By William Nicholls-Allison, school counsellor, Victoria
Every day, I have the great privilege of listening to children talk about their lives, their struggles, and their needs. What I hear, and what many educators and caregivers are seeing, is that many children are struggling with their mental health.
This situation is worsened by the fact that right now, in BC, many children and families cannot access mental health care. This is despite the fact that Canadian health care is, by law, universal, comprehensive, and accessible.1 Simply put, private mental health services are unaffordable for many families, and the public services cannot keep up with the level of need.
Child & Youth Mental Health (CYMH) is the main source of public mental health services for children in BC. Those services are provided by CYMH school counsellors and community-based professionals, such as Indigenous counsellors and youth and family counsellors.
CYMH offers services for children with significant mental health needs. Although the cost is free and there are CYMH offices in 100 communities in BC, the wait times
School counsellors (or “teacher-counsellors”) provide mental health services to all students. Since they work inside the school building and their services are free, they are the most accessible and affordable service for children in BC. In most districts, they are both BC certified teachers and mental health care professionals who hold a master’s degree in counselling, psychology, or a related discipline. This unique combination of experience and training means school counsellors provide a wide range of services, including mental health promotion, mental illness prevention, and more.
Like CYMH, there are also barriers to accessing school counsellors. The main barrier is the limited number of counsellors available in districts, with the student to school counsellor ratio set at 693 to 1. This ratio is outdated and does not align with research evidence that recommends a ratio of 250 to 1. As BC School Counsellors Association President Dave Mackenzie wrote, “[the ratios] are a travesty and deserve attention from the Ministry of Education.”2
These barriers to accessing public mental health care have created a precarious situation in our province, especially for families who cannot access private mental health care. Given the seriousness of the problem, it is important for educators and families to be informed about how mental illness affects children, the current state of children’s mental health, and what we can do about it.
Mental illnesses are common, debilitating, and distressing. They are also a risk factor for numerous life-threatening physical illnesses, such as heart disease and diabetes, as well as suicide—one of the leading causes of death among young Canadians.
Childhood mental illnesses affect every aspect of a child’s development: their growth, learning, physical health, relationships, and their future potential. Furthermore, families bear a heavy burden. Parents and caregivers experience emotional and financial stress, with many caregivers taking time off work and families paying out-of-pocket for services.
When childhood mental illnesses go untreated, they often evolve into chronic, disabling, and expensive illnesses in adulthood. These can impair a person’s ability to work, to complete higher education, to contribute to the economy, and to fulfill family duties. In addition, untreated childhood mental illnesses and trauma are both risk factors for experiencing homelessness and substance use in adulthood. The fact that more than 10,000 British Columbians have died by drug overdose in the last six years illustrates the critical importance of ensuring every child receives the care they need, when they need it.
Therefore, student mental health is central to the purpose of the BC school system, to enable our students “to develop their individual potential and acquire the knowledge, skills, and abilities needed to contribute to a healthy society and a prosperous and sustainable economy.”3
Although a recent study conducted in the United Kingdom suggests that some children’s mental health improved during the COVID-19 pandemic,4 research in Canada shows tremendous increases in mental health referrals and hospitalizations, as well as high rates of anxiety, self-harm, substance use, and suicidal ideation.5 Furthermore, the children and families who have suffered the most are those who were already most vulnerable.
However, children’s mental health was already in crisis before the pandemic. The Children’s Health Policy Centre at Simon Fraser University states, “COVID-19 arrived with a backdrop of high children’s mental health needs, coupled with long-standing service shortfalls.” In the years prior to the pandemic, researchers had already described a “silent epidemic” in children’s mental health in Canada, and a growing need for youth mental health services across the country.
For decades, world-leading experts in children’s mental health have urged governments to take action. In 1970, a Royal Commission declared the state of children’s mental health in Canada “intolerable”; in 2000, the U.S. Surgeon General called it a “health crisis”; in 2012, the Mental Health Commission of Canada wrote, “Despite more than a decade of research that shows the benefits of mental health promotion and mental illness prevention throughout childhood, Canada does not do enough”; and, in 2021, UNICEF stated, “We can wait no longer. We cannot fail another generation. The time to act is now. Governments and societies are investing far, far too little in promoting, protecting, and caring for the mental health of children, young people, and their caregivers.”
Addressing children’s mental health will cost money. However, the cost of neglect is far greater than the cost of care. So, what is the cost of mental illness? In Canada, the cost in a single year is estimated to be greater than $40 billion, rising to $185 billion by 2041.6 These estimates include mental illnesses in both children and adults, but are likely to be underestimates as they exclude costs created by the downstream effects of untreated childhood mental illness. For instance, both homelessness and substance use create immense costs to society.
Fortunately, children can recover from mental illnesses and trauma. Just like physical illnesses, early intervention and effective treatment can make a tremendous difference in a child’s life. When we take care of small problems before they grow, we can prevent chronic, debilitating, and expensive problems later on in life.
Research shows that comprehensive mental health promotion, prevention, and early intervention services produce favourable results, not only for children, but also for families, the economy, and society. For instance, it is estimated that every $1.00 spent on upgrading mental health services can produce a return of $2.30 to $5.70 over the long term.7
There is also a legal rationale for guaranteed access: the Convention on the Rights of the Child (CRC). The articles of the CRC are law in Canada. By ensuring every child gets the care they need to grow and learn well, we protect their rights as outlined in articles 3, 5, 24, and 29 of the CRC.
What is guaranteed access? It means every child gets the care they need, when they need it, where they are. Steps have already been taken by our government, including capacity-building grants, the $400 million Classroom Enhancement Fund, the expansion of Foundry BC, and the implementation of Integrated Child & Youth (ICY) teams in five school districts.
Yet, more must be done. Guaranteed access is not possible if there are not enough qualified mental health care professionals to meet the needs of the population. For guaranteed access, we must:
- improve the province-wide student to school counsellor ratio in the collective agreement to 250 to 1.
- enhance the capacity of CYMH by hiring more suitably trained mental health care professionals to meet the needs of children and youth in BC.
- implement ICY teams in every school district region.
- build, enhance, and maintain linkages between all these services.
Every citizen of BC can advocate for guaranteed access. We can start by talking to family, friends, and colleagues about the issue. Your BCTF local may also already be discussing advocacy for student mental health. Then, we can exercise our rights by writing to our local MLA to advocate for change.
This article is a summary of a much more comprehensive overview of the subject, which you can read at www.willtobe.org.
1 www.sencanada.ca/en/content/sen/committee/372/soci/rep/repoct02vol6part7-e
2 www.bccounsellor-digital.com/bcot/0122_spring_summer_2022/MobilePagedArticle action?articleId=1775872#articleId1775872
3 www2.gov.bc.ca/gov/content/governments/organizational-structure/ministries-organizations/ministries/education
4 https://link.springer.com/article/10.1007/s00787-021-01934-z
5 https://link.springer.com/article/10.17269/s41997-021-00567-8
6 www.mentalhealthcommission.ca/wp-content/uploads/drupal/MHCC_Report_Base_Case_FINAL_ENG_0_0.pdf
7 www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30024-4/fulltext