Question Period Note: Mental Health Supports for children and Youth

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• The Government is committed to supporting the mental health and substance use needs of children and youth.
• We are working to increase access to mental health and addictions services, such as the Budget 2017 commitment of $5 billion over 10 years to provinces and territories, which included a priority to expand access to community-based mental health and addiction services for children and youth (age 10-25).
• In April 2020 and in response to the pandemic, Health Canada launched Wellness Together Canada, a portal that offers online mental health and substance use supports. Through the portal, children and youth (ages 5 to 29) can have free access to a range of resources, including Kids Help Phone. Budget 2022 provided $140 million over two years for the Portal to continue to provide supports for Canadians.
• The Government will work across departments to ensure children and youth have access to mental health supports as they recover from the pandemic and in the long-term.

IF PRESSED ON FUNDING FOR CHILDREN AND YOUTH…
• In addition to Wellness Together Canada, which provides online, phone and text based support to young people who are dealing with mental health issues, $15M is being invested in Kids Help Phone from April 2020 to March 2023, so that it can continue to provide mental health support to youth in need during the pandemic.
• Through Budget 2021, the Government is also investing approximately $100M over 3 years to support projects that promote mental health and prevent mental illness in populations disproportionately impacted by the pandemic, including youth.

IF PRESSED ON THE NEED TO PREVENT CHILD- AND YOUTH-BASED VIOLENCE…
• The Public Health Agency of Canada (PHAC) funds programming to prevent teen and youth dating violence, including community and school-based initiatives that teach skills for healthy and safe relationships based on respect and consent.
• In addition, PHAC funds initiatives to prevent and address family- and gender-based violence and its health impacts including trauma- and violence-informed physical and mental health promotion for children and youth.

IF PRESSED ON SUPPORT FOR INTEGRATED YOUTH SERVICES …
• The Government continues to work with provinces, territories, and stakeholders to help spread and scale Integrated Youth Services (IYS) models of care.
• This builds on work to increase access to mental health and addictions services for children and youth, which includes the Budget 2017 commitment of $5 billion over 10 years to provinces and territories through bilateral agreements.
• All 13 provinces and territories have developed or are developing an Integrated Youth Services (IYS) network in their regions. Additionally, there is an Indigenous IYS network in progress.
• In total, there are approximately 50 operational integrated youth hubs across Canada and 60 under development.

Mental illness health issues can impact any population and children and youth are no exception. In fact, almost two thirds of mental health disorders emerge before the age of 25. It is estimated that mental health issues affect over 800,000 Canadian children and youth annually.

Youth disproportionately visit the Emergency Department (ED) seeking mental health/substance use services. For example, between 2008-2009 and 2018-19 there was a 61% increase in visits made by youth to the ED for such services. During this time, hospitalizations for mental health disorders also increased by 60%.

This cohort is also affected by suicide. In 2020, suicide was the second leading cause of death among individuals aged 15 to 34. In 2020, among individuals aged 15 to 24 years, males accounted for 68% of suicide deaths; and among individuals aged 25 to 34 years, males account for 75% of suicide deaths.

The COVID-19 pandemic has had significant impacts on the mental health of children and youth. Concerns about the virus itself have been compounded by impacts on school and routines, social activities, isolation, and decreased access to services and supports.

Results from 2022 showed that youth were less likely to report excellent or very good mental health as compared to older Canadians. Most Canadians were less likely to report excellent or very good mental health during the COVID-19 period, and the difference between 2019 and 2022 was particularly evident for younger adults. Only 50.9% of those aged 18 to 34 reported excellent or very good mental health in 2021-2022 during the pandemic, compared to 60.8% before the pandemic in 2019. In children aged 12-17 years, 61.2% reported that their mental health was very good or excellent in 2021-2022, compared to 73.0% in 2019.

More recent survey results from early 2021 showed that younger Canadians persistently indicate the highest anxiety and depression of all age groups. For example, almost 30% of 16 to 17 year olds reported high levels of anxiety and depression, and one in three reported suicidal ideation in the past year. Conversely, this group reported a lower incidence of diagnosis of a mental health issue, suggesting they do not have access to diagnostic services and care.

Additionally, in a Statistics Canada survey of perceptions of personal safety, 11% of Youth aged 15 to 24 reported that harassment or attacks on the basis of race, ethnicity, or skin colour have increased in their neighbourhood since the start of the pandemic.

Government Actions and Investments to Support the Mental Health Needs of Children and Youth

Funding to Provincial and Territorial Governments and Integrated Youth Services

The Government of Canada is investing $5 billion over ten years to improve Canadians’ access to mental health services (2017-2027). The investment is being provided directly to provinces and territories via negotiated bilateral agreements, informed by the 2017 Common Statement of Principles on Shared Health Priorities agreed to by FPT Ministers of Health. In it, Ministers of Health agreed to prioritize expanded access to community-based mental health and addiction services for children and youth as one of three priorities for the federal funding.

