) are living with a mental health challenge. 75% of these mental health problems occur before the age of 25, while 50% develop by age 14. In fact, young people aged 15 to 24 are more likely to experience mental illness than any other age group.

It is estimated that 10-20% of Canadian youth are affected by a mental illness or disorder. While at the same time, at least 3.2 million youth between the ages of 12 to 19 are at risk for developing a mental health challenge.

Here in British Columbia the numbers are not any better. According to the Ministry of Children and Family Development, approximately 15% of children and youth (140,000) in B.C. experience some sort of mental health problem. And just as troubling, it is estimated that less than 30% of youth who need mental health services ever access them, significantly increasing the chances that these challenges will carry-on into adulthood.

Understanding the true prevalence and scope of mental health challenges is the first step to reassessing how we as a society approach the topic of mental health as a whole. With an underfunded system focused primarily on the treatment of disease, we find ourselves fighting against mental illness instead of striving for mental well-being.

Weekly Action Item

This week’s action item is simple, yet it is perhaps the most important thing you can do to support the mental health and well-being of yourself and others – Get Informed.

Educate yourself about what mental health, and mental ill-health, really mean: What is mental health?  How can we promote and achieve mental well-being? What is mental illness? What are signs and symptoms of mental illness? How can mental health challenges materialize in day-to-day life? How can you support someone struggling with mental health challenges? These are just a few of the questions that I hope you will all seek to understand over the next week.

To assist you in this endeavor you can find a wealth of resources online. Below I have provided links to just a few of them:

• Canadian Mental Health Association, BC Division
• Kelty Mental Health
• Here to Help
• Mind Check
• Mind Your Mind