The Decibel - What are schools doing to help youth mental health?

Episode Date: September 6, 2023

It’s back-to-school week for young people across the country. And despite bringing back full in-class learning three years since the peak of the COVID-19 pandemic, students continue to experience and report mental-health issues.Dr. Deinera Exner-Cortens is an associate professor in the Department of Psychology at the University of Calgary. She is going to talk to us about how we can be better at a policy level and in schools to help kids needing more mental-health support.Questions? Comments? Ideas? Email us at [e-mail]

This week, kids across Canada are going back to school. And though we're mostly back to in-person learning, there was a long stretch of online learning and cancelled activities during the pandemic. So we know that a number of children and youth are suffering with mental health. I think it's important to point out that a lot of children and youth were suffering before the pandemic, and that hasn't improved. And for some children and youth, that's gotten worse. Dr. Dayanara Exner-Cortens is a Canada Research Chair in Childhood Health Promotion

and an Associate Professor in the Department of Psychology at the University of Calgary. She'll talk about what schools and educators can do better to help kids in a mental health crisis. I'm Mainika Raman-Wilms, and this is The Decibel from The Globe and Mail. Dayanera, thank you so much for being here today. Thank you for having me. I appreciate the opportunity. Off the top here, can you just tell me a little bit about the work that you do with teens and kids' mental health, and what are they telling you about how they feel these days? I think there's obviously diversity in how youth are doing in their mental health. But overall,

I think the pandemic was really hard on a lot of youth and youth who are still bearing the inequitable brunt of the pandemic in terms of mental health are also youth from communities that are historically and systemically marginalized. And that was true before the pandemic. And it's true now. So certainly, talking to youth from racialized communities, in particular, black youth, indigenous youth, 2SLGBTQIA plus youth, youth with disabilities, like they are struggling in different ways. Yeah. So there's a general problem, but of course, not everyone is affected in the same way. So as you said, there's certain groups of kids that are feeling this more than others. And that's not to say that some youth aren't doing well, like there are youth who are

doing very well, who are thriving. But overall, we know that youth mental health in Canada is at a bit of a crisis point. So do we know how many youth, kids and teens are struggling with their mental health? It depends on what exactly we're looking at. But we have a lot of different numbers that all together present that children and youth are struggling and that struggle appears to have increased since the pandemic. But in terms of specific issues, we know that in Ontario, eating disorders among youth more than doubled during the pandemic and the length of time needed to treat those disorders took longer and they were more severe in nature. Since the start of the pandemic, there's been an 8% increase in hospital stays for Canadian youth for substance use.

So that's comparing 2019-20 data to 2021-22 data. And in particular, in British Columbia, there appears to be like the severity of the issue appears to be greater. A meta-analysis done by researchers at the University of Calgary and University of Ottawa showed a 22% increase in accessing acute care services for suicide attempts in children and youth during the pandemic. So that was from the beginning of 2020 through the end of 2022. So that would mean like 22% more kids basically are accessing those services. Yes, that's correct. Some data from Ontario, again, suggests that mental health service requests are really surging. And again, we don't always have the data, but from the providers I work with, the youth and families, again, have no reason to believe that's not the case across Canada.

There's a huge demand and just not enough resources to meet that demand. So maybe we can talk a bit about the reasons behind this jump. We mentioned the pandemic, but could we actually spell out here, like, what is it about the pandemic that caused this to happen? I think there, like with anything, there's like a number of things going on and that's going to affect children and youth in different communities differently. So certainly social isolation was a factor in terms of not being at school, being in and out of school, being potentially cut off from peers for children and youth. Peers are a really important source of belonging. And so not being around that might have been very stressful economic issues. So in some of the data that we've collected of how kids are doing during and since the pandemic, family job loss is a major predictor of poor mental health. Also, depending on the type of work they were doing, your caregivers might have been a lot more exposed to pandemic risk. We know that for kids that can be an ongoing source of stress in terms of both the immediate stress when it happened and then downstream effects as they're recalling those stressors.

