Children and Youth — Issue No. 21 — Tuesday, June 23, 2015 (HTML)

Present: Jane Thornthwaite, MLA (Chair); Doug Donaldson, MLA (Deputy Chair); Donna Barnett, MLA; Carole James, MLA; Maurine Karagianis, MLA; John Martin, MLA; Dr. Darryl Plecas, MLA; Jennifer Rice, MLA; Dr. Moira Stilwell, MLA

3. The following witnesses appeared before the Committee and answered questions related to youth mental health in British Columbia:

The following electronic version is for informational purposes only.
The printed version remains the official version.

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
CHILDREN AND YOUTH


CONTENTS
Page
Youth Mental Health in British Columbia	488
N. Dubord
M. Granum
L. Birnie
D. Mackenzie
B. Seal
C. Waddell
C. Wilkie
I. Söchting
O. van Samang

J. Thornthwaite (Chair): Good afternoon, everyone. I’m Jane Thornthwaite. I’m the MLA for North Vancouver–Seymour and the Chair of the Select Standing Committee on Children and Youth. I wanted to welcome you to the first of two meetings in Vancouver in support of the committee’s mandate to foster greater awareness and understanding of the B.C. child- and youth-serving system.

Towards this end, the committee agreed in fall 2013 to undertake a special project examining youth mental health. Positive mental health is so important to ensuring B.C.’s children and youth can enjoy fulfilling lives, connected with family and friends, and can reach their full potential.

We’ve also seen, through recent reports by the Representative for Children and Youth, that mental health can be a significant health issue for young people and that poor mental health can have particularly devastating impacts on vulnerable children and youth, such as those in care. With this in mind, the committee undertook work to explore this important issue.

The committee’s first phase sought evidence on some key questions. What are the main challenges around youth mental health? Are there any gaps in service delivery? What are the best practices for treating or preventing youth mental health issues? And where should resources be targeted in the future?

The committee issued its interim report on youth mental health in November of 2014. The committee received a total of 153 oral and written submissions from individuals and from organizations representing health professionals, service providers, aboriginal groups, government, academics and other stakeholders. The committee will build on the excellent input received in its first phase of work as we undertake our second phase.

Our second phase involves seeking concrete and practical solutions to enhance youth mental health services and outcomes in B.C. Based on our findings, the committee will make recommendations to the Legislative Assembly.

We have six presenters today and 12 tomorrow that have been invited for their expertise and experience in areas relevant to youth mental health. We have enough time on our agenda to allow ten-minute presentations from each of our invited witnesses, with each presentation followed by 20 minutes for questions from committee members. I do encourage you to stick to the time. We really want to get the committee members to be able to ask questions and engage.

The proceedings are being recorded by Hansard Services, and a transcript of the entire meeting will be made available on our website.

I’ll now ask my committee members to introduce themselves first, starting with my Deputy Chair to the left.

D. Donaldson (Deputy Chair): Hi. Doug Donaldson, MLA for Stikine up in the northwest part of the province. I’m Deputy Chair of this committee, and my portfolio in the official opposition is children and youth.

Welcome. I’ve looked through your slides and look forward to the solutions area especially.

J. Rice: Hi. I’m Jennifer Rice. I’m the MLA for North Coast. I’m located in Prince Rupert, and I represent a huge area on the northwest coast — Haida Gwaii down to Bella Bella and the Bella Coola area.

My portfolio is northern and rural health, and I’m the deputy opposition spokesperson for Children and Family Development.

J. Martin: Good afternoon, and thanks so much for being here. I’m John Martin, the MLA for Chilliwack.

M. Karagianis: Good afternoon. I’m Maurine Karagianis. I’m the MLA for Esquimalt–Royal Roads on Vancouver Island, and I hold the opposition files for women, for seniors and for child care.

C. James: Hi. I’m Carole James. I’m the MLA for Victoria–Beacon Hill, and I’m Finance critic.

D. Barnett: Hi. I’m Donna Barnett, and I’m the MLA for the Cariboo-Chilcotin.

J. Thornthwaite (Chair): Jane Thornthwaite, MLA for North Vancouver–Seymour and the Chair.

Just to put it in context, the people that we’ve had who have already presented in this second phase…. We had Dr. Morrison and Dr. Peterson from New Brunswick. We had Jeremy Church from Mountainside Secondary and Kathreen Riel from the WITS program. We had a joint presentation from the Ministries of Health, Education and MCFD, as well as the First Nations Health Authority. That was all previous to today.

Having said all of that, I’d like to turn over the floor to our first invited presenter, Chief Officer Neil Dubord of the B.C. transit police and Melissa Granum.

You know what? I had in my notes to be able to…. I guess the first challenge I had was to be able to find this location, so I consider myself fairly successful. It worked out very well.

Thank you for the opportunity to be able to present to the Select Committee on Children and Youth. Today I’m here representing a unique position with regards to two different police agencies. I am currently the police chief of the Metro Vancouver transit police or B.C. transit police, and on Monday I get sworn in as the Delta police chief for the Delta police department. So it’s a little bit different in the fact that I have the opportunity to be able to present a perspective from both police departments.

With me is Melissa Granum, who is the manager of corporate planning and communications for the Delta police department. Melissa and I will both be presenting here today.

I always start my presentations with what I call a BLUF statement. BLUF stands for the bottom line up front. That way I can keep to my ten-minute time frame and also give the committee an idea of where I’m going to go with my presentation.

We’re going to talk about six slides today. It’s going to take us approximately ten minutes. The purpose of the presentation is not to look at single points of focus, such as what partnerships would help with youth mental health, but instead suggest an accountability mechanism to co-op partnerships.

I would like to take you through a small case study on a youth who was diagnosed with mental health issues at the age of 13. This youth was born in 1993. He was a large youth, and he ended up growing up to be 6 foot 4, 200 pounds. He was always a larger youth. In 2006 he had his first mental health complaint to the Delta police department. He was 13 years of age.

I’d like to read you some notes from that particular police report. This is a direct quote from the police report over seven years ago.

“The youth is 13 years old and suffers from mental illness. He is currently attending an adolescent day-treatment program at Surrey Memorial Hospital. This program is designed to support individuals suffering from mental disorders. The youth has also been referred to a Delta mental health worker. However, he apparently refuses to see her.

“The youth was released from Children’s Hospital approximately one year ago at 12 years old after being admitted for mental health issues. The discharge report indicated that the youth was at high risk to have psychotic episodes in the future, in particular if under the influence of drugs. The youth has displayed that he will be physically resistant to police and is showing signs of self-harm by cutting his wrists. His father reports his son is mentally unstable, violent and uses non-prescription drugs.”

This particular youth, by the time that he was 14 years old, had gone missing six times already. He was reported missing six times. Starting in 2007…. Often we find those youths use the transit system as a method for them to be able to commute around the Metro Vancouver area. After the first 30 months he had received five fare-evasion tickets and was being dealt with on frequent occasions by the transit police.

Starting at age 12, and by the time he was arrested for murder, he had over 200 PRIME entries into the police database. He had at least 18 different addresses during the seven years. There were over 40 entries for violence, weapons and threats. He was arrested for murder and is in custody currently on the murder charge.

It’s impossible to capture the resources from all the different service providers from the time the youth was 12 years old and had his first interaction with the system, not to mention the victimization that he caused to others who he interacted with. What is interesting regarding this youth is that mental health problems were suspected and recorded by police school-resource officers at the age of 13, yet a lack of coordination and capacity of the system prevented us from stopping a homicide seven years later.

I would like to keep the discussion fairly focused on the four questions that were provided to us to provide some sort of framework.

I’m sure that as you are drawing to the close of your consultations, you’ve heard from many different police agencies or many different agencies. The answers provided to the questions to the standing committee will not be that different from me here today and what you have heard from other agencies. We hope to be able to provide you with some high-level answers to these questions and then move into some other thoughts for your consideration.

The first question: what relationships, partnerships, do you have with service providers in your community or region?

We have strong partnerships with service providers such as the police, other police departments, the Crown, corrections, MCFD, health, education and social services. Currently, the Delta police department has a dedicated mental health worker that works exclusively with high-risk youth — not just high-risk youth but high-risk patients — and has a dramatic impact on the service demands that we are seeing.

The second question I’d like to cover is: how could youth mental health services and supporters in your community be better coordinated?

When youth come into contact with the police under serious circumstances, police involve the appropriate stakeholders. Wraparound services with youth liaison of-
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ficers, family counsellors, MCFD and school counsellors would all be of great assistance when we start to be able to coordinate all of that information. Often freedom-of-information issues come into effect that lack the ability for us to coordinate. Coordinated efforts with MCFD is common practice with youth at risk. There exists a need for more of what I call strategic diversion.

We all have diversion programs, but when I talk about strategic diversion programs, it’s where diversion is used as a tool not just to deal with the crisis but to deal with the long-term prognosis and be actually proactive into the long-term maturing of that particular youth. That’s where I think we lack in the ability to have coordinated efforts — in that long-term strategic diversion.

How might crisis response services be provided to ensure that the youth and their families have 24-7 access?

The 24-7 care is currently handled by police, obviously — we become the de facto agency to be able to manage that — and a hospital’s ER. The Surrey Memorial Hospital has a great new approach now that is being used. They are providing us with the facilities for us to be able to actually triage that 24-7 access much better, and 24-7 access to social services and mental health would certainly be a great advantage to us.

Currently the Delta police department does not have an ACT team similar to the Vancouver police department to manage some of these 24-7 issues.

The last question before I turn it over to Melissa is: what professional expertise is required for staff to deal with child and youth mental health issues?

We do have significant police training in crisis intervention. However, we do not have tremendous training in youth mental health. We know that there are some dramatic differences in youth mental health that we need to be aware of.

In conversation with Dr. John Taylor, who is a child and youth psychologist, he suggested that his experience has been that the police response to a youth in mental health crisis is far different than an adult response. In an adult response, often the police are seen to be criminalizing mental health. In a youth response, the police can sometimes have a calming effect for that particular youth. It’s a little bit different approach than we would see typically when we would deal with someone who is not a youth, having a mental health crisis.

The general police population has some very basic training on de-escalation, etc., but nothing in relation to youth specifically. We’re not exactly sure what that training would look like, due to the complexity of youth mental health.

M. Granum: When Chief Dubord and I were discussing solutions for youth mental health in the province, we came up with what we believe to be things that most agencies have already identified as problems. With respect to all of these solutions, we believe they’re well-thought-out and no doubt have an effect and impact on youth mental health, but they are at risk of becoming rhetoric.

We talk about more resources. We look at psychiatric beds in hospitals. Fraser Health, for 1.6 million people, has ten psychiatric youth beds. Vancouver Coastal Health has 26. Six of those are short-term psychiatric emergency beds. That’s almost a no-brainer, in some ways, when we look at resources.

We talk about funding for community-based resources. Not wanting to institutionalize youth with mental health issues, we do need to inject more money into community-based: better information-sharing between agencies and wraparound services, better alignment of resources, mental health resources for schools.

I’m sure you’ve heard from administrators through schools. Schools are the place where youth spend a lot of their time, and they do present a lot of issues in the classroom — perhaps with conduct issues. Teachers, school counsellors and school administrators don’t have the training or capacity to understand, diagnose or handle untreated mental illness in the classroom. It could be a brain injury. It could be a mental health disorder. All they see are conduct issues.

Richmond school district — I’m not sure if you’re aware of it — has a youth adolescent team. They’re designed specifically to help close that gap between youth with mental health issues and teachers and administrators that don’t know what to do with them. They’re not there as school psychologists that run psych-ed evaluations or anything like that. They’re there to help teachers understand what these kids are going through. They’re trained in fetal alcohol spectrum disorder, ADHD and all of those — anxiety and depression.

When you consider that one out of five students in our school system is suffering or will suffer from some sort of mental illness or anxiety disorder…. It’s a high number, and we believe that that’s a place where we could put more resources into the schools as well as capacity-building for parents, guardians and caregivers. I often think about how, if one of my children came home with an addiction or had some kind of emergent psychiatric issue, I would manage being a professional, raising my other children, getting them to soccer and football and all those things along with then dealing with doctors, with MCFD, with Health, with the school district. It can be overwhelming for parents.

Again, we talk about the 24-7. Really, the issue there for us is that when there isn’t 24-7 social work care, mental health care, we do end up criminalizing people. They get arrested. They’re a section 28. It’s not the right approach.

N. Dubord: As we began to look at what kinds of solutions might be available, we talked about creating a single accountability structure for all government min-
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istries, agencies and publicly funded organizations with one factor in mind — that factor being the child. What happens now is the demand for service is controlled by the capacity of the service provider. Patients are triaged and put on wait-lists. So it becomes an exercise in risk, and the focus on the child is lost within the system itself. And that system has significant capacity issues.

There are various pieces of legislation that build in duties and accountabilities for police and other service providers in an attempt to avoid mental health consumers from falling through the cracks, such as the youth identified at the start of this particular presentation or the recent account of Paige’s story, which we are all very familiar with.

M. Granum: As a caveat at this point, it’s important to note that neither of us are experts in the acts that are applicable to our youth. However, we do believe that, as a high-level concept, the Representative for Children and Youth Act should carry more legislative weight around accountability for service providers.

Doing research on the representative’s office and the work that she’s done, I can only imagine — and it’s just my opinion — that she’s probably frustrated with what she has faced. She’s fully aware of shortcomings, she articulates herself very clearly, and she offers clear, concise recommendations which she has no ability to implement.

As police personnel, we’re held to an exceptionally high standard through the Police Complaint Commissioner. His powers are written directly into the Police Act, and he has the authority to enforce orders, overturn DA decisions and call for public hearings. We do believe that the children and youth of this province deserve service providers that are held to these same levels of accountability.

We believe that this accountability could be articulated through something that we see as a B.C. child and youth bill of rights. We believe our youth have rights, and we believe that there could be a simple document that commits all service providers to those rights. The bill would take the burden away from youth and their families and guardians, and it would acknowledge their rights. As Chief Dubord mentioned earlier, there are acts that legislate basic service level requirements. However, this bill would take it a step further.

We’re not attempting to determine today what that bill would look like. But it could have, as examples: statements around education free from bullying, discrimination and harassment; safe and nurturing home environments; timely and effective medical care — that includes mental health care — efficient and effective social services; easy access to what is needed for each youth in our province; and that all agencies work together in the best interests of the child.

This may mean we have to look at how we do things — perhaps privacy, how we do privacy — differently. Again, as the chief mentioned, we must shift our thinking away from a supply base to a demand base. We must give our youth what they need in all aspects of their lives.

As we described, the youth with the experience of episodes of mental illness starting at 12 and going over the next seven years had over 200 police contacts, 40 violent crime charges and was the subject of a number of missing person reports and complaints. He was eventually out on bail for one day before he committed murder.

These are just the police contacts. You can only imagine the overall cost, as we mentioned, to all the service providers, including health, corrections, court, education and the future costs while the subject is in custody — and the loss of productivity to society.

It’s easy to see how a proactive approach might actually save money. A proactive approach includes all government, either through funding, legislation or policy development. We are not suggesting this is going to be easy, but we are talking about a major shift in thinking.

We know the solutions — whether it’s the police, health care, social services, education or the representative. We all have an idea of what needs to be done, but we have not had the proper structure or mechanism to effectively implement the solutions or the strategies that have been mentioned.

The focus needs to change from the capacity of the system to the child. The focus needs to change from the capacity of the system to meeting the demand. Failure to do this means that we will continue to dilute the real costs of youth mental health to all the service providers in the system — in effect, hiding the real cost to society. Not only is this suggestion an opportunity to create efficiencies over time; it’s also the right thing to do for our children.

D. Donaldson (Deputy Chair): Thank you. That was excellent information. I have a few questions, but I’ll limit it to one. Then, if there’s more time, I’ll come around to the next one.

