Teen to Adult Mental Health Reform: What’s Preventing Us from Connecting the Dots?

Dots can be hard to connect, especially when it comes to addressing the continuing challenge of teen mental health. The state of services in New Brunswick is replicated right across Canada, especially outside our major cities. Ten years ago, some 1,200 parents and ordinary citizens launched a New Brunswick movement to create a Centre for Excellence for children and youth with complex needs. In the wake of the tragic March 2021 death of 13-year-old Lexi Daken of Fredericton, it’s fair to ask why, since then, so little has changed for teens in crisis.

The images of that day stay with you. Mobilized by Fredericton parent Maureen Bilerman, hundreds of Dots for Youth advocates descended upon downtown Fredericton to form a human chain, connecting the dots, fingertip-to-fingertip, from the Victoria Health Centre to the Provincial Legislature. That demonstration was sparked by an equally disturbing personal story, but it drew powerful inspiration from a truly ground-breaking report, Connecting the Dots, produced in February 2008 by then Child and Youth Advocate Bernard Richard.

What happened over the past decade is a cautionary tale packing some profound lessons. Shocking and disturbing incidents stir outrage, visionary plans for systemic change appear, the momentum dies down, competing regional interests’ surface, and it all comes unraveled en route to effective implementation.

“Sadly, not much has really changed, “says Bernard Richard, looking back over the past ten to twelve years.  “We are still a long way from achieving the goals and implementing the recommendations set out in Connecting the Dots. Despite repeated commitments, revolving door governments, not much has transpired in filling the holes in our community-based network of support for teens in crisis.”

Richard’s report proposed systemic reform, far ahead of its time.  Breaking with the conventional social service model, he singlehandedly put “integrated service delivery” on the child and youth services agenda. Back then, it was considered revolutionary to recommend reengineering the system to focus on student needs rather than the priorities of competing government departments.

Seeing that children and youth at-risk were falling through the cracks, Richard proposed integrating services and focusing psych-social- medical resources. “The one child, one file” concept made perfect sense, but takes years to put in place in a siloed system. “Everyone should have access to the same case file, and no one should have to tell their story over and over again,” he insists. “No one would be missed if there was true integrated support and one case manager per file.” 

Successive governments, Liberal and Conservative, have bungled the most important file – the proposed Centre for Excellence, one critically-important project which had the potential to turn the situation around in child and teen mental health services. From 2011 to 2015, a province-wide network for service excellence gained momentum and a consensus formed around locating the hub in Moncton or Fredericton, closest the hospitals with youth psychiatric services.

The May 2015 provincial decision, since rescinded, to build a Centre for Youth Services in Campbellton, essentially ignored the demographics of teen mental health case-loads and ran counter to the vast majority of the community feedback. 

Long-time advocates like Dots.NB founder Maureen Bilerman were distraught over the decision and its ramifications. “It’s a sad day for families and youth in crisis,” she said in a series of media interviews. “Shock, disbelief and disappointment” were the words she used to describe her reaction. “Most of the youth-at-risk are from the urban centres of Saint John, Moncton, or Fredericton, and it makes no sense, so it must be a political decision.” 

Political advocacy for teen mental health reform may not have reshaped the system, but it has continued to raise awareness and generate plenty of activity. When Bilerman chose to step back, after a decade of pressing for change, her Dots NB organization merged with the longer-established Partners for Youth Alliance, also based in the provincial capital.

Youth in Action mental health activities peaked in the 2018-19 school year, just prior to the pandemic. Some 74,400 students were exposed to mental health activities, held province-wide for two days, dubbed “Ring a Bell” and “Bell Let’s Talk.” Specific programs were delivered in 7 high schools, and some 200 students participated in one-time mental health presentations.

Most students surveyed gave the high school mental health sessions an “Apple” rating, indicating that they found them to be positive experiences. Raising awareness is beneficial, but reaching the students most in need of help remained as elusive as ever. 

The Pandemic dealt a significant blow to such school initiatives. School closures in March of 2020 interrupted communications and the Partners for Youth group reportedly experienced “radio silence” from youth and educators in the partnered schools. Students and teachers were, according to the agency, “overwhelmed” and “treading to keep their heads above water.”

School shutdowns adversely affected those who needed guidance, counselling, and supports the most. The Partners for Youth 2019-20 annual report put it rather bluntly: “Many students who had difficulties with Mental Wellness ahead of school closures had fallen off the school’s radar completely.”  That has the makings of a youth social service crisis. 

The Fredericton agency’s Executive Director John Sharpe has seen it all, over thirty years working with youth-at-risk. Many investigations and reviews have echoed the findings of a 2009 report by Justice Michael McKee, all painting a similar picture of a system that’s “overwhelmed, understaffed and inadequate for the care of youth.”

“We don’t want to rebuild the system,” Sharpe recently commented. “We want a new system… we want a transformed system. What that means is we have youth, family and community at the centre.” Waiting for champions has turned this reform drive into an exhausting decathlon. 

The road to youth mental health reform is paved with good intentions, but initiatives either run out of high-test gas, are diverted into cul-de-sacs, or get co-opted by research groups chasing government grants. Far too many reform initiatives end up being ‘studied to death’ or kicked down the road through the commissioning of yet another government report.

