Almost half of children with mental disorders receive no help

Given the high burden of childhood mental disorders, all children with these conditions should have rapid access to effective treatments. Access to mental health services is also a fundamental right of all children, as evidenced by Canada and many other countries declaring their obligation to provide such services. To understand how well Canada is meeting its obligation to these children, The Children’s Health Policy Centre conducted an analysis to identify how many children with mental disorders received interventions for these conditions. We did so using data from our review on the prevalence of childhood mental disorders, which was originally published in Evidence Based Mental Health. 

Eight of the 14 high-quality epidemiological studies that we reviewed provided data on services children with mental disorders received. While all the data were high quality, each study defined and evaluated services somewhat differently. For example, some covered only mental health care, such as psychotherapy or psychiatric medications, while others covered a wide range of interventions, such as self-help groups and probation services. We also found gaps in the data, such as missing details on specific types of psychotherapy or medication and the duration of services. Our analysis nevertheless revealed that for children who were coping with mental disorders, only 44.2% — or fewer than half — received any services for these conditions.

For more information, see Vol. 16, No. 2 of the Children’s Mental Health Research Quarterly.

Childhood mental disorders create a heavy burden

Having a child with a mental disorder can have considerable consequences for families. For example, one study found that parents of children with mental disorders were significantly more likely to reduce their work hours or to end their employment altogether, compared with parents of children with physical health conditions. Parents of children with mental disorders were also significantly more likely to spend more than four hours per week arranging for child care, compared with parents of children with physical health conditions. Financial costs can also add up. For example, parents may have to miss work to address their children’s mental health needs, or they may face out-of-pocket expenses for medications or for psychosocial interventions that are not publicly funded.

Beyond these high individual burdens, childhood mental conditions also have significant consequences for society. Because these disorders are the leading cause of childhood disability, they come with steep costs in lost human potential. These disorders also come with large expenditures across multiple public sectors, including health care, education, and social and justice services. Costs are particularly high when children do not receive needed treatments or receive them in a timely way, such that mental health problems worsen and become needlessly entrenched, even continuing into adulthood. Yet effective treatment approaches for the majority of these disorders already exist and many of these treatments have been shown to be cost-effective. For more information, see Vol. 16, No. 2 of the Children’s Mental Health Research Quarterly.

Showcasing Indigenous-led-research

Centre Director Charlotte Waddell gave a virtual talk about a Nuu-chah-nulth-led study on healthy child development to the child health advisory board at the Canadian Institutes of Health Research on April 10.

The talk was titled, “Everything is One, Everything is Connected.”

Waddell presented together with SFU scholar Pablo Nepomnaschy, on behalf of Lynnette Lucas and the Nuu-chah-nulth Tribal Council team, the study leads.

The presentation described a multi-generational study being conducted by and within the 14 Nuu-chah-nulth Nations, whose ancestral lands are located on the west coast of Vancouver Island.

“As non-Indigenous research allies,” Waddell said, “team members from SFU are helping to merge the best of Indigenous and ‘Western’ science while upholding high ethical standards including ensuring Indigenous data sovereignty.”

“This study will be ‘the Framingham’ of Indigenous Peoples,” Waddell added, quoting Indigenous scholar Jeff Reading, who is co-leading the Nuu-chah-nulth project. Framingham refers to a famous long-term cardiovascular health study that began in 1948 and is now on its third generation of participants, helping to improve population wellbeing.

Funding and community consultations for the Nuu-chah-nulth project began in 2017 and continued in 2022 with a grant of $15 million over six years from the Canadian Institutes of Health Research, in partnership with Alberta First Nations.

“Everything we do,” Waddell said, “involves constant reciprocity and respect for Indigenous Knowledge and wishes.

“We are working to overcome some of the harmful legacies of colonialism by supporting Indigenous leadership of research that is by and about them, as one step towards truth and reconciliation.”

Childhood mental disorders are more common than many think

To estimate the percentage of children with mental disorders, the Children’s Health Policy Centre analyzed data from nearly 62,000 young people contained in 14 high-quality studies. We found that 12.7% of children, or approximately one in eight, met diagnostic criteria for a mental disorder at any given time. In BC, this means approximately 95,000 young people currently meet criteria for a mental disorder, making the burden high across the province. And many children carry an even higher burden as 26.5% of young people with disorders had two or more concurrently.

We also calculated prevalence for 12 of the most common disorders or disorder groups. Anxiety disorders topped the list at 5.2%. Other common problems included attention-deficit/hyperactivity disorder (ADHD, 3.7%), oppositional defiant disorder (3.3%), any substance use disorder (2.3%), major depressive disorder (1.3%) and conduct disorder (1.3%). For more information, see Vol. 16, No. 2 of the Children’s Mental Health Research Quarterly.

World Autism Awareness Day is April 2

The UN will observe World Autism Awareness Day on April 2 with a virtual event designed to promote acceptance and appreciation of autistic people and their contributions to society. The theme for this year’s event is Moving from Surviving to Thriving: Autistic individuals share regional perspectives.

The event is organized in collaboration with autistic advocates and participants and will be delivered by the Institute of Neurodiversity, a non-profit organization established and run by neurodivergent people for neurodivergent people and their allies. Additional support comes from the Group for Autism, Insurance, Investment, and Neurodiversity.