You talked about a need for more strategic diversion, Neil, focusing on long-term prognosis, and action was lacking there. How do you see that unfolding in light of the recommendations you’re making? Can you talk a little bit more about that?

N. Dubord: Absolutely. The idea of strategic diversion would look at the actual long…. Instead of just the crisis intervention point…. Often the police are very good at diversion, but it’s just to eliminate the immediate crisis, whatever crisis that may be. We are crisis responders.

When we’re talking about strategic diversion, we’re talking about the long-term, proactive approach to be
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able to work with all the different service providers in an effective manner to ensure there’s a plan for that child in moving forward. That plan could be held to a certain level of accountability through some form, whether it be a child and youth bill of rights or something similar.

C. James: Thank you for the presentation — very clear and clear recommendations as well.

I want to talk a little bit about the…. You mention crisis and that the police, and you, are often on the front line when a mental health issue happens with youth. You’re often called because of a crisis point. You mentioned a list of people that you work with and that you access services from.

I wonder if you could talk a little bit about that, because one of the things that we’ve heard pretty commonly is the challenge in being able to figure out: who do you go to, which service provider? Who do you reach out to? So I wonder if you could talk a little bit about either the challenges or what’s working in that process for you.

N. Dubord: Absolutely. I guess I can talk about…. I know cops, and cops have a way of finding a way to get things done. So we’ll find, at the front line, they’re able to get things done.

What I mean by that is that it’s typically personality-based rather than position- and ministry-based. What they end up doing is they know someone within the system who they can pick up the phone and they can call. They make it happen as a result of that call. But there are not the systems in place to allow us to be able to….

You know, that one cop and that one social worker now are gone, and the whole system seems to fade.

J. Martin: Thank you very much. The one thing I’m just a bit curious about, more in a sort of cursory kind of perspective…. Most people that have been in law enforcement for a long, long time…. When they started out in that career, they never really imagined that the social work component and dealing with mental health issues was going to be a major component of the job.

Without some significant paradigm shift in the way we think about law enforcement, in broad general terms, what chance is there of seeing this movement in policing so that there is a natural fit, where it’s understood across the rank and file, right from the senior administrator all the way down to the criminal justice courses in college, first year. If you’re going to be involved in law enforcement, you’re going to be a social worker dealing with a heck of a lot of mental health cases?

N. Dubord: Agreed. Often we’re seeing as high as 20 percent or 25 percent of all of our calls have some issue of mental health. So it’s a large percentage. One in every five calls we go to has some form of mental health issue that we’re dealing with. I think it all comes down to recruiting strategies and, really, the overall philosophy of policing.

Often we recruit…. And TV is sometimes our best recruiter for us. They watch these shows, and they have a picture of what policing looks like according to what they see on TV when, in fact, the actual work on the ground is quite different. Really, that comes back to how we bring people through those criminal justice classes. It goes back to our recruiting teams and how we recruit people and the overall philosophy of the department.

Certainly, I can speak for the Delta police department. We believe strongly in the ideas of community policing, of partnerships and relationships and of problem-solving. When you put that together, you tend to have a different outlook of just straight enforcement-style policing.

I always say that we’re peace officers first, and as peace officers, we’re there to be able to keep the peace and bring peace to the neighbourhoods. But often we’re called law enforcement officers, and that puts us down to one role that we have within the overall profession that we have as peace officers.

Two questions. When you think about what you’re proposing that we do or try and do, it seems like you could look at some of these things as being more significant than others — for example, information-sharing. I mean, if you don’t get that fixed, then all the other stuff you’re proposing doesn’t mean a whole lot, right?

So what would you consider the most significant thing that we could do if you could only pick one thing? We all know there’s a multiplicity of things. What would be that thing which has the most urgency that really needs to be fixed to give us some progress?

N. Dubord: Probably that would be the first piece, information-sharing — the ability for us to be able to share information between the interdependent partners within the system. Being able to ensure that we’re all well informed would probably be the first thing, I would think.

If I could have a No. 2, if you were to give me No. 2…. You never do with No. 1. No. 2 would be around the ability to be able to create some sort of accountability.

I’ll speak in terms of something that I’m familiar with. I think you are as well, Dr. Plecas. A compstat process, a computer statistics process, brings accountability into the mechanism so all the police departments work together — so all our different investigative units, our finance units, our HR units. Everyone comes together to be able to prevent and enforce the laws and reduce crime around a compstat process or something similar, an interagency that has some accountability mechanisms that hold us
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all accountable to making sure we get done what we need to do.

My second question — if I may, Chair — relates to having you think about your experience in Alberta and with transit. You know, it’s a lot of years. Both of you have seen how this problem has changed over time. So I guess two things. To what extent has it grown? You mention the figure of 20 percent of cases. And, in part, to what extent are you dealing with the same individuals over and over and over again?

N. Dubord: Great. I’ll start that question, and then I’ll turn it over to Melissa as well.

My experience in Alberta. Of course, I was with the Edmonton Police Service for 25 years, and I was a deputy chief with the Edmonton Police Service. When I was a young constable walking a beat in Edmonton around one of the local haunts, the York Hotel, we didn’t know it as mental health issues at that particular time. It was often dual diagnosis. It was someone with a mental illness, but we didn’t recognize it. We thought they were drunk or high, or we thought something else was going on. We didn’t have the proper awareness of the situation.

Although I think the situation, intuitively, is growing, I can’t tell you that for sure. I certainly am far greater aware of it. We’re documenting it better in our police reports, and we know that there’s a larger percentage we’re dealing with now that is mental health related or dual diagnosis with some sort of addiction issue. I think the issue has come to the forefront. We’re starting to document it properly, and it’s a large piece of our business, to sort of answer that.

Now, the second part of that question was talking about…. You wanted to answer anything in particular?

N. Dubord: Yes. We know that a small percentage — 10 percent of the people that we deal with frequently — commit 50 percent to 60 percent of the crime.

You just have to look at this one case study that we’ve provided here, where you have over 200 police entries, and that doesn’t count all the times that that person is just picked up and driven home and dropped off to their parent, and there are those phone calls to the parent from the school resource officer — all those other interactions that happen during that person’s lifetime. So we know that it’s a small percentage of people causing us a large percentage of the issues.

M. Granum: Yeah. I think, as well, when I began with Delta police in 2008 we were just implementing our community health intervention program — which is our mental health officer. I’ve seen an evolution of how police respond to these calls. I think police have become very aware of the fact that problem-solving at the front end really does help reduce calls for service, and we do have case studies around that.

I know that there are some horrible files that end up on the front page of the newspaper, but for the most part, police come into contact thousands and thousands of times a day in Vancouver and across the country, and the vast majority are well managed. I believe our police do care, and they are familiar with the concepts around mental health and a reduction of the victimization of the people that they’re dealing with. Of course, I’m coming from a police perspective, so I’m going to say some nice things about the police — which I think sometimes is good to do.

I have seen, like I said, an evolution over the years, and I do hope that that continues. There is the argument: Is it within the police mandate? Is it within the scope of the Police Act that the police are social workers in the community? Well, the reality is that we are called during a crisis, and we have to manage those things properly and effectively and reduce the victimization. I think that it’s an ongoing work in progress, but keep working at it.

D. Donaldson (Deputy Chair): A pretty straightforward one. The dedicated mental health worker that you referenced. Is that five days a week, seven days a week? Where are they situated, and who pays for that person?

N. Dubord: That particular person is working a 40-hour workweek. One person is all we have. Currently they are working with only high-risk files. Often what is happening is all the files within the Delta police department are focused in to that mental health worker. They’re triaging the files, identifying the ones of high risk and then going out and doing the follow-up with that, hopefully in partnership with the health authority that they’re working with. And that is paid for by the Delta police department.

M. Granum: Just to add to that, as well, we do have a relationship with Fraser Health. We have a psychiatric liaison nurse that does work directly with that mental health officer on an almost daily basis.

J. Thornthwaite (Chair): Thank you very much for presenting. Perhaps you could leave your business cards with us before you depart. I appreciate the questions from the members and your time that you took today to contribute.
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J. Thornthwaite (Chair): We’ll do a little switcheroo here with the next presenters that I see are here. So shall we take just three minutes?

Our next presenters are from the B.C. School Centred Mental Health Coalition — Laurie Birnie, the chair, Dave Mackenzie and Steve.

But you don’t look like Steve. Well, Deborah can introduce herself when she’s speaking.

L. Birnie: First of all, thank you very much for allowing us to come and speak. We represent a coalition of lots of educational partners. There are about forty organizations that are represented and about 100 members in our coalition, and we represent most of the players in education: trustees, administrators, teachers, parents, the BCTF. We also have people from the Ministry of Health, the MCFD — just an extensive group of people that are part of our coalition.

Over the last year or so we’ve developed a strategic plan, which you have in the notes that you got. The most significant piece of that…. The vision for our coalition is that schools are safe, caring learning places for kids. And when we talk about mental health and wellness, we are the front lines of mental health and wellness for children and families. We are the first place, in many instances, where families are dealing with outside agencies in many cases. We believe it is part of our responsibility and our mission to support and build capacity to foster mental wellness in our schools.

For us in the coalition, one of our main tenets is to build communities in which everyone feels safe, feels seen, heard and belongs and is cared for. Next to the family, school connectedness is the most defined protective factor in a young person’s life. When we look at connectedness and belonging we know that it improves academic outcomes. It improves health outcomes, and we know that this is how we make a difference with individual children.

As a coalition, we have four strategic priorities: student and family engagement around mental health and wellness; building school system capacity for mental health and wellness; building those partnerships with those that serve our families and our systems around that need; and to take a look at the policies and practices that guide our practice and what we do with children in schools.

So here we are — school connectedness. We know that it reduces student vulnerability. It supports good mental health. It’s critical in achieving the educational outcomes that we all have for our school system. And it provides an important environment to influence positive learning and physical and emotional outcomes.

One of the things that we have done is that we’ve partnered with DASH BC, and we have an initiative on building connectedness for kids in schools. There were, I think, six grants being given to different schools around the province in which they explored one way to build connectedness and belonging in their communities. They took the grant to develop their thinking around that particular project and to take a look at the research and what that particular project did in order to enhance kids’ feelings of belonging.

It was pretty exciting, and there are several videos that have been created. What we’re finding is that when other people are seeing the work that those grantees have done, it is inspiring them to find ways to connect in their own communities. It’s building on that, and there’s a real synergy around connectedness and belonging because of those grants.

D. Mackenzie: Something I’ll also add is that I think the beauty and the success of those projects is that they’re created and undertaken by the schools within the context of their community, so they are incredibly responsive and nimble to the issues that are surfaced in those particular communities. When we ask them to create their projects, we always ask them to consider: is this something that could be scalable or reproduced in another community?

But I think the value came from, and still comes from, communities looking at: “What is it that we need?” Rather than being given something and saying “Make it fit,” communities created something that addressed an issue or a problem. What we know about school connectedness is that, as Laurie mentioned earlier, there are significant academic benefits, but the social and emotional benefits of being connected to your school community are significant.

Schools are that one institution in society that sees mental health issues, but we don’t define the people we work with by a mental health challenge or a substance use challenge that they have. But we often identify that it’s getting in the road of them being successful, participating citizens within the school or their community.

The coalition really provides an opportunity — sort of a framework or an example — of how various ministries and non-governmental agencies and organizations can actually work together on identifying, addressing and dealing with mental health and substance use challenges in our community with our youth.

Again, it’s focused on what works in a particular community in the Fraser Valley isn’t necessarily something that’s going to work on the west coast of Vancouver Island. But the tenets, the principles, behind the work in both of those two places in our province are the same. You give the strength and you give the authority and permission for local people to deal with local problems. I think that’s one of the strengths that the coalition has been able to develop over its relatively short life. We hope it continues.
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L. Birnie: The collaborative action around building school capacity has been that interministerial piece that we’ve talked about.

One of our recommendations is expanding the school connectedness initiative — that uptake that we were talking about — so that more communities can find that link that will bring kids into the school and get them to connect with other kids in the school. We know that isolation is one of the huge issues around mental health and wellness issues.

I remember at one of our meetings Sherri Mohoruk was talking to us about a circumstance that she had reviewed from the coroner’s inquest. One of the things that came up out of that inquest…. It was an adolescent who had committed suicide. One of the things that they found out in that investigation was that that child did not feel connected to their community. He felt like he had no one to talk to and no champions there.

So we think it’s a pretty fundamental thing to have that connection at school. That’s really what school connectedness is about. It’s always nice for people to know your name, but it’s really about creating champions within the community — the school community and, also, extending outside the community so that children have a place to go, so children and youth have someone that they can trust and can count on.

We know that when children see themselves as worthy in other people’s eyes, then no matter what their situation, they can manage it. And they need help. We’re not saying that this is a magic bullet. But we do know that it is the most solid foundation that we can give our children.

We believe that it’s really important that we support integrated services in school and community settings, encouraging school connectedness through interagency collaboration and wraparound support. We see school as the centre of conversations around child and youth mental health and wellness.

They’re in the schools for the most extended part of the day, and we are the place where we should gather the support. We believe that we should have teams that can work with outside agencies seamlessly to give them the support that they need.

D. Mackenzie: The first round of the work that you’re doing identified that lack of coordinated, integrated service as an issue. I’m going to reiterate again: I think the mental health coalition that Laurie and I are a part of is an example of how, again, different ministries and NGOs can work together. We often hear about policies and procedures that sometimes get in the way of collaboration. Our group is an example of where that doesn’t happen.

People come to those groups willing to listen to an issue or a problem that surfaces. Sometimes they have a solution or a program or a way of being that they can offer in that moment. But often they can go away, consider that with their organization and come back two meetings later with: “I think we have something for you.”

If we don’t have those opportunities to have those ongoing, consistent conversations, we don’t get an opportunity to do that interagency sort of work that needs to be done. There are significant structures within government. There are different protocols. But the reality is that when we come to the coalition, we leave the hat that we wear at the door and we’re there for the issue and the challenge of addressing mental health and substance use issues for young people in schools.

Working as a school counsellor in the Okanagan, I’m happy to say that I think we have a good relationship with our community partners. That came after a ton of work, both formally and informally. I have to say that most of it has been informally.

My worry about that — it’s something we’re trying to address within the coalition — is that when you rely on personal relationships to create that collaborative work, when that person moves to a different position, when that person retires, sometimes you take three or four or five steps back, or sometimes it completely disappears. Without a comprehensive strategy and structure in place, good work can still happen, but it happens on the back of personal relationships.

That is important, and I’m sure you’ll hear and you’ve heard that relationships are key in this work. But there need to be formalized relationships within organizations as well as individuals. We need to give permission to those organizations to work together, and we need to give them time to work together. Just to assume that they’re going to do it…. Each organization has their own mandates, their own priorities and objectives. Sometimes they intersect, and sometimes they don’t.

The coalition is an opportunity, as I said, to work on something that’s near and dear to everybody who shows up at that table. Whether you’re a school counsellor or a director with DASH BC or a parent advisory council member, everybody comes with the same focus: what can we do to address the needs of kids?

L. Birnie: I think one of the things, too, is that when we meet and are together as a coalition and we’re seeing each other and hearing our work, all of a sudden there are a whole lot of possibilities that I never imagined were there before. I’m an elementary principal, and I would never have even assumed that I could be at a wraparound meeting at Children’s Hospital with a neuropsychologist, a social worker, but that’s what I did last Monday.

I was in the hospital. There were ten of us around the table. There was someone from the representative’s office, a social worker. MCFD was there. The neuropsychologist was there. I brought a staff member who works with the child daily. The parents were there. Together we talked about what the child needed and what the family needed. Hats off at the door. Our roles were left behind, and we
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just really got down to the business of care.

