Child and Youth Mental Health in Ontario

May is Mental Health Awareness Month in Ontario. The first week of May asks us to reflect on child and youth mental health, with May 1-7^th being Children’s Mental Health Week. This week is a time to recognize the importance of mental health in our younger populations and to acknowledge that many families are struggling. According to Children’s Mental Health Ontario (CMHO), “as many as 1 in 5 children and youth in Ontario will experience some form of mental health problem,” and “5 out of 6 of those kids will not receive the treatment they need.”[1]  It is also important to be aware that 70% of mental health diagnoses have their onset during childhood or adolescence. Additionally, Canada has the third highest youth suicide rate in the industrialized world, which illustrates the importance of supporting children’s mental health.

When we apply the concept of intersectionality to mental health, we recognize that several factors interact to influence an individual’s mental health. Things like race, gender identity, age, socioeconomic status, and support systems all come together to determine an individual’s protective factors and risks for experiencing mental health challenges. When we look at the state of mental health in Ontario’s youth and children, it becomes clear that using an equitable approach to mental health would greatly improve the state of our young peoples’ well-being.

Overall Prevalence

The Canadian Institute for Health Information (CIHI) shared a report in May 2022 that explored the mental health of children and youth in Canada. In their report they share that in 2019, there were 39,801 children and youth hospitalizations for mental health disorders and 146,845 children and youth hospitalizations for all other conditions. In 2020, there were 36,708 children and youth hospitalizations for mental health disorders and 122,996 children and youth hospitalizations for all other conditions. The proportion of hospitalizations that were for mental health disorders increased from 21% in 2019 to 23% in 2020; meaning that nearly a quarter of all hospitalizations for children and youth aged 5 to 24 were for mental health conditions in 2020. Furthermore, 58% of those were for females and 42% were for males. Females aged 15 to 17, specifically, were 2 times more likely to be hospitalized than males the same age.[2]

According to the Centre for Addiction and Mental Health (CAMH), young people aged 15 to 24 are more likely to experience mental illness and/or substance use disorders than any other age group. Based on their data, 39% of Ontario high-school students indicate a moderate-to-serious level of psychological distress (symptoms of anxiety and depression) and 17% indicate a serious level of psychological distress. In 2018, suicide was the leading cause of death for children aged 10 to 14 and, after accidents, suicide is the second leading cause of death for youth aged 15 to 24.[3]

General System Challenges

CMHO shares that 36% of Ontario parents have sought help for a child who is struggling with their mental health and 40% of those parents did not receive the help they needed. Half of Ontario parents who have sought mental health help for their child said they have faced challenges in getting the services they needed. The primary reason cited in a survey conducted by CMHO was long wait times (65%). Other challenges included services not offering what the child needs (38%), not knowing where to go (26%), and no services being offered where they live (14%). 76% of the families surveyed indicated it was very or extremely difficult to know where to find help. When youth were asked why seeking help is challenging, 63% pointed to stigma as the most likely reason to not seek help. Furthermore, poor transitions from youth to adult mental health services causes disengagement from care in up to 60% of known cases.[1]

Mental Health Challenges for Black Youth

Earlier this month, the Black Physicians’ Association of Ontario held a conference for family doctors, nurse practitioners, psychiatrists, psychologists, social workers, and other health care providers to discuss barriers that exist in Black Ontarians gaining access to health care, including access to mental health care for youth specifically. In an article written for CBC News, Dr. Mojola Omole, president of the Association and a general surgeon in Toronto, shared that, “Black youth experience the mental health system very differently than other races,” and health care providers can make the situation worse.[4] CMHO data confirms that black youth are significantly under-represented in mental health and treatment-oriented services and overrepresented in containment-focused facilities.[1] Omole suggests that this is, “in part due to anti-Black racism and implicit biases.”[4]

For example, when Black youth become loud or agitated it is often falsely perceived as aggression where it may be seen as “typical” adolescent behaviour in other youth. Dr. Amy Gajaria, a child and adolescent psychiatrist at the Centre for Addiction and Mental Health in Toronto, agrees that Black youth are often misunderstood and, as such, misdiagnosed. With non-Black youth, mental health care providers are more likely to dig into what is behind the irritable or aggressive behaviours to reach a diagnosis of anxiety, depression, or trauma. “Unfortunately, we know for Black youth, a lot of clinicians just stop with the behaviour. They see the anger, they see the irritability, and they stop there. And then their diagnosis goes to things like ADHD, oppositional defiant conduct disorder, which really does a disservice to kids and misses what’s actually driving all those things.”[4]

Additionally, Black youth face significantly longer wait times for access to mental health care. Tiyondah Fante-Coleman, a researcher with the Pathways to Care project at the Black Health Alliance and speaker at this month’s conference, shared statistics from a large 2015 Canadian study that showed Black-Caribbean children and youth waited an average of 16 months for mental health care compared to 7 months for white patients. Fante-Coleman also highlighted the reality that Black youth are much more likely than non-Black youth to enter the mental health system due to encounters with law enforcement or the justice system. Other causes of the long wait times may be that Black youth face more financial barriers, there may be a lack of mental health care providers in their area, they are facing stigma, and the fact that mental health services are overwhelmed by the current demand.[4]

Mental Health Challenges for Indigenous Youth

First Nations youth aged 15 to 24 die by suicide about 6 times more often than non-Indigenous youth and suicide rates for Inuit youth, specifically, are about 24 times the national average.[3] According to Statistics Canada, the 2017 Aboriginal Peoples Survey showed that almost 1 in 5 Indigenous youth had been diagnosed with a mood disorder and nearly 1 in 4 had been diagnosed with an anxiety disorder. Within these groups, young women were more likely to be diagnosed than young men and were less likely to report having excellent or very good mental health. Statistics Canada notes that this disparity is likely caused by young women being more likely to seek help and be open about their struggles compared to young men.[5]

It is worth noting that current research on Indigenous youth mental health and access to care is extremely lacking. While there is much theoretical research being done on how to better support Indigenous communities and provide increased access to care, which is extremely important, there does not seem to be many sources of practical research and findings. This lack of research is a clear example of the inequity that exists in mental health care in Ontario and Canada at large.

