I thank the chair and the members of the committee for the honour of the invitation and this opportunity.
As an introduction, I'm a clinical assistant professor and subspecialist child and adolescent psychiatrist. I've been in practice for 14 years. I was a medical director for a major psychiatric emergency unit at B.C. Children's Hospital for over 10 years. You've already met my colleague, Dr. Quynh Doan, an emergency physician with whom I co-created the HEARTSMAP, a psychosocial screening tool for youth. I'm also the creator of the ASARI, a leading practice tool for the completion of suicide risk documentation.
I'm passionate about teaching, suicidology and mental health research, but most of all, I'm extremely committed to the health and well-being of the over 10,000 child and adolescent patients who I've seen in emergency settings and the children and adolescents who I'll never get a chance to see.
Though my opening statement will not focus on these, I have submitted a briefing note for your consideration. Instead of drowning this committee with more wordy words, I've chosen to deliver graphs that demonstrate important data-driven perspectives that I consider to be crucial and neglected knowledge. I've also included five graphs to demonstrate the complexity of the data we are seeing in Canada for youth with mental health changes since the pandemic.
As a quick aside, I never imagined that my experience in suicidology would lead me to be mired in political battles, but during the pandemic my advocacy has led me to correctly cautioning against the proclamations of increasing rates of suicide due to the pandemic. In fact, they have decreased. I have been in public responding to the horrific use of children's mental health and suicide by politicians and non-mental health experts to justify resisting protections against a pandemic that has killed millions and has created over 10 million orphans worldwide.
I have published and will publish more data that challenges the dominant moral panic narrative that there have only been mental health deteriorations in youth. Some youth have thrived and we need to understand why that is.
To the larger issue of mental health, my clinical work involves assessing children in the emergency department for mental health complaints and consulting with colleagues across B.C. The impacts of lack of service are readily apparent to me. A significant percentage of my patients and their families are wait-listed for mental health services at the moment that I'm seeing them, leaving me with only the daunting option of calling to advocate for expediency or telling these suffering youth to keep waiting. Children who present to mental health teams across Canada are rejected for service due to exclusion criteria or put on tremendous wait-lists because it's not severe enough only later to present to me with a suicide attempt after months of unaddressed suffering.
I deal disproportionately with youth in government custodial care or indigenous youth in Canada, knowing full well that the systemic barriers, racism and colonization are the reason that I see this disproportionate amount. The moral injury I suffer on a regular basis is incredible. I'm just glad to be the type of person who works hard to do my best during adversity because if I ever were to stop and just survey the bleakness of some of the things that I see, it might just crush me.
There are many things I think the federal government could do to improve mental health care and outcomes for children, and a non-comprehensive list would include improving the social determinants of health, like poverty, abuse, education and systemic barriers; ensuring the highest quality of care to children who are minoritized, underprivileged or living in remote areas; providing cost-free access for families to pharmaceuticals and therapies; eliminating exclusion criteria from youth services, which only further systemic discrimination; ensuring federal support for youth with disabilities for all neurodiversities; ensuring federal standards for early access and timely access to care; providing money to provinces with agreement to create treatment centres with day treatment, “step up step down” and neurodiversity focuses; creating standards for school safety; and establishing science-supported ways to make school less stressful for children.
Psychiatrists are trained in a bio-psychosocial model, and from day one we're taught the importance of the social determinants of health. Frustratingly, I have few ways to prescribe or modify the social determinants of health to provide programs that would deliver services to youth who need them or to affect on a large scale the effects of colonization on indigenous youth, but the government does have those powers.
On behalf of the children I work with and the families and caregivers who love them, for all the youth I don't get a chance to see, I'm so grateful this committee is tackling this issue and I really hope that serious and substantive change will come from the fruit of these labours.
Thank you.