Speeches | Child, Family and Adolescent Mental Health

25 June 2013

Honourable senators, I know it is late, and after many late nights, we are all tired. I appreciate honourable senators' patience and attention to what I believe to be a very compelling and important topic.

Tonight I am speaking about the valiant and persistent efforts, often against great odds, of CASA, a northern Alberta not-for- profit organization that has been providing services to children and adolescents with mental health and learning problems for more than three decades. By extension, CASA works with and supports the families of these children, who suffer deeply along with them.

CASA has served our community — northern Alberta, based in Edmonton — and many children and families within this community with great distinction for these many years.

I speak today specifically to draw attention to the desperate state of their facilities and their need for a capital infusion to replace a collapsing building with a modern educational and treatment facility. I speak to draw attention to the fact that despite tireless efforts, CASA has been unable to secure the funding they need to do their important work at the high level at which they want to do it, and we need them to do it.

It is suggested by the experience of CASA in this regard, I believe, that support for children's mental health services, including federal support, is inadequate across the country and in need of attention.

This neglect of children's mental health services can and does have serious rebound effects that harm children's lives and incur untold costs on society more generally. Untreated childhood and adolescent mental illness and disability, including learning disabilities, result in adults whose lives and the lives of their families are diminished by sustained and worsening mental illness; who cannot find or perform productive and fulfilling work; whose continuing problems will bear on social support networks in their futures; and whose behaviour trajectory can often bring them into intense conflict with the law.

Research further shows that those with lifelong mental illnesses are as much as four times more likely to be victims of crime. For three decades, CASA has stood between so many vulnerable northern Alberta children and these outcomes. CASA has helped and helped, and now CASA needs our help.

CASA is the most remarkable of institutions. It is a non-profit that is run, as so many are, by a voluntary board. Since 1978, it has provided educational and mental health services to some of the most vulnerable and disadvantaged children and adolescents in our northern Alberta communities. CASA's staff is literally state of the art. It is filled with multidisciplinary professionals, including psychiatrists, nurses, social workers, teachers and therapists. Their services include academic support, social skills training, psychotherapy and a variety of other therapies including trauma and attachment therapies. They provide specialized programs like Headstart and outreach for Aboriginal children.

From their recent newsletter, I would like to select some lines for honourable senators' consideration to provide some insight into the kinds of issues that CASA deals with:

Start with a real live child, the one you know who is near and dear to your heart. Mix in a double helping of depression or anxiety disorder, a splash of Attention Deficit Hyperactivity Disorder and, to top it off, a learning disability and perhaps developmental delay. These multiple issues often cluster together in a number of combinations that make a child's life very stressful at home, at school and in the community. The child's pain is further complicated by the impact of loving but worried, stressed-out adults in their lives. All of this, when unaddressed, has serious long-term impact on the child's emotional well-being, and social and educational development.... and if a child was one of these conditions, there is a very increased chance of one or more of these other conditions also occurring, each with its own degree of intensity.

Testimonials from CASA include the heart-wrenching story of a four-year-old who claims he wants to stab himself with a knife, a nine-year-old girl who contemplates suicide, a 14-year-old girl who sets fires to her school following the trauma of a violent assault.

Of particular importance in the context of crime prevention, CASA provides day treatment programs for children and youth suffering from oppositional defiance disorder, ODD; conduct disorder, CD; and antisocial personality disorder. ODD occurs in about 10 per cent of all children. It presents as a very bad case of a very bad temper and is characterized by blaming one's mistakes on others, being spiteful and vindictive, being cruel and deceitful. If left untreated, in a typical and reasonably stable home environment, about half the children grow out of it. The other half, perhaps not lucky enough to have stable homes and consistent parental attention and discipline, will often go on to develop conduct disorder and even antisocial personality disorder.

Those suffering from these kinds of conditions are typified by their engagement in criminal behaviour — setting fires, theft and assault. This is not just kids being kids; these are serious crimes spurred by mental illness that far too often goes untreated.

To focus on the importance of CASA's work for the greater good, honourable senators, consider a study conducted in 2006 by the U.S. Department of Justice, which found that up to 87 per cent of the youth incarcerated in juvenile detention centres at any given time across the U.S. had been diagnosed with conduct disorder. These numbers are consistent with the Canadian experience, where the vast majority of youth in juvenile detention centres suffer from conduct disorder, learning disabilities and/or similar conditions.

It is not just crime that is at stake here. A 1997 study of teen suicide in a large metropolitan centre in Canada concluded that 89 per cent of teens' suicide notes contained spelling errors and handwriting consistent with learning disabilities. Another study, conducted in 2009, found that people with reported learning disabilities were twice as likely to report high levels of distress, depression, anxiety disorders and suicidal thoughts, and all of these things seem to get worse with age.

These conditions are what the children and adolescents helped by CASA suffer and confront every day of their lives. CASA treats these children with compassion, dignity and respect, and with state-of-the-art mental health and other related professionals.

CASA serves about 3,000 infants, children and youth at any given time. They see about 200 per day in one program or another, and fully 13 per cent of the children enrolled in CASA are Aboriginal.

What is the cost to all of us in not adequately treating these children and youth? Alberta has just built a $600-million remand centre in Edmonton. Eighty per cent of the inmates there will have some form of childhood psychological trauma, learning disability or any number of mental health issues. There is credible evidence that for every dollar we put into child and youth mental health treatment, we avert $7 of cost in future public support, and that in no way anticipates the cost of their lost productivity to our economy and to our society throughout their lives.

Ninety-eight per cent of the parents of children treated by CASA will say that the care they have received is excellent. We can imagine one can see in their eyes the profound gratitude for what CASA has done for their children and for their families. Compare that with the evidence that 87 per cent of incarcerated youth have mental health disorders like ODD and CD, and we can see a good part of the value of CASA's remarkable work.

