Children and Youth — Issue No. 22 — Wednesday, June 24, 2015 (HTML)

Present: Jane Thornthwaite, MLA (Chair); Doug Donaldson, MLA (Deputy Chair); Donna Barnett, MLA; Mike Bernier, 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	520
G. Fedor
N. Gale
S. Epperson
B. Vincent
T. Norton
B. Gutray
J. Morris
S. Mathias
D. Kelly
W. Christian
C. Saari
D. Smith
M. Chow
W. Arruda
D. Abma
J. Schiffer
C. Coniglio
J. Davidson
C. Hampson
S. Kutcher
B. Adair
T. Ritchey

J. Thornthwaite (Chair): Good morning, everyone. I’m Jane Thornthwaite. I’m the MLA for North Vancouver–Seymour as well as the Chair of the Select Standing Committee for Children and Youth. I’d like to just give a few remarks just before we begin.

This is our second meeting 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 from 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 the important issue. The committee’s first phase sought evidence on some key questions. What are the main challenges around youth mental health in B.C.? Are there gaps in service delivery? What are the best practices for treating and preventing youth mental health issues, and how should resources be targeted in the future?

The committee issued its interim report on youth mental health in November 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 the next phase of our work.

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

Previous presenters that we have had in the last session. In April we had Dr. Morrison and Dr. Peterson from the University of New Brunswick. We had Mountainside Secondary School principal Jeremy Church, Kathreen Riel from the WITS program, and we had a presentation from the joint Ministries of Health, Education and MCFD as well as the First Nations Health Authority.

Yesterday we had presentations from the Transit Police and Delta police; from Laurie Birnie, who’s the principal of Aspenwood Elementary, but she came with a group from the B.C. School Centred Mental Health Coalition; Brent Seal and his Edge program; Dr. Charlotte Waddell from SFU; Dr. Ingrid Söchting and Dr. Colleen Wilkie, registered psychologists; and Ocean van Samang, child and youth crisis program at Fraser Health.

Today we have 12 presenters that have been invited for their expertise and experience in areas relevant to youth mental health, and we have enough time on our agenda to allow ten-minute presentations — each of the committee members has read your material — and then 20 minutes for discussion and questions from the committee members.

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

D. Barnett: Good morning. I’m Donna Barnett. I’m the MLA for Cariboo-Chilcotin. Our first presenters are two very special, wonderful people from my riding.

M. Bernier: I’m Mike Bernier. I’m the MLA for Peace River South. Thanks for coming.

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

M. Karagianis: I’m Maurine Karagianis, MLA for Esquimalt–Royal Roads and, in opposition, I’m responsible for the file on women, child care and seniors.

D. Donaldson (Deputy Chair): Good morning. Doug Donaldson, Deputy Chair of this committee. I’m the MLA for Stikine, in the northwest part of the province, and I’m the official opposition spokesperson for Children and Family Development.

M. Stilwell: Good morning. I’m Moira Stilwell. I am the MLA for Vancouver-Langara.

J. Thornthwaite (Chair): And I’m Jane Thornthwaite, the Chair of the select standing committee.

With that, I’d like to turn over the floor to our first presenters, Dr. Glenn Fedor, Cariboo Action Team, and Nancy Gale, Cariboo Child Development Centre Association. Welcome.

G. Fedor: Thank you for allowing us to present today. I asked Nancy to go first, but she insisted I go first and introduce some of the stuff we’re doing.

I’m a family doctor in Williams Lake. I’ve been there for 34 years, and I’ve been the co-chair of the Cariboo Action Team in the Cariboo.

You’ve read the report, and I’m actually more interested in your questions later, so I just wanted to focus on a couple of things. One is — and most of you are familiar with it, I’m sure — Setting Priorities for the B.C. Health System.

One of the top priorities was providing patient-centred care. The principles were dignity, respect, information-sharing, participation and collaboration. Really, that’s what I see in the Child and Youth Mental Health Collaborative, which helped establish these Cariboo Action Teams for the last 2½ years we’ve been funded. I see it as a great success. We’ve got a great promoter in Donna Barnett.

I just want to highlight some of the things we’ve done. What you see on the slides in front of you as well as the handout is our patient journey map. We did two, but this is the one that involves First Nations. We saw this as one of our critical engagement tools, communication tools.

We sat down in three different sessions, engaged the community members and some of the aboriginal clinicians that actually work with youth and families. But also families themselves participated and created this wonderful sort of map that we are using in our journey in our collaborative to try and break down barriers, break down silos, identify the access problems.

I think it’s been a tremendous success. In fact, I believe that the BBC in England actually picked up on this and wanted more information on it. I’ll be happy to answer more about that.

The other two things that we’ve done are…. I know that you were looking for some concrete and practical solutions. One of the things that our team was instrumental in fostering in the collaborative was these new ER protocols for mental health and substance use for children and youth. We’ve now created tools for emergency physicians to properly assess, communicate their assessment and have a planned approach on how to deal with these youth.