What’s really standing in the way of the needed changes? “The outrage is now at an all-time high,” according to Dots for Youth founder Bilerman. “What we lack,” she believes, “is the capacity for transformational change management. Models exist and we could pull it off here in New Brunswick.”  Let’s hope the ‘Powers That Be’ are listening.

What’s the situation in your province, district or local community?  To what extent are the service gaps visible in New Brunswick present in your community? What does it take to “connect the dots” and establish a full continuum of support services from childhood to adolescence and on into adulthood?

 

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Teen Mental Health Services: What’s Standing in the Way of Connecting the Dots?*

Dots can be hard to connect, especially when it comes to addressing teen mental health in New Brunswick. Ten years ago, some 1,200 parents and ordinary citizens launched a movement to create a Centre for Excellence for children and youth with complex needs. In the wake of the tragic death of 13-year-old Lexi Daken, it’s fair to ask why, since then, so little has changed for teens in crisis.
The images of that day stay with you. Mobilized by Fredericton parent Maureen Bilerman, hundreds of Dots for Youth advocates descended upon downtown Fredericton to form a human chain, connecting the dots, fingertip-to-fingertip, from the Victoria Health Centre to the Provincial Legislature. That demonstration was sparked by an equally disturbing personal story, but it drew powerful inspiration from a truly ground-breaking report, Connecting the Dots, produced in February 2008 by then Child and Youth Advocate Bernard Richard.
What happened over the past decade is a cautionary tale packing some profound lessons. Shocking and disturbing incidents stir outrage, visionary plans for systemic change appear, the momentum dies down, competing regional interests’ surface, and it all comes unraveled en route to effective implementation.
“Sadly, not much has really changed, “says Bernard Richard, looking back over the past ten to twelve years. “We are still a long way from achieving the goals and implementing the recommendations set out in Connecting the Dots. Despite repeated commitments, revolving door governments, not much has transpired in filling the holes in our community-based network of support for teens in crisis.”
Richard’s report proposed systemic reform, far ahead of its time. Breaking with the conventional social service model, he singlehandedly put “integrated service delivery” on the child and youth services agenda. Back then, it was considered revolutionary to recommend reengineering the system to focus on student needs rather than the priorities of competing government departments.
Seeing that children and youth at-risk were falling through the cracks, Richard proposed integrating services and focusing psych-social- medical resources. “The one child, one file” concept made perfect sense, but takes years to put in place in a siloed system. “Everyone should have access to the same case file, and no one should have to tell their story over and over again,” he insists. “No one would be missed if there was true integrated support and one case manager per file.”

Successive governments, Liberal and Conservative, have bungled the most important file – the proposed Centre for Excellence, one critically-important project which had the potential to turn the situation around in child and teen mental health services. From 2011 to 2015, a province-wide network for service excellence gained momentum and a consensus formed around locating the hub in Moncton or Fredericton, closest the hospitals with youth psychiatric services.
The May 2015 provincial decision, since rescinded, to build a Centre for Youth Services in Campbellton, essentially ignored the demographics of teen mental health case-loads and ran counter to the vast majority of the community feedback.
Long-time advocates like Dots.NB founder Maureen Bilerman were distraught over the decision and its ramifications. “It’s a sad day for families and youth in crisis,” she said in a series of media interviews. “Shock, disbelief and disappointment” were the words she used to describe her reaction. “Most of the youth-at-risk are from the urban centres of Saint John, Moncton, or Fredericton, and it makes no sense, so it must be a political decision.”
Political advocacy for teen mental health reform may not have reshaped the system, but it has continued to raise awareness and generate plenty of activity. When Bilerman chose to step back, after a decade of pressing for change, her Dots NB organization merged with the longer-established Partners for Youth Alliance, also based in the provincial capital.
Youth in Action mental health activities peaked in the 2018-19 school year, just prior to the pandemic. Some 74,400 students were exposed to mental health activities, held province-wide for two days, dubbed “Ring a Bell” and “Bell Let’s Talk.” Specific programs were delivered in 7 high schools, and some 200 students participated in one-time mental health presentations.
Most students surveyed gave the high school mental health sessions an “Apple” rating, indicating that they found them to be positive experiences. Raising awareness is beneficial, but reaching the students most in need of help remained as elusive as ever.
The Pandemic dealt a significant blow to such school initiatives. School closures in March of 2020 interrupted communications and the Partners for Youth group reportedly experienced “radio silence” from youth and educators in the partnered schools. Students and teachers were, according to the agency, “overwhelmed” and “treading to keep their heads above water.”
School shutdowns adversely affected those who needed guidance, counselling, and supports the most. The Partners for Youth 2019-20 annual report put it rather bluntly: “Many students who had difficulties with Mental Wellness ahead of school closures had fallen off the school’s radar completely.” That has the makings of a youth social service crisis.
The Fredericton agency’s Executive Director John Sharpe has seen it all, over thirty years working with youth-at-risk. Many investigations and reviews have echoed the findings of a 2009 report by Justice Michael McKee, all painting a similar picture of a system that’s “overwhelmed, understaffed and inadequate for the care of youth.”
“We don’t want to rebuild the system,” Sharpe recently commented. “We want a new system… we want a transformed system. What that means is we have youth, family and community at the centre.” Waiting for champions has turned this reform drive into an exhausting decathlon.
The road to youth mental health reform is paved with good intentions, but initiatives either run out of high-test gas, are diverted into cul-de-sacs, or get co-opted by research groups chasing government grants. Far too many reform initiatives end up being ‘studied to death’ or kicked down the road through the commissioning of yet another government report.
What’s really standing in the way of the needed changes? “The outrage is now at an all-time high,” according to Dots for Youth founder Bilerman. “What we lack,” she believes, “is the capacity for transformational change management. Models exist and we could pull it off here in New Brunswick.” Let’s hope the ‘Powers That Be’ are listening.