All 13 provinces and territories have developed or are developing an Integrated Youth Services (IYS) network in their regions. Additionally, there is an Indigenous IYS network in progress. These hubs are easily accessible community-based “one stop shops” that provide an integrated suite of services, which can include peer support, mental health and primary care support and employment counselling, as well as support for navigating these systems of care.

There are approximately 50 operational integrated youth hubs across Canada and 60 under development. Three of the most developed networks are in British Columbia (Foundry), Ontario (Youth Wellness Hubs Ontario), and Quebec (Aire Ouverte), with British Columbia and Ontario specifically identifying the use of bilateral funding to support these networks. This demonstrates how the federal government can work constructively with provinces and territories to spread and scale evidence-based practices in the mental health and substance use space.

The development of an Indigenous IYS network was driven by the participation of Indigenous communities across Canada. These First Nations and Inuit communities led efforts to shift youth mental health towards culturally competent care through the Access Open Minds Indigenous Council. Several Indigenous communities are currently participating in an emerging Indigenous IYS network.

2021 Mandate Commitments

The Government of Canada is committed to working with provinces, territories and other partners to promote access to high-quality mental health and substance use services for Canadians with a range of needs.

In support of this aim, the Minister of Mental Health and Addictions has been mandated with:
• Ensuring mental health care is treated as a full and equal part of the universal health care system;
• Understanding and addressing health inequities, including for Indigenous people, Black Canadians and vulnerable Canadians;
• Leading a whole-of-society approach to address problematic substance use in Canada; and
• Working in collaboration with provinces/territories
To realize these objectives, the Minister will deliver on a comprehensive set of new and ongoing commitments, including establishing a permanent, ongoing Canada Mental Health Transfer to help expand the delivery of high quality and accessible mental health services, including for prevention and treatment.
Budget 2022 reaffirmed the intention of engaging provinces and territories on the development of a CMHT, which would provide a permanent and ongoing source of funding for mental health services.
National Standards for Mental Health and Substance Use Services

Budget 2021 provided $45 million over two years, starting in 2021-22, to Health Canada, the Public Health Agency of Canada, and the Canadian Institutes of Health Research to help develop national mental health service standards, in collaboration with provinces and territories, health organizations, and key stakeholders.

On March 14, 2022, Health Canada announced a partnership with Standards Council of Canada (SCC) to develop national standards for mental health and substance use services, to help fulfil commitments made in Budget 2021. Standards will be evidence-based and developed through consensus-based processes that engage experts, health organizations, people with lived and living experience, and other key stakeholders. Standards are tools for supporting health providers in the delivery of high-quality and equitable mental health and substance use services, and will help to ensure a consistent level of care is provided. They will also help to formalize what Canadians can expect in terms of the quality of services, while providing an evidence-based framework for service delivery in priority areas.

SCC is coordinating the development of an integrated suite of national standards for mental health and substance use services in priority areas that align with the Common Statement of Principles on Shared Health Priorities (CSOP), which includes Integrated Youth Services. The Government has emphasized the importance of engagement with diverse stakeholders and promotion of health equity principles, which have been incorporated into the development process.

Mental Health Promotion and Teen Dating Violence

Through the Public Health Agency of Canada’s (PHAC) Mental Health Promotion Innovation Fund, the Government of Canada is investing $39 million from 2019-2028 to address multiple risk and protective factors to promote mental health for children, youth, young adults and populations susceptible to mental health inequities (e.g., low-income families, immigrants and refugees, First Nations, Inuit, Métis, LGBTQ2+, people living with disabilities and people with other socio-economic risk factors).

PHAC also funds programming to prevent teen and youth dating violence, including community and school-based initiatives that teach skills for healthy and safe relationships based on respect and consent. In addition, PHAC funds initiatives to support the health of survivors of family violence, including trauma-informed physical and mental health promotion for youth.

Suicide Prevention

The Canadian Radio-television and Telecommunications Commission (CRTC) recently announced that it will adopt 9-8-8 for Canadians to call or text when in need of immediate mental health crisis and suicide prevention support. This will be launched across Canada on November 30, 2023.

In parallel, the Public Health Agency of Canada (PHAC) is preparing for implementation of a three-digit number for suicide prevention from a service delivery perspective. On August 31, 2022, PHAC announced that the Centre for Addiction and Mental Health (CAMH) was selected to lead coordination of 9-8-8 service delivery, building on its experience delivering Talk Suicide Canada. As a first step, CAMH will develop collaborations with key organizations to start building capacity, and engage with stakeholders to inform the scope and requirements of a timely, quality service. In addition, PHAC is engaging stakeholders from a range of sectors, including Provinces and Territories, Indigenous partners, public safety officials, People with Lived Experience, on the scope and service delivery elements, including working to understand anticipated demand for 9-8-8. Finally, PHAC is learning from international experience, including the United States, which recently introduced 988 in July 2022.

