Raise awareness of FASD and suicide prevention in September

Sept. 9 and 10 are important days for raising awareness of two preventable health concerns.

Sept. 9 marks international Fetal Alcohol Spectrum Disorder (FASD) Awareness Day. Founded by three parent advocates in 1999, the day takes place on the ninth day of the ninth month to highlight the importance of avoiding alcohol for the full nine months of pregnancy. It was established to bring attention to FASD and to highlight the impact of prenatal exposure to alcohol on fetal development. FASD Awareness Day also advocates for better diagnosis and support for individuals living with FASD. To learn more about the prevention of FASD, see Vol. 5, No. 2 of the Children’s Mental Health Research Quarterly.

The following day, Sept. 10, is World Suicide Prevention Day. Suicide is a major global health problem leading to more than 700,000 deaths each year. World Suicide Prevention Day aims to spread the message that suicide is preventable. It also raises awareness, works to reduce stigma and emphasizes the need to prioritize mental health and suicide prevention in government policymaking. This year introduces a new triennial theme, Changing the Narrative on Suicide, which advocates for a societal shift from a culture of stigma and silence to one of support and understanding. To learn more about suicide prevention for young people, see Vol. 16, No. 4 and Vol. 17, No. 1 of the Children’s Mental Health Research Quarterly.

What puts young people at risk for multiple mental health hospitalizations?

Despite the drawbacks of hospitalization, for many young people it is a repeat experience. A recent meta-analysis involving more than 83,000 young people found that 13.2% were readmitted to a psychiatric hospital after being discharged. BC data show similarly problematic readmission rates, with 553 young people being hospitalized for mental health concerns three or more times in 2019.

Researchers have been able to identify risk factors for being readmitted to hospital including initial hospitalizations being due to suicidal ideation and diagnoses involving psychotic, bipolar, attention-deficit/hyperactivity, autism spectrum, intellectual or eating disorders.

As well, youth with longer hospital stays and youth discharged to residential treatment were more likely to be readmitted than those with shorter stays who were discharged to other settings, such as their homes. Of note, age, gender, race/ethnicity, family psychiatric history, maltreatment history and non-suicidal self-injury were unrelated to readmission risk. Also unrelated to readmission risk were diagnoses of depressive, anxiety, oppositional defiant, conduct and posttraumatic stress disorders.

For more information, see Vol. 16, No. 3 of the Children’s Mental Health Research Quarterly.

Coming together to end overdose on International Overdose Awareness Day

International Overdose Awareness Day is the world’s largest annual campaign to end overdose. Convened each year by the Melbourne-based Penington Institute, the day acknowledges the grief felt by the family and friends of those who have died or been permanently injured by an overdose, raises awareness of overdose and spreads the message that drug overdose is preventable.

This year’s theme, “Together we can,” encourages people to come together on August 31 and support those connected to the tragedy of overdose. Visit the International Overdose Awareness Day website to learn more and access campaign resources.

Overdose deaths and opioid misuse are a critical problem in BC. The BC government declared a public health emergency eight years ago due to the number of toxic drug related overdoses. When it comes to children and youth, knowing how many young people are using opioids is critical to inform prevention efforts. To learn more about opioid use and prevention in children and young people, see Volume 18, No. 2 of the Children’s Mental Health Research Quarterly.

Why Canada needs to invest in opioid prevention for children

A prevention program for Grade 7 students could help end the opioid crisis, according to a recent article by the team from the Children’s Health Policy Centre.

Published in The Conversation, the article is based on research findings about school-based primary prevention interventions over the last 20 years.

“Many of Canada’s responses to the opioid crisis still focus downstream on adults, after problems have started or become entrenched,” the article said. “In contrast, primary prevention operates upstream in childhood — before most young people start engaging in substance use, misuse or experimentation.”

The two most promising school-based programs are: Strengthening Families and Project PATHS, and they have been tested in the US and Hong Kong. Both led to significant reductions in opioid use by young people, including over long-term follow-up.

The two programs have another feature adding to their appeal for delivery in Canada, according to the authors. Training for facilitators is very brief — only two days for Strengthening Families and three days for Project PATHS.

“The short training time also helps reduce delivery costs, further increasing the appeal for policy-makers and school administrators,” the article said.

