This is the second in a two-part series. Click here to read part one.
In 2008, the province was told it had “miles to go” to address mental health issues in children.
Seven years later, 69 per cent of children with mental disorders – more than 50,000 kids – still do not receive specialized services.
The government says progress is being made, with 5,000 more children getting help. But while that number has increased, The News has found that the agency tasked with treating such kids employs fewer nurses and psychologists than it did in 2008.
Similarly, over the last seven years, provincial spending on Children and Youth Mental Health (CYMH) services has failed to keep up with inflation, much less the number of clients.
This comes despite repeated pleas – from parents, from the province’s Representative for Children and Youth, and last November from the BC Liberal-chaired Select Standing Committee on Children and Youth– for the government to make youth mental health a priority.
That has left service providers doing their best to treat a growing clientele with funding that hasn’t seen a substantial boost in years.
As the executive director of the Fraser Valley Child Development Centre (FVCDC), Karen McLean oversees a team that provides support to children with developmental and behavioural disorders – including ADHD (Attention Deficit and Hyperactivity Disorder) and Anxiety Disorder.
McLean said her organization has been receiving more referrals in recent years – often from schools.
McLean says the CYMH front-line staff do great work in assisting families, but there have been no appreciable hikes in funding for FVCDC programs for some time. Asked when funding last increased, a long pause follows.
“It’s been probably seven or eight years.”
In 2003, the province created a special plan it labelled as a landmark in efforts to address mental health concerns in children. Five years later, a follow-up report was issued called “Promises Kept, Miles to Go.” That title summed up the report’s diverse conclusions.
That 2008 report found that while advances had been made, “the overall child and youth mental health service system is clearly inadequate in many respects.”
Since then, British Columbia’s Representative for Children and Youth, Mary Ellen Turpel-Lafond, has repeatedly told the government that the mental health system for children is failing and requires significant improvement.
And last year, a team headed by SFU professor Charlotte Waddell delivered a strong call to action in a report prepared for the Ministry of Child and Family Development (MCFD).
Families face “stark service shortfalls,” and only one-third of children who need help get it, Waddell and her team wrote.
“Mental disorders are arguably the leading health problems that Canadian children and youth face from infancy onwards,” the report concluded. “These shortfalls would not be tolerated for physical health problems in young people, such as cancer or diabetes, and should no longer be tolerated for mental health problems.”
That report recommended tripling investments in evidence-based treatment systems and prevention programs to both treat mental disorders and reduce their prevalence in the province. That sounds expensive, but the B.C. government’s current spending on CYMH is just 0.2 per cent of provincial spending.
In 2008/9 the CYMH budget doubled to $89 million. Since then, as the total provincial government budget has grown by 21 per cent to $45 billion – more than half of which goes to health care – spending on child and youth mental health has risen by just $4 million, or 4.4 per cent over six years, a figure less than the inflation rate.
The increase in the number of children and youth receiving services means there has been a decrease in per-child funding.
The $93 million allocated to CYMH services last year was less than half of what the government spent on Community, Sport and Cultural Development. It’s also less than seven per cent of the province’s total spending on mental health and substance use services.
The 2015/16 budget saw total government spending rise by $500 million. Of that, $1.3 million went into CYMH services.
The lack of spending growth can be seen in staffing levels, with the number of psychiatrists and nurse clinicians employed by CYMH declining over the last seven years.
In 2008, the province employed 59 front-line nurses and seven supervising nurses, according to numbers provided by the MCFD.
By 2015, the number of front-line nurses had dropped to 42, although the number of supervisors had risen to 10.
The number of front-line psychologists declined from 37 to 33 over the same seven years, while the number of supervising psychologists rose from six to eight.
In response to a series of questions about changing staffing levels, a government spokesperson said the number of front-line staff employed by CYMH has increased by two per cent, from 442 to 453. Most of those are social program officers who provide services such as intake, assessment, diagnosis, treatment and crisis intervention for children. Such officers make considerably less money than psychologists.