It often takes many years for a young brain to be damaged, through the accumulated trauma of a dysfunctional home life or often no real home life at all. For genetic mental health conditions, it can take many years, or they can worsen significantly over the years as well.

The science of mental illness and behavioural problems is such that we can now predict with a good deal of accuracy what will become of a very young child displaying given kinds of behaviour if he or she is not treated. Often it is all too easy to predict that they can end up in the criminal justice system and we would have known that it was going to happen.

Among the many tragedies in all of this is that there are not enough resources available for the kinds of treatment that are required, even though so much of this mental illness is actually treatable. The science and understanding that can now predict outcomes can also change them, and it takes many years of specialized care and treatment to fix these illnesses, or at least to diminish their most corrosive effects.

It requires continuity, persistence, people and facilities. It requires the kind of care and treatment provided by CASA, but while CASA is capable of providing the continuity, the persistence and the people — and it at least has been to this point — it is the facility that eludes them.

The problem is that CASA does much of its work out of a 62- year-old former school. It is crumbling, with gaping fissures that go from inside to outside. I have seen them. You can literally see through the walls in some places. It is impossible to heat this facility adequately in the winter and impossible to cool it adequately in the summer. There is not enough room in it for all that CASA has to do and for all the good that CASA can do. It is a school without a state-of-the-art mental health treatment facility. It is a school. It is not the kind of full-service treatment facility that CASA really needs.

They need $18 million for a new facility and they cannot get it. They cannot get help from the province and they cannot get help from the federal government.

The remand centre cost $600 million, and recently the Stollery Children's Hospital in Edmonton received $55 million. The Stollery is also a remarkable and wonderful institution, and it deserves and needs that $55 million. Consider that every bit as profound as the health problems that the Stollery deals with, with so many children, and deals with so well, are the mental health problems that CASA deals with as well. Every bit as profound as the problems that Stollery deals with are the mental health problems that CASA deals with. However, the health problems that CASA deals with have that stigma that is attached to mental health issues, unfortunately, and they seem to get forgotten.

To compound the stigma of these afflictions is a facility that is so old and decrepit that it is an unfortunate analogy for that stigma and only reinforces what every child who goes there must feel already every day of their lives. Eighteen million dollars is what is required.

In 2011, it cost up to $250,000 to house an inmate in prison for one year, not to mention the cost of building the cell, and yet we seem to focus on imprisoning as the priority way for dealing with crime. If the work of CASA averted just 72 of the 3,000 clients they have right now from ending up in prison, we would break even on CASA's $18-million facility requirement in just one year. The savings? Compare $250,000 for a year in prison with CASA's average cost per client, which is $3,500 per year.

We are an enlightened society. Canada is a remarkably giving and compassionate place. There is so much money in our society today, more than ever before, and so few seem to have any of it, or so often it seems not to be where it needs to be to make lives significantly better.

I know the argument that says we are all responsible for ourselves, and there is a certain romantic appeal to that idea of rugged individualism, but neither of these concepts applies to these troubled children and their struggling families. They lack the capacity to fix these problems, to confront this pain by themselves. They need our help; the families need our help; and CASA needs our help. Somehow the federal government has to address this case and cases that I am sure exist all across Canada just like it.

It can be argued that this is not federal jurisdiction, and in fact the federal government argues that, but the supports that these young people will need as adults often fall within federal jurisdiction and cost the federal taxpayer.

The federal government needs to break this impasse. It is the right thing to do. We will all be stronger and better for having done it and so will these children and families who so desperately rely on all that CASA can give them.

Hon. Jane Cordy: Will the honourable senator take a question?

Senator Mitchell: Yes.

Senator Cordy: Thank you very much for an excellent inquiry. I made a request to the Social Affairs Committee that we do a study on the mental health of children and youth. I hope the steering committee will look favourably on that. I agree with the honourable senator; it is so important.

In fact, former Senator Michael Kirby, who as honourable senators know chaired the Mental Health Commission, has suggested that indeed we have to do a lot of work on children and youth mental health because children with mental health problems are falling through the cracks.

The honourable senator certainly indicated indirectly in his speech the effect early intervention would have in helping children and youth. Many of the adults who have mental health problems have said the first time they recognized it was when they were teenagers. Does the honourable senator believe that early intervention would be beneficial to children and youth?

Senator Mitchell: Could I have five more minutes?

Hon. Senators: Agreed.

Senator Mitchell: Honourable senators, there are several points there I would like to address.

First, I am happy to hear that consideration has been given to the possibility of the Social Affairs Committee doing a study. If that is to be the case, I would encourage that CASA be called to witness and that perhaps the facility in Edmonton be the object or target of a visit by the committee. It would be revealing and powerful. I was moved deeply and profoundly when I visited.

I want to emphasize the importance of early intervention. In fact, Stan Kutcher from Nova Scotia is a well-known psychiatrist who has done a great deal of work. I was at a presentation he made where he makes the point that young brains — very young brains, almost from birth sometimes — can be damaged and are damaged by the environment within which they live, such as dysfunctional homes, or other kinds of pressures and stresses that youth can be subjected to. Over time, that can mount and compound the illness that they may be genetically predisposed to having or that may be inflicted upon them because of these circumstances.

He makes it very clear, and the research and studies beyond even what Dr. Kutcher does make it clear that early intervention at any stage, even later in life, but the earlier the intervention, the more likely it will be successful. It needs to be comprehensive and all-encompassing because often these children have been in a comprehensive and all-encompassing very negative environment. Therefore, they need to have a facility like the one imagined by CASA where they can come and spend day after day in a defined, compassionate environment where they can receive the mental health and learning disability kinds of support that they need and that will really make their lives better and make them better contributing members of society in the longer term.

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