Dr. Peter Szatmari, Chief, Child & Youth Mental Health Collaborative, SickKids, CAMH and University of Toronto, Chief of the Department of Psychiatry, SickKids, and Trustee, SickKids Centre for Community Mental Health Board of Trustees, gives an assessment of the current state of mental health care for children and youth, and why we have reason to be optimistic.
Simply stated, for the population of children with significant mental health challenges, the short and long-term health outcomes are simply not good enough. In Ontario, about 20 per cent of children and youth have a mental health challenge; about half of those (or ten per cent of the population) have a mental disorder. Even children under five years of age experience high rates of mental health problems. Only about one in six children with a disorder are able to access services. The prevalence of disorders, particularly anxiety and mood disorders, seems to be increasing in the last decade, putting added pressure on existing services.
While we do have evidence-based interventions that are modestly effective, internationally too many children and youth (about 50 per cent) do not access them, do not respond to treatment or only achieve partial remission. In the ‘real world,’ many children and youth that need these services are unable to access them either due to stigma, or a lack of understanding of how these types of health problems present. All too often, when children and youth do access services, they do not stay engaged until the completion of treatment. Most youth only attend on average half of the number of recommended treatment sessions. Moreover, many services that are provided by hospitals or in the community are not evidence-based and instead are driven by the providers’ preference or training.
On the other hand, there is much room for optimism
There has been a remarkable progress in the field in the last decade both in understanding basic mechanisms that might underlie mental health challenges, in developing new and innovative interventions and in understanding how to translate those interventions into clinical practice. Our understanding of brain mechanisms that underlie mental health disorders has expanded remarkably. We now know a great deal more about brain circuits associated with social processes, fear, and reward systems. These discoveries hold out great promise for future discoveries and advancements. We also know much more about the genetic vulnerability associated with mental disorders and this holds great potential for prevention and drug development. There is no question that much remains still to be done to improve the effectiveness of our current interventions, to make them more cost-effective and easily available. The long-term dream is to ensure that the right kid gets the right intervention at the right time for the right cost. To do this, we have to develop new models of service delivery that involve partnerships with community providers and take full advantage of technology both as a way of monitoring mental health symptoms and as a way of delivering key interventions.
At SickKids, at SickKids Centre for Community Mental Health, and in the mental health community at large, there has never been a more exciting time to be more involved in research and in the clinical delivery of mental health services to children and youth. There is a sense of excitement and collaboration that has never been there before as the possibility opens up that we can finally make a real difference in the lives of millions of children, youth and their families who struggle every day with mental health challenges.