I think that’s what we’re looking for, and that’s what we mean when we’re talking about school connectedness. It is a deeper and more abiding relationship with the people that we serve and the families that we care for. We have children now being diagnosed with very serious medical concerns. In my time over 34 years in public education in B.C., the amount of children who are coming through our doors who have circumstances that we never imagined we would know about is just piling up.

We need to be a place where all comers are accepted and we don’t release children because we can’t cope with what they need. We need to make sure that we are flexible and that our systems are nimble so that they can respond to the needs of those children. That’s what school connectedness, in its deepest meaning, brings to the table.

J. Thornthwaite (Chair): Laurie, are you just about finished your presentation? I’m just watching the time here.

Being in public education, there are lots of systems that we have that we just kind of all of a sudden throw out and start new ones. We’re not asking that you throw things out. We’re taking a look at what the structures are that we have and how we can re-envision them to meet the needs that we’re looking at.

One of the things that we’re looking at is the ERASE strategies that are out, that are really framed around the evidence of antisocial behaviour. We’re wanting to take a look at expanding that mandate around more prosocial behaviours and looking at mental health as a part of that program. There is a structure in place, so we just need to kind of re-envision. We need to grow it so that it can be more responsive to that proactive piece and to mental health and wellness.

D. Plecas: Thank you very much for your presentation. I love what you do. I think it’s awesome. Never mind what I think or anybody here would think. I think the research is pretty clear that one of the most powerful things we can do to help young people in schools is connectedness — no question about that.

But it seems…. You’re talking about connectedness. I mean, there are two parts to it. One is the connectedness to all of the helpers, agencies and community outside. But then there’s the connectedness of the youth to their friends and teachers and what’s going on in the school and in the classroom.

I guess it’s just surprising to me that this — I mean, unless it’s been going on for a long time — is a relatively new initiative. This is such a no-brainer. What has been going on? Like, what is the reason? I see you’ve got six schools that you’ve provided grants to. Why isn’t this going on everywhere, and why hasn’t it been going on for a long, long time?

D. Mackenzie: Well, I think it actually has been going on for a very long time, but it probably has been going under different names. We’ve tried to formalize it a little bit more. Also, as the challenges present themselves in a more frequent manner and the system isn’t able to respond like it used to, we have to look to our community partners. We have to look to other people than ourselves to try to deal with those issues.

I think, at a classroom level, with those teachers that make an impact on kids, if you gave them the definition of “connectedness,” they would say: “That’s what I do.” But they don’t call it that. They call it relationships. Maybe we’re phrasing it differently.

I think that the notion of connectedness, as you mentioned, has to be twofold. It has to be system connectedness, but it also has to be individual connectedness. They can’t be separate from each other. It has to be a part of how an organization does business but within the context of how people do business with each other on an individual basis. But we need structures in place that require organizations to do that. It needs to be a part of what they do.

What exactly is it that we could do, government can do, to help you reach your vision and mission — if there are one, two, three things — getting very specific?

L. Birnie: The government is re-envisioning accountability right now in terms of the new learning plan, the B.C. ed plan. So what are the priorities within accountability?

When you ask someone, “Have you done your job?” what are you measuring? Are we measuring children’s academic success? Are we measuring their connectedness and their sense of belonging and well-being? You set the priorities by what you judge us by. That’s really the most important thing, I think.

Connectedness and belonging have been going on for a long, long time, but it isn’t valued beyond just “everybody feels really good” — you know. Outside, in the broader community, what are we asking from our schools? We don’t always ask for them to be places where everybody belongs and everybody finds a place and fulfills their personal growth and potential. I think the new education plan is getting us there, but it’s the accountability piece that’s the other thing, I think.

D. Mackenzie: Something I’ll add to that is that I think one of the dangers is for a group like this in government
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to say: “Tell us what you need, and we’ll give it to you.” You may get a lot of requests. But being offered that opportunity, I think you will get some fantastic community-specific and regional-specific ideas.

If they can show how they’re connected to and evaluating and measuring how connected the school community is, both at a system level and at an individual level, and make that a part of the accountability and make that a measure of how successful you are, the rest will follow. In the classroom, students will read better, write better, do math better. You almost don’t need to measure those because those will come. Kids come to school with a zest for learning. Everybody sort of agrees that that’s what kids come to. They don’t always leave high school with that.

J. Thornthwaite (Chair): I’ve got ten minutes. I’ve got Maurine, Carole and Doug. Maybe if you wanted to ask your questions first, and they could answer them. It just might be easier, because there might be the same questions. Do you want to try it that way? Just ask your questions, and then you can answer them. Maybe we can answer them all at once.

M. Karagianis: Great. Thank you very much. One of the things that we heard consistently in the first phase that we did was the disjointed nature of services around the province and the difficulty of families and children accessing services. I didn’t really…. I’m not sure I’ve heard in your presentation any reference to level of service and where and when it’s available.

Another thing that we’ve heard…. Something that we really liked from our presenters from New Brunswick was “one child, one file” as they go through the education and the health care supports and all of the other supports. That was actually referenced by our previous presenter when they talked about making mental health services all about the child.

I wouldn’t mind having you comment on that. It seems to me that all this collaboration is excellent. But I don’t hear…. You know, where are the services? Are you able to access the services? Unique projects in communities are wonderful and innovative. But level of service, early intervention — are those resources there? And if they are not there, where are they needed, and how are they needed? That’s really what this committee is probing: what’s needed and where there are huge gaps. So I’d be interested to hear what you have to say about that.

J. Thornthwaite (Chair): Let’s let Carole ask, and then Doug, and then you can answer them all.

C. James: Thanks for your presentation, and thank you for your work. A couple of questions. One is related to funding — funding for the coalition and funding for the grants that you give out. Does that come from one ministry? Is it shared? Is it modelling the coalition through the funding? I’d be interested in that.

What kind of follow-up happens with the projects? Once a school has taken on a project, is there any kind of follow-up after the project is there?

And then the last piece. I wonder if you could describe a project. Hopefully, people will be looking at the information from this committee later on. I think it would be interesting for them to know: what is a project that’s been funded that describes the connectedness that you’ve been talking about?

D. Donaldson (Deputy Chair): Thank you for the presentation. Great work. Especially, I like the philosophy of community- and regional-specific. You know, I come from an area that has a predominantly First Nations population and a total lack of youth mental health services. The connectedness picture there would be much different than other parts of the province and perhaps similar to other parts of the province. But I really like the community-specific aspect to what you’re endeavouring to do.

The question I had was around your first recommendation — to expand the school-connected initiative — similar to Carole. How much would that cost? What’s the demand? You said six $5,000 grants were accessed for 2014-15. How much demand was there beyond those six? And the 113 applicants from all regions — is that past grantees? That would seem to be more than six a year in the past. Has the funding decreased for this kind of initiative in the last number of years?

D. Mackenzie: I’ll start by responding to the question around services and the level of service. I think when we talk about child and youth mental health and substance use services, we often talk about those responsive services — students identified either through involvement with the justice system or a lack of school involvement. Then we try to put services in place. I think we have good services around the province. We can always use more. I don’t think anybody’s going to question that.

Where I think there is a glaring hole is on the preventative side of things: in the capacity-building of kids to manage themselves better, in the capacity of schools and teachers and administrators to respond sooner and more appropriately so that we don’t have to rely on the most expensive services that we have.

A young person shows up in the ER as a result of a panic attack. That’s a very, very expensive consult for a panic attack that actually could have likely been de-escalated at a school level if enough people were trained to be able to recognize that’s what it was and these are some strategies that you could use.

A plug for school counsellors. Elementary counsellors sometimes work with a caseload of 2,000 to 1. In a secondary school you would be lucky if you’re working 400
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to 1 or 500 to 1. That’s rare, actually. It’s probably closer to 600 or 700 to 1. Asking school counsellors just to be the only person in the school with those skills is unrealistic. But where do you come up with the resources and the will to be able to train the average person in a school? I don’t mean just teachers — certified educational assistants, noonhour supervisors, any supportive adult in the building. We rely on what it is that they bring as a person, not what their role brings them, in terms of supporting those kids.

When we talk about services, for me, I would leave it to the people within MCFD and Health to talk about those upper-tier level of services, and they’ll tell you about how they could rearrange things. I think when we talk about schools, we’re talking about capacity before the issue surfaces. Right now we don’t have a comprehensive approach or strategy to address that.

We have great things that happen around the province. The grants are a great way of highlighting what some schools are doing, but in every single one of those grants, it’s individual schools that are doing it. It’s not school districts. It’s not parts of the province. It’s a champion individual who rallies other individuals to do some great things. We don’t currently have a system or a shelf that we can hang it on that everybody can access.

Now, we’re trying to build that capacity within DASH B.C., but that’s a lot to ask for a small, non-governmental agency to do. I think that’s a role for government, to say: “No, we’re going to provide you with the bookshelf. We’re going to provide you with the librarians to shelve things.” We need you to source it for us. You need to give us what it is that works and let something from the Stikine be front and centre for other aboriginal communities, because what they do there might actually transfer into other aboriginal communities.

I think one of the things is an experience that we had in my school, for instance. We had a child who was transferring in from another school, a kindergarten child. She came with three months of kindergarten and an extensive behavioural dossier. She was on limited entry. She could only come to school for an hour a day. That’s pretty incredible for a five-year-old.

One of the things…. We’re not specialists. We don’t know what the treatment is. But we know that if kids feel safe and that they belong, then…. Sometimes the environment can actually dysregulate a child even further than what their circumstance actually does. So a child who has anxiety and who is placed in a classroom that doesn’t attend to that can become further dysregulated and end up with a huge behaviour problem that need not have existed.

That particular child came to the school three years ago. At first we had conversations with the parents. We said: “She belongs here. She is our child because she is in our catchment area. We need for you to trust us and leave her here with us.” The kindergarten teacher wore that child for about a week.

She’s in grade 2 now, and you would never know that that child came with a significant designation and a significant learning-behaviour dossier. I’m not saying that she doesn’t have anxiety — because that doesn’t go away — but “living with” is really what we’re talking about when we’re talking about this connectedness piece. It’s about stepping in and being the champion that the child needs at the time and allowing our staff and members of our community to take that role and do what we need.

In order for that teacher to do that, we needed to send someone into that class to support — not to pull them out but to remain in the class — so that the children had another caring adult who could be there and help while that had to happen. The fact of the matter is that that actually sent a message to the parents, to our community, to the kids in that class in a way that we never could have done before: that school is a safe place where people care.

I know it’s an isolated incident, but that’s really the work of the coalition. We are taking those isolated incidents where we’ve made a difference in terms of what a child or family needs in the moment and being open to that and not being prescriptive: “This is our box, this is our mandate, and this is only how we can operate.” That’s really what the connectedness grants are doing in a larger scale. We’re upscaling that.

D. Mackenzie: I know one of the questions that was asked, I think, by two different people was: “Give us an example of something that’s happening.” Respectfully, I’m not going to give you one, because what I’ve noticed in the 17 years I’ve been in education is examples that are given often then try to be replicated.

What you do in West Vancouver isn’t necessarily going to work in Stikine, and I have to be cognizant of the fact, as a public…. This is a part of public record, as a part of recommendations. The easy thing is to come up with: “This is the solution.” There isn’t one solution.

Stan Kutcher from back east has a great mental health curriculum, and it’s talked about: “Maybe we should be using that.” That assumes we know what the problem is. I don’t think we truly understand what the problem is. Could we use more services to address those kids who involved themselves with a hospital, in crisis, or with the justice system? Absolutely. But those are really expensive interventions, incredibly expensive interventions.

If we took that money and applied it at the foundational level, building communities that are safe and caring, with capacity to deal with issues when they first surface, we can actually avoid having to spend the big dollars at the top end. I know that the acute side of things is always going to get more attention, but I think government has
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an opportunity to say: “That’s important, but this bottom piece is just as important.”

When someone shows up talking about suicide, things happen for that young person. There’s no question about that. Is it always enough? Maybe not. But when a kid shows up at school disconnected or feeling unregulated, is there attention for them? Lots of times there isn’t — until it rises to the level of: “You’re interrupting everybody else, so now we’re going to deal with you.” Well, what about the kid before it got to that place? We need to look at that.

There are so many experts and champions around the province. We need to give them an opportunity to come and speak, not to this group but to a group like the coalition or another body that’s created — or an enhanced ERASE strategy that deals on the front end. ERASE was a responsive strategy to bullying that was happening in schools.

That’s important. There’s no doubt about that. But from what we know about a kid who is being victimized or the victim themselves, there are often precursors that went unrecognized or unaddressed. We only deal with it again because in education, that’s the acute side of the health care system. Everybody says: “Absolutely, we have to address that.” Sometimes our ability to change that and influence that is limited. We’re much more successful at the lower end.

L. Birnie: Just to answer the question about how we are funded — we’re not. The coalition is made up of a whole bunch of different groups. I represent school district 43 and the B.C. principals and vice-principals, and those groups sponsor my attendance. Every once in a while one of the groups gives us a place to meet and something to eat while we’re talking. That’s how we operate.

It’s the compelling topic that brings people to the table. I think that that’s why it’s worked so well. If you’re looking for a model, a coalition is a really powerful one. If we could see it kind of repeated in local areas where the people who are interested join together around this issue, I think that would be a significant model.

D. Mackenzie: I will caution, though…. We’re nimble because we don’t have a funder. But we’re always on the bleeding edge of it not happening. There are always the calls: “Who’s going to fund the lunch this time?” “Who’s going to find us a place where 40 of us can sit and talk and not feel like we’re sitting on each other’s laps?” And that changes. It’s a fluid thing. Again, it’s the commitment of everybody around the table to be patient. Sometimes it’s the week before the event, and we’re still figuring out where we’re supposed to be going.

As a school counsellor, my association sponsors me to attend and then share information back with my members. But those are contributions that my individual members make for me to be there. And then, by the grace of my principal and my counselling partner that I’m out of the school half a dozen days a year, where I’m not servicing the kids I’m supposed to be working with….

Do I feel it’s important work? Absolutely. Do I hope that the work that I’m involved in at the coalition will help slow a trajectory of a challenged situation? I absolutely hope that it does.

J. Thornthwaite (Chair): Well, we appreciate the work that you’re doing. We really appreciate you coming here and speaking with us and sharing your experiences.

We’re going to have to move on because we’ve got our next presenter here. Thank you very much for coming and for all the work that you do.

B. Seal: I’ll just get started. First of all, I just want to thank you all for this opportunity to share some time together, especially to Jane for inviting me, and just all the work you’ve been doing in your roles and in this committee. I’m going to share a bit of my story, and you’ll just get to know me a little bit, why I’m so passionate about mental health and why I’m involved.

Essentially, I was studying in university, first couple of years of university trying to make that transition from sort of party guy, hockey player, snowboarder living in Whistler for a little bit to active, engaged student, and I started to struggle with my mental health. In 2005, my first semester at SFU studying business there, I experienced psychosis and had to drop out of college. I entered into the EPI program, the early psychosis intervention program, that the government runs — an amazing program.

Essentially, I just tried to put it behind me, forget about it, get on with my life and get on with my studies. A year and a half later I had a relapse, and it was much worse. The symptoms of paranoia turned from, before, thinking people hated me and wanted to beat me up to: “People want to kill me, and the world is coming to an end.”

I attempted suicide, ended up in the hospital, where it got much worse. I won’t even go into the details of the hallucinations I went through, but it was pretty full on. They said: “Brent, you don’t get the flu; you get pneumonia, in terms of psychosis.” It was an unreal experience, but I got stabilized. Thankfully, medication, therapy, the EPI program, family support, school support — best-case scenario in all categories.

I remember lying in bed at night and just thinking to myself, so isolated, saying, “If I ever recover, I want to do
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something. I want to start an organization to help young people through these challenges,” because the isolation I felt was just as bad as the symptoms I was experiencing.

