Insights (Essays)

Insights (Essays) May 2021

Timely Access to Child and Adolescent Mental Healthcare Matters Now More Than Ever

Rob Meeder and Nadiya Sunderji

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COVID-19 has amplified what was already a growing problem – children struggling with their mental health and inadequate access to specialized mental healthcare, especially physician-delivered care. Many children have to wait too long before they can be seen by a specialized physician for their mental health. Crisis services are available and emergency departments are always open but an early intervention before a crisis develops is vastly preferable for children, their families and the healthcare system.

The COVID-19 pandemic has increasingly affected children’s mental health. The direct effects of social isolation, closed schools and pandemic-related family stress have been difficult on children and youth. The mental and physical health impacts of Adverse Childhood Experiences (ACEs) can reverberate for a lifetime. Formally, ACEs include child abuse and neglect, parental separation, substance use and mental health disorders. However, other stressors such as poverty, systemic racism and cyberbullying can be equally devastating. By these measures, the COVID-19 pandemic has been an unparalleled ACE-generator, especially for families who were already on the edge.

We will see the effects of the pandemic for decades. Some of our youngest children have only known strangers with masks on. Research is now emerging on how this has affected language development. Some children have not seen their grandparents for over a year – a loss of intergenerational connectedness and learning. Organized sports, youth drop-in centres, camps, or even simple fraternizing have all been highly limited and youth have flocked to social networking sites, such as SnapChat and Instagram. If we thought screen time and social media usage were problems before COVID-19, they are even bigger problems now. Virtual school for many children has been a poor substitute for engaged, in-person learning. Children learn as much through play and social interactions on the playground and in high school hallways as they do in the classroom.

There is undeniable evidence that mental health and physical health are intricately connected. Stress, especially in early life when the brain is rapidly developing, can have huge mental and physical health ramifications for decades. Stress rewires the brain, and the development of neuronal pathways is shifted toward surviving rather than thriving. Children who experience early life stressors are more likely to grow up with difficulties regulating their emotions and decreased attention, working memory, mental flexibility and skills for self-control. The resulting impact on relationships and learning, in turn, leads to more negative experiences resulting in a downward spiral. Stress also impacts the immune system, the cardiovascular system, the gastrointestinal system and virtually every other system in the human body. If the stress is tolerable, it can enhance resilience. However, childhood stress – which is chronic and severe – is linked to many common diseases of adulthood, such as cancer, diabetes and cardiovascular disease. Poor mental health can make everything worse, and the earlier it starts, the worse the outcome. In other words, mental and physical health are inextricably linked, mutually reinforcing and of equal priority.

We need to use these facts to move forward – not just by addressing the impacts of early life stress but also by preventing them from occurring in the first place. Do we want physically healthy children and adults? We need to start by addressing early life stress and the mental well-being of families and children. We need to start by eliminating and mitigating ACEs, and introducing and enhancing positive experiences. Additional services are needed to help rectify the inequity in access to mental healthcare for children and families. Hospitals, primary care and community mental health organizations and their medical professionals, interprofessional healthcare providers and social service providers need to work together to achieve this with a goal to provide specialized care for those who need it. Cross-sectoral collaboration and the delivery of education can build capacity throughout the healthcare and social service systems for timely and effective interactions that deliver a good experience for children and their families.

At Waypoint Centre for Mental Health Care in Penetanguishene, ON, the Family, Child and Youth Mental Health program is expanding with support from the Ministry of Health to reach this goal. Psychiatrists and pediatricians with a focus on child and adolescent mental health are working in partnership with primary care providers and therapists across the Central Ontario region to support preventive, family-centred and trauma-informed care.

We must continue to advocate for the mental health of families, children and youth and look for further ways to improve the mental health and addiction system. Parents are doing their best right now, and we need to ensure they have even more support to help their children recover from the impacts of the pandemic and be ready to weather, heaven forbid, the next global crisis. 

About the Author(s)

Rob Meeder is a pediatrician and medical director of Family, Child and Youth Mental Health at Waypoint Centre for Mental Health Care in Penetanguishene, ON.

Nadiya Sunderji is the psychiatrist-in-chief at Waypoint Centre for Mental Health Care in Penetanguishene, ON.

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