From community to hospital: Developing a mental health strategy to meet the needs of children and youth

Christina Bartha is Executive Director of the SickKids Centre for Community Mental Health and the Brain and Mental Health Program at SickKids.

At The Hospital for Sick Children (SickKids), we are well known for the role we play in the delivery of specialized physical health services to children and youth, but today on Bell Let’s Talk Day, I want to focus on our interest, recognition and commitment to the continued need for mental health services for children, youth and their families.

With 70 per cent of mental health disorders presenting before the age of 17, mental health in paediatrics and extending to transitional age youth is a critical area of concern. At SickKids, we serve young people with primary mental health concerns, as well as those with both medical and mental health diagnoses. We see the complex challenges faced by their families and the impact of these disorders on the health and development of their children. So much is dependent on whether they can access the right intervention at the right time, in the right environment.

SickKids’ interest in better serving children and youth was expanded in 2017, when we integrated with one of the largest Toronto children’s mental health agencies, the Hincks-Dellcrest Centre, now known as the SickKids Centre for Community Mental Health. Across two community sites and at our hospital, we operate a full continuum of mental health services – early intervention, counselling and therapy, intensive and residential treatment and acute mental health care in emergency, urgent care and inpatient settings.      

The SickKids’ five-year trend data tells an important story in Toronto and is reflective of the provincial situation. At SickKids we have seen:

• A 41 per cent increase in patients with mental health crises presenting to our Emergency Department; this compares with 32 per cent across the province – both staggeringly high numbers;
• A 20 per cent increase in admissions to our mental health unit; a 27 per cent increase in kids admitted with both medical and mental health disorders.

To address this need, we started an Urgent Care Clinic that provides rapid access to short-term acute intervention – it now sees over 200 outpatient children and youth per year, but it doesn’t address the shortfall in more intensive therapy that is needed for kids with complex conditions.

How to understand these huge increases in demand comes from the recently published Ontario Child Health Study – which updated its initial 1984 study. The study found that while the prevalence rate of one in five children and youth having a mental health disorder has not shifted in the past 36 years, what has changed is a three-fold increase in parents and youth recognizing the need for mental health support and intervention and a corresponding rise in demand for service, where a shortfall in supply exists. We are seeing big jumps in hospital use because the community based, and primary care mental health services don’t have capacity.

Across the same five years, SickKids has seen a growth in demand for outpatient mental health treatment services – a 32 per cent increase at the hospital and a 21 per cent increase in the community.

With the exception of children and youth with very complex mental health needs – and this can include those with concurrent medical issues – most mental health services are based in the community, where it is a best practice to offer services close to home whenever possible. We need to address the front-line resource and system-building gaps that have prevented appropriate access to services.   

At SickKids, we are developing a strategic plan for mental health that will encompass our entire clinical enterprise – community to hospital. Through many consultations with youth, parents, staff and community partners, it is clear that mental health touches every aspect of care in paediatrics and is widely recognized as a priority.