A year and a half after that I started a student club at campus called Students for Mental Wellness. We did movie nights and speaker events, ran a hiking program and did a two-year mental health study that I can show you after. We studied what was stressing out college students in this two-year study.

After graduating, I decided I wanted to work in the field. I worked at the Kelty Mental Health Resource Centre at Children’s Hospital for three years, for the FORCE Society as a youth in residence. I was the first youth in residence. I was co-partner. We built that program and the peer support and project work, built the Kelty ambassador program, built the Balancing Our Minds Youth Summit, which we now host at Rogers Arena for 1,500 to 1,800 students. I’m one of the co-emcees for that.

A year ago I went fully self-employed, left that position to just do it on my own — do speaking and workshops and training. That’s how I came across Jane, through the child and youth mental health collaborative that I now co-emcee as well. About a year ago I started…. I kept speaking in high schools and seeing the impact that could have on students, but for 40 to 60 minutes for 200 or 300 students.

I thought we could have a bigger impact if I went in for a slightly smaller group but over a longer period of time and really started to try to change their mindset around mental health and wellness. So I started working on this program idea. Initially, it was going to be called high-performance wellness. I thought that was a catchy name. I consulted with current students and schools and changed that name to the Edge, and they allegedly loved that name.

I ran a pilot program in two schools this spring. It’s a five-week program. The first week and last week are in-person workshops. We work on mental health and wellness, goal-setting, prioritizing, clarifying priorities and lining up those priorities with their goals. The middle weeks in between are different topic ideas around mental health and wellness. So that’s essentially the program, but I’ll talk about it a little more.

One of things…. I just sort of went through the questions that were posed from an e-mail from this community, I believe. What can be done to reduce stigma around mental health? I think stigma comes from a lack of understanding and a lack of open dialogue, so just giving young people, especially, the tools to talk openly about their mental health, to get support early on.

Really, what it is about, for me, is rebranding mental health. If you guys remember the cancer industry 20 to 30 years ago, people were ashamed of having cancer. They didn’t talk about it. It was under the radar. Look at the progress they’ve made in the cancer industry and the fact that they’re almost proud to have cancer. You’re supported fully. There are all sorts of cool, fun events happening in cancer. That’s what I try to drive towards in mental health. That’s what I hope this program will contribute to.

The Edge program. Really, what it’s about for me is upstream, tackling things early. Mental health is about more than meds and therapy. Meds and therapy, I think, are often needed but are never enough to get through the challenges young people are facing.

A quote from a Penticton newspaper article title: “Penticton Teacher Says Students are Just ‘Hanging On.’” I think that’s true for students across the province.

What’s my model-approach solution? As I mentioned, the pilot we ran, five weeks, got a lot of feedback from students, surveying them every single week. I’m going to extend it to an eight-week program and do one topic area per week instead of two, just to let them better absorb it.

It’s all about getting more done, being less stressed and having more fun, because that’s the branding. Then you sort of slip the mental health awareness in there and not call it a mental health awareness program, because no student will want to be a part of that. I don’t want this to be a program that students are embarrassed to be a part of. I want them to be proud of it and to tell their friends: “Hey, you’ve got to join this program.”

I have some quotes from students that are in the program that I’ll share after. But I just want to share this quick little video of the program. It’s about one minute. This is the video the students see when they join the program.

There’s a little bit more to that, but that’s the general idea, to make mental health fun. That’s part of the rebranding of mental health. Nobody wants to talk about mental health, because they’re ashamed and there’s stigma. If you just make it fun and engaging and low stress, people are happy to talk about it.

The program is structured with a framework of a foundation of support systems and rest and relaxation, so just building that foundation of wellness and ideas around that — how to identify a support system, who should be in a support system, what do you look for in a support system, how to build a support system for yourself. Similar with rest and relaxation — high-performance rest and relaxation strategies from high performers. The push-pull strategy: push really hard, pull back and unplug from the noise of the world.

There are four pillars: stress management, self-confidence, mental wellness and mental health. Mental wellness is sort of the top end of getting more clarity and focus and identifying your filters you have about the world. Mental health is: how do you recognize when your mental health struggles are something to be con-
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cerned about, and when is it just a regular thing? What are the mental illnesses to be aware of, and what are the resources in the community that we can access? There are guides and resource supports bonuses to support them with that.

Then there’s an inspiration piece at the top that allows them to clarify their priorities — what’s most important in their lives — and set goals in alignment with those priorities. I got that process from a workshop called LifePilot that I took part in while I was at SFU. I took part in it twice. It was such an incredible program, and it had such an impact on myself.

I remember we all set a bunch of goals that day. I remember we had to share one goal. I was about four months after being diagnosed. I had just started sharing my story in little high school classrooms, 20 or 30 students. I set the goal to share my story in front of 1,000 people. I had no right to do that, but that’s the power of goal-setting.

I set that goal on my dorm room door. A thousand people — that’s all it said. It reminded me of it daily. The day I graduated from SFU business, I addressed 1,200 people as the valedictorian of my class. With the youth summit now I’ve spoken to 1,000 people many times. That’s the power of the goal-setting.

The leader of that workshop — I stayed in contact with him. He mentored me for a while. Now we’re pretty much best friends. On Thursday we’re going to the BCBusiness Top 100 event together. Saturday we’re climbing like a 9,000-foot peak. Next week we’re climbing Mount Baker together. Later in the month we’re climbing Mount Rainier together. It’s just this incredible process of seeing these dreams come true through the process of goal-setting — and tying that into mental health and mental wellness, because that’s what keeps me excited and happy and healthy because that’s what I pursue through those goals.

What makes this program successful, and how do we measure “successful”? Young people having access to training on mental health and wellness that they don’t often have access to. I think young people are often relying on their parents to learn about these things. How many young people have great role models for parents in mental health and wellness? Not too many. It’s so that they can be confident in handling and overcoming the challenges they face mentally and stresswise and careerwise.

The study I did. When we identified stressors for students, it was academic success, career success, financial stress. These were the things that were stressing people out. To offer tools and strategies to help them with that is very upstream and can lighten the load on some of the more downstream supports.

The result is just a larger percentage of youth and young people that are contributing to our communities and our province rather than consuming resources from the systems. I really believe that thriving individuals create thriving communities and a thriving province. The fact that over 80,000 youth in B.C. each year experience mental health challenges…. That’s a lot of youth that are struggling, a lot of impact you can have.

I have this whole idea that you go from struggling and getting by — you sort of get locked in that loop of struggling and getting by — and there’s this other thing of thriving. And what’s on the other side of thriving is sharing — sharing your gifts, sharing your message. If you can pop people over to that loop, then you can start to have an impact.

So evaluating this program. It would be both qualitative and quantitative evaluations set up with a person that specially does evaluation frameworks for social enterprises. Surveys immediately before, immediately after — six months out, 12 months out. Broad strokes, surveying everybody that takes part in the program. Then a core cohort of young people that you do more in-depth phone interviews for, really trying to tackle some of those root causes of mental health challenges like isolation, like a lack of acceptance and self-confidence, like the fact that they don’t often have these wellness tools or skills. And just giving them to them.

Ross Greene from Harvard talks about how young people don’t want to cause trouble. They just don’t have the tools, often, to deal with stress, so they get into negative coping strategies — drugs, alcohol, binge eating, self-harm. It’s a coping tool for stress and for isolation. Just shift them over to some positive coping tools. That’s all I’ve done with my life, and my life is completely transformed.

What would it take to expand or replicate the program? Right now it’s sort of me-intensive, having to be there in the in-person workshops the first and last week. Everything else is on line, and activities related to that are on line.

The model for scaling it up would be to shift it all to on-line videos of me and then have a local teacher or counsellor connected with a student locally to facilitate those videos and the dialogue at the local classroom. That allows you to scale up very cost-effectively because it cuts down on travel costs, cuts down on human resources costs. That’s the idea to scale it up.

What additional resources are needed to maximize the impact of this approach? Well, connections to school districts and schools to see who wants to run this program. Most people that I talk to about this program in schools, especially counsellors and teachers, want something like this in their school, but it’s often hard to connect with them.

Funding to subsidize the schools and school districts to run the program. The general fee is $1,500 per school to run the program for the eight weeks and then a per-student fee of $25. What that does is it creates a buy-in for each student.

I think free programs just aren’t valued as much. Twenty-five dollars anybody can afford, but on a sliding scale. If you can’t afford it, pay ten bucks, pay nothing. The counsellors and teachers can identify those students who really can’t afford it. Just have it on a sliding scale. That helps to cover some costs and scale up the program, and it reduces the cost on the system.

I have about 30 schools interested right now. I’m planning to run the school in around ten schools in the fall and scale it up from there. Also, we’d look for funding to support the development and execution of the evaluation framework — just some extra funding to do that.

I’d just like, quickly, to share a couple of quotes from students that went through the pilot and the impact it had on them. One student said: “I love how empowering this program is and how it’s teaching me to take control of my life and teaching me to give myself permission to feel enough to feel happy and to enjoy my life, because it’s my life.”

Another student said: “After this video I feel much more informed about the different challenges we may face. It was interesting to hear that we could be increasing our stress through our filters, and I feel it’s something I can work on to change my view on certain situations, etc. I find this view on mental health refreshing and inspiring. It’s really different than what we usually hear, and the way of tackling them seems manageable and helpful in the long run, to actually permanently shift my own mental wellness.”

Another student said: “The videos contain a lot of valuable information that we don’t usually talk about or even think about. I think this program is good for schools because the new information really gets kids thinking about this subject. I definitely found it valuable.”

A final quote I’ll share is: “I’ve never been so aware of my judgments and thoughts, and being thoughtful of them creates a filter which generates more of a positive outlook on people and situations in general. It was really eye-opening, and I felt I had more control over my mental health and outlook.”

I just want to finish up by sharing a little story of last week. I was doing a keynote speech at a national conference, a psychosocial rehabilitation conference. I got a response that I’ve never had from a speech before — laughter and people crying and people coming up to me after, asking me to speak across the province and across the country, a standing ovation. I was just so lifted up by that. I was just so excited and on a high.

I drove home, and I said, “I’m going to treat myself,” because I like to treat myself after a bit of a stressful day that’s sort of emotionally draining. That’s a heavy workload that day. I’m going to go to Starbucks and get a white chocolate mocha, because that’s my favourite drink at Starbucks. I’m driving home and I think: “Why don’t I actually treat myself and stop at a juice shop?” So I went and got some fresh juice at a juice shop, saying: “I’m going to actually nurture myself and feel good.”

Driving home again, I noticed a lemonade stand — two little boys at a lemonade stand. I haven’t seen one in years. I said: “I’ve got to stop and just help them out.” I stopped, driving by. “How much is your lemonade?” Little tiny cups, half the size of this cup — “That’s a dollar.” A cyclist is driving by at this exact time, and they’re yelling at him to stop. “How much?” So he stops.

I pull out a five-dollar bill. I said, “That’s for me and him,” and he was grateful. They said: “How much change would you like back?” I said, “None,” and their eyes just lit up. They were just: “Are you serious? Oh my god. Thank you, thank you.”

Later that day I just recognized that when we’re generous like that, when we’re in that mode of abundance, we witness ourselves doing good. We witness ourselves being generous, so that shifts our self-identity, and you think of yourself as a good person. You feel good, and you can do more good.

I want young people today to get to where I’m at today — feeling great, having a great lifestyle, great people around me, doing amazing things, feeling amazing — but without going through the hell that I went through to get here. That’s what I try to do with this program.

D. Plecas: Brent, I’ve just got to say that I think you’re just an incredible role model for all people, but I can see how you’d be a great advocate and role model for people with mental health challenges. When you talk about what you do, some people could say there are two audiences. There’s the general group of students, or there are those people who are specifically in need. It seems like you’re kind of trying to do both.

B. Seal: Yes, absolutely. The core audience of who I want to target are the students who are struggling, have struggled. But I never want to segment them on their own, because all of a sudden the stigma kicks in. They say: “Oh, that’s the program for the mentally ill people, the people over there.”

The second target audience is the leaders at the school that are engaged in student government or clubs and that just want to perform at a higher level. Mix them together and create a bunch of role models at the school in grades 10, 11, 12 — so they’re older students — and reshift the definition of cool at the school.

How about we redefine cool? Rather than cool kids doing the drugs and doing that stuff, we build up the confidence of this other group of both people that are struggling who really need it but also the leaders at the school and make it an appealing program.

D. Plecas: That sounds great. I understand that, but
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I wonder if you’ve done much of this with the individuals who have been in a place like you’ve been, helping them get through that, get past that. One could argue — I mean, it seems you would argue — that if you can do it, we could get others to do it. Do you have any…? You must have thought about that.

B. Seal: Well, certainly, I’m not trying to offer treatment, by any means. I’m not a professional. I’m not a doctor or a psychiatrist, so the professional treatment stays. This is a complementary, additional service to those people that might be diagnosed with mental illness but also something that any student can use to help them transition into the world or into university, help them perform better in school and in their communities.

D. Plecas: Let me just ask this last question. I hope I’m not putting you on the spot here.

D. Plecas: You know, just your own…. You have a very, very “The glass is half-full,” optimistic view of things. If somebody said to you, “Look, I’m going to give you 100 people who have experienced psychosis or some other mental health challenge,” what do you think you could…? Remembering, as you say, that obviously you need to have mental health professionals hanging out with you, what would be your feeling about how many of those you could bring to a place like where you are right now?

B. Seal: My journey has been eight years long. It’s not a one-year, an eight-week process, of course. I’m not promising any of that, but the idea is that I carry around with me an invisible mental wellness toolbox, and it’s got all these tools: a support system, my nutrition, my physical fitness.

Just to give young people a toolbox of skills and knowledge and resources and strategies to handle the stress, because whether they’ve struggled or not or are struggling or not, they’re going to face more struggles mentally, the stresses that are so common in today’s world. So it cannot do anything but help anybody handle that stress. The part on stress management is: how do we identify stress? How do we limit stress? How do we handle stress? Just tools to do that.

The feedback on the content has been overwhelmingly positive. The tweaks that they want to make are like: five weeks? Do eight weeks instead. The videos — you have music at the start. They’re ten-minute-long videos per topic. Make a video with music in the background the whole time. These simple little tweaks. But the content feedback has been overwhelmingly positive.

D. Plecas: I’ll just finish here. I guess it’s because one of the things which is so heart-wrenching and discouraging is that so many people with mental health challenges…. Like you say, your journey was eight years. For so many, it’s a lifetime, and it seems like you’ve been able to come up with something for yourself which, if one could apply that to others, we might expect to see the same kind of success. Have you thought about developing that into some kind of program? I say that because I know that what you’re doing now seems to be more general.

B. Seal: This is what I’ve done, right? Not everything, but this is a simple, timely, effective way to pile in this information and the strategies in a consumable, easily digestible way. This is my solution to that exact thing, to say, “This is what I’ve done. This is what I’ve learned from personal development and mental health and wellness and nutrition” — everything, and just package it into this program. That’s what it is: eight weeks, six topics in between and the workshops on either end.

D. Donaldson (Deputy Chair): Thanks for the presentation, Brent. It’s a testimony to your personal endurance and your family and also to the fact that where you lived at the time, there were the professional services available. That’s not the case in many parts of the province. Well done, and good on ya.

I’ve got a question for you that might be a bit of a difficult question, although I think you’ve got some experience to share on it. I couldn’t agree with you more around the wellness tools — the physical, mental, spiritual and emotional tools — that young people in secondary school need to acquire to deal with anxiety and other issues. You’re experienced not only piloting these projects in high schools, but you’re a lot closer to when you were in high school than I am. That’s for sure.

We have teachers that are, I’m sure, aware of those wellness tools, but they’re teaching to testing outcomes from the foundation skills assessment, for instance, so that their school doesn’t get ranked last in the Fraser Institute report. My question to you is…. We talked about structures and mechanisms earlier, so that it isn’t just dependent on one individual like yourself to be able to scale this up and make this available, these wellness tools, throughout the province.

