Child and Youth Mental Health in Canada — Liudmila Husak, Chris Daken and Dr. Chris Wilkes

Avis Favaro

This episode deals with suicide and self-harm and may be upsetting to some listeners, so please note that help is available if you need it by calling 911 or your local crisis centre.

Hello and welcome to the Canadian Health Information Podcast. We call it CHIP for short. My name is Avis Favaro and I’m happy to host a brand-new season of this podcast from the Canadian Institute for Health Information, better known as CIHI. Our goal, an in-depth look at the Canadian health care system as we talk to experts, health workers, and patients about the challenges and potential solutions.

A note: the opinions presented here don’t necessarily reflect those of CIHI, but it is a free and open discussion about our beloved health system and the work that’s being done to help keep Canadians healthy.

On this week’s show, are the kids all right? When COVID shut down life as usual in the spring of 2020, health authorities focused on the immediate physical dangers from the novel coronavirus, but COVID and the measures to control its spread were massive stressors on adults and children who were cut off from school, sports, friends; some may have seen their parents lose work or their businesses; some may have been witnesses to family violence.

The data is showing the disruptions sent more children and teens into mental health crisis.

Chris Daken

With our first suicide attempt in the night that she called 911 herself, waking up to ambulance lights in your driveway is kind of a real eye opener. So after that, we knew we needed to get her some help.

Dr. Wilkes

We’ve had like a 200% increase in numbers coming to our emergency room, increase in a variety of disorders, including anxiety, depression, eating disorders, substance abuse, and the system is really stretched.

Avis Favaro

So we’ll look at the hard numbers, how it’s affecting families and the health system, if these changes are lasting, or if there’s a way to turn things around.

So first, a look at the data. And I’m joined by Liudmila Husak, manager of Health Systems Analytics at CIHI in Toronto.

Hi, Liudmila. So when we look — we’re trying to measure mental health in children. What exactly do you measure?

Liudmila Husak

So we look at the hospitalizations and emergency department visits. We also have data on medication use. We don’t have data on primary health care, so we kind of look at it through the hospital system lens as well as through the medications lens.

Avis Favaro

And what age ranges do you look at?

Liudmila Husak

We are looking at the children and youth, from 5 to 24.

Avis Favaro

Okay. And so what did you find?

Liudmila Husak

So this year was the first year where we started to look at the pandemic data. So first of all, we didn’t see an increase in hospitalizations and emergency department visits, but that needs to be positioned within the broader context.

So what happens within the first few months of the pandemic, people were afraid and worried to go to the hospitals, and they prefer not to go or seek care elsewhere. So the same way, some people chose not to go to be seen for mental health conditions.

However, if we look at the proportion of mental health to all other diseases, that proportion actually increased. So, in fact, 1 in 4 youth hospitalized in Canada last year, in 2020, were hospitalized for mental health conditions.

Avis Favaro

Was that surprising?

Liudmila Husak

It is quite a substantial — quite a big number I should say. What’s really surprised us is the eating disorders increase. And the group that really stood out for us was females, girls, 10 to 17, so for them, hospitalizations increased by 60% and emergency department visits increased by over 100%, so 115 to be precise. So that really stood for us because we look at the numbers frequently and that’s a rare occasion when we see such a huge increase just in 1 year.

Avis Favaro

And that’s worrisome.

Liudmila Husak

Yep.

Avis Favaro

Because you don’t know why, right?

Liudmila Husak

Yeah, there are some explanations for that. So there are linkages to the screen time, to being isolated, not being able to participate in the regular extracurricular activities or not being at school during the pandemic. So all these factors might have led to the increase.

Avis Favaro

What other measures were you finding in terms of medication? Were more children being prescribed antidepressants, antianxiety?

Liudmila Husak

Yes. This is also very interesting because unlike hospitalizations and emergency department visits that had a slight drop early, medications actually increased. So mood and anxiety medication use has been increasing for the last 10 years and it’s also increased in 2020.