*Reprinted from the Telegraph-Journal (Provincial), 12 March 2021.

Why does it take a teen mental health tragedy to draw attention to the serious gap in services? What is standing in the way of meaningful action and progress? How typical is New Brunswick of the situation elsewhere?

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The Back to School Push: Who’s Demanding a Return to Full-Time School in September 2020?

Something is stirring among parents in the wake of the three-month-long experience housebound supervising their children’s schooling during a global pandemic. With reopening plans still up in the air and September mere weeks away, a dramatic shift is taking place as COVID-19 distance education impact assessments surface and more and more parents find their public voices. 

After a five-hour-long July 9-10 meeting, the harried and pressured Ottawa-Carleton District School Board voted for all students to return to K-12 schools full-time in September 2020. Ottawa’s Chief Medical Officer of Health, Dr. Vera Etches supported full-time resumption and elected trustees were deluged with parent concerns about the possible adverse impact of extending distance learning or hybrid part-time scheduling into the Fall Term.

The Ottawa popular media featured the voices of aroused local parents, including working mothers, desperate for a break from home-supervised schooling.  In defending the decision, Board Chair Lynn Scott claimed that the alternative — a hybrid model combining part-time school and remote learning was “never what anybody wanted.”  The coterminous Ottawa Catholic Separate School Board, reading the same signals, followed suit. 

Listening to the vocal Ottawa parents demanding a return to full-time school was reminiscent of the public outcry sparked by news anchor Howard Beale in that memorable scene from the classic 1975 feature film, Network, “I’m as mad as hell, and not going to take it anymore.”

Such parental concerns and frustrations, mostly expressed in more modest and composed forms, are popping-up from province-to-province across Canada. Alberta parent activist and family physician Dr. Nhung Tran-Davies described remote learning supervised by parents as “a failure of pandemic proportions” and urged school districts to restore in-person teaching for the children’s sake.

A parent uprising moved the needle in Nova Scotia. Halifax School Advisory Council Chair Claire Bilek spoke for many on July 9, 2020  when she called upon the Nova Scotia Education Minister and his Department to come up with some plan, or any plan, for the resumption of regular schooling in a matter of weeks.  A newly-formed parent group including Halifax child psychologist Erica Baker issued an open letter posing questions that required immediate answers and Nova Scotia Education Minister Zach Churchill was compelled to announce that the province was committed to achieving “100 % capacity” by September 2020.     

Advocates for a safe and responsible approach to reopening schools can look to British Columbia for some home-grown lessons.  Reopening school on June 1, albeit on a voluntary basis, brought some 200,000 students safely back to the classroom, with the blessing of Dr. Bonnie Henry, Chief Medical Officer of Health, and Teri Mooring, President of the British Columbia Teachers’ Federation. That “trial run” was executed with relatively few adverse health experiences and produced important information and feedback to aid in preparation for the 2020-21 school year. The goal is to have even more students in class in September utilizing a five-stage approach, allowing schools to respond quickly in the event of a second wave. All five stages are supported by strict health and safety guidelines from the provincial health officer, the BC Centre for Disease Control and WorkSafeBC.

Ontario’s initial plans to open schools in September were announced June 19 and were prepared after consulting with health experts, including those at Toronto’s Sick Kids Hospital. The three proposed scenarios were: a full reopening of schools with enhanced health protection measures; a full schedule of distance learning classes; or a hybrid plan, where students would attend in-person school part-time, possibly two days a week, and receive online instruction for the balance of the time. A Sick Kids report, released June 17, provided the rationale, making the case that reopening was essential to relieve the mental health strains and could be accomplished without unduly risking the physical health of children.  The Toronto pediatric experts recommended rigorous hand hygiene and regular screening, but not strict physical distancing or the wearing of masks.  

Suspending school for three months as a lead in to the summer is having harmful effects on the coronavirus generation. We are beginning to take stock of the full impact in terms of student learning loss. Students surveyed June 1-8 by the Upper Canada District School Board in Brockville, Ontario, confirmed that a majority of high schoolers struggled with at home learning and were clearly shortchanged in their education. As most provinces struggle to make a decision on a definitive back-to-school plan, health experts are coming forward to support the Sick Kids report warning about the mental health risks of keeping kids out of the classroom.

Without the routine and social connection that school brings, many kids and teens have reported feeling sad, stressed and anxious since the end of in-person classes in mid-March.  Dr. Kiran Pure, a clinical psychologist in Dartmouth, N.S., reports that, even after restrictions have relaxed, her small team of psychologists is still working “basically non-stop and it’s been a lot of mental health support.” She’s been struck by the intensity of the mental health challenges some kids are experiencing, especially those with existing conditions. Her recommendation: Getting students at risk back to school in September is becoming an urgent necessity. 