It was a tough battle. Initially there were some holdouts from some of the bigger institutions, like: “Why are you having little rural areas telling us how to practise emergency medicine?” Places like…. I won’t mention the big cities.

Basically, they eventually bought in, and we’ve got this rolling out. We’ve got Interior Health, actually, as the pilot area, and this is going to be rolling out soon. I think this is going to be a great success. I’m sure you’ve all heard stories of children and youths with mental health problems ending up in emergency and some of the disaster stories of just how they’re followed up and their care.

The last thing that our team was instrumental in was recruiting a child and youth mental health psychiatrist. Williams Lake has a child and youth psychiatrist. This is a Johns Hopkins–trained, Harvard-trained psychiatrist. We had a little bit of an in because his wife is from Williams Lake, but he could have moved anywhere — Kelowna, Kamloops, Vancouver. He wanted to be in the province.

When he came for his first visit, I made sure he didn’t just visit with the physicians and learn about the community. I made sure he met with the action team. He basically saw our collaborative approach that was happening in the community — working together, working in teams, working with First Nations, working with all the different agencies.

He has been invited to some of the learning sessions in the collaborative. He’s just been floored about what a small community can do. It’s one of our real successes.

Other than that, I’m going to turn it over to Nancy. I’ll let her take it further.

N. Gale: Okay. What we wanted to talk about today was an integrated community approach. I appreciate that it may have more relevance in rural communities, but really, what we’ve been trying to do is horizontal integration.

We’re pretty good at vertical integration. We talk about a team-based approach and vertical integration, where the doctor talks to the nurses, talks to the nutritionist. But what’s happened is that we haven’t had a lot of success in talking horizontally, in terms of working with primary care providers as well as the support systems in communities.

We know that that becomes a big piece. Navigating the system sometimes becomes very tough for families. So what we wanted to talk about here was our experience doing that horizontal integration. Part of the success of that horizontal integration was that we had a provincial framework, and we had provincial support from the top.

What happened is that they supported planning, and they also supported strategic directions. What we were trying was to be realistic, understanding that all of us, or many of us, that sit on the action team are what I affectionately refer to as paid volunteers, which means that you do it off the corner of your desk. You’re always at a point of: “How do I balance all of those priorities?”

What we said clearly was that we wanted to have courageous conversations. We really wanted to engage in something called constructive candour. If you wonder where shift disturbers come from, sometimes in Williams Lake the “f” is silent. We were at a point where what we were able to do was ask each other: what was it that was causing all of that inability to work together?

In addition to Glenn Fedor, we also had an emergency physician, Dr. Jeff Peimer, who is currently working out
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of the child development centre. He’s had some increase in the number of sessionals. He probably is the best shift disturber that I know, and he always asks: why not? So it’s been very exciting to be able to do those kinds of things.

What we looked at…. And I’m not sure that I really called it a cooperative gain. In my worklife, what we’ve been doing in Williams Lake is really trying to be…. There are some positive benefits from working better by working together. We had some ability, because my board are calculated risk-takers, and I’m an intrapreneur instead of an entrepreneur, so we’re always sort of looking at opportunities to find new ways to fund a community organization.

What we were able to do with a conversation with…. A very strong physician in our community said: “If I get her here, can you house her?” Well, I think I’ll scratch my head and we’ll figure out how to do it. It just made sense for us, if we were working with children, that we would have a pediatrician co-located at the child development centre. So we ripped out the wall, we moved a few things, and we were able to make that happen. What this cooperative gain did was it allowed her to build her practice.

The same thing happened with Dr. Peimer. He was able to build his practice. We were able to prorate the cost of administration services, technology, as well as housing and creating a waiting room that made some sense. It’s all of the kinds of services that we require in a community organization, and now we were just able to add health to that piece.

I will tell you that I’m working on the school district. I’m going to try and get a school within the child development centre, but I’m not sure that I can get that far.

The other piece that’s happened. This kind of integrated health care is the kind of thing that…. Just in a recent article in the Vancouver Sun: Omaha, Nebraska, is putting 40 physicians in the same place as 500 community health care providers. We’re not quite that big, but I think in Williams Lake we can take that, and Chilliwack. It’s kind of a model that we could certainly use. So we’re asking that you might want to consider this as a model for rural delivery. The cooperative gains come.

What we know is that many of you in your communities have community organizations and agencies, and I listed some of the highlights of some of the characteristics that you might want to consider in terms of who could be a community hub. They have a history. They have a reputation. They also have an entrepreneurial flair, and they have some real capacity to do that work.

I know that some of the child development centres, particularly in the north and in Abbotsford, are also looking at doing some expansion. It would just make sense if we could start thinking about this integrated care.