The Government of Canada is investing $21 million over five years in the Centre for Addiction and Mental Health (CAMH) to implement and sustain a fully operational pan-Canadian suicide prevention service with its partners. Talk Suicide Canada currently provides 24/7 suicide crisis support via the phone (1-833-456-4566), in English and French, 24 hours a day, seven days a week and by text (45645), in English and French, in the evenings, to people in Canada. By 2023, this service will provide people across Canada with access to 24/7/365 bilingual crisis support from trained responders, using the technology of their choice (voice, text or chat).

The Federal Framework for Suicide Prevention was released November 2016. It focuses on raising public awareness, reducing stigma, disseminating information and data, and promoting the use of research and evidence-based practices. Progress Reports on the Framework are available on Canada.ca, with the next report planned for release in December 2022. In response to motion M-174, which called on the Government of Canada to establish a national suicide prevention action plan and was unanimously supported by parliamentarians in 2019, the Public Health Agency of Canada is developing an action plan that aligns with the Framework.
Support for the Mental Health Needs of Children and Youth
Under the Health Care Policy and Strategies Program (HCPSP) at Health Canada, the federal government is providing funding to the following projects:
• $2M from 2021-2024 to the Canadian Mental Health Association (CMHA) to develop and pilot a national specialized peer support certification program for use by post-secondary institutions to support student mental health.

• $6.8M from 2019-2024 to Foundry to help organizations implement integrated models of youth mental health care. This complements $9M in funding to Frayme from 2019-2024 to promote broader implementation of integrated youth services in Canada.

• $2M from 2021-2026 to the Children’s Hospital of Eastern Ontario (CHEO) to increase the spread of the Aaniish Naa Gegii: the Children’s Health and Well‐being Measure (ACHWM), co-developed with Indigenous partners to help measure the health and wellbeing of Indigenous children.

Wellness Together Canada

Health Canada invested $130 million from 2020-2022 in Wellness Together Canada, an online mental health and substance use support portal, and received $140 million in Budget 2022 to support the portal for two more years, beginning in 2022-23. Launched in April 2020, Wellness Together Canada provides free and confidential onlin0e mental health and substance use supports accessible 24/7 to individuals across Canada in both official languages. Interpretation services are also available during phone sessions in over 200 languages and dialects. Through Wellness Together Canada, individuals in all provinces and territories have immediate access to supports ranging from self-assessment, educational content and self-guided programming, to peer support and confidential sessions with social workers, psychologists and other professionals. Supports are provided online as well as by phone and text for those without internet access.

There are dedicated text lines for youth, adults and front line workers that provide immediate access to support. There is also a dedicated phone line for accessing Program Navigators that can assist with finding resources on the portal. Wellness Together Canada augments existing provincial and territorial services, and does not replace them. In January 2022, Wellness Together Canada launched PocketWell, which is a companion app to the online Portal.

Through the Portal and the app, children and youth (ages 5 to 29) are able to access mental health and substance use resources, including Kids Help Phone, which provides online, phone and text based support to young people who are in crisis or dealing with mental health issues.

Additional resources are being invested in Kids Help Phone ($14.8M over 36 months from April 2020 to March 2023) provide mental health support to youth in need during the pandemic.

As of November 14, 2022, almost 3 million individuals across all provinces and territories have accessed the Wellness Together Canada portal in over 8 million web sessions. The new PocketWell mobile app has been downloaded a total of 30,792 times. Additionally, approximately 45% of registered clients of the portal are under 30, an age group that tends to underutilize traditional mental health services.
Support for the Mental Health Needs of Those Most Affected by COVID-19

Budget 2021 announced $100 million over three years to promote the mental health of those most affected by the pandemic, including youth. Funded projects began in spring 2022 and are reaching diverse populations across Canada. Projects will support mental health promotion and mental illness prevention interventions, in addition to initiatives that build the capacity of service providers to deliver programming in safe, effective and trauma-informed ways.

Mobilizing Data and Evidence to Underpin Initiatives

Between 2016-17 and 2020-21, the Canadian Institutes of Health Research (CIHR) invested over $413 million in mental health and behavioural disorders research.

CIHR, in partnership with the Graham Boeckh Foundation, is supporting ACCESS Open Minds, a national project that is transforming the way youth aged 11-25 access mental health care by developing and testing evidence-informed approaches into IYS. There are currently 17 sites operating in 7 provinces and one territory. These sites have transformed youth mental health services in diverse ways based on local context. For example, in Ulukhaktok, a remote community in the Northwest Territories where professional service providers are not always available, the site is evaluating a model where lay health workers are trained to provide support to youth in distress.