Bringing students back in September is a hot button issue for educators and, especially so for classroom teachers on the front lines. Drawing comparisons between teachers and other “essential workers” labouring outside their homes throughout the pandemic rankles teachers. Today’s teachers pride themselves on being professionals more like doctors or dentists than essential workers in the child care, food services, delivery, and restaurant fields, many of whom are already back at work. Many educators, speaking freely on social media, are fearful and angry, especially when politicians advocate bringing back schools to help kick-start the stalled economy. 

Medical science will not likely provide a risk-free option, especially now that we have received conflicting advice from respected pediatricians and epidemiologists. Some well-intentioned health professional prescriptions, such as that of Amy Greer, Nisha Thampi and Ashleigh Tuite, apply sound clinical lessons, but may set benchmarks rendering the September resumption of school next-to-impossible. 

Fears and anxieties still run high because the COVID-19 pandemic is horrible and health protection is everyone’s priority.  Finding the right balance and developing a safe and broadly acceptable school resumption plan is fraught with challenges and potential complications. With the curve flattened and infection rates minimal, it is time to get students back to in-person schooling, particularly K-8 students who require daily adult supervision.

Why are increasing numbers of parents calling for the return of full-time, in-person schooling? Who should be making the call on the resumption of school in September 2020?  Where do education ministers and policy advisors turn when public health officials and medical researchers are not fully aligned?  How important is the resumption of school to the full restoration of essential services and a productive economy?  Most importantly, do students, parents and taxpayers have a right to expect a much more effective model of educational delivery in the upcoming 2020-21 school year?  

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Resilience and Schools: Do Miracle ‘Self-Help’ Cures Improve At-Risk Children’s Lives or Have Negligible Effect?

Today’s world is awash in miracle self-help cures for our lack of “resilience” and it has now welled-up in our schools. Mindfulness, neuroplasticity, trauma-informed cognitive behavioural therapy, psychoanalysis, career coaching, and yoga are all being adopted by well-meaning educators.  Children and teens who are identified as anxious, hyper-active, overweight or downhearted are far too often pathologized as having “mental health issues.” Hordes of gurus and experts are ready with the latest inspirational programs and quick fixes for all their problems.

Pursuing individual social well-being is not the answer, particularly for troubled, at-risk, and struggling children and youth. That is one of the most fundamental lessons conveyed in Michael Ungar’s latest book, Change Your World (2019), a masterful synthesis of 20 years of research in the field of resilience.  It will be an eye-opener to all who were, up until now, unacquainted with his ground-breaking work assessing the effectiveness of at-risk services for children and youth.

The first wave of New Age self-help came through the medium of TED Talks peaking in the late 2000s. Educational gurus mimicking Sir Ken Robinson were full of magic solutions to cure every conceivable ill besetting students, teachers, and school communities. Dr. Ungar has little use for such solutions because they seldom work. “Self-help fixes are like empty calories,” he writes. “The effects are fleeting and often detrimental in the long term. Worse, they promote victim blaming. The notion that your resilience is your problem alone is ideology, not science.”

Ungar is clear about what went wrong. “We have been giving people the wrong message. Resilience is not a DIY endeavour. Self-help fails because the stresses that put our lives in jeopardy in the first place remain in the world around us even after we’ve taken the “cures.” The fact is that people who can find the resources they require for success in their environments are far more likely to succeed than individuals with positive thoughts and the latest power poses.”

Studying resilience around the world through his Resilience Research Centre at Dalhousie University  produced some profound lessons. Some young people and adults “beat the odds” better than expected, especially those in war-torn societies and disaster zones. The reason has more to do with their social and physical environments than with personal traits such as “grit,” “growth mindset.” or “self-regulation.”  Changing the environments has more of an impact than changing outlooks and mindsets or even offering formal programs.

Services provided by health, social welfare and educational systems, Ungar and his research team discovered, are rarely assessed for their effectiveness in helping children, youth or adults “bounce back” from adversity or escape the bonds of dependence. For a professional social worker, Ungar is not afraid to pose the tough questions. What actually works in nurturing well-being and building resilience? Most importantly, does resilience depend on the services we receive?

Ungar’s Resilience Research Centre focuses on adolescents and young adults who are using multiple services. Many of his subjects are young people needing special educational supports at the same time that they are under the supervision of a child-welfare worker because of exposure to family violence.  Some are youth with severe mental-health problems such as attention-deficit disorder and conduct disorder serving probation orders for drug offenses or violent acts.  Other participants have learning challenges,including anxiety disorders. The balance are homeless because they had run away from abusive parents.

His initial study of Canadian youth examined the relationship between risk exposure, resilience and behavioural outcomes for almost 500 young people, all of them facing serious challenges. It was later expanded to include more than 7,000 young people around the world. The overall conclusion was that “resilience depends more on what we receive than what we have within us.” Providing supportive environments and needs-based resources, more than individual talent or positive attitude, accounted for the difference between youths who did well and those who slid into drug addiction, truancy and high-risk sexual activity.

School systems do not always fare well in Ungar’s resilience research findings. Education district offices and schools can be resistant to tailoring their programs and services to meet student an d family needs. One common example –  school guidance counsellors who insisted that parents take time off from minimum-wage jobs to attend case conferences because guidance counsellors and psychometricians do not work evenings. The results were predictable:  “the most vulnerable families did not show up because they could not afford the lost time at work. It was their children, doubly disadvantaged by learning difficulties and poverty, who wound up untreated and who eventually dropped out of school.”