Do you think from your experience that what you’re doing now can be brought into the Ministry of Education and undertaken by teachers, for instance, or others so that it’s not just dependent on the initiative of someone like yourself and can be actually available throughout the province?

B. Seal: That’s my goal. Whether I run it through my social enterprise or whether it’s government-run, that’s less of my concern rather than getting this into the system for more students. Always open to working…. I’ve worked a lot with government over the last five years,
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eight years, and would be fully open to that, yeah.

I think it’s more about the content and the ideas rather than the individual who’s sharing them. I think the individual makes an impact. You want role models, of course, sharing this information. But the idea to scale it up — let’s find a way how to do that. A partnership with the ministry or the government in some way is probably the best idea of how to do that. Absolutely.

J. Thornthwaite (Chair): Thank you, Brent. Perhaps we should package you, and you can come and inspire us over in the Legislature.

J. Thornthwaite (Chair): Very good. Well, we really appreciate you coming in. Thank you for offering your insight. Then we can access…. Or maybe you want to send the link to the video so that we can watch it.

B. Seal: You all have my business card, I think, so feel free to get in touch. Thank you again, everybody.

J. Thornthwaite (Chair): Our next presenter is Dr. Charlotte Waddell, from SFU — Canada Research Chair in Children’s Health Policy and professor and director of Children’s Health Policy Centre, faculty of health sciences, SFU. Welcome.

C. Waddell: Thank you, Jane, and thank you to the committee for having me back again this year. It’s a great pleasure to spend some more time with you.

I met with you about a month ago, Jane, and you asked me if there was a magic bullet for all of this. I said: “No, there’s not one, but there might be six.” That’s what I really want to chat with you about today.

Thank you for that conversation, Jane. It was very helpful in clarifying our thinking.

I have two colleagues here with me today: Jen Barican and Caitlyn Andres. They are co-authors of all of the work that we’ve done. I just wanted to let you know they were here today too.

I’m going to spend two minutes recapping the challenges. You’ve heard a lot about that, and that was your focus last year, I know. Basically, the main challenge is the high prevalence of clinical disorders. The bottom line in this table is the only one you need to really look at: 12.6 percent of kids, 84,000 kids, in British Columbia at any given time have clinically significant disorders.

The other terrible problem is the stark service shortfalls that you’ve been hearing a great deal about. You did last year as well. Over two-thirds of the kids with disorders aren’t receiving needed services. That’s about 58,000 children a year in British Columbia.

Prevention programs, as some of the two earlier speakers alluded to, could do a great deal to reduce those numbers, but we don’t fund a whole lot of those either. These shortfalls we do not tolerate for childhood cancer or diabetes. In those arenas we treat 100 percent, and these shortfalls shouldn’t be tolerated any longer for kids’ mental health problems.

As you’ve heard numerous times, huge impact for kids. High distress. They can’t finish school. Their employment chances are reduced. Lifelong mental health problems. Increased early mortality. Ongoing lost human potential. For families, huge distress and costs. And for kids with mental disorders, these costs and distress often increase as children become older and reach adulthood.

Collectively, it affects all of us, of course. The leading cause of disability, affecting everybody’s workplace, affecting every university — costs exceeding $50 billion annually in Canada. Lost human potential is not even calculable. No one even tries to get that. Lots of attention, but I really applaud the committee for moving on to look at identifying the solutions and then taking action as well.

Moving on to look at some solutions and what are some next steps that could be very powerful and could have a huge impact. I want to put these suggested solutions in a public health framework, because there are a number of things we have to do: promoting healthy development for all kids, preventing disorders, providing treatment and tracking our outcomes — keeping track of how we’re doing.

Two things that, to me, are closely coupled: prevention and treatment. I want to just really focus on those. That’s where the six magic bullets are, actually.

Back to the table of prevalence. There are four very, very common disorders: anxiety, substance use, behaviour disorders and depression. Taken together, these affect about 58,000 B.C. kids at any given time. What’s really interesting about these four disorders is we have very strong research evidence that we can not only treat effectively, but we can also prevent. We can also lower the incidence of these disorders, particularly if we start early in childhood.

What are those six magic bullets? Six highly effective psychosocial interventions, actually. I’m not going to discuss medications today. The big impact is in psychosocial interventions, or all of the kinds of treatments that don’t involve doctors and hospitals and traditional medical model approaches.

Two generic approaches, if you will — one, parent training; the other, cognitive behavioural therapy. Each has been studied in numerous high-quality, randomized controlled trials in young people. Each has huge flexibility, and each applies across all of those four common
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disorders. So then four exemplar programs have got particularly high efficacy in real-world settings and are particularly powerful at preventing the disorders.

So those two generic prevention approaches. Parent training is something that makes an incredible difference. The earlier you start, the better — bigger impact starting even prenatally. Don’t wait even until children are born. Strong evidence that it prevents substance use disorders. It also can prevent and treat conduct disorder.

Cognitive behavioural therapy, or CBT, is a wonderful intervention that can be used for prevention and treatment with kids as little as five or six years old. It can be used through to the end of the teens. For teens making that transition to adulthood, it’s a very effective treatment for adult populations as well. So it’s a lifelong approach, potentially. It prevents anxiety and depression and also treats all four of those very common disorders.

These exemplar programs aren’t the only programs. There are lots of other good programs, but these were four that just really stand out because they can be delivered very early in life, starting with nurse-family partnership; Incredible Years and Triple P, it’s called, in the two- to four-year-old age range. Friends in middle schools prevents anxiety disorders.

Other examples, just to name a couple more. Strengthening families is a parenting program being run by the Canadian Mental Health Association, being evaluated in British Columbia, very similar to Incredible Years and Triple P. Perry Preschool is a famous American program and very similar again. There are many more examples. These were just the exemplars.

You might ask: what about the costs? I do just want to raise the question for the committee. There are many things we spend a lot of money on collectively, and we never ask for justification. We just spend the money. For children’s mental health somehow we seem to have to always provide a justification, so I want to provide that for you just so you know there’s a strong economic case as well as an ethical and research case.

All of the programs I’ve just described show great cost returns. Probably the star is nurse-family partnership. You can save $18,000 — that’s U.S. dollars — per family when you track costs over ten or 15 years. These are costs that you don’t have to spend on emergency room visits, hospitalizations of children with injuries, doctors visits, social assistance, taking kids into foster care, taking moms and kids into the justice system. So big savings over the long term.

Those are six “magic bullets” — treatment and prevention, four disorders, six approaches.

There’s another element of what we need to do here that’s part of the picture that hasn’t really been truly tackled in B.C. yet. Back to the public health strategy, across the bottom: monitor our progress. This is just a matter of: how do we count what we’re doing? How do we know that we’re doing the right things and doing them right with kids?

One of the papers I included in the package for all of you is a paper on children’s mental health indicators. I’ll leave that for your reading — a great cure for insomnia, if anybody has that.

Basically, we did a study a couple of years ago really trying to examine the available data. I just want to make a distinction. The data on prevalence that I showed you a moment ago in those tables comes from very large epidemiological surveys that researchers do in the population. So you take thousands of kids, you look at representative samples, and you use research measures for those other studies. This indicator study, we didn’t do that approach at all. We went looking for data that governments are already collecting — data that is there that could be potentially used.

We found 15 public data sources: things like physician billings that include diagnoses, things like encounters with the justice system, encounters with the child protection system. We found that you could amass those data sources to measure up to 90 different children’s mental health indicators — data that we’re already gathering.

Now, Jane, back to your point about where do we start. What’s one magic bullet? Here there is a magic bullet, and it’s called the brief child and family phone interview. That’s a bit of a jargonistic name for a 30-minute telephone protocol that anyone — a teacher, a clinician, a family doctor, anybody — could do with a child, a parent or a teacher to do a quick scan on that child’s functioning and on mental health symptoms that they may have. It’s a great tool for measuring how we are doing in the clinical services, how we are doing in the general population for all the kids that we’re not reaching. How are we doing in a school? How are we doing with little kids, with older kids? That’s one thing that we could really make a difference by starting in on.

The last couple of minutes. Going from you know the challenges; there are some solutions that can be identified based on the research. What about taking action? B.C., as I think everyone knows, has actually made reasonable progress in the past. The Child and Youth Mental Health Plan, 2003 to 2008, led by the Ministry for Children and Family Development, or MCFD….

There was an influx of new funding. Parent training was provided in a variety of manners. Friends was set up in B.C. schools — the anxiety prevention program. CBT training was provided to child and youth mental health practitioners in the community across the province, and for the first time in Canada, that modality was available for kids to receive treatment. That instrument I talked about, the brief child and family phone interview, was introduced as a way to measure the effectiveness of clinical services by MCFD.

There then was a bit of a hiatus, following 2008. Fast-
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forward to 2010 when the B.C. government, led by the Ministry of Health together with MCFD, introduced Healthy Minds, Healthy People. The one innovation there: the nurse-family partnership is now being implemented and evaluated across the province with 1,000 children and 1,000 mothers. All the regional health authorities are partners on this. So progress there too.

But sustaining this progress has been difficult. We’ve made a couple of fabulous starts, but we have not sustained. We did lead the country in 2003 to 2008. Other provinces still call me to this day — they may call you as well; I hope they do — to say: “How did you do it, and what happened?” The fact remains that we still have a state where the majority of children with mental disorders are not receiving treatment and there are very few prevention programs. Nurse-family partnership is being tested. Friends is running in some B.C. schools, but the numbers have receded.

Next steps. Just a quick summary of maybe what the implications are from this perspective, which is the research perspective. You could make those six highly effective interventions available across the province to all the kids in B.C. Right away you could be reaching up to 58,000 of those 84,000 children who are affected. You could use the brief child and family phone interview to track our progress. You could use that with community populations of kids you’re not reaching to find out how they’re doing, and you could track indicators within any services that are being given.

Last year when I met with the committee, these were the other recommendations. I just want to, I guess, share them once again. Last year we said that if you’re only reaching a third of the kids, it seems to follow that investments should be tripled so that we’re reaching 100 percent of the kids.

Adding those new prevention investments, because that will lower the numbers over time. Of course, provide a coordinated and comprehensive range of, particularly, community-based approaches, because the main action in children’s mental health is in the community. Starting early. Start with pre-natal and early childhood, middle childhood and then into the teens. Then help kids make that transition to adulthood in a really positive way and then track our outcomes.

Now, Darryl, last year you asked me about comparative spending, B.C. compared to other provinces. I apologize for taking so long to get back to you. It took a little digging, but these are estimates. These come from B.C. budget estimates and also Ontario budget estimates. We couldn’t find those very easily for other provinces, but it gives a handy comparison.

For 2014 estimates, B.C. is looking at those 84,000 children, estimated from epidemiological surveys, to have mental disorders at any given time. Ontario, a bigger province — 270,000. All provincial government spending here — $44 billion. In Ontario it’s $127 billion. Children’s mental health spending: $79 million here, $517 million in Ontario.

Just to let you know, these are two quite comparable numbers in the sense that the main agency responsible here is MCFD, for children’s out-patient services, and the main agency in Ontario is the Ministry of Children and Youth Services, a very parallel structure. These are the comparisons of those two ministries. Health and other spending are not included. Those figures weren’t available for us or Ontario.

Children’s mental health spending as a proportion — to really get to the answer to your question, Darryl — doubled in Ontario. Spending per child: $900 here versus $1,900 in Ontario. So double by that metric also. Is it possible to fathom increasing this? Well, the next couple of lines say: “Yes, it is, because we’ve done it.”

Spending on children with autism — in B.C. it’s between $6,000 and $22,000 per child, in Ontario $10,000 a child. The increases in autism spending over the last ten years — tenfold increases. That has been largely due to extraordinary advocacy by parents of kids with autism.

Lots of the parents of kids with the other mental disorders are not in a position to do that kind of advocating, mainly due to reasons of social disadvantage. They’re not going to be able to do that. We have to do it for them. We have to advocate for those kids. But it’s possible to increase the money a lot.

I’m just going to end with a quote from a Nobel laureate in economics, James Heckman. “Early interventions targeted towards disadvantaged children have much higher returns than later interventions.” He gives a couple of examples: reduced pupil-teacher ratios, public job training, convict rehabilitation, expenditures on police. Society currently overinvests in remediation at later stages and underinvests in the early years.

Just in closing, a health policy scholar, Peter, talks about our public policies making statements about who we are as a society. And Postman talks about children being the living messages we send to a time we will not see.

J. Martin: A few slides back there was a little bit of a statement, and you made a comment that we’re only reaching one-third of the kids, so if we triple our budget, we’ll reach them all. What economic model suggests that it’s that simplistic — that you double your money, you get double the results; you triple your money, you get triple the results? We’ve seen time and time again that simply allocating more money to a problem doesn’t simply make it go away. So where does that come from?

C. Waddell: I couldn’t agree more that just adding the money without taking a close look at what you spend the money on…. It’s utterly essential to do that. It’s my assertion that we should reach 100 percent of kids who have mental disorders, like we reach 100 percent of children
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who have cancer or childhood diabetes.

If we work backwards from that and we’re only reaching a third of them now with effective treatment programs, I would say let’s try to reach 100 percent, not 30 percent, and with effective programs. I didn’t put too much in the slides today. I talked a bit more about that with you all last year.

Your point is very well taken. We shouldn’t invest in ineffective approaches. There are lots of public examples of that, for sure, including in children’s mental health. So the effective examples are things like I shared. Those would give you a great return on investment.

Ineffective things that we do currently. We do spend money now that isn’t effective, for example, on inappropriate physician prescribing, using the wrong medications that actually cause harm to kids while not providing these effective psychosocial interventions or providing psychosocial interventions that aren’t in this category — well tested and known to be effective. In other words, if you offer them to kids, the majority of kids will get better.

D. Donaldson (Deputy Chair): Another great presentation, especially…. Is it Neil Postman at the end? I really like Neil Postman. It’s a great quote. I’m going to use it. I missed that one.

My question has to do with sustaining the progress in B.C. Interestingly, you pointed out that after 2003 to 2008 on MCFD’s plan we’ve been unable to sustain that progress. You mentioned one — that the Friends program had receded. Are there other reasons why the gains have not been sustained since 2008, seven years ago? That was one specific example. Are you saying it receded because of just lack of funding to offer it, and are there other examples of why you’ve come to the conclusion that we’ve fallen back from those gains that we made?

C. Waddell: Well, the conclusion comes from a couple of different places. One is that there was very strong leadership provided by MCFD in those five years, and that leadership had support at the top, within government, is my understanding. That came with new money. It came with empowering that ministry to really have a very comprehensive public health–oriented plan and to launch things like the Friends program across the country.

My understanding is that that leadership flagged and the support provided to and within MCFD also flagged. There was a period of time when there was not strong central leadership like that. So Friends is still running, but not in quite as many schools. There’s been a drop-off in things like the vigour of the cognitive behavioural training made available and that asserted as a clinical standard of care.

Support for that ministry to resume the leadership that it did have would be very helpful, I would think. It’s the one central ministry with the mandate to provide programs through the community, especially these psychosocial programs which, in general, are more effective for children.

D. Barnett: I think maybe that answered my question in some way — the question Doug just presented — but I have another. I don’t know whether it’s a question or a comment.

It’s very interesting listening to all the different agencies and organizations present what they’re doing out there for children and mental health, and it seems that we keep hearing the word “collaboration.” Do you think that maybe there is enough support out there, but it’s not cohesive?

C. Waddell: I think that’s right. I think that’s a very good perception. I think it goes back to, Doug, what you were talking about, the lead and empowering the lead agency — in this case mostly likely MCFD — but empowering someone that has the big picture, able to look at kids across the age span, able to look at all of the mental disorders, able to bring together all of the communities across the province.

