Kids With Mental Illness Going to Hospital Is on the Rise

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In the coming weeks leading up to the release of the 2020 provincial budget by the Government of Ontario, Children’s Mental Health Ontario’s members, which provide the majority of publicly-provided child and youth mental health care in the province, and youth and family mental health advocates will be attending public meetings with Ontario government leaders and MPPs to urge them to increase investments in community child and youth mental health care. They will remind government decision-makers that the length of time and the number of young people and their families waiting for Ontario publicly-provided child and youth mental health care is at an all-time high. And, they will share their front-line and lived experiences about families that are in crisis and struggling at home, work, and school because they are not able to access the mental health care they need.

Here is an excerpt of a statement presented by Christina Bartha MSW RSW, Executive Director, Brain and Mental Health Program, SickKids Centre for Community Mental Health

With 70% of mental health disorders presenting before the age of 17, mental health in pediatrics and extending to transitional age youth is now a critical area of concern.

At SickKids we serve young people with primary mental health concerns, as well as those with concurrent 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-Dell crest Centre, now 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, emergency services, urgent care and mental health inpatient beds, which includes our pediatric ICU’s where we admit children and youth as a result of suicide attempts. The breadth of this continuum and working with our system partners allows us to have a comprehensive perspective on what is needed.

Our five-year trend data at SickKids tells an important story in Toronto and is reflective of the provincial situation.

At SickKids we have seen:

A 41% increase in patients with mental health crises presenting to our Emergency Department; this compares with 32% across the province – both staggeringly high numbers.
A 20% increase in admissions to our mental health unit; a 27% 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 children and youth per year, but it doesn’t address the shortfall in more intensive therapy that is needed for kids with complex conditions.

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, we have seen a growth in demand for outpatient mental health treatment services – a 32% increase at the hospital and a 21% increase in the community. This has stretched resources and compounded the long-standing access issues of this sector.

Tell the Ontario Government to invest in Ontario Child and Youth Mental Health Centres

SickKids is no different from other providers – the longest waits are for intensive services for the highest need’s kids. These are the children and youth with significant anxiety, depression and challenging behaviours that lead to difficulties with school, peers, their families and in the community. Left untreated or under-treated, the long-term development and outcomes for these young people are compromised.

We need to address the front-line resource and infrastructure gaps that have prevented appropriate access to services needed by children, youth and families.

We believe we have a system that very clearly needs two things:

1. We need to increase capacity by increasing the number of front-line clinicians who serve kids, youth and families.

The current system is under-sized to respond to huge increases in demand. We see the challenge in our Emergency Department where patients present from not only Toronto but Peterborough, Oshawa, Simcoe County, Peel and even as far west as London. Many families drive to SK seeking help and when we try to refer them back to their home community, we see the long wait times they are facing.

2. We need investments in system building

The OHT initiative is a promising redesign of our health system and much of the conversation has been on seamless pathways of care powered by information flow made possible by technology. Children’s Mental Health has not been part of any agenda that has looked at the building blocks of good system support – clinical documentation systems allowing for data capture that helps inform decision making. Budgets were not built with any of this in mind and these resources are an important part of planning and measuring progress.

Mental Health touches every aspect of care in pediatrics and everyone endorses it as a priority. Collaboration, integration, partnerships will help us leverage the resources that we have, but with growth numbers as high as 41% in our Emergency Department, 20% in our inpatient unit, 20 to 30% in outpatient services, there is a foundational resource problem.

Front line care and infrastructure investment is essential in Toronto and across the province.