What is also interesting about this data that’s the use is twice as high in females compared to males, and that trend continues over the pandemic. So even though people maybe chose not to go to the hospitals, to emergency department visits, they continued to be prescribed, so likely they got care elsewhere, through the primary care providers or elsewhere. And so we like to say that over the hospital lens, we’re looking at the tip of the iceberg. There’s also many people in the primary care or maybe not even getting care that we don’t see in our data.

Avis Favaro

And what about geography in terms of economic groups?

Liudmila Husak

For example, for overall mental health conditions, people living in the low-income neighbourhood are being seen more or kind of visit hospitals and emergency departments more for mental health conditions. For eating disorders, it’s a bit reverse. So it’s people living in the most affluent neighbourhoods are being seen most frequently in hospitals and emergency departments.

Avis Favaro

What does it tell us about the mental health of children and teens in Canada?

Liudmila Husak

Definitely there was an effect of the pandemic on the mental health. Definitely it was a negative effect. So some organizations declare as code pink, hospitals like SickKids or CHEO kind of raise an emergency alarm in terms of the state of the children in mental health use in Canada and kind of calling attention to the issue.

Avis Favaro

Do you think it’s — 

Liudmila Husak

I think it’s warranted. I do hope, like as a mom of teenager and an 8-year-old, I hope now that everything has reopened the mental health would get better overall. Hopefully, the pandemic kind of is slowing down. But we’ll continue to monitor trends and we’ll see how it looks like next year.

Avis Favaro

Thank you very much, Liudmila. I appreciate it.

Liudmila Husak

Thanks, Avis. Thank you for having me.

Avis Favaro

Behind the numbers are families with painful stories, some who must live with the consequences. So we’re going to talk about what happened to 16-year-old Lexi Daken when she tried to get help for emotional struggles during the pandemic.

So joining us now is Lexi’s father, Chris Daken, in Fredericton.

Hi, Chris. How are you doing?

Chris Daken

Hi. I’m doing well. Thanks for having me.

Avis Favaro

Great. Thank you so much. Can you paint a picture for us of what Lexi was like?

Chris Daken

Lexi was kind of a typical teenager. You know, she had her circle of friends, was active in sports. We did a lot of family activities like skiing, camping, hunting, fishing, ATVing. She was a kid that spent a lot of time with family and friends.

Avis Favaro

You sent some photos. She’s a lovely girl. Did she ever have any signs of mental distress?

Chris Daken

Not really. Like it was kind of an onset quick. Like, I mean, I know she struggled with her mental health for a while, but I wouldn’t say that it was, like I know some kids probably struggle with mental health for several years, and like that wasn’t really the case with Lexi.

Avis Favaro

Was it the pandemic?

Chris Daken

I’m sure that played a part. I don’t think it — it wasn’t the only factor with Lexi’s mental health, but I’m sure the COVID restrictions played a part in how she felt.

Lexi was the type of person that liked a routine, get up same morning, come from home, from school, homework, chat with friends, activities. So when COVID hit, that pattern in her life really changed. She didn’t have that group of friends to talk to everyday at school and I guess it’s not the same as talking to somebody on a phone with Snapchat or Instagram or whatever. Like it’s not that personal connection, I guess, and I think that was a part. Sports were restricted which were all activities Lexi done, so there were several, I guess, mitigating factors too, so.

Avis Favaro

So what did you see happen to her mood?

Chris Daken

She just seemed to get a little more like isolated once COVID hit. She was probably in her bedroom a little bit more than she had normally been. She wasn’t as much in the living room with the rest of the family like.

Avis Favaro

When did you start to get worried?

Chris Daken

I guess really when I first got worried was probably like Lexi’s first suicide attempt back in November. Like up until that, I mean, I knew she was kind of depressed and sad, but I guess as a parent, like maybe you have a blind eye to your own child, right? And you don’t think that stuff’s going to happen.

But I guess with her first suicide attempt in the night that she called 911 herself, waking up to ambulance lights in your driveway is kind of a real eye opener. So after that, we knew we needed to get her some help, so.

