Children’s Mental Health Ontario
Santé mentale pour enfants Ontario
The Unique Value of
Children’s Mental Health Centres:
A CMHO Position Statement
Table of Contents
1
Purpose
2
The Vital Role of Children’s Mental Health Centres in a System of Care
4
Growing Wait Times for Treatment are Failing Children, Youth and Families
6
The Risk of Failure
7
Optimizing the Children’s Mental Health System
2
3
4
4
5
5
6
7
7
8
Alleviating hospital capacity pressures due to children and youth in crisis
Supporting primary health care physicians
Reducing mental health related demands on educators
The crisis of capacity within children’s mental health centres
Transformation in other sectors
Meeting increasing demand on the system
Short-term implications of wait times at children’s mental health centres
Long-term repercussions of failing to invest in the capacity of children’s
mental health centres
Summary
Key recommendations
The Unique Value of Children’s Ment al Health Centres - Novemb er 2015 | i
The Unique Value of Children’s Mental Health Centres
Any or all parts of this publication may be reproduced or copied with acknowledgment, without the
permission of the publisher. However, this publication may not be reproduced and distributed for a fee
without the specific, written authorization of the publisher.
The ideas presented in this statement reflect the views and concerns expressed by Children’s Mental
Health Ontario (CMHO), the Value of Children’s Mental Health Centres Task Force, and the member
agencies and external partners with whom we consulted.
The authors would like to acknowledge the important contributions of the Value of Children’s Mental
Health Centres Task Force for their hard work on the development of this position statement:
Gloria Chaim
Kim Ciavarella
Shannon Cormier
Ewa Deszynski
Ric Jones
Betty Kashima
Michele Lupa
Susan Sweetman
Michael Tross
Cheryl Webb
Ailene Wittstein
Deputy Clinical Director, Centre for Addiction and Mental Health
Executive Director, Banyan Community Services
Executive Director, North of Superior Counselling Programs
Executive Director, Etobicoke Children’s Centre
Quality Assurance Lead, Chimo Youth and Family Services
Executive Director, Aisling Discoveries Child and Family Centre
Executive Director, Mothercraft
Executive Director, Children’s Mental Health Services (Chair)
Director of Residential and Counselling Programs, YouthLink
Executive Director, Adventure Place Child and Family Centre
Executive Director, Merrymount Family Support and Crisis Centre Suggested Citation:
The Value of Children’s Mental Health Centres: A CMHO Position Statement. (2015). Children’s Mental Health
Ontario: Toronto.
Please direct all inquiries to:
Children’s Mental Health Ontario
Tel: (416) 921-2109
[email protected]
www.kidsmentalhealth.ca
Children’s Mental Health Ontario (CMHO) works to identify and develop solutions to
important policy issues affecting the child and youth mental health sector. We represent
more than 85 accredited children’s mental health centres that provide treatment
and support to children, youth and families. This includes targeted prevention, early
intervention, short- and long-term counselling and therapy, and intensive services such as
The Unique Value of Children’s Ment al Health Centres - Novemb er 2015 | ii
1.Purpose
M
ental health issues are multifaceted and require
a coordinated treatment approach. Due to the
complexities involved, children, youth and families* seek
treatment for a variety of mental health issues across
various settings, including primary care, hospitals, schools
and children’s mental health centres (CMHCs).
Children’s mental health centres (CMHCs)
are the backbone of Ontario’s communitybased child and youth mental health system.
They deliver a complex array of programs
and services in each area including:
• targeted prevention (inclusive of
pre- natal care for at-risk mothers and
infants);
• brief services;
• counselling and therapy;
• family capacity-building and support;
• specialized consultation and assessments;
• crisis support services; and
• intensive treatment services (e.g. in home,
childREN’S
Mental
health
centres
health
education
residential, section 23 programs and/or
secure treatment).
family
CMHCs are also responsible for guiding key
processes including:
children
Children’s Mental Health System of Care
The Government of Ontario (the government) introduced
the Moving on Mental Health (MoMH) plan with the goal of
providing the right services for children and youth, in the
right place, at the right time. Research demonstrates that
appropriate and timely access to proper care will help
mitigate future mental health issues and reduce the cost
of other supports over one’s life span.2
This paper will describe the important role that CMHCs
play in an integrated system of care and will articulate how
the government can improve system efficiency, as well as
outcomes for children, youth and families, by investing in
their capacity.