OK, so so that's the impact of the pandemic. Are there also other factors that are contributing to, I guess, the decline in some ways of some kids' mental health? So systemically, we know Canada has history and ongoing colonization. So for First Nations, Métis, and Inuit youth, that history matters, whether they had a parent or a grandparent in residential schools, as well as current involvement with the child welfare system, which is often referred to as this generation's residential schools. So having that involvement with child welfare is really linked to poor mental health. So a lot of systemic things for Black youth in Canada, the systemic racism that they face. Asian youth faced increased racism

and discrimination during the pandemic. So those systemic and structural factors are really, really important to consider when we're thinking about how children and youth are doing and who might be sort of bearing the disproportionate brunt of the impacts both during and since the pandemic. And Dayanera, I know you mentioned that, of course, certain groups of kids are affected differently. I read also that young girls are struggling more than boys as well. Can you unpack that? Why is that the case? So that hasn't changed. So that was the case before the pandemic. It's the case now in terms of depression and anxiety symptoms, eating disorders. And there's a lot of different theories on why that occurs. I take a gendered

lens. So there's a lot of social expectations for girls that might be linked to higher rates of some of those issues in terms of expectations around bodies, expectations around caregiving and how we might share feelings and thoughts with friends. And that might lead to us ruminating on those things. There's, you know, perhaps evidence that there's some biological differences, genetic personality, but I tend to think more about the gendered piece in terms of what girls are being asked to do, expected to do as they develop and how that might link to mental health symptoms of depression and anxiety. Okay, so it's that time of year again, where kids, kids are going back to school. And this,

this year, but mostly kids are in the classroom again. So I guess I wonder about what we teach kids in school. Right. There's a big focus on physical education. We know there's health class, gym class. I wonder about mental health at school, though. Do we teach kids these days about mental health literacy? And I guess how important would it be to teach kids that? Yeah. So I think when we think about mental health at school, we want to think about having things

for all kids. So we call those universal things for kids who need a little bit more and then really indicated services for kids who need that one-on-one support. So at that universal level, things in the classroom like mental health literacy are really important. So mental health literacy helps children and youth to understand what mental health is, the difference between mental health, mental illness, feeling mentally unwell, where to go if they need to seek help.

So Ontario is bringing in mental health literacy into curriculum, which is great. We know that for things to be sustained and to happen, having it in curriculum is really important. A couple of years ago, BC brought in social emotional learning across curriculum, which is another way of fostering mental well-being. And so there are efforts across the country. They tend to be a bit sporadic, not necessarily uniform, which in part is because education is a provincial mandate, but having those opportunities to do that promotion. But yes, mental health literacy, but that also includes things like having welcoming classrooms, students feeling like they belong, having anti-racism policies at school. So mental

health literacy is part of that, but it's definitely not the whole picture. Let's talk a little bit more about the curriculums that you mentioned, because this seems like a big thing that Ontario is bringing in a curriculum that's actually focused on mental health for kids. BC is doing something similar. What exactly does this entail? So I can't speak to the Ontario curriculum. I think it hasn't been fully released yet, but from my understanding, it's going to be rolled out across different grades. But typically, mental health literacy includes the things that I just mentioned. So I believe right now it's going to be rolled out to grade seven and eight students and teachers.

And there's going to also be some revisions to the grade 10 careers curriculum. Yeah. So that's kind of what we, like the education part of it in school. But kids are spending a lot of time in school, right? They spend their full days for 10 months of the year there. Do they have access to mental health supports in schools? So that varies across the country and particularly if you're located in an urban setting versus rural and remote.

So probably across the country, Ontario has the best system for setting up supports in schools. So School Mental Health Ontario is something that works across the province in partnership with the Ministry of Education to make sure there are mental health supports in every division. I'm not aware of any other province that has that kind of setup in Alberta. You know, it's very much individual school divisions, innovating, doing great things, working really hard, but there's no sort of central system or structure for how that's done. In terms of is there enough support? No. Do how many kids have access? We don't really know that. I was reading about this a few weeks

ago. And even in 1987, there was a call that the caseloads of school psychologists were too high. And it definitely has not improved since then. So this has been a long standing issue, where the number of school psychologists, school social workers is just not enough to meet the demand. And then particularly in rural and remote areas where there may not also be much in terms of community level services. So really, it sounds like it really depends on where you are, the services that are there in your school, if you even have access to a school psychologist or a counselor. It really depends and it varies across the country then. Yeah. And, you know, we're not the best at collecting data in Canada. And so I don't, I'm not aware of like, that we have a sense of what the ratios are across the country.