I guess my question to you is…. You wanted some realistic expectations and some realistic recommendations. I like m’s, so it’s about mandate, it’s about money, and it’s about market. On my report, what I looked at was: could we find some ways of doing this mixed delivery of rural health care and sort of put it as part and have some policy and some legislation that favours that type of development? We will certainly need an investment, in terms of leasehold improvements.

The other piece is to do some work in terms of market. Where are those existing hubs? I know that the Ministry of Health is doing sort of an analysis of their facilities, so for many of those rural communities I would expect that we’re probably going to be down in the bottom part of the priority list. There may be some other alternatives, where a much smaller investment could make these hubs happen.

Then if there were some ways to support that co-location and some of those leasehold improvements, I think you might get a better bang for the buck.

The last piece that we’ve discovered in Williams Lake is a piece that’s missing, and it’s some of the new work that’s happening in child and youth mental health. It’s that we need to sort of shift some of our focus to children between the ages of 16 and 25. We know that if they’re not making those appropriate connections, what happens is that they end up, you know, becoming the million-dollar babies, where they’re intersecting in other systems — homelessness, addictions.

What we talked about was how we do those better services, understanding that although they may be 16 or 18 or 21 or 24, what has happened developmentally is that they may not be an adult. If we do that better connection with service, I think we can have better outcomes — long-term outcomes.

I would ask that the work that we’ve been doing in Williams Lake continue. There’s another piece that we need to…. Unfortunately, when you do pilot projects or you do innovation, you just kind of get it going and then the funding runs out. My suggestion is that we’d like to continue improving youth transitions, and we have some ideas about how we might want to do that.

M. Karagianis: Thanks very much for a great presentation. Nancy, one of the things we have heard quite often in these forums that we’ve done — both the first one and this second one as well — is the importance of kind of early intervention, prevention, tying services into the education system as a first place to identify and, obviously, make contact with children. Can you touch on that a little bit in your model? I can see that your recommendations are excellent and things, but I didn’t really kind of tease that piece out of what you were presenting.

N. Gale: The child development centre provides all of those early intervention services that are provided. I listed all of the services of the Ministry of Children and Family Development. All of those programs are services that the child development centre provides. Having the
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pediatrician with the child development centre — what happens is that we’re…. And we also do prenatal, so we are really focused on those first 1,000 days of a child’s life.

What we know in some of the models and some of the work that we’ve been doing on autism is that many times those markers are there at six months and 18 months. It was probably subtle, but part of what happens is that about 60 percent of the children that we serve are children who are under the age of five. So by having a school within the child development centre, where you have a school within a school, for those children that need additional support, what would happen is that they would also have those other community supports with them.

D. Barnett: Thank you very much to both of you for coming. You didn’t really mention the autism spoke centre that we have. It is a brand-new centre. As you know, there were about eight or ten spokes from the big centre. Then the spokes…. Fortunately, Williams Lake was very successful. It has been constructed. It’s a fabulous building. I was there Monday, I guess, and they are starting to have their clients come. They have 55 autistic young people already, and the door has just opened.

Nancy, maybe you could tell us how your innovation and creation in Williams Lake obtained the funding to have the autism centre, because this is quite the story.

N. Gale: It started with…. We went to parents, and we said to parents: “You know, if we had all the money in the world, what would it look like?” We also have a co-op in Williams Lake. We have five not-for-profits that have come together and share back-of-house services. It’s not really an innovation; we’ve been doing it for ten years. So it’s really our practice.

What has happened is that one of the workers from the Association for Community Living that does all of our yardwork…. I pay them for the yardwork. That’s their earned revenue. We just move money around in the co-op. What’s happened is that she said: “I have a contact in Vancouver who had a grandson with autism and who is looking to put $96,000 somewhere. If there was anybody who could make $96,000 happen, your name came to the top of the list.”

We met with parents. We put the proposal together, and I got a handwritten cheque in the mail for $96,000. And I think: “Holy mackerel. Now I have to do it.”

We were able to work with a construction company. We were able to work with the architect. We had planned a renovation to the child development centre so we could house the physicians.

We knew that we were going to be bringing in more child and youth mental health workers from MCFD and from the community, but we also knew that we needed to have that primary care. So we had to create a facility that had that ability. It made sense to do the autism centre at the same time that we had planned our construction.

We were the first community agency or community organization to receive a small loan from Community Futures. What we were able to do was use all of our various resources, and we were able to fund both of those projects at 80 percent. So we’re just at the point….

We’ve been working with the people from the Pacific Autism Centre, and what we’d like to do is…. We’re hoping to launch a B.C. campaign called “Mile of Change.” So if you line a mile’s worth of loonies and toonies, it’s $63,000. I’d be very close to paying off my loan from Community Futures.

Part of what we looked at was that we wanted to create a house-like structure. What we were discovering was that we need to be less institutional. Many of the skill sets that we’re trying to develop are life skills. So we have a teaching bathroom, we have a teaching kitchen, and we have technology now with First Nations Health.