After repeated requests for an interview with MCFD minister Stephanie Cadieux over the course of several weeks, The News was informed the minister was unavailable.
MCFD communication staff did provide written statements to a series of questions regarding child and youth mental health.
The statements, attributed to the minister, acknowledge that more B.C. children are facing mental health challenges. Asked if child and youth mental health is a priority, the statements point to the $1.3-million rise in CYMH funding as evidence that the government is “committed to serving and supporting children and youth with mental health and/or substance use challenges and their families.”
They also pointed out that ministry of health spending on mental health and substance issues has increased by 63 per cent since 2000, although the majority of those services are targeted at adults.
The ministry added: “Is there more to do? Yes, there is always more we’d like to do. And when budget allows, we will continue to look at areas where an increased investment will make the most impact.”
The ministry also cited several improvements to the system as evidence of progress, including online tools to help families find information on services, and a partnership with the Canadian Mental Health Association (CMHA) to deliver “an early intervention telephone-based coaching program to support families.”
The ministry also implemented a more efficient intake process in 20 communities. After determining wait times had been reduced “from days to hours,” the process will be rolled out provincewide.
And the ministry recently promised more money for Families Organized for Recognition and Care Equality(FORCE), a group that works to support families.
When it comes to reforming the system, the provincial government isn’t short on advice.
Nearly a year after receiving the Waddell report, MCFD staff “are still reviewing the recommendations and will work to incorporate them in our work moving forward,” according to the ministry.
Meanwhile, the province’s Select Standing Committee on Children and Youth – which exists to receive reports from Turpel-Lafond – launched a “special project examining youth mental health” in the province. The project is now in its second phase, and is holding public meetings with service providers and stakeholders.
In November, the committee, which is chaired by BC Liberal MLA Jane Thornthwaite, and includes MLAs from both major parties, including Abbotsford South MLA Darryl Plecas, delivered an interim report to the legislature that declared “the prevalence of mental health issues among youth is alarming,” and that “current service levels and delivery models are not meeting growing demands for services.”
The report continued: “The committee believes that youth mental health needs to be treated as a high priority by government, and that a concerted effort is required to develop a cohesive and effective mental health system that provides timely, responsive, and seamless services to youth and families. This will require additional resources, enhancements to existing services, and the identification of service delivery models tailored to meet the specific needs of communities across the province.”
Three months later, that interim report was on the minds of staff at the B.C. division of the (CMHA) when they evaluated the provincial government’s 2015/16 budget.
With the budget for CYMH services slated to increase by just $2.8 million over the next three years, Jonathan Morris, public policy director for CMHA BC, called the budget a “missed opportunity.”
In an interview, Thornthwaite, who is also the parliamentary secretary for child mental health, wouldn’t comment on budgeting for CYMH programs, saying that is not her role.
The standing committee will eventually deliver recommendations on how to improve the child mental health system. But asked whether parents should expect improvements and action to result from those recommendations, Thornthwaite avoided making any promises.
“I can’t speak on behalf of government; what direction they’re going to go,” she said. But she did point to the creation of an integrated model of service delivery in the interior of the province.
“There’s a lot of movement going ahead right now.”
Asked if government would commit to implementing any recommendations from Thornthwaite’s committee, a MCFD statement attributed to Cadieux said government would “consider” them.
Earlier this month, the standing committee was briefed on the New Brunswick delivery system. Thornthwaite said she was intrigued to hear that province had improved services by fostering more co-operation between providers – and that it didn’t require more funding.
Meanwhile, back at the FVCDC, McLean said staff are doing their best with the available resources.
“There are kids who are waiting for services,” she said.
She is optimistic that some of the structural changes being made will help make the system more efficient and easier to navigate.
McLean believes uncertain economic times have limited government spending, but she warns that underfunding the system isn’t necessarily economically prudent in the long run, citing societal costs that come with dealing with adults with addictions, mental illnesses and learning disabilities.
“The importance of our investment in young children, in their positive growth and development and early intervention when they have struggles, will pay for itself down the road,” she said.
“Hopefully, the economy improves.”