Mental Health Challenges for 2SLGBTQIA+ Youth

An evidence brief created by Rainbow Health Ontario and CAMH shares that LGBTQ youth have an increased risk of suicide, substance abuse, isolation and experiencing sexual abuse. One Canadian study estimated that the risk of suicide among LGB youth is 14 times higher than for their heterosexual peers and another large statistically representative study of trans people in Ontario found that 77% had seriously considered suicide, and 45% had attempted suicide. Trans youth were at greatest risk of suicidality, as were those who had experienced physical or sexual assault. 2SLGBTQIA+ people often experience stigma and discrimination, and this stigma can have a variety of negative consequences throughout the life span, including internalized homophobia and stress-related cortisol production in, both of which are associated with increased depression, anxiety, and suicidal thoughts.[6]

In 2022-2023, the LGBT Youthline, a volunteer-based peer-support line for youth in Ontario, provided support to just under 3,000 youth, as outlined in their Annual Report. 57% of their help-seekers resided in Toronto and the GTA with the remaining 43% spread across the rest of the province. 34% of their service users were Black, Indigenous, persons of colour and 62% were trans. The top issue explored was isolation, followed closely by relationship troubles – peer, romantic/sexual, and family. 31% of their users were under the age of 15 and 27% of the remainder were aged 16-18. These numbers clearly highlight the need for 2SLGBTQIA+ youth to have access to affirming care and mental health supports.[7]

Looking to the Future: Protective Factors and Service Equity

In December 2021, the Knowledge Institute on Child and Youth Mental Health and Addictions released their report titled, “We journey together: How Ontario’s child and youth mental health agencies are addressing racial equity”. In this report they shared that the best ways to advance racial equity are:

• having strong leadership and support,
• having racially diverse teams,
• collaborating with community partners, and
• establishing trust and building a culture of receptiveness to new or different ideas.

Additionally, they shared the following suggestions on where their sample of 102 agencies showed room for improvement:

• developing written plans to address racial equity,
• integrating knowledge and skills on racial equity into performance objectives and appraisals,
• co-developing services with racialized clients and communities, and
• collecting and analyzing race-based or health equity data to promote accountability.[8]

For support geared toward Black communities specifically, the Mental Health Commission of Canada suggests spreading the message that seeking support is not just for those with a mental illness — it is an important part of maintaining overall good health. They also suggest including Black representation in awareness campaigns, including multiple Black representatives in the development of mental health programs and initiatives to advocate for the diverse needs of their communities, and, in care settings, ensuring that all professionals receive cultural competency training to better understand the factors that may contribute to poor mental health in Black communities.[9]

Deloitte’s publication, “Voices of Indigenous youth leaders on reconciliation Volume 3: Breaking colonial legacies and mapping new pathways to mental wellness”, shares multiple ways to better support Indigenous youth. Through conversation with Indigenous youth, they determined four key pillars to success in supporting mental wellbeing with a culturally intelligent approach. These four pillars are to:

• identify the social determinants of health,
• draw on Indigenous strengths-based mental wellness approaches,
• access mainstream mental wellness care and supports, and
• navigate the mental wellness services system.

Furthermore, they suggest that:

• all levels of government should provide sufficient funding to ensure basic infrastructure and services such as housing, clean drinking water, health care, education, and transportation in Indigenous communities,
• provincial and territorial governments should prioritize improving access to community and hospital-based mental wellness supports,
• health care systems and mental health care providers should collaborate more closely with educational institutions to improve and promote supports and services for Indigenous students, and
• businesses and governments (as employers) should increase efforts to educate Canadians about Indigenous Peoples, our shared history, and the lasting impacts of colonialism.

The above should be done by working with local Indigenous Nations to raise awareness and learn how to work with and serve Indigenous Peoples to foster empathy and understanding and decrease racism and bias. [10]

In 2SLGBTQIA+ youth, supportive environments are key to mental health. A Canadian Study found that support from family and friends reduced stress and contributed to positive mental health in youth. Experiencing positive responses to coming out is also associated with reduced risk of substance abuse. Youth who build connections within the 2SLGBTQIA+ community have been found to significantly reduce their internalized homophobia and family acceptance of 2SLGBTQIA+ adolescents is associated with both good mental and physical health.[6]

By addressing the intersectionality of mental health, we can work towards creating inclusive and just support systems that meet the diverse needs of all individuals. Of course, advocating for policies and practices that prioritize equity, dismantle systemic barriers, and create environments where everyone feels taken care of, is of the utmost importance.

Resources for Support

Black Youth Helpline: https://blackyouth.ca/

Fabiola’s Addiction and Mental Health Awareness & Support Foundation: https://famhas.ca/

We Matter Campaign: https://wemattercampaign.org/

Hope for Wellness Helpline: https://www.hopeforwellness.ca/

LGBT Youthline: https://www.youthline.ca/

The Trevor Project: https://www.thetrevorproject.org/

Free helplines: https://www.dcontario.org/locations/

9-8-8 Suicide Crisis Helpline: https://988.ca/

Sources