Someone that has the capacity to look at that big picture — that kind of coordination and collaboration — yeah, badly needed. I agree.

D. Barnett: Do you believe that that should be the Ministry of Children and Family, or should it be something else?

C. Waddell: What I do know directly is that, in those years of the first children’s mental health plan, when B.C. was making history, it was groundbreaking in Canada that there was no one else that went forward with a plan like that. That ministry was well able to lead. It brought everybody who needed to be together — the Ministry of Health, the Ministry of Education — and definitely looked at kids from prenatal through into the transition to adulthood. It was done, and it was done well.

That’s the one place where, perhaps, there has always been that capacity to look at the full picture for the province. Not to say that other similar groups couldn’t emerge that took that really large-picture approach, but that worked well before.

C. James: Thank you for a very clear presentation. I really appreciate the specificity around recommendations. I think you pointed out the importance of research. The importance of making sure that the programs are there, I think, has been reinforced by everyone throughout our entire work that we’ve been doing — that one size does not fit all, that nobody is looking for one pill that’s going to fix it all. I think you’ve identified that.

I wonder if you’ve done research, and it’s particularly
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in the prevention end, because I think the intervention end tends to be a targeted approach, as we know. It’s the in prevention end that there’s a huge debate in the social services field around targeted versus universal. I wondered if there’s been any kind of research or if you’ve looked at any kind of research around the prevention end on that issue of targeted versus universal?

C. Waddell: Wonderful question. Lots of important implications, whether you look at universal or targeting or approaching kids just who have the most needs. What our group does at SFU is to regularly review all the research literature. We’re involved in some studies ourselves, but we’re always reviewing other people’s studies. Jenn and Katlyn, who are here with me…. That’s one of their primary roles, so I’ll answer on that perspective.

For us, we want to look at the research evidence on effectiveness. What actually works for kids, and does the program make kids better or does it cause harm or is it just neutral?

The answer is a mix. Some programs do better in a universal format. The Friends program is a great example of a universal program delivered by teachers and schools. Give it to all the kids. There’s no stigma. The teachers love it. The kids love it. Everybody gains from that kind of…. It’s a CBT approach, actually, that it uses. But all children, it turns out in careful evaluations, like the program a lot and end up with fewer anxiety symptoms.

There are other programs, like the nurse-family partnership. When people have looked at spreading that out and giving it to more, say, middle class moms — because that’s a program targeted to really low-income moms — no program effects. We just don’t see the same effects.

My response is always going to be: does it work for kids, and how well does it work? The answer varies. Some work really well as universal programs; some work better when they’re targeted. I think we need a mix of both.

One of the things which is inspiring for me here…. We’ve heard lots of people tell us that we need to have better information-sharing and we need to have better collaboration. Of course, it would be wonderful if we had that. But I look at what you’re talking about here as interventions we could employ now. They’ve already been employed and demonstrated to be successful.

Would it be fair to say that…? Let us say we made no progress on information-sharing, no progress on collaboration. We could still have a powerful impact if we just did these kinds of things.

We’re running behind about — I don’t know — 12 minutes, which I guess isn’t that bad. But I just want to thank everybody for being very succinct in their questions and their answers.

Our next presenter is Dr. Ingrid Söchting — I’m sorry if I’ve pronounced your name wrong — and Dr. Colleen Wilkie as well.

Thank you very much for coming. Maybe you could introduce yourselves and start right away.

C. Wilkie: We’re really glad to be here today. We’re kind of following from the last presentation. Dr. Söchting and I are all about group therapy and group interventions.

I’d like to introduce myself. I’m Dr. Colleen Wilkie. I have over 20 years of clinical experience as a registered psychologist and a real passion for group. I’ve been a longtime member of the Canadian Group Psychotherapy Association, a certification that I completed after I completed my training as a psychologist. I’m currently on the CGPA board of directors. I have a private practice in Langley, and I provide teaching and training in group therapy.

I. Söchting: I’m Ingrid Söchting. No offence for the difficulty pronouncing my name.

I also have 20 years of full-time clinical work, most of that in Vancouver Coastal Health, where I and an interdisciplinary mental health team created a very successful group therapy program, ranging from adolescence to later life — people 65 years and above. I am certified in the American Group Psychotherapy Association as a group therapist. I am a board member of the Canadian Group Psychotherapy Foundation.

I am presently the director of the UBC Psychology Clinic, and I teach in the department of psychiatry. I am, in fact, responsible for all CBT training for psychiatry residents in British Columbia. I provide a lot of teaching, supervision and research on group therapy. One of my most recent publications was a commissioned book by the publisher Wileyon CBT group therapy — where are the challenges and where are new opportunities. That book also includes the chapter pretty much echoing much of what Dr. Waddell presented about the evidence that we know using CBT for children.

I will continue, and then I’ll pass it over to Colleen after the first half of the set of slides. Again, thank you very much for having us offer this presentation and speak about our passion for group psychotherapy.

For sure, there are many forms of innovative interventions needed to address our present mental health crisis for children and adolescents, but group therapy is
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certainly, or could be, a very important part of that solution. As Dr. Waddell has already mentioned, it’s really nice when you are hearing a consistent message, I’m sure.

We do already know a lot about the evidence for CBT for children. Dr. Waddell mostly spoke about CBT generally. But what is so interesting is that you can actually deliver cognitive behaviour therapy in both an individual format as well as a group format.

Lots of research has been and is being done showing that for almost all mental health problems for children and youth, the two formats are equally helpful. In some cases, the group format is, in fact, superior. Some of that may have to do with the possibility for reducing stigma, which Colleen will talk a little bit more about.

The Friends program can also be administered in a group format with great results. For children and youths with depression, we have, even locally, mental health practitioners who have developed an excellent manual and protocol called Antidepressant Skills for Teens, which is successfully used in groups as well.

What, of course, is very helpful about these more short-term therapies is that they are indeed very effective in the shorter term. So we’re not necessarily talking about years and years to offer significant improvement for depressed youths. But with 14 weeks of two-hour, let’s say, group therapy sessions, you can see significant improvements in either preventing a teen from becoming more severely depressed or giving them coping skills so that they can prevent further episodes of depression.

The earlier we can intervene with depression, the better. Depression is very serious. It’s considered chronic mental disability. We get into real problems when we see adults, which I also treat, being unable to keep up their work, faltering on their rent payments. The earlier we can intervene, the better we can help people and our society.

What is also interesting, if we look at the research, is that we are increasingly knowing more about the role of peers and the role of parents. Depending on the age group, the role of parents and peers of course vary. But if we look at the research, we can include the evidence into our group therapy models to make them even more effective.

For example, sometimes it’s actually better to have the parents for younger children in the group. For older children, it’s better to have parallel groups, where the parents get their own group.

Again, I just want to echo what Dr. Waddell already said. We actually have a lot of evidence. We even have guidelines. For example, from the United Kingdom, the NICE guidelines — you may or may not familiar with those. NICE stands for National Institute of Clinical Excellence. They are updated every year, so you can go in right now. Well, it may be 2014. You can pick any mental health problem and an age group, and the guidelines will tell you which intervention should be tried first, second and third.

For child anxiety and depression, for sure, we see cognitive behaviour therapy recommended as the first-line intervention. There was a wonderful series in the Globe and Mail in May talking about all this evidence and asking the question of why we aren’t actually implementing it when we know what is helpful for our children and youths.

I believe I already addressed that group therapy has lots of support, showing its helpfulness as well as its cost efficiencies. It’s interesting. Sometimes people think we are just advocating or wanting to use group therapy because it’s cheaper when you treat ten children during one hour as opposed to one. But it really isn’t just because it’s cheaper that I’m a great advocate for it. It is a very human form of treatment where you actually see people often getting better, because it also addresses problems such as social isolation. That’s something that is harder to do in individual psychotherapy. So not only are we helping people improve their symptoms, but we’re also helping them with self-esteem and social isolation and what it means to sort of be part of a community that welcomes you.

We can certainly look at some numbers. Fees for group therapy are typically 30 to 50 percent less than for individual therapy, so even if you have people going to a private group, they will be paying less than they would do for individual therapy because a therapist collects fees from about eight people, let’s say.

We can also treat four times as many clients for the same amount of clinician time, which is why it is or ought to be a very attractive option in publicly funded mental health settings. You are really paying way less for the number of therapists required.

It is also advantageous that the group continues even if a person cannot make it. In publicly funded settings, where I have worked for over 20 years, if a client doesn’t show for the individual session, we still have to pay the therapist. It is very rare that all eight members of a group, for example, are absent.

These are just some very compelling reasons, again, for considering group therapy.

If we want to continue to look at costs, these are U.S. numbers. These researchers found that group therapy for panic disorder costs, per person, $523, in comparison to $1,357 for individual CBT. And medication is extremely expensive — about twice as expensive as individual therapy. Again, it should not be difficult to convince people about the cost advantages of using shorter-term cognitive behaviour therapies for anxiety disorders.

In conclusion of my part, we have a solid base of empirical research confirming that group therapy is as effective as individual therapy. We have a number of group therapy models. It is not just CBT, but CBT is certainly one that is uniquely or especially helpful for anxiety and depression. But for other problems, such as eating disor-
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ders, there are other models that are equally or possibly more attractive than CBT.

We have different kinds of research, both wait-list-controlled and also large, randomized controlled studies, again showing the effectiveness of group therapy.

C. Wilkie: What would it take to actually implement these ideas? I guess it also follows from our group perspective, where more heads are better than one. What we’re advocating is the creation of a task force of health professionals with a wide range of skills.

It would be nice if everybody had all of these skills — specialists in group therapy, specialists in mental health issues for children and youth, specialists in research, both outcome research as well as measurement. There’s also, I think, a needs assessment so we can actually target the intervention to the specific children and youth in a particular community and then also include people who are in the community, kind of the front-line workers.

I’m thinking, too, that this would need to include some involvement, of course, with parents and caregivers and the people who are, I guess, kind of the front-line people who are closest to the youth that are really needing some services.

To follow on that, to maximize the impact, we would recommend development of training workshops. We’d be targeting regulated health professionals. That would be kind of the entry point. These are people who have the training and the experience in their own regulated health profession and then adding group therapy or group intervention as a more complex skill. This is why we’re thinking that group therapy training specifically is essential.

When we’re thinking about the group, when I’m putting someone into a group, I think of there being two clients. One, I’m thinking: “Is this client appropriate for this group?” Then I’m also thinking: “Is this group appropriate for this client?”

There’s some need to acknowledge that the part about the group that is extremely powerful is what we call the group process. That’s everything else that’s happening in the group other than the actual content or the words that are said. It’s the relationships that are developed. It’s the sense of safety. It’s the sense of esprit de corps. It’s the sense that “there’s a group of people who really understand me and who have my back.” That’s the statement about the whole being more than the sum of the parts.

Group therapy is not individual therapy with an audience. When I’m training group therapists, it’s very tempting, when you come from an individual therapy perspective, to think, “Okay, Susan, let’s have a focus on you for a while,” and then we all watch. That’s not harnessing the power of the group. Group outcomes are associated with member-to-member interaction. That also is the key piece that is associated with cohesion, or the sense that this group has that esprit de corps and is also associated with the treatment outcomes that Ingrid was talking about.

It’s also not providing information to more than one person. What I really appreciate about Ingrid’s work is that she will use a cognitive behavioural approach, which is very psychoeducational, but will also harness the power of the group — member-to-member interaction. I’d be very surprised to see Ingrid standing up in front of a group and saying: “Here are all the coping strategies.” This is not a classroom environment. The real richness comes from interaction between the members and interaction with the leader.

I just needed to include this, because I think it really captures it. “Knowledge of group dynamics for a group leader is as essential as knowledge of physiology for a physician.” If you don’t have a sense of group dynamics or the group process, I think you can do a lot of damage as well as missing out on these opportunities of the power of a well-run group.

What does that look like in terms of training? As I was saying before, a regulated health care professional…. We know that these people have met the standards for their profession: education, training, supervised experience. They are accountable to a regulatory body. What I think is really important is to start with the basics in terms of providing treatment or intervention — typically that’s the kind of individual therapy — and then adding on the skills for group.

One of the things that can happen, for example, is that there’s a common stage development that all groups go through. In the second stage it’s a bit like the whole group is an adolescent and they’re going to be challenging the leader. That’s a high-risk situation for there to be a scapegoat.

The group might have this idea of “if we could only get rid of this person here, everything would be fine,” which is not so good for the person who’s on the receiving end of that. Then the whole group goes ahead and kind of pretends that they’ve solved the problem, when in fact they haven’t. Any parent knows that you can’t go over it or around it. You need to go through that and go through the conflict. It’s a skilled group leader who can manage that and create a safe environment for all of the participants to do their work.

Also, reducing stigma. Group therapy and group interventions are perfect for reducing stigma. I think we’ve talked about the power of knowing that you’re not alone. The kind of technical term is “universality.” I can say that to individual clients, but it doesn’t meet the impact of somebody in a group who realizes: “Everybody else struggles the way that I do. They all look good on the outside, but they’re all struggling on the inside, just like me.”

Group can also provide opportunities to demonstrate your competence. You can help somebody else as well
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as receiving feedback yourself. The vicarious learning — seeing others like you progress — is only one part. Actually, the more important piece is the behaviour. Sitting back passively over the course of a group is not going to be helpful and is something that an experienced clinician should be focusing on. What we’re trying to do is create a safe environment so that people can take the risks to interact with their peers in a different and more healthy way.

These are all ways of reducing stigma. That’s inside the group. The other thing would be kind of outside the group, so considering having groups or group interventions in different locations that don’t have the medical or the mental health stigma — so meeting people where they are.

Slide 3, where you talked about the task force…. You also really, I think, are defining the three elements to have a robust group therapy system as part of the mental health system. I’m interested in what the systemic or systematic barriers are to, first of all, having more people who have these skills and delivering them. It’s clear that it’s actually very difficult to find a group, even in large urban areas. There seems to be a real scarcity of people who have the skills and will do the work. That’s number one.

Also, the middle point. I think we probably can find experts and outcome research and measurement more easily than the other things. I’m interested in what are the systemic and systematic issues that come from the health regions and the community health centres, who I would think would have a very obvious need and desire to propagate this as an accessible therapeutic tool.

If you could just comment on what’s getting in the way of getting those things going.

I. Söchting: I’m happy to do that, having worked for 20 years and been a sort of a clinician champion for group therapy and been so surprised that the decision-makers didn’t think this was the best thing since sliced bread, because it is. Of course, some really get it. There’s always nervousness, I suppose. I mean, I understand the barriers, but I think they’re highly surmountable.

I think, first of all, it has to do with an overall vision for what kind of program we want as opposed to kind of an ad hoc, piecemeal put-together. Once you have an overall vision — and Dr. Waddell spoke about that as well — that will guide your hires. Then you will hire mental health clinicians who have some demonstrated supervised group therapy experience or show high potential for benefiting from that kind of training.

I think that’s a big key. People aren’t really hired to fit into an overall vision.

C. Wilkie: I would agree. I think group therapy tends to be attractive when there’s a long wait-list, and then people are kind of scrambling.

I think clinicians are aware of the power and, I guess, the potential for things to go awry. I think then they become more conservative and tend to do kind of things that are more familiar, like the therapy with one in an audience delivering information. I think that then you get services that are not as effectiveness as someone who is trained, who can kind of harness the group. I think that’s one.

Two, I think sometimes group is a hard sell. It’s a hard sell for the participants, and they really need someone to champion…. We’re social animals really wanting to be liked by other people, so to go in front of a group of others and to kind of expose your dirty laundry, it’s like: who in their right mind would do that? Yet it’s also a place of a lot of support.

There’s a little bit of a hard sell from a participant’s perspective but I think also from a clinician’s perspective. Sometimes it’s very difficult for a clinician to think, “Oh, I’m doing really good work individually with this person,” and then to think: “Oh, this person could benefit from a group.”

