I agree a review is definitely needed because the current methods don’t work for children turning 19 or families. The current disjointed systems don’t provide enough support and are cut off when youth turn 19 and are non-existent for families. Family services are sadly lacking and creating conflict within families seeking assistance due to the division of services and methods currently provided. Some of the issues that need to be considered are listed below. I strongly recommend reading the full report or excerpts below.
The Ministry of Health has seen an average 2.9% increase per year in the number of children and youth with mental health diagnoses accessing a broad range of Ministry of Health funded services. Between 2009 and 2013, BC has seen a 43% increase in the number of children, youth, and young adults aged 0-24 presenting to hospitals to seek mental health and substance use services … those aged 15-19 have the greatest rate of increase (73 % increase between 2009 and 2013). Joint Ministry Written Submission, July 2015
Ministry officials recognized that there is more to do. The Ministry of Children and Family Development is leading a working group with other ministries to review Child and Youth Mental Health Services, and to make recommendations to Cabinet by June 30, 2016 on potential improvements. The recommendations will “be inclusive of youth up to age 24 years and will be based on a system-wide review of service needs and service gaps,” and will involve input from families, academic experts, and community and physician partners.
The evidence presented to the Committee led Members to conclude that urgent action is required. The children, youth, and young adults of British Columbia are currently not being adequately served by the existing level and structure of service delivery. Given the critical importance of early and formative years to success in adulthood, it is imperative that the existing deficiencies in mental health services be addressed as quickly as possible.
Leadership and Accountability
The issue of leadership and accountability in child and youth mental health was raised in several submissions, including a recommendation to transfer responsibility for Child and Youth Mental Health Services from the Ministry of Children and Family Development to the Ministry of Health. For example, the BC Psychiatrists Association expressed the view that the Ministry of Health was doing good work in expanding telehealth for rural areas, and that moving Child and Youth Mental Health Services to the Ministry of Health could improve service delivery by using telehealth approaches. Proponents of a consolidation of child and youth mental health leadership and programs within the Ministry of Health indicate that such a reorganization could result in the following advantages:
• Consolidation of funding for and the delivery of all mental health services, since children and youth frequently first access mental health services in physicians’ offices, walk-in clinics, and hospitals;
• Consolidation would build on the Ministry of Health’s work to provide outpatient youth addiction services to support mentally ill youth, many of whom struggle with alcohol and drug dependencies;
• Funding for child and youth mental health services might be enhanced if core services were the responsibility of the Ministry of Health;
• Barriers to access could be reduced because some families will not approach the Ministry of Children and Family Development for assistance with child and youth mental health issues given the Ministry’s ability to remove children from their home, or due to existing strained relationships over other child custody and protection issues;
• Consolidation could allow for more consistency of services between primary and community services if it was under one ministry;
• Consolidation could improve the broader deployment of telehealth programs in rural and remote areas; and
• Consolidation could facilitate more integrated service delivery, most critically, for transition-aged youth and young adults up to the age of 25.
On the other hand, a reorganization of programs into the Ministry of Health could have adverse implications:
• It may be costly and disruptive to undertake a ministry restructuring;
• The transfer may not be any more likely to result in the kind of multi-setting, multi-disciplinary collaboration that is needed and is already partially underway;
• Child and youth mental health services might be overwhelmed by other Ministry priorities;
• Funding and delivering services through the Ministry of Health could promote a “medical model” of care, under which mental health may tend to be defined as an absence of mental illness, with heavy focus on medication and intensive treatment for serious mental illnesses rather than prevention and early intervention; and
• Having the services in a child and youth-serving ministry is more likely to facilitate a holistic view of child and youth wellness, with consideration for the interdependent individual, familial and social determinants of health.
The Committee heard evidence suggesting that, on balance, a major reorganization of child and youth mental health roles and responsibilities within an existing ministry may not result in better service. Dr. Charlotte Waddell of Simon Fraser University’s Children’s Health Policy Centre said that the Ministry of Children and Family Development is “the one central ministry with the mandate to provide programs through the community, especially these psychosocial programs which, in general, are more effective for children.” She also noted that the ministry was “well able” to lead BC’s ground breaking 2003 five-year child and youth mental health plan, including bringing together the Ministries of Health and Education. While she felt something is currently missing in terms of leadership and momentum, the plan “was done, and it was done well. That’s the one place where, perhaps, there has always been that capacity to look at the full picture for the province.”
Public submissions to the Committee attested that a multidisciplinary approach is required. Services should be provided by the right practitioner and accessed at the right intensity at the right time. It is hard to imagine the possibility of receiving the “wrong” level of service when parents may be desperate for any service at all. However, inappropriate and/or delayed referrals can and do happen, and are often not efficient and not in the best interest of the child or youth. Even more troubling is that referrals may not be made at all when there is a lack of cooperation and coordination between health authorities and other health care providers.
Policing and justice costs related to mental illness are significant and appear to be growing. Whether it is the number of “mental health calls” attended by police, or the costs of having mentally ill youth in custody, police are increasingly sounding the alarm over this issue. Chief Officer Neil Dubord of the Delta Police observed that “24-7 care is currently handled by police, obviously — we become the de facto agency to be able to manage that — and a hospital’s ER,” and reported that one in every five calls attended by police involves some form of mental health issue. The human health and safety costs are also significant: harm to victims and families, and potentially harm to the mentally distressed people who are police-involved or who commit crimes.