In concluding, the authors noted that the federal government has committed more than a billion dollars since 2017 to address the toxic drug problem — paralleled by provincial and territorial funding. “But a policy shift towards meaningful prevention also requires tackling the realities of current Canadian health spending priorities,” they said.

“Only 6.1% of health spending in 2023 went towards public health including prevention, a longstanding pattern. So concerted, coordinated and collaborative efforts are needed within and across every policy level and jurisdiction.”

So new prevention efforts are badly needed to tackle the opioid crisis in Canada — thereby ensuring that many more children do not go on to experience avoidable harms.

Read the full article here.

International Youth Day 2024 celebrates youth digital innovation

Young people are increasingly connected to technology and are leading the way in digital innovation. That’s why the UN’s theme for International Youth Day this year is “From Clicks to Progress: Youth Digital Pathways for Sustainable Development.”

This theme celebrates young people’s digital contributions while highlighting the challenges youth face, including disparities in access to technologies and digital skills for young women and youth in low-income countries. International Youth Day 2024 advocates for enhancing digital inclusion and recognizing the contributions of young people as digital innovators.

International Youth Day was established by the UN in 2000. It advocates for the meaningful inclusion of youth in all areas of society and is held annually on August 12.

The 50th edition of the Children’s Mental Health Research Quarterly celebrates youth and offers fifty lessons learned to help improve young people’s mental health. To learn more and explore these 50 lessons, see Volume 13, No. 2.

Transgender youth face significant health concerns

Transgender and nonbinary children and youth often face significant challenges compared to their cisgender peers. Many experience peer victimization, and trans teens also face verbal harassment in many Canadian schools. These adverse experiences also extend into the home, where trans and nonbinary youth may face emotional neglect or abuse by a parent or other adult.

These experiences cause significant harm, and they also place trans and nonbinary youth at risk for secondary mental health disorders such as depression and anxiety.

Knowing how many transgender and nonbinary youth are dealing with these disorders is critical to inform prevention and treatment efforts. A recent report by the Children’s Health Policy Centre, funded by the BC Ministry of Health, investigated the prevalence of mental health concerns for trans and nonbinary young people.

The report identified:

  • The overall prevalence of mental disorders in transgender and nonbinary youth, which is 56.6% This makes it between 5.9 and 13 times higher than their cisgender counterparts.
  • Significant rates of self harm or suicidal ideation among transgender and nonbinary youth, with prevalence up to five times higher than in their cisgender peers.
  • A need for easily accessible and effective mental health treatments for these children and youth.
  • The importance of addressing the unacceptable and preventable adverse experiences that many transgender and nonbinary young people face and that can contribute to the development of mental health conditions.

These findings can inform efforts to improve mental health service planning, delivery and equity for transgender and nonbinary children and youth in British Columbia.

To learn more, read the report and review the findings.

Mental Health of Transgender and Nonbinary Children and Youth: Informing Service Needs

Schwartz C, Barican J, White O, Tang J, Catherine N, Thomson K, & Waddell C. (2024). Mental Health of Transgender and Nonbinary Children and Youth: Informing Service Needs. Vancouver, BC: Children’s Health Policy Centre, Faculty of Health Sciences, Simon Fraser University.

Executive Summary

Many transgender and nonbinary children and youth face added challenges compared with their cisgender counterparts, including more frequent adverse experiences, peer victimization and harassment. These avoidable hardships cause harm in and of themselves and also raise risks for secondary mental health problems. Knowing the prevalence of mental health concerns for transgender and nonbinary young people is therefore crucial as the numbers of those in need can and should inform service planning to ensure both adequate mental healthcare and greater equity. 

To provide the most accurate estimate, we conducted a systematic review of studies on the prevalence of mental disorders in transgender and nonbinary young people. The two studies that met inclusion criteria, were both conducted in the United States (US). The first study assessed overall prevalence, finding that 56.6% of transgender young people had experienced at least one mental disorder in the previous six months — a proportion between 5.9 and 13.0 times higher than cisgender counterparts. As well, for individual disorders as well as disorder groups, prevalence was higher for transgender children and youth compared with cisgender counterparts. The second study focused exclusively on eating disorders, finding that 4.2% of transgender youth had this diagnosis — a proportion approximately 200% higher than expected according to studies in general populations of young people.