What will happen is we’ll be able to connect parents to the various resources that they need as well as the physicians. As soon as we had a child psychiatrist and a GP with a mental health specialty, what happened is that they were absolutely excited to be able to put the technology in our facility. So we’re now at a point where we can start using technology as well.

D. Donaldson (Deputy Chair): Thanks for the presentation. Congratulations. I mean, the enthusiasm, the energy, the perseverance show. A lot of what you talked about resonates with the experiences I’ve had, especially the chart. I could probably name a dozen kids or young adults that could fit into any one of those circles.

My question is around mandate. I know small communities deal with artificial boundaries way too often — artificial boundaries that the province creates, artificial boundaries that the federal and provincial jurisdictions create, municipal boundaries, regional district boundaries, hospital district boundaries. Lots of overlapping mandates. I think one of the things I thought about when you mentioned mandate is the mandate to let accountable community groups do the work that they know needs to be done and have the province offer some flexibility and step back from being the sole owner of the mandate.

Having said that, can you describe to me your relationship…? I know Williams Lake has a delegated aboriginal agency serving many of the reserves around Williams Lake. As well, I have visited the friendship centre in Williams Lake and know that they have a lot of programs that fit within what you’re trying to do, yet I didn’t see them mentioned in your background briefing. So could you just talk about that a little bit for me?

N. Gale: They’re typically our partners, right? So what would happen is that if there was a specific child or a specific family, then the wraparound would in-
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clude them. It’s more patient-centred — more along that family-centred.

The friendship centre does all of the services that the co-op does. So if you take the co-op and the friendship centre, they really are parallel organizations. When you take five not-for-profits, looking at what the friendship centre does…. All of us have individual relationships with the friendship centre and intersect with those programs.

We work quite well together, actually. Because of the pediatrician being at the child development centre, what we’ve discovered is that many…. We’ve had much more intersection and contact with First Nations organizations because a physician is at the child development centre. That makes the big difference. That really has become our entry point.

The physician can walk down the hall — right? — with the family and the worker from a First Nations organization and introduce themselves to another professional.

G. Fedor: I’ll just mention that on our action team we have four aboriginal representatives. There are some clinicians that work with clients. There’s an aboriginal patient mental health navigator from the Chilcotin area as well as two administrators from various First Nations. They contribute very actively in their role. In fact, they were the ones that helped develop some of the patient journey maps and get people together.

I’ll just mention the role of the divisions of family practice. I’m sure most of you are aware of divisions of family practice. They sort of oversee some of our funds that come from the Shared Care Committee, which is a partnership between the Ministry of Health and Doctors of B.C. They’ve been supportive.

Actually, through the division of family practice GP for Me initiative, one of our priorities was First Nations telehealth. The First Nations Health Authority was actually getting into telehealth, so they partnered with our division.

Now we’re setting up, I believe, sites in about six or seven different areas throughout all the Cariboo for physicians to connect with First Nations people. It’s not just a primary connection but more a secondary connection after the fact so people don’t have to travel. We still want face-to-face, person-to-person contact, but this allows people to have follow-ups remotely. I don’t know how many have been up to the Chilcotin and the Cariboo, but it’s a huge area and very remote in certain areas.

N. Gale: The five First Nations telehealth sites — we’re connected to those five sites too. That’s the other piece.

C. James: Thank you for your presentation, and thank you for the work you do. I think all of us look for those integrated services and supports, and to see it actually working and functioning and successful and expanding is exciting.

You mentioned that work is often done off the corner of the desk. I think we hear that over and over again — that when people come together, it’s relationships, and they connect with each other, and that often what’s missing is that coordinating role. I noticed in your presentation you talk about a project coordinator, that the project coordinator is funded. I wonder if you could talk a little bit about that role and how important it is. We’ve heard from others the challenge that they face without having that leadership or that champion or that coordinator.

G. Fedor: I’ll give an analogy. Actually, I confess, I was a little bit ignorant in that role. We had funding for it, and basically, I was kind of the project coordinator lead for a bit. All the team members kind of were helping out. Nancy used to take minutes. Other people would do it. We would kind of coordinate, but I make the analogy that we were kind of like a beer league hockey team. You get together, and you can have some pretty good beer league hockey players, but you really need a coach to succeed. That’s really where our project coordinator is.

Our project coordinator is a part-time position. It’s just two days a week, I believe. Actually, she has a full-time job with our health authority as an administrative assistant, so she has that other great connection. She’s been able to sort of really work with the big collaborative players — you know, the provincial that’s under the direction of Val Tregillus.

We have a collaborative coach from Impact B.C. I forget what the acronym…. I think most of you know about Impact B.C. Basically, she works closely with them.

She works with our division executive director on the budget. She makes sure wherever data…. She’s actually setting up various contracts. Actually, in our chartlet — we call it chartlets, but it’s basically our initiatives that we’ve focused on — we’re focused on mental health literacy as well as fostering caring adults in the community. Right now we have someone coming to our community this fall to have a two-day workshop, working with caregivers, families, doctors and providing education on, I think, early infancy, trauma, attachment.

