Bonjour. Thank you for the opportunity to speak to you today.
My name is Dr. Mark Feldman. I am a pediatrician. I have worked at the Hospital for Sick Children in Toronto for the past 30 years. I am speaking to you today, however, on behalf of the Canadian Paediatric Society as its 101st president. The CPS is a voluntary professional association that represents approximately 4,000 pediatricians across our country.
You've just heard that there's a critical gap in timely, affordable and equitable access to mental health care across Canada for children and youth. What I wish to do today is to provide some additional context and the perspective of pediatricians from your provinces, and to offer some potential solutions.
The other day, Dr. Ungar spoke to this committee about the concept of resilience. Resilience is in part mediated by brain plasticity. Brain plasticity is the ability of the growing brain to adapt, heal and develop normally if positive changes are made early. Dr. Ungar emphasized that missed opportunities to treat mental health disease during childhood has devastating consequences later in life.
Children with attention deficit disorder, for example, will have more typical, more normal development of their brains, as demonstrated on pictures of brains—serial imaging studies with magnetic resonance imaging—if they receive treatment early for their ADHD.
I'll give you an example of what early intervention might look like. I have a patient who I think illustrates it well.
Kareem was referred to me at the age of 10 with behaviour problems. His father was not involved. His mother struggled with alcoholism. His brother was in jail. Kareem was a good kid, however. He was smart, kind and charming. But he struggled with impulsivity and inattention, so he struggled socially and academically. He was diagnosed with ADHD, received treatment at a critical time in his brain development and improved dramatically and rapidly. Fast-forward 15 years: I had the honour of attending his university convocation along with his mother and his fiancé. He is now a loved, respected, taxpaying member of society.
Was this a one-off? High-quality research has demonstrated that intervention for children and youth with ADHD, for example, can lower the risk of school failure, suicide, drug addiction, teen pregnancy, car accidents and incarceration. It improves the quality of life. It improves the likelihood of higher education and even lifespan.
The implication of early intervention in cost-averted care for children and youth with mental health disease is significant. Mental health problems serious enough to disrupt functioning and development affect approximately 1.2 million children and youth in Canada—that we know of—yet fewer than 20% of those receive appropriate treatment. This gap existed long before the pandemic. Children and youth who are immigrants or refugees or BIPOC or who live in remote communities are even less likely than their peers to receive appropriate mental health care, and are more likely to use services like emergency rooms when in crisis.
I recently had the privilege of meeting with the presidents of provincial pediatric societies across Canada to identify priorities nationally and to share strategies locally. Without exception, each provincial lead identified the mental health care access gap for children and youth to be a number one issue.
As you know, in 1985 the Canada Health Act was created to “protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers”. In Toronto, there's a clinic in North York that offers care for children with learning, mood and anxiety issues. The initial assessment by a physician costs $2,000. That's followed by a psycho-educational assessment at a cost of $5,000. Therapy sessions, if necessary, quickly add up to another $3,000. That's a $10,000 bill.
The wait time for publicly funded mental health care in different provinces, to see somebody like me, is anywhere between six months and two and a half years. If I then refer them for therapy, such as talk therapy, psychology services are generally not publicly funded in Canada.
On behalf of the Canadian Paediatric Society, we ask the federal government to uphold the commitment to establish a fully funded permanent Canada mental health transfer, and that 30% of federal mental health transfer payments are directed towards those under the age of 25 to ensure timely and equitable access to mental health care.
Some of the ways that money can be spent are funding the development of clinical practice guidelines, educational tools, navigational resources and systems as well as funding continuing professional development training programs for practising health care providers to upscale our skills and to support evidence-based mental health care for children and youth.
We would like to see that money is spent to ensure that assessments performed by psychologists and therapies delivered by psychologists or by other non-physician mental health care practitioners are similarly publicly funded, regulated and evidence-based.
I have all kinds of potential solutions, and I look forward to your questions.
Thank you.