Avis Favaro

You went looking for help. What did you find when you said, please, my daughter needs help?

Chris Daken

Well, I’m sure I found the same as what a lot of parents, not just in New Brunswick, but across the country, that there’s a lot of closed doors. Mental health access in Canada is not an easy thing to get. We never really got the service that we needed from the hospital.

Avis Favaro

Can you share what the diagnosis was?

Chris Daken

Depression and borderline personality disorder. I found the diagnosis hard to comprehend. I’m not a professional, so maybe there were tell-tale signs that they seen right away, and I’ve never said that the diagnosis was right or wrong, I’ve just always felt that that would be a hard thing to diagnose with, you know, a half hour, 20-minute visit.

Avis Favaro

How long did Lexi wait in hospital to be seen?

Chris Daken

I think it was almost 8 hours.

Avis Favaro

Was she ever seen by a psychiatrist?

Chris Daken

No.

Avis Favaro

They went home before they could see her? So what do you think about how she was treated at the hospital, that last time?

Chris Daken

I mean, obviously, I’m not happy with the service. You know, if somebody goes in with a heart attack or a broken arm or a broken foot, they get the service. And it’s never a question of, you got a broken arm, I don’t want to see you today, come back tomorrow. Like that’s never a question on something like that. But it just seems to be the way our health care system looks at a mental health patient.

Avis Favaro

Were you worried when they discharged her that she was going to die?

Chris Daken

No. Even the night Lexi died, like her and I had drove to Saint John together, just her and I, and that trip, you know, we were making plans for the weekend and making plans for the summer, so I was never expecting that to be our last night, so.

Avis Favaro

So, must have been an incredible shock. Could her death have been prevented?

Chris Daken

Absolutely. Yeah. And that’s already been — after Lexi’s death caused like a fairly large media stir here in New Brunswick and all into Canada. And I know her story had went across Canada for a while and with the amount of media attention and stuff that her story had garnered by us sharing what had happened and the scenario, like our New Brunswick Child and Youth Advocate team had commissioned a couple reviews and reports, and right in that report the Child and Youth Advocate team had determined that Lexi’s death was preventable. And so.

Avis Favaro

You must feel let down.

Chris Daken

Yeah. I mean, it’s been almost 16 months, so you kind of come to grips with certain things after a while. They don’t ever get easier but you kind of learn to live with the heartache and grief, I guess, so.

Avis Favaro

Yeah. A lot of parents wouldn’t want to talk about solutions when they’re dealing with grief, but you’ve made it part of your mission to try and make things better. What would you like to see done when a teen like Lexi goes to emergency?

Chris Daken

You take a 15- or 16-year-old kid that willfully admits to somebody that I don’t want to live anymore, and then you present at the ER hoping to get some help, then the ER basically pushes you away, it’s almost like the ER’s calling or a hospital’s almost calling your bluff; are you really going to do this or not?

And that’s the frustrating part as a parent and I know there’s probably hundreds and thousands of parents that feel the exact same way as me, as like what do I have to do to get my child the help that they need?

Avis Favaro

So the province did respond with some recommendations on how to deal with kids and teens like Lexi. Is that a start?

Chris Daken

It’s a start. There were 21 recommendations that the health minister promised that would have been implemented within a year’s time. And I think when we did — or I guess when CBC did the report on those 21 recommendations, 9 have been implemented and the others have all been marked as in-progress.

Avis Favaro

What is your message in regards to children and mental health?

Chris Daken

From that report that they released, Greg Nicholas talked about hospitals put a dollar value on the death of each child. And the number that he gave was quite a drastic number. This is basically what it costs our province for every child death that we have, regardless of the circumstance.

So I looked at that number, and I’m thinking, like, if — we’ll say, like $750,000 is what it costs the province for a death. Why isn’t that money better spent in up-front care as opposed to reactionary care or cost?