“Student well-being” was sanctified in the Ontario school system from 2010 to 2018 and is now being mimicked in other Canadian provincial school systems. Yet Canadian resilience research demonstrates that social, economic and communitarian contexts and supports are far more important to student health, fitness, and financial security than our individual thoughts, feelings or behaviours.  “When it comes to maintaining well-being and finding success,” Ungar claims, “environments matter.”  A positive attitude helps students and adults capitalize on opportunities, but “positive thinking” on its own does not help in surviving childhood abuse, crime-ridden neighbourhoods, or natural disasters.

Why do today’s pop culture gurus, child psychologists, and behavioural therapists put so much faith in miracle cures and self-help strategies?  How and why have educators embraced those approaches?  What can be learned from Michael Ungar’s ground-breaking research? To what extent is what’s surrounding us more important that what’s within us when it comes to developing resilience in school and in life? 

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Marijuana Legalization and Teens: Are High Schools the New First Line of Defense?

Teachers are talking and raising alarm bells about the impact of marijuana legalization on students and our high schools – and the real daily challenges that lie ahead. This is a head’s up – we should all be listening to those on the front lines of education.

Seven American states and the District of Columbia have followed the early adopter, Colorado, in legalizing the recreational use of cannabis and the movement is spreading to other states. Four of the seven states legalized its use in November 2016, and the Canadian government has established its implementation date later this year.

Looking across Canada, province after province has been announcing its implementation policy, focusing almost exclusively on the control and regulation of the previously illegal substance, provoking fierce debates over who will reap most of the the exise tax windfall and  whether cannabis will be sold in government stores or delegated to heavily regulated private vendors. All of the provincial policy pronouncements claim that the policy will be designed to protect “public health and safety” and safeguard “children and youth”  from the “harmful effects.”

Marijuana legalization policy across Canada is a top-down federal initiative driven largely by changing public attitudes and conditioned by the current realities of widespread use of marijuana, purchased though illicit means. Setting the age of restriction, guided by the proposed federal policy framework, has turned out to be an exercise in reaching a “compromise” rather than heeding the advice of leading medical experts and the Canadian Medical Association (CMA). The CMA proposed age 25 and then accepted age 21 as more “realistic.” It’s going to be 18 year-of-age in Alberta and Quebec, and 19 years-of-age in most other provinces. Getting it “out of high schools” was a critical factor in bumping it up to age 19 in most provinces.

Every Canadian province is complying with the federal legislation, but — in our federal system – it’s “customized” for each jurisdiction. The Canadian Western provinces, Alberta, British Columbia, and Saskatchewan have opted for regulating private retail stores, while Ontario and the Maritime provinces (Nova Scotia, New Brunswick, and P.E.I.), are expanding their liquor control commissions to accommodate retail sales of cannabis.

My home province, Nova Scotia, tends to find the “middle ground” in public policy and has done so once again. That’s why Nova Scotia provides perhaps the best point of entry into the Canadian situation.

On top of chronic absenteeism, ‘accept all excuses’ policies, and bureaucratic paperwork, most of Nova Scotia’s high school teachers will soon, as of September 2018, be battling a spike in marijuana use and greater peer pressure to smoke pot on the mistaken assumption that it is “harmless” at any age.

In the scramble to meet the federal July 1, 2018 implementation date, provincial authorities, in Nova Scotia and elsewhere, are grossly underestimating the potential harm to student health, safety, and life outcomes. That much is clear after carefully examining the best background research, the October 6 to 31 survey consultation, and the December 7 policy pronouncement.

The Nova Scotia government, guided by the steady hand of Minister Mark Furey, has done a reasonably good job in responding, under tight timelines, to the immediate challenge of establishing a strict control and distribution regime, albeit dependent upon the traditional public sector apparatus and the NSLC stores.

The essential problem is that control and regulation is only half of the challenge – and it sends out implicit signals that, after the failure of the ‘war on drugs,’ softened public attitudes will now dictate policy, irrespective of the health harms inflicted on children and youth.

One in five young people between 15 and 24 years of age, according to a recent national study, report daily or almost daily use of cannabis. They also see marijuana as “much safer than alcohol and tobacco” and “not as dangerous as drunk driving.” Few either know about or seem concerned over the clear linkage between heavy use and early onset psychosis.

Three major education policy concerns are not being addressed, all of which are identified in the current research on the harmful effects of marijuana on children and youth up until age 25.  With the legalization of marijuana, evidence-based policy needs to recognize that:

• Heavy marijuana use can, and does, damage age 13 to 18 brain development: A 2016 Canadian Centre on Substance Abuse study confirmed the direct link to loss of concentration and memory, jumbled thinking, and paranoid psychosis.
• Marijuana users perform more poorly in quantitative subjects requiring precision, like mathematics and senior science: Clear evidence was presented in 2017 by Dutch researchers Olivier Marie and Ulf Zolitz that ‘liberalizing’ rules also led to decreased academic success among Maastricht University students, and particularly for struggling students.
• Legalization of marijuana increases the number of teen users: Early initiators increase their use significantly and overall reported use rises by about 10 per cent to one out of three teens, including previously low-risk students (New York University 2014, Oregon Research Institute 2017).

