The US Surgeon General recently issued an advisory on the youth mental health crisis, which was worsened by COVID-19, calling for swift, coordinated actions. The situation in BC is similar. It is time for BC and Canada to create comprehensive strategies for child and youth mental health and substance use (CYMHSU), emphasizing prevention.
In 2018, one in six BC youth seriously considered suicide in the prior year, one in five self-reported anxiety disorders, one in eight engaged in purging, and one in seven were depressed. All rates increased more than 50% since 2013, with the worst rates among female and LGBTQ+ youth. Even pre-COVID-19, BC was not on track to meet its mental health and substance use targets. The situation is similar across Canada, which ranked 31st of 38 high-income countries in children and youth well-being and mental health. Unlike in Canada, many countries are showing improvement, highlighting the systemic failure and that something can be done.
The pandemic exacerbated the situation further. An Ontario study found that approximately 70% of children and adolescents experienced deterioration in at least one mental health domain (anxiety, irritability, hyperactivity, attention, depression, or obsessions/compulsions). The BC COVID SPEAK survey confirmed a disproportionate impact on families living with children. In 2021, opioid overdoses were the third-leading cause of death for BC children under age 19, with a record 29 deaths.
The majority of CYMHSU disorders begin before the age of 15. They are a leading cause of disability and are underfunded compared with other causes of disease burden.[3,6] Beyond disease burden, CYMHSU problems early in life lead to impairment across family, social, and academic domains, creating socioeconomic inequities. BC’s investments in early childhood education, social and emotional learning, poverty reduction, and mental health services are commendable but insufficient, as noted by Jennifer Charlesworth, BC’s representative for children and youth. Furthermore, both BC and Canada lack funding for evidence-based CYMHSU prevention.
Much more can be done, from better prevention of intergenerational trauma to systematically delivering a suite of effective preventive interventions [Table], including parenting programs, school-based programs, and cognitive-behavioral-therapy-based interventions, both universal and targeted. CYMHSU preventive interventions are highly cost-effective, with societal savings of $6000 to $14 000 per participant. Preventing a single case of conduct disorder is estimated to yield lifetime savings of $5 million per child. However, evidence-based preventive interventions are far from being implemented systematically in BC or Canada, with little reporting on the impact of current strategies. Therefore, an immediate scale-up of evidence-based measures is needed.
During the pandemic, we have seen that public health, the health care system, and the government can collaboratively monitor, act, and adjust to address a population-level health threat. We must do the same for the CYMHSU crisis. Physicians can play a role by raising awareness of the crisis, demanding action, or joining the CYMHSU Community of Practice voices. Physicians can also identify and refer children, youth, and families using resources available from https://openmindbc.ca.
To solve the crisis, it is crucial for the provincial and federal governments to establish a comprehensive strategy that includes prevention, with increased publicly reported surveillance and evaluation. The future well-being of our province and country rests on how we support and invest in the next generation’s mental health.
—Veronic Clair, MD, PhD, CCFP, FRCPC
Chair, Council on Health Promotion
—Steve Mathias, MD, FRCPC
This article is the opinion of the author(s) and not necessarily the Council on Health Promotion or Doctors of BC. This article has not been peer reviewed by the BCMJ Editorial Board.
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2. Smith A, Peled M, Reinhart S, et al. Doing OK? Checking in on the mental health of BC youth. Vancouver: McCreary Centre Society, 2021. Accessed 18 March 2022. https://mcs.bc.ca/pdf/doing_ok.pdf.
4. Cost KT, Crosbie J, Anagnostou E, et al. Mostly worse, occasionally better: Impact of COVID-19 pandemic on the mental health of Canadian children and adolescents. Eur Child Adolesc Psychiatry 2021;1-14. doi: 10.1007/s00787-021-01744-3.
5. BC Centre for Disease Control. Summary: BC COVID-19 SPEAK round 2 data provides insight into how people in BC are coping with pandemic. 2021. Accessed 18 March 2022. www.bccdc.ca/Health-Info-Site/Documents/SPEAK/SPEAK_Round2_Summary.pdf.
6. Vigo DV, Kestel D, Pendakur K, et al. Disease burden and government spending on mental, neurological, and substance use disorders, and self-harm: Cross-sectional, ecological study of health system response in the Americas. Lancet Public Health 2019;4(2):e89-e96.
7. Culbert L. BC Budget 2021: New money, promises for mental health and the overdose crisis. Vancouver Sun. 20 April 2021. Accessed 18 March 2022. https://vancouversun.com/health/local-health/bc-budget-2021-new-money-promises-for-mental-health-and-the-overdose-crisis.
8. Schwartz C, Yung D, Barican J, Waddell C. Preventing and treating childhood mental disorders: Effective interventions. Vancouver: Children’s Health Policy Centre, Simon Fraser University, 2020. Accessed 18 March 2022. https://childhealthpolicy.ca/wp-content/uploads/2020/11/CHPC-Effective-Interventions-Report-2020.10.25.pdf.
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