I. Söchting: I just want to add to that that there are ways to overcome that challenge. Of course, in my book I talk about all those practical problems because I’ve seen them all.

Research shows that if you ask people, “Would you rather have your cognitive behaviour therapy for your anxiety disorders delivered by an individual or in a group?” 95 percent of people, across the age range, will say “individual” for all the reasons that we know and that you said.

However, if you invite people in for an informal, once-a-week information session — as we did in the publicly funded place where I work — to come in and learn a bit more about group therapy, then suddenly you have much greater interest after people have been to that information evening, and then they are much more willing to sign up. In fact, it is extremely rare that someone starts a group and doesn’t like it.

It’s amazing, for the reasons that Colleen also spoke about — coming to the group and seeing that everybody looks okay, right? People will often say, particularly younger people: “I expected to come and see a bunch of weirdos or people being really crazy, and you all look kind of normal. I can’t believe it.” Just getting them to that first session — we can do that, so long as the clinician champions at the sites are encouraged or are sort of given full support to overcome the barriers.

M. Stilwell: Can I just ask, I hope, a related follow-up question? You talked about waiting lists. Because there’s
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a relative scarcity of group therapy, I don’t know if this is an issue, but there’s a lot of pressure not to have a waiting list, which creates the unintended and uncounted problem, front-end, of people creating barriers and obstacles to getting onto the waiting list. It becomes very difficult to assess the need and capacity and access.

Do you have experiences from your own practice about that? We did hear stories of parents with youth who clearly needed help, and the people who were assessing them for whatever reason ended up being a barrier to getting into care.

I. Söchting: It may not relate. Like you mean not making an appropriate recommendation?

M. Stilwell: Right. And if there’s a waiting list, there is an incentive not to make that recommendation — right? — when you’re supposed to be keeping your waiting list down.

I. Söchting: Again, a healthy, well-functioning, integrated group therapy program can build in problems with wait-lists. Even though the real group may not be available to a user for three months, they can be in a once-a-week sort of wait group. It’s a bit of a holding place where you can have staff who have less training, but it can also be a good place for lesser-trained staff to get their feet wet with group therapy.

C. Wilkie: Maybe I’ll just add to that, too. I think what Ingrid is talking about is the typical kind of wait-list group or rapid-access group. It is based on a single-session format, so you’re going to be trying to determine the themes and the coping strategies that the people are needing in that one hour or hour and a half so that everybody is getting some benefit, with the realization that sometimes people might not be back.

I’m currently in private practice, but I have done some work in publicly funded mental health. What I noticed — and it’s been a few years since I’ve been in publicly funded mental health — is that there were some group programs that would be outside of my catchment area. I’d think, “Oh, this is perfect for this particular person,” and find that they wouldn’t be able to access that. And it would be more of the specialized groups.

M. Stilwell: Is that a health region policy — that they don’t take people from another region?

C. Wilkie: I’m not sure. I just knew the result from the clinician’s perspective, thinking: “Oh yeah, this sounds like this would be ideal.”

I. Söchting: Where I worked, we had a group that was unique in the Lower Mainland. We were told, as clinicians and psychiatrists that called…. They said, “We cannot accept people from outside that catchment area,” even though everything was within Vancouver Coastal Health. I don’t know why. It’s very problematic, because you’re denying the best care for someone who just lives on the other side of the Fraser River.

J. Thornthwaite (Chair): We have five more minutes, and we have three people: Darryl, Carole and Doug.

D. Plecas: Thank you very much for your presentation. I guess I’m one of these people who do think it’s the greatest thing since sliced bread. Therefore, I have a bit of a concern about the need for a task force. Maybe it’s just that I can’t stand the term “task force.” It takes forever to get through to the end.

It seems to me that you know this works — no further research necessary. Why can’t we just skip the task force? I mean, I understand the bit about the research and measurement, but really, let’s get on with it. Isn’t that a possibility?

C. Wilkie: Yes, I think so. It’s, again, getting a group of people with the expertise. Maybe it’s the word “task force.” We wouldn’t want you to get hung up on the word “task force.” Yeah, we’re keen to go, as well, with a group of qualified people who can cover all of the things that we need this group to cover on.

D. Plecas: You simply need a bigger pool of competent therapists, and the education and the value of it.

I. Söchting: Leadership and accountability. If we were to go ahead with something, we would want to have a pretty close reporting relationship to people in the appropriate ministry who cared equally, and there would be built-in accountability.

C. James: Thank you for your presentation. I want to talk about one other piece that I think is critical, and that’s the education piece.

I think you mentioned it when you were talking about the right group and the importance of having the right group. I think that is often the stigma to group therapy for people. They’ve been in a wrong group, or it’s been used — and I think you described it so well — as a budget tool. We’ll just put these 12 people who are waiting into a group and think that that works, rather than making sure that it’s the right fit or that it’s a positive experience.

I certainly have heard from parents that they’ve seen it as a stalling tactic for their kids who’ve gone for services. “Well, there’s no service available for you, so we’ll put you in this group. You can go once every three weeks. You’ll have something to do.” I think there’s a need to address
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that piece, to be able to educate people on the strength that I think you’ve described so well.

I just wondered if there were any other jurisdictions that you’ve seen, in your research in your book that you’ve done, that have talked about both a positive way to get people into the right group — whether that’s the intake process or individual therapy first and going into a group, to be able to make sure that they’re assessed properly — and then I guess the second piece is a good education. Is there anywhere where there’s a lot of group therapy going on, in the world, that is effective?

C. Wilkie: Let’s see. A number of things. There was one group program. It’s really changed, but I really felt like I had come home. This was a number of years ago at Peace Arch Hospital. It was a nurse clinician who was heading the group program. There were a number of different groups. That would be, for me, kind of one of the hallmarks.

There was kind of a rapid-access group. There were some CBT groups, an assertiveness group. There was an interpersonal process group. There was a wide range of people who came in, seeing a clinician individually. They completed measures at the beginning as part of the intake. They had a connection for that one hour but with one of the clinicians who was also one of the group therapists. They went in for an hour, two hours, to talk about: “What is group therapy? This is what we offer.”

Then, the other piece that’s very unusual is that the staff meetings were also a place where the staff would not only kind of, you know, talk the talk but walk the walk. It would be: “Okay, so this kind of thing happened over here on Tuesday. How are we all going to work together to support each other about this issue?” Or if you have a conflict with somebody over here, it’s like: “Well, let’s all talk about it.” We all work as a team. We are a group as well. It was such a solid way of working.

I think that means hiring a person who’s in a leadership position who is very familiar with group and can walk the walk. Then things flow from there.

I. Söchting: I think where we see the really strong, successful group therapy programs…. We have a couple of local examples. Otherwise, we go to Australia or the Netherlands. But again, you need to have almost like a co-leadership model with the clinician as well as a manager or director. So both work together.

D. Donaldson (Deputy Chair): Thanks for the presentation. Just to follow on Carole’s point…. It wasn’t a youth but an adult that I know who, after experiencing an industrial accident, a mill explosion, suffered from post-traumatic stress disorder. He was told, “You need to go to group therapy,” and it was for alcohol and drug — individuals that were having issues with that. So, you know, totally not the right place and using an incorrect tool, I think, in that case. But I do believe that the tool you described here, if implemented properly, would be a wonderful option for children and youth — around anxiety, especially.

My question is on delivery. On the one slide there, you had a bullet point about 12 to 14 sessions. I believe you said there would be, maybe, a two-hour weekly session. I mean, the reality that I see is that….

You know, I live in an area where public transportation is an issue. Youth could not get, on a weekly basis, to a session for 14 weeks in a row. These kids aren’t even going to school for 14 weeks in a row, let alone to a group therapy session, for all sorts of reasons. Maybe the night before, they didn’t have a proper place to sleep, or maybe their parents were up all night drinking and partying, or maybe they haven’t had enough food to get out of bed and don’t feel motivated.

My question to you is: as a committee, if we recommended that group therapy and CBT, for instance, around anxiety would be a great thing to expand in the province, how do we say that without saying and putting a caveat on the assumption in the context that there’s housing, there’s transportation, there’s food, there’s a poverty plan? Can you help me out on that?

I. Söchting: Well, I mean, there are examples from rural areas. One option is to have more of an Internet virtual group. You could have some children from one area possibly go to the local community centre, where they can connect on line. So you actually have people in the group sitting in different places in British Columbia. You can do that. It’s not ideal, but you build it so that it is definitely not harmful, and you also build it, of course, so that you know you can be satisfied that it is beneficial.

If children cannot do it at home because there are too many distractions…. If you could get them to, as I said, a community centre, there could be someone helping them log in. So you have, maybe, two kids in northern B.C., you have three in the Kamloops area, and you have three sitting somewhere in the Lower Mainland. You can have a group if you have competent, skilled leaders. And this is done. We have examples of people with hoarding disorder who have difficulty leaving their homes doing these on-line groups.

J. Thornthwaite (Chair): We’re running really late. Jennifer, did you have something very quick?

We very much appreciate you coming in and giving us the insight and also the time that you took to present.

We have one more presenter. We’re running 15 min-
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utes late. I apologize. Maybe if we could just do the switch quite quickly. Thank you.

Our next presenter is Ocean van Samang. Go ahead, Ocean. We’ve got half an hour, but obviously that includes your entire presentation, the entire time, because we were originally scheduled to finish at four. We’d really like to finish at 4:15.

My name is Ocean van Samang. I have been in the field of mental health and disabilities, working largely with educational institutions, for more than 15 years. I’m currently the clinical coordinator of the child and youth crisis program, but I’m also a consultant and trainer with Safer Schools Together. I’m largely responsible for the mental health component and training for the ERASE strategy for the full-day mental health training.

One of the reasons that I’m here is to talk about the space. I’ve heard a lot of the presentations today, and they very much are in line with where I believe we need to make change as well. One of those places is absolutely in the school system.

As a child and youth therapist, I know that it’s much easier to work with youth at the early end of the spectrum, when we’re just identifying changes, rather than when they meet the diagnostic criteria for an illness. For me, the change needs to happen not so much in the programming that happens after kids have become quite ill but in the prevention model.

There are a few things that are already working. I’ve heard, again, other presenters today speak of the Friends program. I’m a huge proponent of the Friends program. I think, for elementary, it’s one of the best anti-anxiety programs, and it’s fantastic for reducing stigma because it’s taught across the board.

We also know that the provincial initiative around Healthy Minds, Healthy People has drawn the spotlight to mental health literacy, which I think is important.

The ERASE strategy, which started off as anti-bullying, has progressed and in the last three years has started to bring in the mental health training. It’s largely targeting administrators and counsellors at the moment.

There are other programs — and I’m sure we’ll hear more tomorrow as well — for high school students. But for me, it’s elementary that I want to focus on.

There are these wonderful programs, as we’ve talked about. I don’t think we need to re-create the wheel, in that sense, but there is something that’s happening. I heard an earlier presenter allude to the fact that there’s a significant decline in the use of Friends in school. I see that as well. Across the board I’m seeing many of these tools — these wonderful, well-developed, evidence-based curriculums — not being used.

Taking a look at working every day with schools, with counsellors, with teachers — kind of questioning and looking at what that is — what it comes down to is both comfort level and the applicability of the material to students.

A typical K-to-12 teacher will not always see where mental health is relevant in their classroom. They may be able to identify a couple of those kids with behavioural issues. They could probably easily identify those kids. Maybe it might be, as they start to get into the older grades, easier to identify youth with mental health diagnoses. But the applicability of what it looks like early comes down to just a lack of knowing, because it isn’t information that’s included in teacher training.

It isn’t information that’s included in the majority of training for most people. If you speak to the general public, they’re not always able to identify what symptoms would be involved in mental health and certainly not what that would look like in a classroom in a six- or a seven-year-old.

The other piece, I think, that’s happening is that a lot of the very well intentioned curriculums target…. They pathologize. They look at what the problems are once the problems exist, as opposed to looking at, again, how this might be presenting in its early stages. In order to target stigma, we need to start having conversations about a whole range of things in terms of mental health.

One of the examples around that. This is a piece from this Speak Up presentation. Speak Up was funded for three years. It was in grade 10 planning classes. It was to look at early intervention and identification. Why I think this is particularly relevant…. If you notice where the dotted line for early intervention is, its right after changes to thoughts, feelings and behaviours.

But here’s the piece. We don’t understand what our regular thoughts, feelings and behaviours are. How many of you, on a daily basis, have a conversation about what you’re thinking, what you’re feeling and how you’re acting as a result of that? That’s not how we talk, and it’s not how teachers talk. It’s not how they introduce their everyday curriculum. It’s not how they introduce the start of their day. Without an understanding of what our expected thoughts, feelings and behaviours are….

And particularly, what’s expected anxiety? Anxiety is a normal and healthy response. I will talk about that in a little while. Without that understanding, we certainly can’t identify where those changes come in.

Part of the stigma reduction piece in this is about the spectrum. We need to talk about the whole piece from mental wellness to mental illness. There’s a whole lot in between. We don’t need to just focus on mental illness. Focusing on mental wellness also talks about, again, what we can expect to see in our regular thoughts, feelings, behaviours and daily interactions, what we can expect to see when anxiety is normal and how to respond to that in a way that manages that and is healthy.

What’s the solution with that? For me, again, it’s not about creating new curriculum or a new program. It’s
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about creating buy-in for those already existing programs, finding the relevance of talking about mental health in classrooms, particularly from K to 5.

One of the ways that I can see that happening is through the ERASE training. Because the ERASE training is in every province and in the district already — they have existing relationships; they have set out times — it would be very easy to add on a level 1 for teachers and EAs. It’s the front-line staff in the classroom who inadvertently add to stigma by not understanding mental health or who are choosing not to participate in programs like Friends. If Friends could be in every classroom, it would be fantastic. In order for that to happen, teachers need to see why it’s relevant, why it makes a difference.

We have pro-D day training, and we hit the teachers in the province from K to 5 as to what this looks like in this classroom, why it’s relevant to them, why it’s important and why some of these pieces are normal. But we need to teach management strategies so that they don’t devolve along the spectrum to illnesses. We can get somewhere with that.

One of the things that does, one of the spaces in terms of reducing stigma, is it allows teachers to view their kids — especially those young boys that they identify with behavioural problems — through a lens of compassion. That adds a huge advantage to how we’re going to support these kids and whether these kids progress down the road to needing very targeted mental health services at a later date.

It has been suggested that I give a little bit of an example of why this is applicable. We all talk about mental health. We all talk about…. Especially here — all of you are here for a vested interest in this area. But how many of us talk on a regular day about how we use anti-anxiety techniques or how — what I’ve heard in every presentation today — CBT is a part of our daily lives? That’s a piece that I want to just talk about a little bit and give a brief demonstration on the kind of information that could be taught to teachers to create buy-in.

There are two pieces that I’ll talk about. One of them is anxiety. That will be the bulk of what I talk about. I’ll also talk just a little bit about ADHD because ADHD and anxiety exist and co-morbidly are significant in the classroom.

When I talk about anxiety…. When we understand anxiety, there are sort of two significant components. One is the physiological component, the biological component that comes from our amygdala. That’s our fight, flight or freeze response. The other is the psychological component. That comes from the overestimation of danger and the underestimation of our ability to manage those situations.

When we look at the psychological component, a lot of that has to do with, again, training in terms of understanding what our thoughts, our feelings and our behaviours are, and in understanding how to change those thoughts or what core beliefs — beliefs that form who we are based on our early experiences…. For kids in K to 2, we’re talking about their childhood experiences with their parents or their early education experiences. Moments where they felt valued or not valued will form their core beliefs.