Then we’re also working with the United Way. We’ve actually contributed some money to basically collect data from students grades 6, 8, 10 and 12 through the whole Cariboo and Chilcotin, which is a follow-up of a youth survey that was done about six years ago.

We’re really excited about this data because there have been a lot of initiatives instituted in the last six years in the communities. Now we’re going to have the follow-up data to see what we have really accomplished. The exciting part of this is we’re actually getting the data from the Chilcotin now, which represents a lot of the First Nation communities, so that’s going to be exciting.
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N. Gale: So looking at resiliency — one of those factors, right? More community development factors in terms of resiliency.

J. Thornthwaite (Chair): I’ve got six minutes left. I’ve got Mike, and then the final word goes to Donna.

M. Bernier: Mine’s more of, I guess, a high-level comment than a question. First of all, thank you very much for coming and presenting. It’s very inspiring. Representing a smaller northern rural community myself, I think one of the things that we hear quite often is that people seem to rely on the larger centres to be able to administer services. I always wondered: how can we make this work in smaller, more remote, I guess, communities? I more want to just say thank you very much.

In smaller communities we can have programs in place, but without champions to really move those programs forward…. Sometimes they can be with all great intentions and hard workers, but the champions need to be there. So if you know any friends that have wives or that are doctors that want to move up to Dawson Creek or that area, too, let me know.

Really, for me, when I hear about the frustration, one thing I’ll take away is that this can be done in smaller areas. You don’t have to rely on the larger centres. I know Donna has talked very highly of you. I just want to congratulate you for all the work you’ve done.

I think in some respect it’s easier in smaller areas. When you look at team-building, it’s about relationships and roles, and I think it’s easier in small communities like this. In our team we share kids on soccer teams, hockey teams. We know each other. We see them in the grocery stores. In fact, I think our success story has been partly because of the size of Williams Lake.

I often say we have local expertise. We have local leaders. We have families that want to get involved. We have the resources in the small areas. Despite what you hear about Williams Lake in the news sometimes, we are a great community, really. We’re passionate about what we do.

D. Barnett: Well, it is true. We do have a lot. The other day at the chamber meeting, you know, everybody’s talking about doom and gloom and this and that. So we had a chamber meeting, and what we focused on was basically the attributes of Williams Lake — the things you’re doing, the things Dr. Neufeld has been doing. We have another speaker we won’t tell you about.

It is very positive, what is happening in small communities. When you have strong leadership like we have, that’s what will make things better. I’ve known Nancy for…. I won’t say how long. We’ve worked together on many different…. Building trails to child care, believe it or not. Dr. Fedor has become a real champion with the program he’s got. We have to ensure that these programs carry on. We can’t one-time-fund success.

If anything comes out of this, I am going to make a recommendation to this committee that these types of programs that are successful be funded through. We get something that works, and then we don’t carry it on. That is a failure on the part of government.

Thank you both very much. I’m sure I’ll be talking to you soon. Have a safe trip.

J. Thornthwaite (Chair): Thank you very much for your presentation. I’d just like to personally congratulate you and encourage you to continue to work on getting those schools. We’ve learned from the committee and other presenters, if you go back to other presenters, that the schools are integral, and we need to get the education system to step up.

G. Fedor: I’ll just share one quick fact. Other members of action teams from Vernon and Kelowna and myself are going down to New Orleans in Louisiana in November to present the work of our collaborative and the action teams to a sort of school-based-care conference. It’s an international conference where they want to know about how to strengthen activities in school mental health. We’re actually excited. I think, actually, we were excited just to be invited, because we weren’t sure we were going to be invited. We’re going international.

J. Thornthwaite (Chair): Well, congratulations and good luck, and keep up the good work.

S. Epperson: Thank you. I may be coming from quite a different place than people you’re going to be hearing from today and through your meetings, and I really appreciate the opportunity to speak to the committee. I definitely share your concerns about the mental health challenges facing children and youth and our duty to respond thoughtfully and effectively to them.

I’m here in two capacities. I’m a parent, and one of my sons has been in our mental health system for over a dozen years. I’m also a member of the clergy and on the front line. I’m called to respond to people who are suffering
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emotional and mental distress. I’ve made scores of visits to our hospitals, to psych assessment units, in-patient clinics, all our hospitals, community mental health centres and also to halfway houses.

I’ve preached on our mental health crisis. I’ve held numerous private office consultations with individuals and families, and I’ve helped to organize support groups and public education presentations and seminars.

From years of personal and professional experience, I really have to tell you that my biggest fear is that we’re massively misunderstanding the suffering of children and teens. We’re taking their feelings, their thoughts and suffering, and we’re transforming them into symptoms, into diagnoses, into reductive theories and then prescribing an array of psychiatric drugs that have dire short- and long-term consequences.