I know government has to put more money into the hospital system to recruit more staff to give better access. We’re going to have more mental health professionals, like psychiatrists, psychologists, counsellors, that’s all needed. And I’m sure if you ask any one of them right now, they’re probably maxed out to their limits of what they can handle for patients.

Avis Favaro

But — there’s a but here — we need more. It might have saved Lexi’s life.

Chris, I just want to say thank you so much. When someone is filled with grief, as you and your family must be, it must be very hard to talk about it. But hopefully, somebody out there listening will hear your story and join in the efforts to get better services.

In emergency rooms and clinics across the country, mental health experts are now trying to cope with what many say is a full-blown emergency. More kids who need counselling and medical care for depression, drug use, and eating disorders. But there is also a backlog of cases and long waits for care, if they get it at all.

So joining us now is Dr. Chris Wilkes, a psychiatrist in Calgary, and you work at Alberta Health Services. Hi, Dr. Wilkes.

Dr. Chris Wilkes

Hello there, Avis.

Avis Favaro

So tell us what you started to see during the pandemic in terms of cases.

Dr. Chris Wilkes

Well, during the pandemic, the first thing we observed was a decrease in visits to all of our services as there was that lockdown and shutdown of schools and shutdowns of other social activities.

And then there was a gradual increase of numbers of patients coming to the emergency room, and that continued right until most recently, this winter and spring, when we’ve had like a 200% increase in numbers coming to our emergency room, increase in a variety of disorders including anxiety, depression, eating disorders, substance abuse, suicidal behaviour. So we have been very, very busy.

Avis Favaro

Right. When you say 200% increase, that sounds huge.

Dr. Chris Wilkes

Well, we use the term tsunami of mental health referrals. And as you alluded to earlier, our cousins south of the border, we’ll say, they declared a national emergency for children’s mental health. We haven’t declared a national emergency, but we are certainly stressed and there is a crisis in terms of support for children and mental health patients.

Avis Favaro

Were there any cases that struck you? Stick with you?

Dr. Chris Wilkes

The cases that stick in my mind are those cases where we were unable to save people and there were certain situations where adolescents were using substances and they died accidentally, I think as an overdose, because there’s no one there to help them survive with a naloxone pen.

Avis Favaro

What’s the youngest?

Dr. Chris Wilkes
We are seeing, Avis, a lot more of the younger children, 10 to 14, who are coming in states of distress and sometimes self-injury, that they haven’t had the access to some of the other lethal means to hurt themselves, but they’re in complete disarray, disorganization, and need help.

Avis Favaro

How do you feel? You’re a psychiatrist. You trained to help children.

Dr. Chris Wilkes

Yes. Yes. Well, that’s a really good question and I think I would speak not just for myself and my colleagues, it’s exhausting and it is, at times, demoralizing when you realize that the need for children/adolescents is just so large.

All you can do is provide a small contribution to decreasing the suffering and the burden of suffering for families. And there’s a lot more that needs to be done in the community at the family level.

Avis Favaro

Mm-hmm. One of the things that CIHI identified was a huge spike in eating disorders along with the waves. Did you see that as well?

Dr. Chris Wilkes

Indeed. We’ve seen a massive increase in eating disorders across the age spectrum. That, of course, has occurred in the context of also increased anxiety, increased time at home, and decreased support with friends.

Avis Favaro

Mm-hmm. Now, are there enough services for these children in distress? We just heard from the father of a 16-year-old who waited in ER for a psychiatric consult and didn’t get one, and she died. What’s the picture across Canada?

Dr. Chris Wilkes

Well, first, let me offer my condolences. That’s a dreadful situation for any parent to be in.

And then I will add, we are woefully underfunded and we were woefully underfunded in services before the pandemic. And as you’re probably aware with CIHI data, there was already a dramatic increase in the numbers of hospital admissions and the emergency room visits because children/adolescents were having difficulty regulating their emotions. And then when COVID hit, that just started to increase.