When we have these core beliefs behind us, which help to influence our thoughts and our feelings, then we can easily go up the overestimating danger and underestimating our ability to manage that. When you combine that with the physiological piece that’s happening, it’s very obvious — it’s very easy — to understand what’s happening in anxiety.

The amygdala. It’s our fight, flight or freeze response. It’s the caveman part of our brain. It’s a fantastic part of our brain because it has these wonderful, life-saving abilities. If we were to walk out of here and there was a bear in Robson Square — it’d be a very interesting day — we would want our amygdala to trigger that life-or-death danger response.

In doing so, it does a bunch of wonderful things. It shoots hormones out from our brain, so we get an influx of adrenaline and cortisol. It increases our heart rate. It slows down our breathing to help manage our increased heart rate. It pulls our circulation away from our hands and our feet so that, as a caveman, if we’re running barefoot over bramble bushes, we wouldn’t feel it as much. Or if we’re trying to avoid the bear and knocking things out of our way, we don’t feel that pain as acutely.

It stops digestion, which is a fantastic piece. Who needs digestion when you’re really just trying to save your life? But you can imagine — and we see this with anxious youth, who are in a heightened state of anxiety and panic regularly — that stopped digestion ends up creating problems, right? We see that later in youth.

We have this great system for saving our lives, which we want to kick in, in these life-or-death danger situations. But this caveman part of our brain doesn’t have the ability to distinguish between whether it’s truly a life-or-death situation or whether or not we’re just perceiving that. So a jolt of fear from a surprise quiz or a teacher who’s inadvertently being condescending to a youth can also trigger that same response. Now, you can imagine, as a little boy — I use little boys as examples because that’s typically what we see in our younger years when I get called in to assess a youth — who has his amygdala triggered, he goes into a fight response.

I said I’d allude a little bit to ADHD. ADHD, or even along the path to ADHD, has compromised executive functioning. Part of executive functioning is impulse control and emotional regulation. If you have a youth who gets triggered into full fear and goes into a fight mode and the part of their brain that’s responsible for helping them manage those impulses or control those emotions is compromised, you have a fairly easy and ob-
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vious equation for the little boy who sweeps the stuff off the table or throws the blocks at his classmate or throws himself against the wall.

It’s very easy as a classroom teacher to see that as behaviour and be frustrated with how big that is and how hard that is to manage in terms of managing that classroom. But if we could understand what’s happening in that brain and if we were doing universal conversation around, “What thoughts are you having that are making you feel afraid, and how do we respond to our bodies physiologically?” then we might be able to manage that differently.

One of the pieces of the Friends training that I love is around what they call the milkshake breathing or blowing bubbles really slowly — deep breathing. Every person who has ever had to see any psychologist, any counsellor, any school counsellor or even the principal has been told to just calm down and take a deep breath.

Most people just kind of back away from that a little bit. But what we actually know is that deep breathing is the only way to physiologically respond to that fight, flight or freeze response. When we slow our breath down and we take slow, deep breaths in through the nose and out through the mouth, we send a message to our heart that it can slow down. That sends a message to our brain to stop releasing those chemicals that are sending us into a panic.

It’s really important to know that while we’re in that panicked space, when our amygdala is fully triggered, we are not able to access our prefrontal cortex. It actually can take 20 minutes to get back to that part of your brain that can make good decisions. So we want to stop kids from getting into that fully triggered space. How we need to do that is by using breathing as prevention, not just as a reaction to when a kid is already elevated or escalated in their behaviour.

We also want to look at talking — again, I alluded to those thoughts, feelings and behaviours — about how our thoughts are impacting us. When I work with youth…. I do a lot of training for teachers, so I do a lot of pro-D days. I go in to talk about managing anxiety and ADHD in the classroom. I give this example every time because every single time I give it, somebody goes: “Oh.”

When we talk about youth, imagine a youth who is excited about a date coming up. They have plans to go for coffee with somebody that’s maybe a new friend, somebody they’re looking forward to spending some time with. They get a text that says, “Can’t make coffee” — no explanation, no attempt at rebooking. If I ask every youth — and I do — what they’re feeling or what their response is to that text, they will, across the board, say they are angry. They are disappointed. They are sad. They are scared. They are anxious. They will name these very big, very negative feelings.

They will say that it was the cancelled plans that caused them to feel angry or depressed or sad or anxious. But then I point out that perhaps it’s not the actual text, but it’s their interpretation. This is where those thoughts pieces come into our feelings. They are making some assumptions about what has happened in terms of the cancelled plans. Again, across the board, with the youth that I’m dealing with.... And teachers, when I ask them to pretend they’re teenagers and try not to trigger their own amygdala responses — they come up with the same piece as well. They found something better to do. There’s someone else they wanted to hang out with.

As we take down those plans, we get to that space where, ultimately, they don’t feel good enough. When you don’t feel good enough about yourself, cancelled plans will make you interpret that as being about you.

I will say to the youth: “What if I told you that, in fact, what happened was that that person failed their science test, and their mom had said: ‘You fail your test, you’re grounded, and I take your phone away.’ Before the phone was taken away, they madly texted, ‘Can’t make coffee,’ so that you weren’t sitting alone waiting, thinking you had been stood up. Now, how do you feel?”

They’ll sit back and say: “Well, still disappointed, but I’m not angry or not really depressed or not anxious, and” — we’d look at the behavioural component to that — “I’m not going to avoid school tomorrow.”

These are really simple ways of just identifying our thoughts. But again, in classrooms we’re not having conversations about what those thoughts are. We can easily…. This is applicable to everybody from six years old to sixty years old.

If you’re walking down the hallway and you see a colleague and they frown, do you think: “They didn’t like what I said before”? Or maybe they have indigestion from that pizza at lunch. We go to these assumptions about ourselves, because that’s a normal cognitive distortion that we all have. Unless we’re talking about that as being normal, we also aren’t talking about how it is that we respond to that, how it is that we learn to think in different ways and see a different result.

When we’re talking about little kids, talking about adding deep breathing, imagine in every school system from K to 12, before we have a test, every kid puts down their pencil and takes three deep breaths — in through the nose, out through their mouth. We’ve targeted the kids who have anxiety. We’ve targeted the kids who have completely normal, expected, anxious responses to a test. And we’ve started to reduce the stigma, because we’re saying: “Hey, it’s okay to be a little bit anxious and take a deep breath.”

We can do very simple things in classrooms with sensory responses, to add to that part of the brain where the kids are having trouble with both their amygdala and their executive functioning, with things like heavy work, which is just giving proprioceptive feedback to the body so that kids know where they are in space and don’t feel so frightened. Or classroom modifications where there’s a
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space for kids to go and calm themselves down so they’re not removed and singled out as a problem.

To me, it’s just around creating buy-in, by creating this environment where we have these conversations early. From K to 5 is where we start, and then the work continues on because kids are comfortable talking about what their thoughts are, what their feelings are and what their behavioural responses to those thoughts and feelings are from an early age. And we allow teachers to see why it is that that kid in the classroom might be acting out. It might not be behaviour; it might be anxiety. And: “Hey, if I start using Friends in my classroom, I might have a different response with that.”

The last little piece that I have with my slide here is a slide that I use in the Safer Schools training for administrators. It talks about identifying on the spectrum, from mild to severe, presentations of anxiety in the classroom. Again, across the board, at every presentation that I’ve done around the province, we’ve been approached by more than 80 percent afterwards to come and do this as professional development days for teachers. What they’re saying is that the people in the classrooms who are seeing these things first are the ones that need to know that that’s an indication of a problem.

J. Thornthwaite (Chair): Thank you, Ocean. I think we should have you come to the Legislature, to the chamber, and do cognitive behavioural therapy for MLAs. I think we could probably get universal approval.

J. Thornthwaite (Chair): It’s a lost cause, Doug says. Now, that’s not very positive.

M. Karagianis: Ocean, that was very interesting. It makes me think I’d like to have all my grandchildren put through this environment so that they can grow up healthy and happy.

What are the barriers at this point to this kind of training taking place throughout the system? Because it does seem to be a theme that we’ve heard throughout our hearings. It’s about early intervention and about prevention and about how those two are really important in the long scheme for healthy, happy lives.

What do you think is the major barrier to finding a way to put what seem very realistic, doable, practical and achievable steps in place in the education system?

O. van Samang: I think, historically, the struggle has been with, again, finding the relevance in terms of education, but what we’re starting to see now is a shift in that.

The ERASE strategy has been working with every district around culture and climate in the school, and we’re starting to see a shift. Now what we’re starting to see are administrators…. We know that schools really are top-down: that the principals and the vice-principals, in terms of what their approach around stigma or mental health reduction and literacy is, will frame the rest of the staff as well. Now we’re starting to see that. So it has been a top-down barrier. “We don’t see that that’s as important.”

I mean, teachers will say: “But I have these learning outcomes that I have to get through, and I….” You know. And pro-D days are not necessarily mandatory, and so there have been some pieces around: “Oh, I’ll just go to what I’m interested in.” Whereas, if we say, “Okay, every K-to-5 teacher attends this training,” then we’ll get enough of them.

I think that that’s one piece, and then again, I think really indicating the applicability of this to every classroom and not just to those one or two kids that they might identify will be the shift.

M. Stilwell: I do take your point that the principal very much sets the tone in each school and how important that is. Just as a mother, that’s certainly been my observation.

I am curious, and I don’t know whether you know the answer. Given how much we are learning about the brain, how it works and how it develops, I am very surprised that this would not be part of basic teachers’ training. You cannot reach your learning goals if you cannot manage the thoughts, feelings and behaviours of the people in the class.

To me…. Something so fundamental and basic and new and important information that we all can relate to — why is it not part of the education curriculum? As I say, you may not know the answer, but I find that quite remarkable.

O. van Samang: As a child and youth therapist, I agree wholeheartedly. I do find it remarkable that it’s not there. I hope that that’s a shift that we see. I do believe that the provincial lens on improving mental health literacy, and as you said, the continued research and information available around how the brain works, could lend itself that way.

I think it would be very easy to add into the curriculum. I think if we teach the teachers who are in the schools now and then continue to add this into the curriculum, then we can move it on a go-forward basis with sustainability, which is, of course, important.

I don’t know why it’s not there. I suspect it’s been…. Change is slow sometimes, and again, we haven’t always had the lens to create those changes top-down.

You know, the “what’s working” part — I see what difference that can make in the schools I know and how that can be enhanced. I guess what I don’t see is some of what that’s not addressing.
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When you have the bullet point about making mental health training accessible to all teachers, EAs and other front-line staff, that’s great, but…. Perhaps FASD is not a good example, but I know that many children in classrooms that I know have a substantial component of FASD children, and it doesn’t matter if the teacher has mental health training. There’s assistance that’s needed in addition to a teacher teaching a curriculum, whether it’s teaching assistants or outside the classroom.

I’m curious as to the child and youth crisis program. What’s the focus there on those kinds of assistance that teachers need?

O. van Samang: I’m here sort of in two roles, so I think that I have…. I’m the clinical coordinator for the child and youth crisis program, and our role is to go into schools after youth have been identified as being in a mental health crisis and to provide intervention. The prevention component piece is largely from my Safer Schools hat, because that’s where the training component is.

To answer your question around FASD, I think that there are two pieces. What you’re talking about in terms of under-resourced classrooms is absolutely true. When you have youth and children with severe mental health issues, with severe medical presentations — things like FASD, Down syndrome, autism — that don’t have full funding to be able to managed in the classroom, a day of training probably isn’t going to address that fully.

However, that being said, a lot of the behaviours that come out in some of those presentations will still create a space where there might be an opportunity for calming techniques that are more easily accessible because they’re across the board. Deep breathing is going to benefit everybody. There’s really nobody who’s not going to benefit from that piece.

But there’s also the understanding that when our brain is impacted, as in FASD, the ability to fully understand cause and effect is completely compromised in that presentation. Helping, finding ways to support that part of the brain that’s not there, by providing some of those answers…. Again, that lens of compassion that might be provided through understating some of these presentations would be beneficial for those youth as well.

If the kids who haven’t quite hit that spectrum are managed in the classrooms in a way that is inclusive and preventative, then they won’t take as much time away from the teachers, so the teachers may have some opportunities to deal with the kids who are higher needs.

C. James: Thank you for your presentation. I think many teachers — and I think it’s just been an example of what’s happened in the education system over the last ten years or so — just feel like it’s one more thing they’re asked to take on and that it’s one more responsibility that’s been downloaded onto the schools and onto them as teachers.

I wondered whether the opportunity is already there to have teacher champions. There’s no question, for the teachers that I’ve talked to who’ve gone through some of these programs….

Even the kinds of ideas, like teachers in Delta who are using exercise balls instead of desk chairs for the really active little boys in the classroom — they are huge champions for this kind of work and how critical it is in the classroom because they’ve seen the impact. They’ve seen the positive change in the classroom for all the kids.

I just wondered whether you’re using teacher champions, or whether there’s an opportunity to do that, because I think it’s probably going to be one of better ways to be able to spread the program.

O. van Samang: Certainly, within the context of…. If we had several teachers in an elementary school generally trained around this information, then you have your one or two teacher champions within the school who can really help support.

Part of what I would think would be necessary in terms of this kind of training is not just a one-shot deal but a follow-up. “What happened when you tried to implement this in the classroom? What barriers are you hitting?” Opportunities for them to be able to ask questions and say, “What do I do here?” and have people able to provide some support there — some of that could be done through teacher champions. Absolutely.

You’re absolutely right on the button. “This isn’t my job. I’m not a therapist. I shouldn’t have to do this.” That’s the stigma piece that I think we need to address. That’s about the buy-in that I’m talking about. “You’re right. You aren’t a therapist. Please do not diagnose these children in your classroom.”

If we teach basic anxiety-management skills to all kids, then you’re not being a mental health clinician. You’re not being a therapist. You’re helping to reduce stigma and add coping skills into our life skills component, which is very much a part of our education system.

J. Thornthwaite (Chair): Thank you very much, Ocean. We really appreciate you coming in and sharing your expertise and your ideas.

Just a note to our team. Kate is handing out the draft report, our final report, which we think is finished, but we want you to take a look at it before we actually present it to the Legislature. This is the one you’ve already seen.
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We just want to make sure that you’re absolutely comfortable with it. It’s just our final report from a deadline a while back.

For tomorrow’s presentations, Alayna over there has our binders for tomorrow if you want to pick them up or if you didn’t print them out from what we got e-mailed. Other than that, we’ll see everybody tomorrow.

Hansard Services publishes transcripts both in print and on the Internet.
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Question Period podcasts are available on the Internet.

1) BC Transit Police	Chief Officer Neil Dubord
Delta Police	Melissa Granum
2) BC School Centred Mental Health Coalition	Laurie Birnie
	Dave Mackenzie
	Deborah Garrity
3) Brent Seal
4) Simon Fraser University, Faculty of Health Sciences	Dr. Charlotte Waddell
5) UBC Psychology Clinic	Dr. Ingrid Söchting
Registered Psychologist	Colleen Wilke
6) Child and Youth Crisis Program	Ocean van Samang

Chair:	Jane Thornthwaite (North Vancouver–Seymour BC Liberal)
Deputy Chair:	Doug Donaldson (Stikine NDP)
Members:	Donna Barnett (Cariboo-Chilcotin BC Liberal)
	Mike Bernier (Peace River South BC Liberal)
	Carole James (Victoria–Beacon Hill NDP)
	Maurine Karagianis (Esquimalt–Royal Roads NDP)
	John Martin (Chilliwack BC Liberal)
	Dr. Darryl Plecas (Abbotsford South BC Liberal)
	Jennifer Rice (North Coast NDP)
	Dr. Moira Stilwell (Vancouver-Langara BC Liberal)
Clerk:	Kate Ryan-Lloyd

REPORT OF PROCEEDINGS (Hansard)

SELECT STANDING COMMITTEE ON CHILDREN AND YOUTH

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
CHILDREN AND YOUTH