• coordinated access;
• intake, eligibility and consent;
• identifying strengths, needs and risks;
• child, youth and family engagement;
• service planning and review;
• case management/service coordination;
• monitoring and evaluating client response
to service; and
• transition planning and preparation.1
* The term ‘children, youth and families’ is intended to include all infants, children and youth from 0-18 years of age, young adults
transitioning to the adult system, and young mothers receiving support from children’s mental health centres.
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2.The Vital Role of Children’s
Mental Health Centres in a
System of Care
CMHCs have tremendous expertise in providing
direct treatment and services to children, youth
and families. They are family-focused, close to
home and responsive to community need. CMHCs
offer culturally and linguistically appropriate
services, helping to reduce barriers to mental health
treatment. They are also instrumental in building
connections across sectors to help ensure that
families are well supported while they navigate the
system.
When community-based care is easy to access,
those seeking help are less likely to utilize resourceintensive interventions, such as costly visits to the
Emergency Department (ED). Yet, CMHCs have been
chronically underfunded, impacting their ability to
support the system as a whole.
Fourteen percent of Canadian children experience
mental health disorders that significantly impair
their functioning, but most never gain access to
mental health treatment in part due to the limited
availability of services.3 A significant obstacle
preventing CMHCs from fulfilling their crucial role
in the system of care is the lack of capacity to serve
children and youth in dire need of services, which
is evidenced by unacceptable wait times for key
services in Ontario, exceeding one year.4
Unique benefits of the children’s mental
health centres (CMHCs) include:
• longitudinal care provided to children from
birth to adulthood;
• community-based settings (outside of
hospital environments) to effectively treat
on-going child and youth mental health
issues in less traumatizing environments
for fragile young people in crisis;
• treatment in a child and youth-friendly
setting, where rapport and trust with
counsellors and psychiatrists can be
developed over time;
• comprehensive treatment provided to
the entire family unit, helping to create a
supportive environment for both the child
or youth and his or her family;
• transitional support to reduce the rate of
hospital re-admissions;
• flexible services to meet the unique needs
of children, youth and families;
• service delivery tailored to the distinct
needs of local populations that are
culturally and linguistically appropriate;
• recognized service cost efficiencies;
• appropriate and effective levels of care; and
• services delivered typically free of charge.
2.1 Alleviating hospital capacity pressures due to children and youth in crisis
Hospitals play an important role in the system of care by providing acute ED and in-patient services
for children and youth in crisis. Additionally, some hospitals provide mental health related outpatient
programs. However, in many cases, seeking care in hospitals for a mental health issue reflects an inability
for families to access the right kind of treatment in their communities before a crisis occurs. Early
identification, intervention and prevention programs are vital to prevent children and youth from
requiring short-term stabilization and acute mental health care in hospitals later on in life. Similarly,
prompt access to counselling and therapy for identified mental health issues helps keep children, youth
and families from reaching a point of crisis.
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New statistics from the Canadian Institute of Health
Information show a 48% increase in ED visits and a
58% increase in hospitalizations for children and
youth with mental disorders in Ontario from 20062014.5 These statistics are particularly distressing
given hospitalizations for other conditions over the
same period of time have decreased by 12%.6
My counselor at a CMHC got to
know me and my issues and was able
to help me work through them. At the
hospital, each visit meant different
people who didn’t know me and
weren’t able to provide me with the
help I needed.”
–Matthew, 18, Brampton, ON
Children and youth cannot receive the treatment they
require from hospital ED or inpatient units where the
focus is on emergency, acute, short-term stabilization.
Over a third of children and youth presenting in hospitals with mental health challenges in Ontario had
three or more repeat visits to emergency departments, compared to only 13% of those with other issues.
Alarmingly, 11% had three or more inpatient stays, more than double the figure of those with other
issues.7
The high utilization of hospitals by children and youth with mental health issues indicates that the
system of care is not currently being optimized. Immense pressures on ED and inpatient units could be
relieved by investing in the capacity of CMHCs, helping to support the system as a whole.