Event organizers have gathered an all-autistic lineup of panelists representing the six inhabited areas of the globe — Africa, Asia and the Pacific, Europe, Latin American and the Caribbean, North America and Oceania. The panelists will share regional perspectives and together will provide a global overview of the state of affairs for autistic people.

The event will take place from 10 am to 1 pm EDT. You can register to attend the virtual event here.

International Day for the Elimination of Racial Discrimination is March 21

Observed annually on March 21, the International Day for the Elimination of Racial Discrimination commemorates the Sharpeville Massacre of 1960, when police in Sharpeville, South Africa, killed 69 people at a peaceful demonstration against apartheid “pass laws.” The United Nations General Assembly designated the day in 1966. It calls on all of us — individuals, organizations and governments — to work to end racial discrimination in all areas of life.

As a determinant of health, racism has a profound impact on child well-being. To learn more about this and about our evaluation of childhood antiracism interventions, see Volume 15, No. 3 of the Children’s Mental Health Research Quarterly.

How practitioners and policy-makers can support children with obsessive compulsive disorder

Findings from a recent systematic review by the Children’s Health Policy Centre offer hope for children with obsessive compulsive disorder (OCD). These results suggest five implications for practice and policy:

  • Start with Cognitive Behavioural Therapy (CBT) for childhood OCD. A strong body of evidence supports CBT — showing that it produces clinically meaningful reductions in both symptoms and diagnoses. It is also effective for children ranging from ages three to 18. CBT should therefore be the starting point for treatment.
  • Build CBT capacity. Despite the strong evidence for CBT’s effectiveness in treating OCD, many young people have difficulties finding a practitioner to provide this intervention. In fact, in most countries, young people with OCD have limited access to CBT. Canadian policy-makers therefore may need to invest in training so that more practitioners can provide this highly effective treatment in public settings — and so that all children with OCD can receive timely treatment, with no out-of-pocket costs.
  • Support family involvement. CBT for OCD often incorporates families into the treatment. The roles for families can be extensive, ranging from helping to develop treatment goals to encouraging children to practise CBT techniques. For younger children, family involvement is critical, as Family CBT is the form of CBT that has shown efficacy with children younger than age eight. For older children, family involvement should also be encouraged where feasible. As well, when family issues impede CBT’s effectiveness, Positive Family Interaction Therapy may be a helpful addition.
  • Reach more children in need by expanding delivery options. Many children can benefit from CBT without ever entering a practitioner’s office. Studies show the effectiveness of telephone- and internet-based CBT equals that of in-person delivery for many children. These delivery modalities also make it possible to reach more children, including those in more remote communities. Internet delivery may also help reduce costs because it requires less practitioner time.
  • Consider medications when CBT does not succeed. Some children continue to experience impairing symptoms, even after an adequate course of CBT. For these children, medications should be considered — particularly fluoxetine and sertraline, given their efficacy and more favourable adverse event profile. Still, children taking either medication need to be carefully monitored to assess both its effectiveness and potential adverse events.

All children diagnosed with OCD need rapid access to CBT. By providing this treatment early in the disorder’s course, associated distress and impairment for children and their families can be greatly contained. For more information, see Vol. 16, No. 1 of the Children’s Mental Health Research Quarterly.

Preventing and Treating Childhood Eating Disorders

  • How can we prevent and treat childhood eating disorders? This presentation from February 2024 looks at the prevalence of eating disorders in young people and identifies what puts youth at risk. It also discusses effective interventions for the prevention and treatment of these disorders.

Parents can help children with obsessive-compulsive disorder by disengaging

Watching a child struggle with OCD symptoms can be both agonizing and frustrating. As a result, many family members try to help by assisting with their child’s OCD rituals. This can range from a mother repeatedly answering her son’s questions about his well-being to reduce his distress to a father changing his work schedule to allow more time for his daughter to repeatedly check the locks when leaving home. The frequency of family members participating in children’s OCD symptoms is so common that the term “family accommodation” was coined to describe it.

In fact, one study found that 99% of parents reported participating in at least one type of accommodating behaviour and 77% reported doing so daily. Despite parents having the best of intentions, accommodating OCD symptoms comes with risks, including maintaining or worsening the severity of the child’s symptoms and impairment. But the good news is that parents can learn strategies that help them disengage from these behaviours. For more information, see Vol. 16, No. 1  of the Children’s Mental Health Research Quarterly.

Help defeat bullying by marking pink shirt day

Pink Shirt Day, also known as antibullying day, encourages people across Canada to stand against all forms of bullying. Since its inception in 2007, Pink Shirt Day has helped raise millions of dollars for antibullying initiatives. This year, on February 28, participants in schools and workplaces nationwide will come together to raise awareness, promote inclusion and celebrate acts of kindness.

Bullying remains a significant problem in schools — a 2019 report by Smith et al. and the McCreary Centre Society found that 53% of BC students aged 12 to 19 years reported experiencing at least one form of bullying in the past year. But the right interventions can make a difference. In fact, the Children’s Health Policy Centre’s recent systematic review of antibullying programs found five interventions that reduced at least one form of bullying. To learn more, see Vol. 15, No. 4 of the Children’s Mental Health Research Quarterly.