So in the US, the recommended ratio is 1000 students to one school psychologist. I don't know of any research here that specifically looks at that. You know, I can say in our experience working with divisions, be they urban, rural, remote, none of them have enough mental health staff. And then particularly in rural and remote areas, but in terms of hard numbers, again, I don't know that that's something we really track very well here. We'll be back in a moment. We're talking about in school. What about outside of school for kids and teens? I mean, we hear all the time about how long wait lists are for treatment. So if someone is in crisis and they need to talk to someone, what are the options that are available to them? So I'm in Calgary. We are very fortunate to have just opened a brand new facility for child and youth mental health. And that's great. But there are kids all over the province, many of whom live in rural and remote areas who

don't have access to any specialized mental health services. And so there are pockets for sure of innovation of great things happening. But the access to mental health services is inequitable by geography. And even in Calgary, it's great, we have that center, but there's still like a huge demand for those services. It's also a really complicated landscape. So I work in this area. And when I have friends whose children are struggling, I have to really go down a rabbit hole to figure out which services. So I think I feel for parents and caregivers, it's really not always clear how you even get into the system, how to navigate the system. It can be very confusing and overwhelming.

And then when you find the right door, there might be a really long wait list. So there's a lot of points of improvement that could be made. So how does that work? How does someone, if they need help, like how do they get into the system that you're talking in the schools, a lot of times it's through the emergency department, which isn't probably where we would want that to happen. That can be a really scary place. It can be a place where parents and caregivers feel like they're just being turnstiled. So there's a crisis it's dealt with. The kid comes back out. There's another crisis.

So it just feels like this revolving door. And we already know how stressed our emergency departments are, right? So this is kind of funneling yet another, like another situation into this really overloaded system. Yeah. And I do think going back to our discussion about mental health literacy, that is a reason that it's really important to do that, because hopefully, if kids know the signs and symptoms, they can identify in themselves that something is not right before it gets to that crisis point and hopefully access a pediatrician, a school counselor, a school psychologist, social worker before, you know, it gets to a really bad

place. Dana, you've mentioned a couple times how data is not great across the country because we have a provincial health systems, right? We don't have kind of standard data across the country. Why do we need good data for something like this? Why would it be important? We don't have a good sense across the country using the same measures about what's going on, which makes it hard to respond to know where to direct funding. We also do not collect data that's disaggregated by subgroups that are systemically marginalized. So we have some data by gender, not much, some data by indigeneity, but we don't have data, for example, by population group, by if someone is queer or trans. And that can be really important, too, because it points

out the disparities in what's going on across the country. From a policy level, we don't have national child and youth policy in terms of how we're going to support children and youth. That's been something that people in the child health field have been calling for for a number of years. We need earmarked funding for child and youth mental health. The most recent Raising Canada report, which gathers together all this data on youth well-being, says 25% earmark for child and youth mental health because otherwise it can get swallowed up by the adult system. We don't have enough providers for children and youth. And then more systemically, we have a history of taking children and still to this day, taking children away from their families and treating them really, really poorly in the name of colonization. And so that absolutely

has an impact to this day on how children and youth are doing across the country. Just lastly here, Dayanera, you work with teens directly. What do the teens that you work with say they actually need? I guess I'm wondering about the solutions that we've put out here, like the changes in curriculum, all of those things. Are those actually going to be solutions that are that are going to help them? Yeah. So I think having curriculum that allows them to critically think to questions. So I guess when I was saying mental health literacy is part of it. Yes. But also learning to critique those systems that cause people to not be doing very well is something kids want. They like it. They like to understand how systems work,

why things are the way they are and how they can make a difference. Youth want a seat at the table. We do not take youth voice seriously. We don't listen to them. We think they don't get it. They don't understand. What could they possibly know? They have so many ideas. They're living it. They understand. And so we have to give youth a meaningful seat at the table to tell us what they need and to stop assuming that because we're adults with fancy degrees, we know what youth need. So that would be my my biggest recommendation is making youth the forefront of youth policy. Danara, thank you so much for taking the time to speak with me today. You're welcome.

That's it for today. I'm Mainika Raman-Wilts. Our summer producer is Nagin Nia. Our producers are Madeline White, Cheryl Sutherland, and Rachel Levy-McLaughlin. David Crosby edits the show. Adrienne Chung is our senior producer, and Angela Pachenza is our executive editor. Thanks so much for listening, and I'll talk to you next week.