I’ve seen these kids, and I’ve seen them growing up into adults, and I’m afraid that we’re drugging their emotions, their thinking and their quest for meaning.

When a child is sad, all too often we say: “Oh, she’s depressed.” When they’re elated or in a rage, we say they’re manic. When a child has a lot of energy and can’t sit still in a classroom, we say he’s got ADHD. When they’re frightened, we say they’re anxious. When a person’s distressed about the world and their future in it — and they may come up with unusual beliefs and behaviours — we say they’re psychotic.

We’re not listening to the powerful communication that children and youth are offering to us, and we’re saying instead that she’s bipolar. He’s depressed, psychotic. And in a panic, we say they’ve got to be fixed with drugs, because that’s the tool, the blunt instrument, we have at hand.

These intense emotions usually arise from compelling reasons. There’s abuse. There’s bullying. There is a struggle to cope in a developmentally difficult environment. Maybe it’s just the normal, the difficult human task of trying to forge a viable path into the future in the project we call life.

I fear we’re not looking enough at the root causes of suffering that can arise from a loss of extended family support or divorce or poverty or the pressure of constant assessment and testing in schools. We’re not looking at parents’ confusions about discipline. We’re not looking at the hyperactivity of family life or children’s diets, their consumption of media and the titanic pressures of a highly competitive, monetized culture that’s placed upon them by adults and peers. And we’re not sufficiently taking into account the reduction of unsupervised play and contact with nature.

Dr. Allen Frances, who is the past president of the American Psychiatric Association, stated recently that “the health care industry, from psychiatrists to family doctors, has gone down the wrong path, turning childhood itself into a disease.”

Tamara Pringsheim, a neurologist at the University of Calgary, recently completed the only Canada-wide study on the prescription of anti-psychotic drugs to children, which reported that there was 114 percent increase in prescriptions between 2005 and ’09.

She said this about the findings of her report: “Pills can be seen as a quick and easy solution in a crisis, but in the end, they merely mask the underlying problem…. I’m always telling parents not to pathologize their children’s behaviour, that a lot of this is just normal development.” And she said: “It’s our tolerance for problem behaviour that’s dropped dramatically.”

“Every year, the second-grade teacher in our local public school sent notes home the first week of school to parents of the more rambunctious boys in their class, telling them that their boys had ADHD and to please take them to their pediatricians for a prescription of Ritalin. Our eldest son received one of those notes, and we took him to his doctor. That pediatrician then gave us a piece of his mind.

“He said: ‘If you’re looking for someone to drug a perfectly healthy little boy into sitting still behind a desk for his second-grade teacher, you go find yourself another doctor.’ And that energetic son turned into a dynamic young man who channelled that energy into a successful legal career in New York City, and he’s a wonderful father.

“The other little boys were not that lucky. They had outcomes described in the literature about the long-term effects of years of stimulants on developing bodies and minds: stunted growth, mood dysregulation, behavioural problems. One of those boys — one of my son’s friends — started selling his Ritalin on the playground in sixth grade and later went on to sell street drugs.”

For the past 30 years the overwhelming first-line response of GPs and mental health professionals to children and youth experiencing emotional and mental distress is a diagnosis that they’re suffering from an underlying brain disorder. In spite of the fact that there are still no biological tests, no brain scans and no genetic markers that substantiate this claim, children and teens are still being prescribed stimulants, SSRIs, neuroleptics and major tranquilizers at an alarming rate.

In this province between 1997 and 2007 there was a tenfold increase in prescribing psychiatric drugs to children and adolescents. This continues to go on unabated, in spite of the adverse long-term effects of these drugs.

Those long-term effects include stunted growth, elevated blood pressure, mood swings, sexual dysfunction, involuntary muscle spasms, extreme agitation, massive weight gain, incontinence, sedation and cognitive impairment. Not coincidentally, disability claims attributable to mental illness for adults, children and youth are the fastest-growing category of disability costs in Canada.

A year ago in Vancouver in a seminar presentation on clinical drug testing, Dr. Jim Wright, who’s the chair of the department of pharmacology at UBC, stated the following: “Any truly scientific evidence-based drug trial for any medication should meet seven criteria.” He went on to list those criteria.

Then he said the following astonishing thing: “There have been no trials for psychiatric drugs that meet any
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of these criteria. We are harming a huge number of people.” He said: “It’s shocking. It’s unethical. There are no evidence-based scientific diagnoses in psychiatry, because we don’t even know what we’re talking about.”

In a presentation to UBC pharmacology staff and students last November, Dr. Peter Gotzsche, one of the world’s leading experts on clinical drug trials, concluded without a doubt that the use of psychiatric drugs is causing far more harm than good around the world.

“Over a dozen years ago we entered the mental health system here with one of our sons, trusting in the expertise of psychiatrists and other mental-health professionals. What followed has been a living nightmare. Our son’s physical and mental health has been destroyed by the long-term effects of an array of psychiatric drugs, the trauma of hospitalizations and the treatment that he’s received.

