Hope for Pediatric Mental Health,
by Dr. Mark Feldman, CPS President-Elect
Like many of you I battle each day to find resources for our patients with unmet mental health needs.
Too often, whether or not a young person has access to the care they need is determined by whether or not their parents or guardians have the means to pay for services. The children and youth in my practice who are struggling with anxiety or depression, and whose parents are well resourced, have ready access to cognitive behavioural therapy. My patients struggling in school with Attention Deficit Disorder, Learning Disability or Intellectual Disability, whose parents are well resourced, have ready access to psychoeducational assessment and thus to a well-tailored individual education plan.
My patients with these same struggles, whose parents are not well-resourced or who do not have private health benefits, effectively do not have access to these services. When class barriers intersect with racial barriers, the challenges are only compounded.
Since its founding 100 years ago, the Canadian Paediatric Society has strived to “work together to advance the health of children and youth by nurturing excellence in health care, advocacy, education, research and support of its membership”. Through its efforts in professional education, advocacy, public education, surveillance and research, there is so much for the Canadian Paediatric Society to be proud of but, still, so much more to do.
In June, I begin as the 101st President of the Canadian Paediatric Society, a daunting role with a daunting set of challenges. One of the greatest is the inequitable access to mental health services faced by children across our province, and indeed, across our country.
Canada’s pursuit of a universal, publicly funded health care system began in Saskatchewan in 1947 before expanding nationally, initially to become the Hospital Insurance and Diagnostic Services Act, a publicly funded system for hospital and diagnostic services. In 1962, Saskatchewan again led by example through the Saskatchewan Medical Care Insurance Act, which established cost-sharing of physician services, including outpatient services. This helped to pave the way for a more comprehensive national system. In 1985, the Canada Health Act (CHA) was created to “protect, promote and restore the physical and mental well-being[SG1] of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.”
Over 30 years have now passed since the CHA’s creation and we still have a long ways to go towards truly facilitating “reasonable access to health services” – especially when it comes to mental health.
There is hope, though.
The recent Speech from the Throne (November 23, 2021) and subsequent mandate letter (December 16, 2021) to the Minister of Mental Health and Addictions, Carolyn Bennett, directed her to deliver on commitments which, among others, include:
- permanent transfer of funding to provinces to expand delivery of accessible and free mental health services
- investment in mental health interventions and supports for people disproportionately impacted by COVID-19, with a particular focus on Indigenous Peoples, Black Canadians and vulnerable Canadians.
Perhaps now, more than ever, we have the opportunity and collective will to scale up evidence-based, mental health diagnostic and treatment services. We need to take every opportunity we can to hold government accountable to these commitments.
There is more hope.
Changes at the Royal College through the new Competence by Design curriculum for paediatric residency training has placed an intentional focus on mental health care. Moreover, for practicing paediatricians, there has been a growth of continuing professional development opportunities in paediatric mental health care, through programs such as Project ECHO Ontario Mental Health at CAMH and The University of Toronto, CanREACH, through OMA/PAO led CME and through university-led continuing education conferences and rounds.
COVID-19, virtual care and distance-learning have forced us to find new ways to function as paediatricians. Perhaps now, more than ever, we need to upscale up our own mental health care competencies through continuing professional development opportunities. We also need to influence medical learners, and indeed curriculum, to prioritize multidisciplinary training programs and educational resources in paediatric mental health care – recognizing that increasing the quality and accessibility of services will take a broad and collaborative effort.
With all of us pushing, with the collective efforts of the CPS, the PAO and OMA, maybe we can open Ontario’s paediatric mental health care access gates a little bit wider, for entry by children and youth from any postal code and any tax bracket.
I look forward to finding additional strategies, to hearing your ideas, learning from your initiatives and sharing with you more about the CPS’s efforts to positively influence equitable access to evidence-based mental health care for children and youth. This will be a top priority for me as CPS president.