Medical researchers and practitioners have warned us that legalization carries great dangers, particularly for vulnerable and at-risk youth between 15 and 24 years of age.

One of the leaders in the medical field, Dr. Phil Tiboo, initiator of Nova Scotia’s Weed Myths campaign targeting teens has seen the evidence, first hand, of what heavy use can do at the Halifax QE II Infirmary Early Psychosis clinic. We will pay a price for not heeding the warnings of Dr. Tiboo about popular and rather blasé notions that marijuana is “harmless” to teens and “recreational use” is somehow “fun” and “healthy.”

One glaring example of the mixed messages was the November 2017 CBC Nova Scotia televised debate, entitled “Joint Venture,” a media production that actually made matters worse. It was all framed as a “cool” public policy about to propel us into the “green frontier. Watching and listening to the four panelists must have been terribly upsetting for doctors and high school teachers. Ill-informed comments went unchallenged, and no one spoke for educators who have daily encounters with students “high” on drugs.

High school principals and staff are facing a real test with the legalization of marijuana.  The old line of defense that using marijuana is illegal will have disappeared. Recreational marijuana will be more socially acceptable. The cannabis industry will be openly marketing its products. High school students who drive to school will likely get caught under new laws prohibiting motor vehicle use while impaired by drugs or alcohol. Fewer students will be abstainers when it is perfectly legal to smoke pot when you reach university, college, or the workplace.

We have utterly failed, so far, in getting through to the current generation of teens, so a much more robust approach is in order.  “Be firm at the beginning” is the most common sage advice given to beginning teachers. Clamping down on teen marijuana use during and after school hours will require clarity and firm resolve in the year ahead – and the support of engaged and responsible parents.

Legalization of recreational marijuana is bound to complicate matters for Canadian high schools everywhere. Busting the “Weed Myths” should not be left to doctors and health practitioners. When it comes to meeting this serious challenge, let’s get behind those on the front lines.

What’s really driving the move to legalize the recreational use of marijuana?  Where does that leave education authorities, school principals and high school teachers?  What works, if anything, in deterring teens in the absence of a law prohibiting open public use? Is it possible that teaching in high schools is about to get far more challenging? 

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Teen Mental Health Programs: What Works — and Why — in Schools?

Seeing some 400 teachers and school service providers flooding into the Halifax West High School auditorium on July 20, 2017 was an eye-opening experience. In the middle of the summer, they committed time to a two-day conference focusing on child and teen mental health. Led by Dr. Stan Kutcher, the Mental Health Academy was filling a real need in the school system.

With the news full of stories warning of a “mental health crisis,” teachers in the K-12 system are feeling anxious and more conscious than ever of their role in the front lines of education.  What Dr. Kutcher’s Academy offered was something of a tranquilizer because he not only rejects the “crisis” narrative, but urges classroom practitioners to develop “mental health literacy” so they can “talk smart” with students and their parents.

The fifth edition of the Mental Health Academy, initiated in 2006 by Dr. Kutcher, studiously avoided adding further to the noise and sought to advance teacher education in mental health using evidence-based research and programs.  Stress can be good and bad, Kutcher reminded us, and we need to be able to distinguish among the three types of stress responses identified by the Harvard Center for the Developing Child: positive (daily), tolerable (regularly) and toxic (extremely rare).  Instead of pathologizing “stress” as “anxiety,” what children and youth need most is “inoculation” to help build a more robust stress immune system.

While the incidence of teen mental health problems is not appreciably different than it was fifty years ago, we are far better equipped to respond to the challenges in and around schools. The MH Academy amply demonstrated how much more we know today about adolescent brain development, school staff self-care, anxiety, depression, eating disorders, substance addictions, and teen suicide.  Educating teachers about that research is the real purpose of the Academy.

Mental health disorders are serious and teachers are well-positioned to assist in early identification. About 1 in 5 people may experience a mental disorder during adolescence. If left unrecognized and untreated, they can lead to substantial negative outcomes in physical and mental health, academic and vocational achievement, interpersonal relationships, and other important life experiences. Despite this tremendous burden of mental health disability, youth requiring proper care still do not receive it from childhood through to adulthood.  Lack of knowledge, presence of stigma, and limited access to care all serve as barriers to addressing mental disorders and alleviating the daily challenges.

Promoting Mental Health Literacy (MHL) is Dr. Kutcher’s mission because it is an essential component of improving individual and population health and mental health outcomes. As most mental disorders can be identified by age 25, schools provide the ideal location in which to implement interventions that can be demonstrated to improve mental health and life outcomes.  Good MHL programs tend to exhibit four components: : understanding how to obtain and maintain good mental health; understanding mental disorders and their treatments; decreasing stigma; and enhancing help seeking efficacy (knowing when, where, and how to obtain proper care.

A recent Canadian study of some 10,000 educators, cited by  IWK Health researcher Dr. Yifeng Wei at the Academy, found that over 90 per cent of teachers lacked adequate preparation for responding to mental health issues.  That is startling when one considers the fact that the survey uncovered some 200 different mental health programs being implemented in over 1,000 Canadian schools.

