Good afternoon.
I'm a pediatric emergency physician at BC Children's Hospital, and a health services researcher at UBC. My research has a focus on children and youth mental health care access and utilization.
We have been observing a consistent 6% to 8% rise in the number of pediatric emergency department visits for a mental health-related problem since at least 2002. This trend was maintained during the pandemic. It is most likely, however, that social isolation and psychological stress related to the pandemic significantly impacted children and youth mental health and wellness that is not entirely captured through emergency department visits. Simply looking at emergency department visits and hospitalization for psychiatric conditions may underestimate the psychological impact of the pandemic on our children and their resource needs.
To estimate the psychosocial hidden burden of the pandemic on children and youth in B.C., my team used MyHEARTSMAP, a validated digital psychosocial screening instrument that triggers customized health services recommendations based on the assessment data filled out by youth or their parents.
MyHEARTSMAP covers 10 psychosocial areas that maps to four domains of a youth's mental health, including psychiatric, social, functional status, and youth health. We also examined the association between demographic variables as well as families' pandemic experiences, such as schooling and employment status, among other variables, and their severity of psychosocial difficulties as reported on MyHEARTSMAP.
Between August 2020 and July 2021, we reached a diverse and representative sample of children and youth in B.C. using social media, family-oriented organizations, and Angus Reid, a private recruitment company. Our analysis included 424 assessments from children and their guardians at entry and three months later with 60% retention. At the three-month follow-up, we also asked if they had accessed any of the recommended mental health support services that were triggered at the initial screening, and explored which factors were associated with accessing care.
The majority of participating youth reported some degree of difficulties across the psychiatric, social and functional domains. Adjusting for all other variables, we found that older youth were statistically more likely to report severe difficulties in the psychiatric domain. Gender also played an important role. Compared to boys, youth who identified as non-binary or questioning genders were four times more likely to report more severe concerns in the psychiatry domains, and girls were twice as more likely to report greater social issues.
In B.C. during the study period, there was no universal school closure policies; however, youth who were not attending any formal educational programs either at home or in person at a time when school would normally be in session were twice as more likely to report greater severity in the psychiatry and youth health domains compared to youth who were in full-time, in-person school.
Based on their assessment information, consideration for accessing community mental health services was recommended to 74% of participants. While having the assessment done initiated a family discussion about youth mental health support, having a family doctor was the single greatest predictor of accessing community mental health services with an odds of 11 to 1.
In conclusion, psychosocial difficulties were reported by the majority of participating youth during the pandemic. Fortunately, most were mild, thus adequately accessible community mental health supports in the community are essential to curb escalation needs for more intensive, scarce and costly resources. We also note that specific resources to support youth who may be gender questioning or have non-binary gender identities should be considered.
Overall, I'm advocating for nationwide networks of integrated health services through the expansion of multidisciplinary youth health programs, like the Foundry BC model, where primary health care and specialized mental health care providers work collaboratively and cohesively to provide one stop shop health care to youth age 12 and up. This would also address the findings that family doctors and access to primary care are a key resource for youth accessing mental health resources when the needs are identified.
Thank you.