Did You Know?

On October 10 — World Mental Health Day — mental health organizations and advocates will come together to speak out for better mental health supports in the workplace as part of this year’s theme, “Mental Health at Work.” More than 60% of the global population is employed, making workplace metal health a vital issue for governments, employers and employees to address. Ensuring caregivers and parents have adequate mental health support in the workplace is critical, as the mental health of caregivers significantly impacts that of children and youth. Conversely, childhood mental disorders can also have considerable consequences for families, including parents having to miss work to address their child’s mental health needs. To learn more about the high burden associated with childhood mental disorders, see Vol. 16, No. 2 of the Children’s Mental Health Research Quarterly.

The National Day for Truth and Reconciliation, held annually on Sept. 30, offers an opportunity to reflect on the harms done to Indigenous peoples by Canada’s colonial and residential school systems. From 1867 through 1996, there were 140 federally run residential schools in operation in Canada. The day honours the Survivors of those schools and the children who never returned home.

The National Day for Truth and Reconciliation coincides with Orange Shirt Day, a grassroots initiative that commemorates the residential school experience and promotes the idea “Every Child Matters.” By wearing an orange shirt on Sept. 30, participants can help promote awareness of the individual, family and community intergenerational impacts of residential schools and make a statement in support of reconciliation.

Orange Shirt Day and the Day for Truth and Reconciliation offer a chance to open a dialogue on anti-racism. As a determinant of health, racism has a profound impact on child well-being. To learn more about the impacts of racism on young people, see Vol. 15, No. 3 of the Children’s Mental Health Research Quarterly.

The International Day of Non-Violence occurs a few days later, on October 2. The day commemorates the birth of Mahatma Gandhi, leader of the Indian independence movement. Gandhi used non-violent activism to help end British colonialism in India. Established by the UN in 2007, the goal of the day is to spread the message of non-violence. According to the UN, it reaffirms the desire “to secure a culture of peace, tolerance, understanding and non-violence.”

Violence in the home, including physical punishment, can be a disruptive force in the lives of children and youth. While physical punishment used to be commonplace, fewer and fewer parents are using this form of discipline. To learn more about the trend towards a violence-free childhood, see Vol 9, No. 1 of the Children’s Mental Health Research Quarterly.

Findings from a recent systematic review by the Children’s Health Policy Centre offer hope for children at risk of being hospitalized.  These findings suggest four implications for practice and policy:

• Reduce mental health hospitalizations safely by supporting children in community. An evaluation of a program known as Home Treatment provides evidence that it is possible to shorten inpatient stays when adequate outpatient supports are provided. Young people with these extra supports had stays that were 21 days shorter compared with regular services without any difference in overall functioning eight months later.

• Recognize that extra supports after hospital discharge can have wide-ranging benefits. A study of a program known as Supported Discharge Service demonstrates it’s possible to reduce the number of children frequently engaging in self-harm, while increasing their engagement in school and other productive activities. These findings suggest that supporting children after hospitalization can yield multiple gains across multiple domains.

• Build on the research evidence to better serve children in rural and remote communities. Supported Discharge Service was delivered in two regions, one of which was rural, showing that it is feasible to provide intensive mental health services even in more remote communities. Using technology to deliver interventions virtually may be another way to reach more children in rural and remote communities. Such delivery is increasingly common since the COVID-19 pandemic began, according to a recent US study of mental health care delivery, which found a twelvefold increase in psychologists’ use of telecommunications such as video calls.

• Support children post-hospitalization knowing that doing so will pay off. The Home Treatment and Supported Discharge Service studies both provide evidence of cost-effectiveness. These findings suggest that any costs associated with providing added supports post-hospitalization are likely outweighed by the benefits. For example, even though the costs of Supported Discharge Service were not significantly lower than regular services, the intervention was still cost-effective when considering the benefits it produced, including reducing self-harm and increasing engagement in productive activities.

The CHPC review suggests that after a mental health hospitalization, young people can be supported to return home more quickly and remain there, with less need for rehospitalization. This review also found that intensive community-based services are cost-effective, enabling children and youth to flourish without the impediment of prolonged or repeated hospitalizations. When these interventions are coupled with adequate investments in programs that address social determinants of mental health as well as effective prevention and treatment programs, fewer children will likely need hospital care for mental health issues.

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

Health care practitioners in BC are working to improve the hospital experiences of Indigenous children and their families. Their efforts include hiring staff to help Indigenous individuals receive high-quality, culturally safe health care. Although there is variation across health authorities, such positions can include Aboriginal Patient Liaisons, Aboriginal Patient Navigators, Indigenous Patient Navigators and Indigenous Liaison Nurses. These workers provide a range of services that can include ensuring that planning takes patients’ needs into account; facilitating communication and cultural understanding between patients and providers; assisting with language translation; and making referrals to appropriate community resources.

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

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.

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.

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.

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.

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.

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.