Systematic evidence-based reviews of the most popular mental health programs are not that encouraging.  Four such programs, including two based upon “mindfulness, “Learning to Breathe,” and “Mind Up,” analyzed using the GRADE System, were found to be mostly ineffective and judged not ready for widespread implementation in schools. “Good intentions,” Dr. Wei stated,” do not translate into beneficial outcomes for children and teens.”

One curriculum resource, the Mental Health and High School Curriculum Guide, researched and developed by Kutcher and his research team at Dalhousie’s Medical School, shows more promising results. It’s not a “packaged program,” but rather a full curriculum taught by the usual classroom teachers in Canadian secondary schools. Survey data collected before, immediately after, and 2 months after implementation of The Guide showed that students’ knowledge improved significantly when the program was delivered by their regular teachers.  Embedding a classroom resource, delivered by usual classroom teachers in usual school settings is proving to be far better than utilizing any number of the commercially-marketed mental health programs.

What’s contributing to the widespread public perception that we are experiencing a “mental health crisis” in and around our schools?  Why are classroom teachers so motivated and committed to responding to mental health issues?  Why are education authorities and school districts so quick to snap up the latest program in mental health, student behaviour modification, and suicide prevention?  What’s the secret of the recent success of the the Canadian Teen Mental Health Curriculum Guide? 

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Child Mental Health and the Schools: Wherein Lies the “Crisis”?

The public cries of “crisis” are in the air, especially when it comes to child/teen mental health in the schools. Britain’s government-appointed Mental Health Champion, Natasha Devon, rang the latest alarm bell in The Telegram (April 29, 2016) claiming that the “child mental health crisis is spinning out of control.” In issuing her “Mental Health Manifesto” for Britain’s schoolchildren, Devon frequently cites a scary figure to buttress her public claims — the statistic that “rates of depression and anxiety among teenagers have increased by 70 per cent in the past 25 years.”

Not everyone accepts her public pronouncements at face value — and a few are looking more deeply into the nature, definition, and prevalence of the so-called “child public health crisis.” Devon’s further claim that it constitutes an “epidemic” has sparked even more skepticism. Is this the proverbial twenty-first century equivalent of “crying wolf” or just a manifestation of our contemporary tendency to ‘pathologize’ social-psychological trends?

One of Canada’s leading teen mental health experts, Dr. Stan Kutcher, devotes his life to educating teachers, students and families about mental health disorders, but he is very skeptical about overblown claims. When asked about the purported “crisis” at St. Francis Xavier University a few weeks ago, he startled a local newspaper reporter with this statement: “there is no mental health crisis for crying out loud.”

Dr. Kutcher was not minimizing  the severity of the problem, but rather questioning the veracity of some of the recent public claims. “We have the same proportion of mental illness in our society now that we had 40, 50, 60 years ago,” he explained. “There is no epidemic of illness, there is better recognition of illness, which is good but what we’re seeing now is an epidemic of ‘I think I have a mental disorder when I’m just really feeling unhappy,’ and that is a direct reflection of poor mental health literacy.”

Like many health professionals, Dr. Kutcher sees the popular media as contributing to the public misunderstanding about the nature and prevalence of mental disorders. He’s critical of those who exaggerate the “crisis” and equally concerned about others too quick to dismiss
it as a ‘teenage fad.’“Now the depression happens in adolescents and depression is a serious disease and if you have depression you need the proper treatment for depression, but feeling unhappy, that’s not depression,” he said.“So I think a lot of people have become confused with all the talk about mental health and mental illness without the literacy to understand what they’re talking about.”

Stress and distress is not all bad, according to Kutcher. “People do have daily distress, that is normal, ubiquitous, necessary and good for you,” he said.“And all of us are going to have a mental health problem like the loss of a loved one, moving to a new city, losing your job – those are substantive challenges in our lives and we need extra help for that. But those two things aren’t mental illnesses and they don’t need to be medicalized, they don’t need medications, they don’t need specialized psychotherapy, they don’t need access to the mental health care system.They can be dealt with, the first one, mental distress, by yourself with your friends. The second one with special support, sometimes counselors, sometimes your clergy, whoever.”

As the Sun Life Chair of Teen Mental Health at Dalhousie University Medical School, Kutcher’s assessment carries considerable weight and he makes the critical distinctions that the popular media tend to completely miss: “Mental illnesses are different; they need specialized treatment like a treatment for any illness. But one of the challenges we have is that socially we’re tending to confuse mental distress and mental health problems with mental illness. So, because I feel unhappy today I feel like I should have therapy, because I take umbrage at what you said to me I have an anxiety disorder, that’s not true at all.”

Dr. Kutcher seems to dispute the whole approach taken by Britain’s Mental Health czarina and ‘body health’ counsellor, Natasha Devon. While Devon and her Self-Esteem Team (SET) target standardized tests and exams as “stress-inducers,” Kutcher and other specialists, including Dr. Michael Ungar, see value in competitive activities in developing “resilience” in teens.  Dr. Kutcher puts it this way: “We have to be very careful to differentiate the slings and arrows of outrageous fortune in real life which we have to learn to deal with and overcome, and for which we don’t need treatment, and those things which actually require treatment.”

