Our Children’s Mental Health:

Worth an extra 4¢ a week?

Children’s Mental Health Ontario (CMHO) 2005-06

About children’s mental health

  One in five Ontarians under 19 has a mental health disorder 1  Of these 530,000 children, 300,000 have more than one disorder Ontario’s current children’s mental health system has the capacity to serve fewer

than 1 in 3 of these children

   “… services provided are limited by the level of available funding rather than the level of need.” 2 Total CMH funding in 2004-05 = $365 million Average cost per child = $2500 per year • Almost all are outpatients; only 2% in residential treatment

Children’s mental health disorders

 Serious behaviour & emotional problems  Bullying, violence, fire-setting      Depression, suicide attempts, self-harm Defiance, disruptive behaviour Anxiety, post-traumatic stress (e.g. related to violence or abuse), obsessive-compulsive ADD/ADHD and related school problems Substance abuse & addictions  Other Child & Adolescent Psychiatric disorders  Schizophrenia    Bi-polar (manic-depressive) Anorexia & bulimia Autism spectrum … etc.

About CMHO

  

Promotes, supports and strengthens a sustainable system of mental health services for children, youth and their families

Members: 79 children’s mental health centres (CMHCs) Principal activities:  Standards & Quality: Accreditation and Evidence-based practices    Accountability: Intake, assessment and outcomes measurement Policy: Links to Ministry of Children & Youth Services and other service providers Advocacy & Public Awareness: Addressing stigma, lack of services, access barriers, etc.

Children’s mental health centres provide …

       Therapy for individual children and youth, families and groups Parent support and training Intensive family-based treatment Crisis services Day treatment Residential treatment Prevention programs

Children’s Mental Health Centres Support Many Others

Families Public Safety/Justice Schools Early Childhood Programs Child Protection Physicians & Hospitals

Mental health & health costs

   Mental disorders are the 2

nd highest source

of direct health care costs (hospitals, physicians, medicines) in Canada 3 The average cost of treating children’s mental health problems in community-based agencies is less than $2,500 per child per year. The cost of a pediatric hospital bed is more than $2,500 per day.

4 5 of the 10 leading causes of disability are related to mental disorders 5

Suicide

    

Suicide is the 2 nd leading cause of death

among 10-24 year olds (24% of all deaths) Hospitalization rates for suicide attempts by 15-19 year old Canadians are 73% above the average for all age groups Average hospital stay per suicide attempt = 7.1 days

Canada has the 3 rd worst suicide rate in the world for 15 to 19 year olds

6 In a study of adolescent suicide, at least 78% of subjects saw a physician in the year before their suicide, but only 12% received medical intervention for a psychiatric issue 7

Mental health & education

    Children whose mental health problems are untreated disrupt classes, bully other students, abuse drugs & alcohol, engage in vandalism, etc.

Boards have cut back special education, guidance, social workers and psychologists, creating more demand for CMHC services 8 Cost to federal and Ontario governments of youth who drop out due to lack of mental health treatment = $1.9 billion per year 9

Poor grades and dropping out are strongly correlated with mental health problems

10

Mental health & young offenders

    Average cost of youth detention: $120,000/year 11 Changes to the Youth Criminal Justice Act require more community-based services, less detention Untreated conduct disorder in children often leads to antisocial personality disorder (APD) in adults; people with APD are over-represented in prisons 12 Up to 10% of the cost of crime in Ontario (approx. $300 million) can be attributed to inadequate mental health care for children and youth 13

Mental health & child protection

   The mandate for Children’s Aid Societies was changed in 1995, creating greater demands on CMHCs “We rely on our partners in the community to work with us to meet all the needs of our children – unique and multi-faceted as they are.” 14 Children with depressed mothers have a much higher incidence of ADHD, conduct disorder and emotional problems; in London-Middlesex, for instance, the rate of maternal depression

among children coming into CAS care has doubled since 1995

15

Early treatment is an investment

   75% of 21 year olds with mental health problems had prior problems 16 “When children with disorders are not effectively treated, they do not shed problems as they grow, but become more vulnerable and less resilient as they approach adulthood – a pathway that can result in adult mental ill-health, involvement with the law, and homelessness.” 17