2.2 Supporting primary health care physicians
Primary Health Care (PHC) is also a critical component of the system of care for children, youth and
families dealing with mental health issues. PHC physicians know the family, the patient and their entire
medical history. Yet, PHC physicians often express that they are not equipped nor mandated to provide
specialized counselling services for children and youth. PHC physicians are also challenged with treating
a large number of patients and are limited in the amount of time they are able to allocate to each one.
Getting to the root of a mental health problem takes time, and building rapport is an essential component
of care, especially for children and youth. CMHCs provide highly trained mental health professionals
who are able to offer the expertise and attention required to treat children and youth presenting with a
variety of mental health issues. While PHC physicians play a vital role in identifying mental health issues,
CMHCs are instrumental in providing the necessary support that is required to implement early
intervention programs and to treat moderate and severe mental health issues. In addition, CMHCs
provide extensive counselling for the families involved, which is an important part of the recovery
process for a child or youth.
To create a fully functioning system of care, new initiatives, including family health teams, shared care
approaches and community health centres will need to work with CMHCs to ensure that access points
are clearly understood by children, youth and families with emerging mental health challenges. Increased
communication and collaboration between service providers would also be beneficial in monitoring
progress and recognizing signs of relapse in children, youth and families, helping to maintain progress
gains.
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2.3 Reducing mental health related demands on educators
Child care centres, pre-schools, kindergartens, elementary and high schools are also essential
components of the system. The Ministry of Education clearly articulated that schools are responsible
for mental health promotion and early identification rather than intensive treatment for youth.
When educators or mental health nurses recognize that a child or youth is presenting with a potential
mental health issue, they rely on the ability to make referrals to CMHCs that can provide specialized
treatment. CMHCs also offer support outside of the classroom and can assist families with fostering the
right home environment to help aid in their child’s recovery process. Teachers and educators often need
to devote a disproportionate amount of their time to supporting children and youth dealing with mental
health issues, which can leave little time for assisting other students with their studies. CMHCs act as
a critical piece of the system of care by helping teachers, principals, guidance counsellors and parents
address mental health issues early on, creating a more supportive school environment for all children.
Recommendation: The government must support and invest in a process to foster greater
collaboration and communication between the various mental health service providers, including
CMHCs, hospitals, primary care physicians, and educators, within the system of care. This will result
in clearer pathways for children, youth and families, increased spending efficiencies through a
reduction in service duplications and better long-term outcomes for children, youth and families.
3. Growing Wait Times are Failing Children, Youth and Families
The Ministry of Children and Youth Services (MCYS) is working to improve Ontario’s children’s mental
health system through the execution of MoMH and system transformation. While CMHO applauds these
plans, the new lead agency model may not be effective
in improving system efficiencies that would result in
I was in and out of hospital...I
decreased wait times. In order to meet the proposed
couldn’t physically leave my house…
goals of system transformation, more harmonized
it was intense. I started self-harming
funding is required. Recognizing that the government is
more than I used to. I told my mum
in a challenging fiscal situation, funding demands must
‘I think it’s time to get me into long
be prioritized across the system of care to address
current gaps, to consider how to shift spending patterns,
term treatment’, because the shortand to obtain the greatest value for the dollars invested
term stays that lasted a week weren’t
in mental health across the province.
doing anything.” Youth, ON
3.1 The crisis of capacity within children’s mental health centres
CMHCs are facing a crisis in capacity, as demand for services continues to rise without corresponding
funding increases. Although system transformation will help children, youth and families know where to
seek help, many will face long wait times, preventing them from accessing the services they desperately
require. The success of system transformation is contingent on the ability of CMHCs to build the
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capacity needed to meet rising demand. If clients cannot access services in a timely manner, the goals
of the lead agency model will not be realized, as wait times are prohibitive to positive outcomes for
children, youth and families.
CMHCs face a variety of mounting financial pressures including:
• implementing the new lead agency model, which will require additional administrative support
and new communications strategies and information and technology tools;
• the costs associated with providing more sophisticated outcome measurement data to improve
quality service delivery and to measure system performance;
• base funding envelopes that are not tied to demand or demographic changes; and
• a lack of funding allocations to account for annual increases in budget items such as rent,
property tax, and negotiated union wages.