Once the shock and fear of going to hospital abated, then we saw a lot more of the distress in children and adolescents, and eating disorders was just one part of it. But the anxiety and depression for those vulnerable children in particular was so severe that they needed to end up being admitted into hospital.

Avis Favaro

Is time of the essence here? Are these changes that you’re seeing permanent? Or can they be fixed?

Dr. Chris Wilkes

I think the majority of children and adolescents will be able to rebound back into some healthy activities as we open up our society again and other opportunities are available.

There is a core of children and adolescents who were already vulnerable, but because of the COVID, they had less opportunity to develop coping strategies. So those children/adolescents are going to be struggling for some time, as well as the families who have experienced considerable economic stress.

Some families, as you’re aware, have split up or there’s been domestic strife, a lot more calls to child welfare and domestic violence reports where the police have been involved.

So some things for some people were so stressful that things got broken. And when you break mental health coping strategies or break someone’s self-esteem, it takes time to recover and some may not recover.

Avis Favaro

So you’ve written a letter, you and your colleagues, a national call for action. What do you want to see happen?

Dr. Chris Wilkes

The Canadian Academy of Child & Adolescent Psychiatry was very struck by the fact that all areas across the country and people like me, division heads in child psychiatry, were experiencing pressures for service delivery for large numbers of children and adolescents.

So what we wanted to try and coordinate is to make sure we had more of a national database so we can plan services in the appropriate areas and plan to have evidence-based services that are available.

And I’ll give you an example. In our area, what we’ve identified is school mental health is so important to have support in the community because if they’re not available there, then the children and the families end up coming to emergency room or they ignore the problems until they become so intense that they have to come to the emergency room.

So we’ve advocated strongly that mental health needs to be in the community. It needs to be in the schools. It needs to be supporting education, child welfare, and children with developmental disabilities, in addition to the fact that we also want support in our programs in hospital because there’s just not enough beds or staff to look after the children who’ve come in.

Avis Favaro

Have you received any response? Any signs?

Dr. Chris Wilkes

There’s been a good deal of talk and we are recognizing that mental health is one part of a very complex puzzle that the society is facing. We believe that some of the funding that’s being directed into the community is a good sign. But it’s difficult to be fully optimistic because we are in competition with other services.

Avis Favaro

Is it taking a toll on you?

Dr. Chris Wilkes

Yes. Yes. I think the moral injury or burnout has been significantly increased for doctors. And we have lost some doctors who have moved away and looked at different types of work. So burnout, not just with the doctors, but also with the allied professionals is very significant.

Avis Favaro

You know, the pandemic, let’s just say, it’s not done with us. Is there anything parents should watch for and what should they do if their children, they sense there’s a problem?

Dr. Chris Wilkes

If you see your child or adolescent withdrawing from their usual activities, having difficulty sleeping, or being more agitated or irritable, difficulties with their studies, thinking clearly, and actually saying to parents that they don’t feel happy or they feel there’s no future, or feeling trapped, or feeling bored, these are things that we would be asking parents, sit down, talk with your child/adolescent, find out how they’re feeling, what sort of things are they concerned about. So validating can help your child significantly develop coping strategies.

And the other part is obviously to try and look at reducing the stresses that your child is facing. We have to remember that pleasure and fun are very important aspects of children’s life and if you take away play, or reduce the opportunities for them to play, then it’s hard to maintain what you’d call good mental health.

Avis Favaro

Thank you so much, Dr. Wilkes.

What we’ve heard today is heartbreaking and worrisome. The mental health of our children sets the stage for their ability to function as healthy adults. So thank you for listening and we hope it sparks a discussion on what we all need to do to safeguard the mental health of our youngest.

Our executive producer is Jonathan Kuehlein, and special thanks to Aila Goyette.

If you want to learn more about CIHI’s report on child mental health, please visit the website at cihi.ca. That’s C-I-H-I for the Canadian Institute for Health Information. And remember to subscribe to the CHIP wherever you find your podcasts.

I’m Avis Favaro. Talk to you next time.