“The empirical daily observation by his parents of the effects of some of these drugs and dosages, as well as the scientific literature that we shared with his mental-health teams, were dismissed. Condescension, defensiveness and contempt are common responses I’ve heard from parents in similar situations.

“In sum, the trust and hope that we had in the B.C. mental health system diminished as our son has incurred irreparable physical and neurological damage.”

If the drugs worked, mental and physical health and recovery outcomes would improve. People, especially our children and youth, would be getting better. But by and large, the opposite is the case, because over the long term these drugs induce changes in the brain opposite of what was intended and increase the risk that a person will become chronically ill. I have, sadly, seen this with my own eyes.

Epidemiologists are now reporting massive brain loss, catastrophic organ failure and premature deaths of 25 years and more in those taking psychiatric drugs, after years of prescribed use. Disability data — I think this is especially important for you to hear — are coming in from around the world, showing an astonishing rise in claims due to mental disorders.

This enormous increase — this is not coincidental — has risen in lockstep with the astronomical rise in the use of psychiatric drugs in the past 40 years. If only the drugs worked, people would be recovering, you would think, and disability rates due to mental disorders would be decreasing. But they’re not.

Increasingly, rising disability rates will become financially and socially unsustainable, and health professionals and policy-makers will be held to account by affected individuals, families and taxpayers.

J. Thornthwaite (Chair): Dr. Epperson, I just wanted to interrupt and let you know that we do want to have opportunities for engagement from the committee. You’ve taken ten minutes of your half hour, which is great. But I just wanted to let you know that whatever more time you take is less time for engagement from the committee.

Three years ago Dr. Christian Fibiger of the department of psychiatry at UBC, one of the strongest advocates of the biochemical explanation for mental disorders, said this: “Psychopharmacology is in crisis. The drug data are in, and it is clear that a massive 30-year experiment has failed.”

“We’ve hunted,” wrote Dr. Kenneth Kendler, “for…neurochemical explanations for psychiatric disorders, and we have not found them.”

In 2011 Dr. Ronald Pies said: “In truth, the chemical imbalance notion was always a…urban legend, never a theory seriously propounded by well-informed psychiatrists.”

Yet just last month — I’ll mention this and move on to the end of my remarks — I read a preview of a mental health and high school curriculum written by Dr. Stan Kutcher of Dalhousie University, a curriculum he’s marketing, with the partnership of the education faculty at UBC, for use in B.C. schools.

In the curriculum, I discovered that Dr. Kutcher is still advocating the now widely discredited chemical imbalance explanation for psychiatric disorders. As well, he claims that like other biological illnesses, they can be effectively treated with drugs and the sooner young people are labelled with a mental illness and entered into treatment, the better.

I have to underline something. I’m not like a Scientologist. Do you understand? My congregation is full of psychiatrists, doctors, therapists, social workers, lots of good people who are doing good things all the time. I also know that lots of people swear by their meds, that they’ve been life-savers. I’m not going to argue with that. I’m not going to dispute that.

Clearly, in the short term some of these drugs are effective in being able to knock down some of the most disturbing or alarming behaviours and feelings that are presented to people and cause them a lot of distress. I’m not going to dispute that.

What I am saying…. My truth and the truth of the people that I’ve seen, worked with and been with is that these drugs are causing unbelievable havoc in their lives. A lot of my work is also with adults, and they’re in desperate straits, the people I’m working with. Their physical and their mental health is shot. They’re almost all on disability — long-term, chronic disability for the rest of their lives.

I really think that we must take a look at alternatives that are out there. Psychiatry and psychology are currently undergoing a self-critical paradigm change as research data, studies and a host of stories are being published about the adverse long-term effects of psychiatric drugs and about the trauma many, many people experience in our health system.
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What I fear is that if we don’t take this changing landscape into account, British Columbia is going to end up being a backwater, consigned to discredited mental health theories, out-of-date curricula, intrusive surveillance and dangerous treatment regimes. As we do that, the number of disabled, sedated, traumatized and emotionally and cognitively devastated young people and adults will continue to grow. I think we can do better than that, and we must, for the sake of our children and youth.

I’ll take questions. You’ve seen that I’ve appended a bunch of recommendations to my remarks.

Also, I wanted to add one more recommendation. I’m formally submitting two books and a recent report to the committee, and I want this to be part of the public record. They’re Robert Whitaker’s Anatomy of an Epidemic; Robert Whitaker and Lisa Cosgrove’s Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform; and a report by the division of clinical psychology of the British Psychological Society called Understanding Psychosis and Schizophrenia. I implore this committee and members of your staff to take a look at them.

