1. Our Children’s Mental Health: Worth an extra 4¢ a week? Children’s Mental Health Ontario (CMHO) 2005-06

2. About children’s mental health One in five Ontarians under 19 has a mental health disorder 1 Of these 530,000 children, 300,000 have more than one disorder Ontario’s current children’s mental health system has the capacity to serve fewer than 1 in 3 of these children “… services provided are limited by the level of available funding rather than the level of need.” 2 Total CMH funding in 2004-05 = $365 million Average cost per child = $2500 per year Almost all are outpatients; only 2% in residential treatment

3. Children’s mental health disorders Serious behaviour & emotional problems Bullying, violence, fire-setting Depression, suicide attempts, self-harm Defiance, disruptive behaviour Anxiety, post-traumatic stress (e.g. related to violence or abuse), obsessive-compulsive ADD/ADHD and related school problems Substance abuse & addictions Other Child & Adolescent Psychiatric disorders Schizophrenia Bi-polar (manic-depressive) Anorexia & bulimia Autism spectrum … etc.

4. About CMHO Promotes, supports and strengthens a sustainable system of mental health services for children, youth and their families Members: 79 children’s mental health centres (CMHCs) Principal activities: Standards & Quality: Accreditation and Evidence-based practices Accountability: Intake, assessment and outcomes measurement Policy: Links to Ministry of Children & Youth Services and other service providers Advocacy & Public Awareness: Addressing stigma, lack of services, access barriers, etc.

5. Children’s mental health centres provide … Therapy for individual children and youth, families and groups Parent support and training Intensive family-based treatment Crisis services Day treatment Residential treatment Prevention programs

6. Children’s Mental Health Centres Support Many Others Families Public Safety/Justice Schools Child Protection Early Childhood Programs Physicians & Hospitals

7. Mental health & health costs Mental disorders are the 2 nd highest source of direct health care costs (hospitals, physicians, medicines) in Canada 3 The average cost of treating children’s mental health problems in community-based agencies is less than $2,500 per child per year. The cost of a pediatric hospital bed is more than $2,500 per day. 4 5 of the 10 leading causes of disability are related to mental disorders 5

8. Suicide Suicide is the 2 nd leading cause of death among 10-24 year olds (24% of all deaths) Hospitalization rates for suicide attempts by 15-19 year old Canadians are 73% above the average for all age groups Average hospital stay per suicide attempt = 7.1 days Canada has the 3 rd worst suicide rate in the world for 15 to 19 year olds 6 In a study of adolescent suicide, at least 78% of subjects saw a physician in the year before their suicide, but only 12% received medical intervention for a psychiatric issue 7

9. Mental health & education Children whose mental health problems are untreated disrupt classes, bully other students, abuse drugs & alcohol, engage in vandalism, etc. Boards have cut back special education, guidance, social workers and psychologists, creating more demand for CMHC services 8 Cost to federal and Ontario governments of youth who drop out due to lack of mental health treatment = $1.9 billion per year 9 Poor grades and dropping out are strongly correlated with mental health problems 10

10. Mental health & young offenders Average cost of youth detention: $120,000/year 11 Changes to the Youth Criminal Justice Act require more community-based services, less detention Untreated conduct disorder in children often leads to antisocial personality disorder (APD) in adults; people with APD are over-represented in prisons 12 Up to 10% of the cost of crime in Ontario (approx. $300 million) can be attributed to inadequate mental health care for children and youth 13

11. Mental health & child protection The mandate for Children’s Aid Societies was changed in 1995, creating greater demands on CMHCs “We rely on our partners in the community to work with us to meet all the needs of our children – unique and multi-faceted as they are.” 14 Children with depressed mothers have a much higher incidence of ADHD, conduct disorder and emotional problems; in London-Middlesex, for instance, the rate of maternal depression among children coming into CAS care has doubled since 1995 15

