Our shared vision for mental health services for children and youth

Over the past two years, as President and CEO of SickKids and of The Hincks-Dellcrest Centre, we have had the honour and privilege of creating a shared vision for mental health services for children and youth, bridging the hospital and community. It has been a significant journey for our two organizations, with advice, input and direction from patients, families, government and partner organizations every step of the way.

This shared vision will truly begin to be implemented on February 1, 2017 with the planned historic integration of our two organizations.

Responsibility for the integrated program will fall under our Brain and Mental Health Program. Our pairing of the terms “brain” and “mental health” points to the importance we hold in bridging biological, environmental, and psychological approaches to care.

We believe that our shared vision flows naturally from our thinking about mental and physical illness. On this, Bell Let’s Talk Day, which has fostered a national conversation about the importance of talking openly about mental health, we would like to offer some observations on some of the gaps in the current systems for mental health that we see. We would like to unpack our current thinking about physical illness and mental illness, and suggest that we need to think and interact differently. We hope these observations will resonate with some of our families struggling with mental illness who have been caught between different systems, different practices and societal judgment and have often been left to navigate these on their own.

Over time, in mental health, we’ve developed – and sometimes abandoned – models to think about illness as well as healthy development. We use these models to organize our thinking about diagnosis, treatment, and prognosis. And the model we use at any point in time, also drives the thinking about things like the way we organize our systems of care. When it comes to the brain, particularly a child’s brain, it’s easy to see that we’ve organized our thinking and built our systems with at least two different models in mind.

We have a part of the mental health world organized by a biological model of disease that is closely tied to traditional models of medicine addressed by doctors, nurses and hospitals. In this model we test blood and genes for biological markers; prescribe medicines; and look at the brain architecture. This approach is not infrequently set in the controlled environment of hospitals.

We have another part that’s organized around thinking about a child’s mental state and is built to examine, understand and change the factors that influence our experiences, our feelings, and our thoughts. It is organized around understanding and optimizing function in a child’s natural environment rather than the more controlled setting of the hospital.

The two parts have different tools, different structures, different professionals and different governance.

We believe that both of these models have considerable merit on their own but that both are incomplete. The science of the brain shows clearly that there is a complex interplay between biology, environment, experience and individual mental health:

• We understand that experiences (social environment, relationships, opportunities) are powerful drivers of learning and development. They change brain function and even brain structure. However, we don’t know exactly why certain experiences lead to one pattern in one individual but not in another.
• We know that our genetic makeup plays an important role and we know that certain genes are more important than others in brain development and function. However, how certain genes or gene-gene interactions affect the brain are not fully understood.
• We also know that chemical exposure, in utero and subsequently, can have a big impact. Some of these exposures occur through our diets, others thorough recreational use/abuse, and still others occur through the medications we are prescribed. The effects can be very complex.

There are important interactions between all of these factors but we don’t really know how one factor modifies the impact of another. We do know, however, that we need to work in ways that embrace rather than divide the connections between our mental health and state, from the health and state of the rest of our bodies.

It is for this reason that it is critical to build systems that facilitate integrative thinking and that don’t leave it to parents to navigate the space between. That belief is what’s driving SickKids, a specialized children’s hospital, and The Hincks-Dellcrest Centre, a community based mental health centre, to integrate our strengths.

The goal of our integration is to significantly improve mental health services for children, youth and families, particularly those with complex needs. We plan to create streamlined access to the children’s mental health system, with a clear point of entry into care, defined care pathways and seamless transitions within and between in-hospital and community-based services.

We will continue to innovate in mental health research, education, training and evidence-based service provision under a shared governance and leadership structure, constantly making our model better through deliberate research and our systems better by translating to reliable practice.

By taking a more holistic view focused on all of the factors driving continuous development of brain functions and the manifestations of brain dysfunction in terms of mental illness, we will build integrative approaches that will draw from multiple perspectives and build on the strengths of the many interested, knowledgeable, and committed experts all working to solve the same problems with different tools.

We look forward to continuing our partnership with families and organizations across the hospital and community sectors on this next, momentous, step in our journey.