Mental health disorders are serious and providing more accessible, effective and sustainable services should be a top public policy priority, inside and outside of schools. “Teenage angst,” as Ella Whelan recently pointed out, “is not a serious mental health issue.” It is important to carefully consider all public claims for their veracity and to be skeptical of mental health charities seeking to “normalize mental illness.” We must also recognize that “not all of the kids are all right.” Nor are mental health services accessible or available when and where they are needed in and around the schools. Therein lies the real problem.

What ‘s driving the public call to address the “child mental health crisis” in schools? Are school authorities and educators equipped to make the critical distinction between normal ‘mental health stresses’ and serious disorders requiring treatment?  Is there a danger that those ringing the alarm bells are ‘pathologizing’ teenage anxieties and stress?  Is it possible to identify and support those in serious personal crisis while recognizing that competition and stress develops ‘resilience’ and is part of healthy preparation for life? 

 

 

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Web Junkies and Schools: Should Screen Addiction Be a Public Policy Issue?

An alarming new documentary, Web Junkie, recently aired on  the PBS television network, and alerted North Americans to radical measures being taken to curb screen addiction among children and youth in China. It is a powerful little film exposing the alarming effects on teenagers who become hooked on video games, playing dozens of hours at a time without taking breaks to eat, sleep or even go to the bathroom. Doctors in China have responded by designating “screen addiction” as a clinical disorder and established boot camp-style rehabilitation centres to treat its victims.

Internet addiction among teens may not be a diagnosed clinical disorder here, but it is now quite prevalent nearly everywhere you look—in homes, public spaces, and schools. Most North American physicians and psychologists are concerned about the screen fixation when youths are plugged in and tuned out of “live” interaction for so many hours a day that it imperils their normal, healthy development. More shockingly, it starts in early childhood with toddlers being handed cellphones or tablets to entertain themselves. By the time kids enter school, they are already hooked on the latest devices.

The PBS documentary spurred Jane Brody, Personal Health columnist for The New York Times, to take a closer look at this subterranean issue. She unearthed a 2013 policy statement on “Children, Adolescents, and the Media” approved by the the American Academy of Pediatrics. In it, the American pediatricians cited these shocking statistics from a Kaiser Family Foundation study in 2010: “The average 8- to 10-year-old spends nearly eight hours a day with a variety of different media, and older children and teenagers spend more than 11 hours per day.” Television, long a popular “babysitter,” remains the dominant medium, but the study showed that computers, tablets and cellphones were gradually taking over.

Limiting and controlling children’s screen time was identified as a new and unfamiliar responsibility for today’s parents.  “Many parents seem to have few rules about use of media by their children and adolescents,” the academy stated, and two-thirds of those questioned in the Kaiser study said their parents had no rules about how much time the youngsters spent with media. Busy and stressed out parents, it appears, see the devices as handy ‘electronic passifiers’ to calm perpetually active kids and to free up young adults themselves for screen activities, including ongoing social media interactions.

Recognized experts like Catherine Steiner-Adair, a Harvard affiliated psychologist and author of The Big Disconnect: Protecting Childhood and Family Relationships in the Digital Age, are full of advice for parents, but less so when it comes to schools. Before age 2, children should not be exposed to any electronic media, the pediatrics academy maintains, because “a child’s brain develops rapidly during these first years, and young children learn best by interacting with people, not screens.” Older children and teenagers, according to the experts, should spend no more than one or two hours a day with entertainment media, preferably with high-quality content, and spend more free time playing outdoors, reading, doing hobbies and “using their imaginations in free play.”

Heavy use of electronic media can have significant negative effects on children’s behavior, health and school performance. Recent studies have linked “simulated violence” in video games to tendencies to act violently or to become desensitized to violence around them. Habitual users may become more adept at multitasking, but, over time, lose the capacity to focus or concentrate on what is important, affecting their problem-solving abilities.

Texting is the real electronic epidemic confronting most middle schools and high schools. About one-half of American teens send and receive 60 or more text messages a day  — before, in between, during and after school classes. Teenagers from 12 to 17, according to a 2012 Pew Research Center study averaged 3,364 texts a month. An earlier JFK Medical Center study found that teens sent an average of 34 text messages a night after they went to bed, contributing to the problem of sleep deprivation. One University of Rhode Island researcher, Kristina Hatch, sees a direct connection between heavy use of electronic media and social withdrawal and isolation, leaving kids “lonely and depressed.”

This is not just an American social phenomenon. A 2014 report conducted by WeAreSocial revealed that every day Canadians spend 4.9 hours online on laptop or desktop computers and, in addition, 1.9 hours on mobile devices. Just over two hours a day are now spent on social media, with some 91 % on Facebook and 46% on Twitter. It would be much higher for children and teens being raised in an electronic media saturated culture.

Canadian psychologists and psychiatrists are beginning to take action to address the incidence of Internet addiction. The Canada Life Chair of Teen Mental Health at Dalhousie University, Dr. Stanley Kutcher, is keenly aware of the problem and attempting to promote preventative programs. In a few cities, such as Windsor, Ontario hospitals are responding by establishing services to offer clinical treatment to children, teens and adults struggling with video game and Internet dependency.

How widespread is the problem of Internet and screen addiction among today’s children and teens?  What can parents do to limit and control children’s screen time? Where do the responsibilities of parents end and the interests of schools begin?  Is there a place for Internet addiction education the emerging mental health curriculum? Should we be looking at a public education program involving students, parents and schools?

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