Access to Mental Health services for children and youth in Ontario

• Children and youth suffering from mental illnesses are at risk of self-inflicted injury and suicide. Suicide accounts for over 15% of all deaths of youth and young adults in Ontario. It is the second leading cause of death of young people (15-24). Only motor vehicular traffic accidents claim more lives.

• 9% of the hospital admissions for children aged 10-14 and 13% for youth (15-19) in Ontario are for Mental Disorders. Hospitalizations for self-inflicted injuries are not classified as mental disorders. 25%-30% of deaths due to injury in the 15-24 age group are self inflicted. 25% of hospitalizations of 15-19 years olds are for self-inflicted injuries.

• Admissions for mental disorders is the 3rd leading cause for hospitalization for youth (15-19), surpassed only by pregnancy, or injury (including self-injury). In 1997 there were 4,500 admissions for mental disorders in youth 15-19 in Ontario (1,700 for psychoses and 2,700 for neuroses) ; 9,000 pregnancy related admissions; and 4,600 admissions for injuries including self- inflicted injuries and 314 for cancer.

• In 1997 there were 216 hospital admissions for 10-14 year olds for cancer, 286 admissions for psychoses, and 1200 for neuroses (mood disorders).

• The average hospital stay for a mental disorder is 10 days; a week for neurotic disorders, and two weeks for psychotic disorders. A response to anti-depressants takes a minimum of two weeks to months. The risk of suicide can initially increase as the patient starts to respond to the anti- depressant, and his or her energy level increases. A response to anti-psychotics takes months. Patients are frequently discharged before a therapeutic response to the medication has taken effect, and before it is know whether the patient will actually respond to the prescribed medication.

• The average length of stay is 25 days in the rest of Canada. For Ontario the average length of stay for a mental illness is less than 10. Typically, an assessment takes two weeks.

• One in four hospital days (used hospital beds) is for a mental disorder; 17% for 10-14 age group, and 28% for the 15-19 age group, and this does not include hospitalization for self- inflicted injuries. In comparison, pregnancies account for 16% of the hospitalization for the 15- 19 age group, and cancer less than 5%.

• For every one bed available to assess and treat mental illness in children and youth in Ontario, there are two beds available in other provinces in Canada.

Figure 1: Hospital Days for Mental Illness, for children and youth aged 0-19, days in hospital per 100,000 population. This figure shows the steady decline in hospital beds (1 bed = approximately 365 hospital days at 100% occupancy) in Ontario, and that on a per population basis, provinces other than Ontario have twice as many beds than are available in Ontario. The total hospital days has been normalized to represent a population of 100,000 children and youth (0-19), and hence facilitate comparison between regions of unequal populations.

Figure 2: Length of Stay (LOS) in hospital for Mental Disorders, Ontario and other provinces. This figure shows that hospital stays are considerably shorter in Ontario than in other provinces. A psychiatric assessment takes at least two weeks, and standards of care used in the US suggest 28 days is an appropriate average length of stay for planning purposes.

The Prevalence of Mental Illness

Lifetime:

100%  * The fact that many, if not most, people have experienced mental health problems that mimic
even match some of the symptoms of a diagnosable mental disorder tends, ironically, to prompt
many people to underestimate the painful, disabling nature of severe mental illness.  Women aged
15-19 have the highest prevalence rate for depression at 9%.  Among Canadians age 12+, 4 per
cent reported being depressed for a least weeks in the year. Of those reporting being depressed,
42% were depressed less than 4 weeks.

20% * For about one in five Americans, adulthood -a time for achieving productive vocations and for
sustaining close relationships at home and in the community - is interrupted by mental illness.

1% * Die by their own hand

0.01% * Die by the own hand each year

Adult Prevalence:

20% * Experience a diagnosable mental disorder during the course of a year.

10% *  Use mental health services in any year

9% * Have experienced significant functional impairment due to a mental disorder

7% * Have disorders that persist for at least 1 year

5% * Have a "serious" mental illness (SMI)

4% * Are taking a prescribed anti-depressant

2.5% * Have "severe and persistent" mental illness (SPMI)

0.5% * Are unable to work and receive disability benefits

0.5% * Have unmet health care needs for emotional care (NPHS¹, 1996)

0.05% * Are currently hospitalized

Children and Adolescents:

20% *  Experience a diagnosable mental disorder with at least mild functional impairment

10% * Experience disruptive disorders, a diagnostic category not typically used for adults

7% * Experience serious emotional disturbance

6% * Youth reporting a suicide attempt

4% * Receiving medical treatment for a mental disorder

2% *  Are on a prescribed anti-depressant

0.5% *  Hospitalized for mental disorder each year

0.2% *  Hospitalized for self-inflicted injuries each year

0.08% * Die by their own hand before reaching age 20

0.02% * Are currently hospitalized

0.00004% * Die by their own hand today (youth 15-24)

Costs of Mental Illness

The costs of mental illness are exceedingly high. Canada spends 11% of its health care budget on treating mental disorders. Inc Canada, 9.3% of the country's gross domestic product (GDP) was spent on health care in 1997, or 1% of GDP was spent on mental disorders.  In contrast, the US spent 14% of its GDP on health care.

For more information on health care expenditures see the following:

Toward a Healthy Future: Second Report on the Health of Canadians.
Ref: Stat Can pub # 82-570-XIE.
http://www.statcan.ca:80/english/freepub/82-570-XIE/free.htm

• From the Center of Excellence for Children's Mental Health