(Apr 27, 2009)

One in five Canadian children suffers a mental health problem, sometimes debilitating, sometimes deadly. Yet, Canada has neither a national strategy for children's mental health, nor mandated program funding. Spectator reporter DENISE DAVY travelled across Canada on a fellowship from the Michener-Deacon Foundation to investigate the crisis, focusing on the need for early intervention.

SURREY, B.C. Laughter fills the classroom as a swarm of children race in from morning recess.

Lianne McBride instructs the Grade 5 students at Hillcrest Elementary Institute to open the large book on their desks.

"So class, we are talking today about how our bodies feel stress," she tells them. "What are all the ways your body can tell you when you're stressed?"

Several hands go up. A dark-haired girl in the front row says, "I feel like I've got a chain around my neck and someone is pulling it."

McBride nods.

"Now, I want you to think of all the things we can do to help us feel less stressed."

More hands. Drink water. Take slow breaths. Wash your face.

"Close your eyes and relax your necks. Then take some deep, slow breaths," McBride says, leading them through a relaxation exercise. There's snickering and shuffling. Then quiet.

This simple lesson in stress reduction -- part of a childhood anxiety-prevention program called FRIENDS -- is as much a part of the B.C. school curriculum as reading and writing.

It's also one piece of a pioneering province-wide child and youth mental health plan that put British Columbia on the map as leaders in providing early intervention to kids with mental health problems.

It was no small accomplishment. A team achieved what no other province had been able to, and what many said couldn't be done -- establishing the first child and youth mental health plan in the country.

Six years ago, British Columbia was drowning in the same cauldron of problems with children's mental health services as other provinces, including Ontario.

Years of budget cuts, lost programs and staff cuts left families lining up for months for services, while their children's mental health problems worsened.

Despite countless studies showing the importance of early intervention, a study by the Ministry of Child and Family Development showed only the most violent, disruptive and suicidal children were getting help, while those suffering from "quieter" mental illnesses, specifically anxiety and depression, were waiting the longest.

"We were just missing really important opportunities early on in terms of prevention," said Jayne Barker, director of policy and research at the Mental Health Commission of Canada.

"We were seeing kids who had such severe problems that, by the time we provided them with any service, they were going to be lifetime clients."

Barker set the wheels in motion to change this by developing a provincewide plan.

In 2000, as director of child and youth mental health services at B.C.'s Ministry of Child and Family Development, Barker took the first step by luring Charlotte Waddell away from McMaster University where she'd done her child psychiatry training.

This was key as Waddell had trained under the late Dr. Dan Offord, author of the Ontario Child Health Study, one of the most important population-based studies on children's mental health in the world.

Using numbers from Offord's Ontario Child Health Study, which showed one in five children had some type of mental health disorder, Waddell combined more recent findings from Quebec and Britain that included a wider age range of children and more updated studies.

"We wanted to get a read on those kids who are really seriously affected, so we set a slightly higher standard (than the Offord report)."

Research showed one in seven children in British Columbia had a mental health disorder that was seriously impairing their development.

In British Columbia's population of about four million, that amounted to more than 140,000 children.

Children's mental health problems topped all other health problems in terms of the number affected and degree of impairment.

Armed with studies, Barker and Waddell began meeting with mental health groups, teachers and school administrators.

"We provided the information, and they met with the minister and hammered this home," said Barker. "I don't think the minister ever realized we were feeding them the information."

Waddell said the lobbying was largely effective because they had the right people in the right places. Among them, Premier Gordon Campbell, who had personal experience with mental illness, having grown up with a father who suffered from depression. His father committed suicide when he was 13.

"We had a constellation of very strong leaders, very supportive assistant deputy minister and support group representing families," said Waddell.

On Feb. 6, 2003, B.C.'s child and youth mental health plan was approved by cabinet. The ministry was given $65 million, which allowed them to double the number of clinicians provincewide to more than 500.

The province needed to be pulled out of crisis mode. That meant pulling money out of crisis services and into prevention and risk-reduction programs.

"We had all kinds of people saying kids are going to die and it's going to be your fault," said Barker. "But we had to do it for the long-term health of kids and society."

Barker told people: "If you spend your whole time pulling people out of the stream, you won't have any time to stop them from jumping in."

FRIENDS was a key component of the plan because it was school-based, reaching thousands of children, and because it was a core prevention program.

Developed in Australia, research showed 80 per cent of children who took the program showed no signs of an anxiety disorder for up to six years afterwards.

This was the first time FRIENDS had been used in Canada, and is now in 95 per cent of B.C.'s school districts and many private schools.

In an even more radical move, funding was given to a parent support group called FORCE (Families Organized for Recognized Care Equality) to give parents a voice.

That move, a stunning first for any group of its kind in Canada, allowed FORCE to develop chapters across the province and set up a 1-800 information line for parents.

Another $10 million was carved off for the aboriginal community to develop culturally appropriate child and youth services.

A provincial training program was created for clinicians. Additional funds flowed to programs involving parents, siblings and extended family, and looked at all aspects of the child's life. A funding boost was provided to existing programs that offered a preventive component.

Within a year, parents and clinicians were reporting that children were being seen sooner and families were more satisfied.

A five-year review of the plan showed there's still much to do. Wait times for many kid's mental health services are still too long.

Barker said they failed to get a residential facility set up that was to include respite for parents, because money didn't come through from the child-welfare sector.

But advocates are moving forward.

"We're aware of the fact that we have to keep it on the agenda. It can't become the flavour of the month," said Gayle Read, senior research analyst with the ministry.

Barker hopes her new national role with the Mental Health Commission of Canada will allow her to push other provinces to implement child and youth mental health plans.

"I really think B.C. really got it right in terms of their emphasis on prevention and involvement of the aboriginal community."

"Is it better? Yes. Is it where it needs to be? Absolutely not, but I think we stepped in the right direction by putting the emphasis on early intervention."




VANCOUVER, B.C. When Keli Anderson found her eight-year-old son curled up under a tree in the back yard, she did what any mother would do.

She held him tight and rocked him like a baby. "He was crying, 'Mommy please make it stop,'" said Anderson.

That night came after years of James suffering deep depressions and out-of-control rages. Doctors made it worse by recommending Anderson take parenting classes, or misdiagnosing James.

One doctor prescribed an antidepressant that made him so manic he was afraid to leave home. Worried that his world was closing in, she forced him back to school. On his first day, he threw a desk at the principal. "We were starting to hide the knives because he was absolutely erratic at times."

Afraid for his safety and her own, Anderson had him admitted to a psychiatric ward. There he was diagnosed with bipolar disorder.

Seven weeks later he was discharged. There was no plan, nowhere to go. That moment crystalized what she needed to do. Anderson went public with her family's private pain and contacted a local TV station. Hate mail poured in from people accusing her of exploiting her son. But she also heard from hundreds of parents who were dealing with the same nightmares -- one from a mom whose son killed himself.

"I knew then where I was headed."

Anderson drew up a plan for a nonprofit support group -- FORCE, Families Organized for Recognized Care Equality.

She knocked on doors, met with politicians. Her hard work paid off. When B.C. introduced its child and youth mental health plan in 2003, there was money in the budget for FORCE. Chapters opened across the province with 12 part-time staffers, all moms just like Anderson.

James is now 20, works for his father and has a girlfriend. He takes lithium to control his rages, but still has ups and downs.

And Anderson continues her crusade, talking to groups across the country.

"It's like there's an airport we've been circling for 30 years. I feel like somebody's finally caught us on the radar and said, 'Holy crap, that plane's been in holding a long time. Let it land.'

"That's what I feel like. I feel like finally, maybe, we can finally land."