Thanks very much.
Again, thanks for the opportunity to present today. I am going to talk about the relationships between child and youth mental health and poverty, but I want to begin by giving a brief overview of what we know about child and youth mental health difficulties.
According to the global burden of disease study, mental health and substance use disorders are the leading cause of disease burden worldwide, and Canada is no exception. While we often think of these disorders as disorders of adulthood, it's important to recognize that they emerge early in the life course, with estimates of over 1.2 million Canadian children and youth, or roughly 20%, being affected by a mental health disorder.
There is a large burden of suffering associated with child and youth mental health problems, including the impact on the children themselves and on the families, and costs to the health, educational, and judicial sectors, to name a few. It's troubling that many of these children did not receive specialized mental health services. If left untreated, the consequences are profound, causing significant distress and impairment throughout the life course. Up to three-quarters of adults with mental health disorders date the beginning of their difficulties back to childhood or adolescence.
Many children and youth with mental health problems are exposed to poverty, and there is a dynamic and bidirectional association between child and youth mental health disorders and poverty. While we often think of poverty as a determinant of poor mental health, it's important to acknowledge that poor mental health can contribute to poverty.
First, I'll focus on child and youth mental health problems influencing poverty. We know that these problems are common and can influence children and youth in many ways. For example, children with mental health problems may have trouble doing the things that most children are able to do in that developmental stage, such as progressing in school, having successful friendships, and getting along with their siblings, teachers, and parents.
Prospective studies that follow these same children into early adulthood provide compelling evidence for the long-term adverse effects of childhood mental health problems on young adult functioning. For example, 60% of young adults who experienced a childhood mental health problem report adverse adult outcomes, including high school dropout and unemployment, compared to 20% of those who did not experience a childhood mental health problem.
Additional adverse adult outcomes include physical and mental health problems, problems with social functioning, and legal problems. These impairments in adulthood clearly influence financial and occupational stability and can contribute to poverty.
Second, I'll focus on poverty influencing child and youth mental health. Children living in poverty are two to three times more likely to develop mental health problems. Parental nurturance, cognitive stimulation, and an accumulation of exposure to related psychosocial risk factors can all help explain why children growing up in poverty are more likely to experience mental health problems. For example, children who live in poor households may have parents with their own physical or mental health problems, who have struggled in school and who have difficulties maintaining stable employment or ensuring adequate resources are available to the family. A living situation may be crowded and provide less cognitive stimulation, which may contribute to poor academic outcomes.
Early exposure to poverty has been linked to worse mental health in emerging adulthood as a result of an accumulation of exposure to associated psychosocial risks such as family turmoil and family separation, and physical risk factors such as substandard housing and crowding. It's clear that the experience of childhood poverty modifies dimensions of the personal, familial, school, and community context that children need in order to thrive and contribute meaningfully to society.
I want to end by focusing on six recommendations for mitigating the effects of poverty on child and youth mental health.
Number one, start early. This will allow preventive and early interventions that address early childhood emotional behavioural problems and are likely to have the highest impact, since trajectories of these problems are often established early and tend to persist over time, and the ability to change behaviour and brain plasticity decreases over time.
Number two, provide service at the right time. This will allow a focus on developmentally sensitive periods, such as early childhood and pre-adolescence, early in the course of symptom presentation or illness.
Number three, we want the right identification. From the broadest perspective, the right identification requires increased ability to recognize concerning behaviours, and that means increased education about what the scope is of normal behaviour and what the early signs are of mental illness for youth and children. With the right identification, more systematic identification may occur through established systems of care, such as regular baby and child visits to primary care. This will need associated investments in the primary care system to work. We also want identification that is supportive and not stigmatizing.
Number four, increase the availability of services. We propose increasing the training of allied health professionals and increasing the funding of mental health initiatives for children and youth.
Number five, provide service in the right place. We propose providing universal and targeted programs for prevention and early intervention in community and health agencies, where children at high risk and families with needs will present.
Number six, provide the right intervention. We want to use interventions that target modifiable risk factors, such as caregivers, mental illness and coping, and positive parenting strategies. We want interventions that are multi-systemic and cross-sectoral, so we can target not only child difficulties but also the social needs of families. We also want to use interventions that have evidence or to ensure that interventions are evaluated, if they're used. We certainly don't want to cause harm, and we want to evaluate cost-effectiveness.
We want to thank you again for the opportunity to present in front of this committee.