Kids are in crisis and mental health agencies are struggling to keep up

Demand for walk-in children's mental health services in northern Ontario has more than doubled since the pandemic began. In Ottawa, 30 per cent more youth are accessing counselling and addiction services. In Hamilton and Toronto, suicide attempts by some young people are becoming more severe, causing higher rates of hospitalization than normal.

The way Ontario children are accessing the mental health care system throughout the pandemic tells a story of an increase in anxiety and stress symptoms, and of unprecedented demand that some agencies and hospitals are struggling to keep up with. Wait-lists for intensive mental health care, which were already lengthy before the pandemic, are now doubling in some parts of the province.

You have more kids who are coming into the system who are needing more help," said Kimberly Moran, president and CEO of Children's Mental Health Ontario.

The existing bottleneck on intensive care, she added, is getting more clogged as a result.

With Ontario staring down a second indefinite province-wide school closure on Monday due to record numbers of COVID-19 cases, mental health experts are sounding the alarm on the escalating strain children are facing as a result of the pandemic. School disruptions, though only one factor in a pandemic that has impacted every facet of daily life, are part of the problem.

Most kids are all right, Moran said. They're highly resilient and have robust support systems. But kids with existing mental health conditions, a difficult home life and who are marginalized, are struggling more than ever.

The reasons behind the heightened stress experienced by some children are also changing, Moran said, as the pandemic progresses - social isolation is becoming harder to bear, the rate of children getting sick with COVID-19 is higher than it was in the first wave, and their younger parents are at a higher risk of developing serious illness from the virus due to the new variants.

The lengthened economic strain on parents is also being downloaded to children. In North Bay, clinicians said they are noticing higher rates of family deterioration than before the pandemic.

Typically, we've seen that 40 to 60 per cent of kids come in, they get a session, one to two follow-ups, and then they're good to go," said Trish Benoit, acting director of child and youth services at Hands, a publicly funded mental health service provider in North Bay with a large catchment area in northern Ontario, spanning from Timmins to Muskoka.

But recently, we've seen that has completely gone down," Benoit added. Instead, children are coming to Hands with more complex trauma and self-harm, and more severe levels of anxiety and depression. They're needing longer-term counselling and treatment and intensive services," she said.

This has impacted the wait-times for both Hands' long-term counselling services and intensive services. What used to be a three-to-six-month wait time has now more than doubled to up to a year. Hands has since hired two additional social workers to help, but the agency is still under significant strain.

We just simply don't have enough clinicians," Benoit said, adding that of the 200 children receiving long-term help at any given time, more are requiring intensive help for longer due to the rising complexity of their cases.

At Hands, the number of bookings for walk-in services increased by 184 per cent from April to early December, from 68 bookings to 193. Since August, the agency has averaged about 120 new requests for service each month. Their average number of weekly new clients has increased from 10 to 40 as of January.

Benoit said this trend is observed across many youth mental health agencies in the province. Numbers provided by CMHO echo this - at the walk-in clinic run by Maltby Centre in Kingston, volumes in September 2020 were double what they were the previous year. In Ottawa, the Youth Services Bureau saw a 30 per cent increase in need for youth counselling and addiction services.

What's most alarming for Benoit is the rise in suicidal ideation and self-harm seen by Hands in North Bay. Before, it was people contacting our crisis team because they had feelings of crisis. Now we're seeing really acute suicidal ideation and attempts, and profound loss and depression," she said.

These suicide attempts and ideation are also being observed by Ontario hospitals. At McMaster Children's Hospital, suicide attempts in youth were four times higher during the second wave of COVID-19 compared to the same period in 2019, according to CMHO data. Need for medical support for these youth has tripled, and youth are staying in hospital longer due to the seriousness of attempts.

The increased severity in suicide attempts has also been observed by Michael Garron Hospital in Toronto. The Children's Hospital of Eastern Ontario in Ottawa has also seen a 30 per cent increase in self-harm during the pandemic, CMHO said.

The severity of these cases, Moran said, signals that kids and youth are running out of places to go to get help before they hit a crisis point. While walk-in clinics are readily taking children and youth in for very short-term counselling - about two-to-three sessions - longer-term support for more complex cases is now harder to come by without a significant wait.

There's just not enough places for kids and families to go," Moran said.

The longer kids sit on a wait-list, she added, the more their lives can be at risk. This, at a time of a heightened COVID-19 crisis that has seen hospitals like Sick Kids admit adults to their ICU units for the first time to help care for an overflowing number of critically ill patients.

What we should be doing is strengthening rapidly those services for kids who have more serious mental health issues to prevent them from needing to go to hospital," Moran said. This should be job number one."

If you are thinking of suicide or know someone who is, there is help. Resources are available online at crisisservicescanada.ca or you can connect to the national suicide prevention helpline at 1-833-456-4566, or the Kids Help Phone at 1-800-668-6868.

Nadine Yousif is a Toronto-based reporter for the Star covering mental health. Her reporting is funded by the Canadian government through its Local Journalism Initiative. Follow her on Twitter: @nadineyousif_