The IYS Network of Networks Initiative ($1M over 1 year), was also launched by CIHR in April 2022 to create a Canada-wide network of provincial and territorial learning health systems for Integrated Youth Services for mental health and substance use.

In addition, CIHR committed $6.25M over 5 years to the Mental Health in the Early Years funding opportunity in March 2022, with a focus on mental health initiatives for young children (ages 0-5), Indigenous Peoples, as well as transforming mental health with integrated care.

CIHR is also leading the COVID-19 and Mental Health Research Initiative (CMH) in collaboration with PHAC and Health Canada. This initiative supported 101 research projects, of $13.5 million from CIHR and partners. This work is guided by an Expert Advisory Panel composed of leading Canadian experts in mental health and substance use. New knowledge generated through these projects will be mobilized to ensure it will inform policy making in a timely manner.

Statistics Canada developed and administers a web panel survey, the “Canadian Perspectives Survey Series”. Each month, approximately 4,600 people in the 10 provinces have been responding to the new iteration of the survey. In addition, in collaboration with Statistics Canada, PHAC funded two cycles of data for the Survey on COVID-19 and Mental Health (with a third cycle in development) to better understand the wider impacts of the pandemic on mental health in Canada. A special collection of research articles based on the first cycle of data was released in the Health Promotion and Chronic Disease Prevention Journal on September 27, 2021. The Canadian Community Health Survey also resumed in September 2020. The Canadian Community Health Survey provides data on a variety of mental health indicators, and has been collected for many years prior to the pandemic. It will allow for ongoing measurement of changes in mental health of the Canadian population as the pandemic continues and as Canada recovers.

Additionally, the 2019 Canadian Health Survey on Children and Youth, with a second cycle planned for 2023, explores issues that have an impact on the physical and mental health of children and youth (aged 1-17 years). As well, the 2022 Mental Health and Access to Care Survey, focuses on the mental health status of Canadians aged 15+ years and their access to and need for services and supports. This survey also intends to assess the impact of the COVID-19 pandemic on population health as well as evaluate changes in patterns of mental health, service use and functioning in the last ten years.

Mental Illness Surveillance

As part of its mandate, the Public Health Agency of Canada (PHAC) is pursuing ongoing surveillance of mental illness in the Canadian community. It uses multiple data sources to provide the most up to date evidence available, including the Canadian Chronic Disease Surveillance System (CCDSS), the Canadian Health Survey on Children and Youth (CHSCY) and the Canadian Community Health Survey (CCHS).

The CCDSS is a collaborative network of provincial and territorial chronic disease surveillance systems, supported by PHAC. It identifies chronic disease cases among all residents who are eligible for provincial or territorial health insurance, and contains aggregated data that can be stratified by age, sex and geographical locations. The CCDSS enables to track and report on health services use for mental illness overall and alcohol/drug induced disordersfor mood and anxiety disorders in the Canadian population, as well as for schizophrenia.

The 2019 Canadian Health Survey on Children and Youth (CHSCY) is a national, cross-sectional survey that provides health-related information on Canadian children and youth. The survey is representative of the Canadian population aged 1 to 17 years as of January 31, 2019, living in private dwellings in Canada's ten provinces and three territories.

As well, to help address data gaps around the impact of the COVID-19 pandemic on individuals, families, and communities in terms of their mental health (including symptoms of anxiety and depression, and of post-traumatic stress disorder [PTSD]), PHAC partnered with Statistics Canada in the development of the Survey on COVID-19 and mental health. The survey contains information on the proportion of Canadians who screened positive for these conditions by age group and gender, and look at the more at-risk groups. These surveys were conducted at various times during the COVID-19 pandemic and provide timely information on the impact of the pandemic on the mental health and well-being of Canadians

• Almost two thirds of mental health disorders emerge before the age of 25, and nearly half do before 18. It is estimated that over 800,000 Canadian children and youth use health care services for mental illness of and alcohol/drug induced disorders annually.
• Children and youth are among the highest users of Emergency Department (ED) for mental health and substance use services.
• In 2020, suicide was the second leading cause of death among individuals aged 15 to 34.
• The COVID-19 pandemic has had significant impacts on the mental health of children and youth. The percentage of youth reporting “excellent” or “very good” mental health fell from 73% in 2019 to 67% in 2020 and was even lower in fall 2021/winter 2022 (61%). Furthermore, the percentage of youth reporting that their mental health was “somewhat worse” or “much worse” now compared to before the pandemic rose from 14% in September 2020 to a high of 35% in March/April 2021.
• Before the COVID-19 pandemic, the prevalence of self-reported diagnosed mood and/or anxiety disorders in youth aged 12-19 years increased from 4.5% in 2005 to 11.5% in 2017 (controlling for age). In 2017, a greater percentage of girls than boys self-reported diagnosed mood and/or anxiety disorders (14.4% among girls vs. 8.6 among boys).