3.2 Transformation in other sectors
Concurrent transformations in health, child welfare and education have also put a significant strain on
CMHCs:
• New funding structures incentivize hospitals to treat high-acuity patients and reduce the length
of stay for all other in-patients, leading to faster
discharge of children and youth seeking mental
health treatment.
• Transformational changes in the child welfare
sector keep more children in community settings,
such as kinship homes, requiring those families/
caregivers to access substantial counselling and
therapy services.
Government will see savings of
almost $700 million over the next five
years if hospital utilization rates for
children and youth with mental health
disorders can be returned to 2006/7
levels. 8
• New mental health programs in schools, including
School Mental Health Assist and mental health
nurses in schools, are increasing referrals to CMHCs.
3.3 Meeting increasing demand on the system
Advocacy efforts to reduce stigma have led to an increase in demand across the system with resulting
referrals from hospitals, schools, primary care physicians, and child care centres. As a result, demand
for services in the community sector is continuing to grow. Referrals for treatment are on the rise by a
startling 10% per year.9
Approximately 6,000 children and youth are waiting a year on average for long-term counselling
and therapy services at children’s mental health centres.10 While they wait for service, many of these
children will deteriorate and require multiple and expensive interventions, such as emergency room
visits and in-patient hospital admission, child welfare or youth justice involvement, and resourceintensive interventions at school. This significant gap in the continuum of care is creating compounded
costs, putting a significant strain on limited government resources.
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The 58% increase in inpatient hospital stays for children and youth with mental health needs indicates
that they are failing to obtain the services they require within their communities before a crisis occurs.
This trend is extremely expensive, as average costs for ED visits for mental disorders can be double
those for other health issues, and costs for mental health-related inpatient stays can be up to three times
more than other stays.11
A $30 million annual investment in CMHCs will reach an additional 7,000 children and youth each
year, bringing wait times down. This investment will result in fewer children and youth accessing
expensive hospital services. Further investment in CMHCs can result in substantive savings for the
government as well as optimizing value for money across the system of care.
Recommendation: The government must redeploy investments across the system of care to
prioritize the treatment children, youth and families require at community-based CMHCs. A new
investment of $30 million dollars in CMHCs will reduce unacceptable wait times for services.
4. The Risk of Failure
Seventy percent of mental illnesses emerge in childhood and adolescence.12 If left untreated, mental
health issues can negatively impact children and youth over the course of their lifetime.
4.1 Short-term implications of wait
times at children’s mental health centres
include:
• complaints from children, youth and their
families, as they cannot receive the right care,
at the right time, in the right place;
• emergency room overcrowding and expensive
hospital treatment;
Families need doctors, hospitals,
schools and children’s mental
health centres to work together to
create a system of care that helps
both us and our children, as they
live with serious mental health
challenges.”
– Paul B. (Parent) Toronto, ON
• increased psychotherapy billing by primary care
physicians;
• additional resources allocated to children’s aid to support families in crisis;
• an influx of youth in the justice system;
• overworked teachers struggling to cope with students facing mental health issues;
• an increasing demand for special needs programs in schools;
• stress on families and caregivers, which contributes to unhealthy home environments; and
• out of pocket costs to youth and families seeking care in the private sector or out of country.
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4.2 Long-term repercussions of failing to invest in the capacity of children’s
mental health centres include:
• an overall economic burden of untreated mental illness of approximately $50 billion per
year (including health care costs, reductions in health-related quality of life, and lost
productivity);13entrenched mental health and addiction issues in adulthood, which are more
difficult to treat;
• potentially irreversible behavioural outcomes, as developing minds are particularly sensitive to
difficult experiences;14
• significant school dropout rates and/or reduced academic performance;
• substantial costs in schools to provide support for youth with mental health issues;
• high unemployment and underemployment often tied to reduced academic performance;
• increases in child welfare interventions for youth and families unable to cope with ongoing and/
or severe mental health problems;
• an increase in homeless and drug-involved youth; and
• a continuing cycle of inter-generational mental health issues and social issues when youth with
untreated mental health issues bear children.