For half of Canadians affected by

depression, symptoms start before age 20; the average age for onset of anxiety disorders among Canadians is 12 18

Outcomes

   “Timely access to children’s mental health services is often critical for ensuring the best possible outcomes” 19 Treatment in Ontario’s CMHCs has been shown

to reduce mental health problems for 63%

to 76% of children served (varies by type of disorder) 20 “The strongest support for the effectiveness of outpatient treatment comes from a series of … nine meta-analyses published between 1985 and 1995 … the treatment is highly effective …” 21

Community-based treatment saves tax dollars & lives

 “Underfunding community mental health services leads to three consequences: 

overuse of more expensive health

services,   inappropriate use of services that were never meant to serve the mentally ill, and to the tragedies of

homelessness, victimization and

suicide” 22

Unmet needs

  

Average wait for CMH services in

Ontario: 22 weeks/5 months 23; 15-24 year olds have the highest

level of unmet mental health

needs of any age group (among

ages 15+) 24 In a recent survey of family physicians, children’s mental health service availability rated the highest level of dissatisfaction.

25

Unmet needs (2)

   Children’s mental health centres lost 25% of their capacity between 1993 and 2003 due to cutbacks and frozen budgets “… agencies have reduced services in order to operate within their historical base funding allocation” 26 CMHCs reduced staff by more than 300 positions in 2003 alone due to funding shortfalls – enough to serve about 7,000 children 27

More funding for core services … or more service cuts?

  2004-05 – The new Ontario government provided a 3% base funding increase = $12 MM …

Thank-you!

 

… but last year’s increase only kept pace with inflation

Cost of living (Ontario, 2004-05) + 2.1%   Public sector wages (Ontario, 2004-05) + 3.5% Group insurance premiums (CMHO members) +

6.7%

Is our kids’ mental health worth 4 cents a week?

 2005-06 - core services cannot be

maintained if funding is frozen again

 In order to maintain capacity even at 2004 05 service levels (which are already inadequate), CMHCs require a 3% funding increase for their core service costs, equal to

approximately $12 million

  Hospitals will get at least an additional 7% in 2005-06 … less expensive community-

based services should be getting at least the cost of inflation An extra $12 million for children’s mental

health will cost each Ontario taxpayer $2 per year – about 4 cents per week – our

children’s mental health is certainly worth it!

Notes

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

Ontario Child Health Study, 1989/Statistics Canada, 2003 Ontario Provincial Auditor, 2003 Health Canada, 1998 Ministry of Children and Youth Services estimates, vote 3702 (2004 05); CMHO member survey, 2003; Children’s Hospital of Eastern Ontario, 2003-04 Annual Report World Health Organization UNICEF Adolescent Suicide in Quebec and Prior Utilization of Medical Services, Canadian Journal of Public Health, September-October 2004 Canadian Council for Social Development, 2002 Wright, 1996 Steinhauer, 1998 Ministry of Public Safety & Security, 2000 Steinhauer, 1998 Steinhauer, 1998 Ontario Association of Children’s Aid Societies, December 2003 Leschied, Chiodo, Whitehead & Hurley, 2003

Notes (2)

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27 .

Canadian Mental Health Association, 2003 B. Wattie, 2003 Global Business & Economic Roundtable on Addiction & Mental Health, 2005 Ontario Provincial Auditor, 2003 Standard Client Information System, 1999 US Surgeon General, Children and Mental Health, 1999 Network, Canadian Mental Health Ass’n, Fall 2003 CMHO member survey, 2003 Statistics Canada, 2003 Kates, Fugere, Farrar, CPA Bulletin, April 2004 Ontario Provincial Auditor, 2003 CMHO member survey, 2003