12. Early treatment is an investment 75% of 21 year olds with mental health problems had prior problems 16 “When children with disorders are not effectively treated, they do not shed problems as they grow, but become more vulnerable and less resilient as they approach adulthood – a pathway that can result in adult mental ill-health, involvement with the law, and homelessness.” 17 For half of Canadians affected by depression, symptoms start before age 20; the average age for onset of anxiety disorders among Canadians is 12 18

13. Outcomes “Timely access to children’s mental health services is often critical for ensuring the best possible outcomes” 19 Treatment in Ontario’s CMHCs has been shown to reduce mental health problems for 63% to 76% of children served (varies by type of disorder) 20 “The strongest support for the effectiveness of outpatient treatment comes from a series of … nine meta-analyses published between 1985 and 1995 … the treatment is highly effective …” 21

14. Community-based treatment saves tax dollars & lives “Underfunding community mental health services leads to three consequences: overuse of more expensive health services, inappropriate use of services that were never meant to serve the mentally ill, and to the tragedies of homelessness, victimization and suicide” 22

15. Unmet needs Average wait for CMH services in Ontario: 22 weeks/5 months 23; 15-24 year olds have the highest level of unmet mental health needs of any age group (among ages 15+) 24 In a recent survey of family physicians, children’s mental health service availability rated the highest level of dissatisfaction. 25

16. Unmet needs (2) Children’s mental health centres lost 25% of their capacity between 1993 and 2003 due to cutbacks and frozen budgets “… agencies have reduced services in order to operate within their historical base funding allocation” 26 CMHCs reduced staff by more than 300 positions in 2003 alone due to funding shortfalls – enough to serve about 7,000 children 27

17. More funding for core services … or more service cuts? 2004-05 – The new Ontario government provided a 3% base funding increase = $12 MM … Thank-you! … but last year’s increase only kept pace with inflation Cost of living (Ontario, 2004-05) + 2.1% Public sector wages (Ontario, 2004-05) + 3.5% Group insurance premiums (CMHO members) + 6.7%

18. Is our kids’ mental health worth 4 cents a week? 2005-06 - core services cannot be maintained if funding is frozen again In order to maintain capacity even at 2004- 05 service levels (which are already inadequate), CMHCs require a 3% funding increase for their core service costs, equal to approximately $12 million Hospitals will get at least an additional 7% in 2005-06 … less expensive community- based services should be getting at least the cost of inflation An extra $12 million for children’s mental health will cost each Ontario taxpayer $2 per year – about 4 cents per week – our children’s mental health is certainly worth it!

19. Notes 1. Ontario Child Health Study, 1989/Statistics Canada, 2003 2. Ontario Provincial Auditor, 2003 3. Health Canada, 1998 4. Ministry of Children and Youth Services estimates, vote 3702 (2004- 05); CMHO member survey, 2003; Children’s Hospital of Eastern Ontario, 2003-04 Annual Report 5. World Health Organization 6. UNICEF 7. Adolescent Suicide in Quebec and Prior Utilization of Medical Services, Canadian Journal of Public Health, September-October 2004 8. Canadian Council for Social Development, 2002 9. Wright, 1996 10. Steinhauer, 1998 11. Ministry of Public Safety & Security, 2000 12. Steinhauer, 1998 13. Steinhauer, 1998 14. Ontario Association of Children’s Aid Societies, December 2003 15. Leschied, Chiodo, Whitehead & Hurley, 2003

20. Notes (2) 16. Canadian Mental Health Association, 2003 17. B. Wattie, 2003 18. Global Business & Economic Roundtable on Addiction & Mental Health, 2005 19. Ontario Provincial Auditor, 2003 20. Standard Client Information System, 1999 21. US Surgeon General, Children and Mental Health, 1999 22. Network, Canadian Mental Health Ass’n, Fall 2003 23. CMHO member survey, 2003 24. Statistics Canada, 2003 25. Kates, Fugere, Farrar, CPA Bulletin, April 2004 26. Ontario Provincial Auditor, 2003 27.CMHO member survey, 2003