We also identified two studies that assessed suicidal ideation and self-harm including one of the previously cited American studies. This US study found that 3.2% of transgender youth experienced a self-inflicted injury in the previous six months according to health records — a rate at least 17 times higher than cisgender counterparts. As well, health records noted suicidal ideation for 6.3% of transgender youth — a rate approximately 24 times higher than cisgender counterparts. A Canadian study found even higher rates according to an anonymous survey. Researchers found that nearly 80% of transgender and nonbinary youth reported engaging in self-harm in the past year, approximately five times the rate for cisgender peers. As well, 65.2% of transgender and nonbinary youth reported suicidal ideation in the past year, five times the rate for cisgendered peers.

The high prevalence of mental health concerns for transgender and nonbinary young people underscores the need for easily accessible and effective mental health treatments with these populations. It is also imperative that public mental health services be provided with intensity that is proportionate to the needs, and be delivered by practitioners within settings and systems that are sensitive to the experiences of these young people. This approach aligns with the World Health Organization’s recognition of mental health as a basic human right. It is equally crucial to address the unacceptable and preventable adverse experiences that many transgender and nonbinary young people face and that can contribute to the development of mental health conditions.  Ensuring mental wellbeing for these young people also requires adequate monitoring of service use in relation to the needs, as well as monitoring of social determinants including preventable adversities. Such monitoring plays a vital role because “what gets counted counts.” In other words, comprehensive collective efforts encompassing mental healthcare, prevention and monitoring are needed to bring about mental health equity for transgender and nonbinary young people in BC.

Read the full report here

Why community care is better than in-hospital treatment for children’s mental health

There are many reasons for ensuring that children receive needed mental health care in their communities. The physical environments of hospital emergency rooms, including their busyness and lack of privacy, can be challenging at any time, but even more so when a child is experiencing a mental health problem. When young people are hospitalized, they are also frequently asked to repeat their histories — which often include painful and traumatic experiences — to multiple care providers.

As well, many young people feel labelled and stigmatized after being hospitalized for their mental health needs. Given the discrimination experienced by countless Indigenous individuals in Canadian hospitals, this setting may be particularly difficult for children from these communities. Lastly, at a societal level, hospital care is costly and can consume a disproportionate share of funding for children’s mental health. 

For more information, see Vol. 16, No. 3  of the Children’s Mental Health Research Quarterly.

Rates of hospitalization increasing for children’s mental health concerns

From 2009 to 2019, Canadian hospitals saw a 60.6% increase in children’s emergency-room use for mental health concerns and a 59.7% increase in inpatient admissions. These Canadian data also reveal that ER use and hospitalizations have varied considerably based on children’s age, gender and place of residence. Youth aged 15 to 17 have the highest rates of both ER visits and hospitalizations among young people. The lack of community-based mental health resources for teens may be a possible reason for the disproportionate rates. And among these older teens, girls were twice as likely to be hospitalized as boys. As well, children from rural communities accessed ERs at rates that were nearly 50% higher than those from urban centres. Reasons for higher rural ER use may include a lack of mental health specialists and limited service options in these regions, as well as lengthy travel to access community-based services.

BC data tell a similar story. Here, children’s hospitalizations for mental disorders increased by 68.8% between 2009 and 2019. Notably, these substantial increases occurred despite there being more effective ways to support children. Overall, these data suggest that hospitals are becoming a de facto safety net for the many young people who experience “fragmented care and significant gaps in mental health service systems.”

For more information, see Vol. 16, No. 3 of the Children’s Mental Health Research Quarterly.

A population mental health strategy will help more children

To ensure social and emotional well-being for all children, an important step involves adopting a population mental health strategy. Such a strategy has four crucial pillars. First, policy-makers can address social determinants of mental health — for example, by implementing programs that reduce the number of children living with socio-economic disadvantage. Second, programs can be implemented to prevent disorders before they develop. Third, for those with mental disorders, timely and effective treatments can enable children to recover and resume their progress on positive developmental trajectories. The fourth pillar involves monitoring the success of these efforts and then making any needed adjustments to better address determinants, prevent disorders and provide treatments.

For more information, see Vol. 16, No. 3 of the Children’s Mental Health Research Quarterly.