5. Optimizing the Children’s Mental Health System
5.1 Summary
Children, youth, families, service providers, and government recognize that services must be delivered in
a coordinated manner to optimize efficiency and treatment outcomes across the system of care. Primary
care physicians, psychiatrists, ED and in-patient units, schools and CMHCs need to work together
seamlessly to provide the right type of care, in the right place, at the right time. When there is a lack of
role clarity across the system of care, there is a risk of duplication of services, gaps in treatment options
and client confusion and dissatisfaction. Service providers are aligned in the need for greater role clarity
to help solve the aforementioned issues.
CMHCs provide the mental health treatment children and youth require, together with their families.
With wait times of more than one year for services, children and youth can quickly deteriorate and
become acutely ill, which forces them to use hospitals as a first point of access. When they cannot
receive the care they need in their communities after being discharged, they continue to return to
hospitals in a state of crisis. This leads to skyrocketing rates of emergency room and in-patient hospital
usage in Ontario for children and youth with mental health disorders.
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5.2 Key recommendations
1. The government must support and invest in a process to clarify the roles of the many
different service providers within the system of care. This will result in clearer pathways for
children, youth and families, as well as a reduction in service duplications and gaps.
2. The government must redeploy investments across the system of care to prioritize the
treatment children, youth and families require at community-based CMHCs. A new
investment of $30 million dollars in CMHCs will reduce unacceptable wait times for services.
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1 Ministry of Children and Youth Services. (2015). Community-Based Child and Youth Mental Health Program Guidelines
and Requirements #01: Core Services and Key Processes. Government of Ontario. Retrieved from: http://www.children.
gov.on.ca/htdocs/English/documents/topics/specialneeds/mentalhealth/pgr1.pdf
2 The Economics of Children’s Mental Health. (2009). Children’s Mental Health Research Quarterly Vol . No. 1.
3 Wadell, C. (2004). Children’s Mental Health In Canada: Preventing Disorders and Promoting Population Health .
Canadian Institute for Health Information.
4 2015 Report Card: Child and Youth Mental Health. (2015). Children’s Mental Health Ontario. Retrieved from: http://
www.kidsmentalhealth.ca/documents/cmho-report-card-2015-english.pdf
5 National Ambulatory Care Reporting System, 2006–2007 to 2013–2014, Canadian Institute for Health Information;
Alberta Ambulatory Care Reporting System, 2006–2007 to 2009–2010, Alberta Health Services;
Discharge Abstract Database and Hospital Morbidity Database 2006–2007 to 2013–2014, Ontario Mental Health
Reporting System, 2013–2014, Canadian Institute for Health Information.
6 Ibid.
7
Ibid.
8 Calculation based on internal calculations derived from statistics obtained from National Ambulatory Care Reporting
System, 2006–2007 to 2013–2014, Canadian Institute for Health Information; Alberta Ambulatory Care Reporting
System, 2006–2007 to 2009–2010, Alberta Health Services; Discharge Abstract Database and Hospital Morbidity
Database 2006–2007 to 2013–2014, Ontario Mental Health Reporting System, 2013–2014, Canadian Institute for Health
Information.
9 CMHO 2015 Pre-Budget Submission. (2015). Children’s Mental Health Ontario. Retrieved from: http://www.
kidsmentalhealth.ca/documents/CMHO-PreBudget-Submission-2015-16.pdf
10 Ibid.
11
Care for Children and Youth With Mental Disorders. (2015). Canadian Institute for Health Information. Retrieved
from: https://secure.cihi.ca/free_products/CIHI%20CYMH%20Final%20for%20pubs_EN_web.pdf
12 Government of Canada (2006). The human face of mental health and mental illness in Canada.Statistics Canada (2013).
Canadian Community Health Survey – Mental Health.
13 Ratnasingham S, Cairney J, Rehm J, Manson H, Kurdyak P. (2012). Opening Eyes, Opening Minds: The Ontario
Burden of Mental Illness and Addictions Report. Institute for Clinical Evaluative Sciences. Retrieved from: http://www.
publichealthontario.ca/en/eRepository/Opening_Eyes_Report_En_2012.pdf9
14 Hartley & Lee. (2014). Sensitive Periods in Affective Development: Nonlinear Maturation of Fear Learning.
Neuropsychopharmacology, 40, 50–60.
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