D. Donaldson (Deputy Chair): Thanks for your thoughtful presentation. Yes, anecdotally, I would say that I’ve seen a trend. From my perspective, the point of medication is to get off of it once the crisis has been dealt with. But there seems to be a trend to have lifelong medication when perhaps it’s not appropriate and perhaps because other means of dealing with why the crisis developed in the first place haven’t been addressed.

So thanks for your thoughtful presentation. I will definitely follow up on a couple of the recommendations that you’ve put in your report.

One question I have for you is based on your experience and your perspective. The committee is considering, as part of the overall recommendations perhaps, where responsibility within the provincial government for children and youth mental health services and policies and strategies should actually reside. Currently it resides in the Ministry of Children and Family Development. Do you have any suggestions on that?

S. Epperson: I wish I knew the layout of the land for you folks. I just know that it’s really, really imperative, as you go forward, in any kind of discussion about this, that you include people who are immediately impacted. You’ve got to talk to the people who are in the system. You’ve got to talk to people like my son, his friends, adults, families who are impacted by this. Experts — I mean, academically trained experts who represent professional guilds and their interests — by all means, but you’ve got to talk to people who are dealing with lived experience.

I wish I could give you something more specific about that. You’ve got to have someone on board every time you meet. There shouldn’t be anything about us or about them without them. They should always be present.

D. Plecas: Thank you for your very alarming presentation. I guess my own reading and thinking about this is that it fits very precisely with what you’ve described. I think there’s a fair volume of evidence to tell us what you’ve told us here today. There are lots of others who have been saying this.

My question for you is two parts. One is: what do you think is the driver or drivers behind what’s bringing us there? I mean, in a nutshell, I guess we could say there’s wild overprescription of drugs.

Secondly, what, in your experience or from what you know otherwise, is making it so difficult to get people to listen to the evidence that’s there about what’s been going on? I think — and I’m sure you know this — this isn’t some new thing. This has been going for decades. So if you could give us….

S. Epperson: Boy, I could take a lot of time. I’ll try to boil this down. Two things: one historical, and the other I think is just existential, sociological.

Historically, the whole professional guild of psychiatry was in crisis in the 1950s and ’60s because therapists were coming along and saying: “Basically, we’re providing the same service. Social workers, therapists — we do counselling, and that’s just what you guys do, right? You psychiatrists.”

But a few drugs came along, like Thorazine and Haldol, in the ’50s and early ’60s that seemed to have a really remarkable tranquilizing effect on people who were in a lot of distress in asylums and hospitals. Psychiatrists are doctors. They saw that here was a tool. Here was a prescriptive tool that we could use that would distinguish us from therapists, psychologists, social workers, etc. There was an incredible financial interest, as well, on the part of pharmaceutical companies and by the whole professional guild of psychiatry to go down this route.

I mean, I’m not going to say that there was some sort of nefarious conspiracy or that people had bad intentions at all. I think they had the best of intentions. They needed a tool. There wasn’t enough in their toolkit, and prescription drugs — psychiatric drugs of all sorts — seemed to be able to provide them with a toolkit that they didn’t have before. Consequently, it really raised the legitimacy of the whole psychiatric profession in the 1980s and ’90s and up until today.

Right now you’ve got lots of this vested interest, both by the guild and by the pharmaceutical industry — okay? — in a particular paradigm. It reminds me of the way of how everyone was invested in the Ptolemaic view of the universe, with the Earth at the centre of the cosmos, with everything revolving around the Earth. Everyone bought
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into that. It made a lot of sense until, drop by drop, discrepancies in calculations started to add up. Finally, the model wasn’t viable anymore. Along come Copernicus and Galileo, and we weren’t at the centre of things.

The other thing is very, very emotional, personal, existential. I mean, what parent wants to say that they’ve screwed up? What parent wants to say: “There may be something going on in the lifestyle in our home”? Or teachers — what’s going on in schools? Or just the constant pressures on kids. It’s like what Dr. Pringsheim said in Calgary. “I’m telling parents all the time that what you see is not pathological behaviour. There’s probably nothing wrong with your kids. This is normal development. It’s our tolerance for problem behaviour that’s gone down.”

Like that pediatrician who said: “I’m not going to drug a perfectly healthy kid just so that he could sit in a desk in second grade. Go find someone else. He needs to be out on a horse and chopping wood.”

You don’t want to carry that kind of guilt. If someone says, “Ah, your child is sick, and here’s a pill,” you grab it. You go for it in hopes that they’re right. But the effects of being medicated on these things give rise to other symptoms that then add on other meds.

Do you know that a lot of people are on four, five, six different drugs? They start out with an antidepressant and then add on a mood stabilizer. Then here comes an antipsychotic and then another antipsychotic, until young kids look like elderly people opening up their medicine cabinet, and their medicine cabinet is full of drugs they have to take every day.

Dr. Jim Wright of the department of pharmacology said: “Do you know what the chances of someone recovering from polypharmacy are, of people being on multiple drugs?” He says it’s one in ten million.

Thank you for your presentation. I just wanted to respond to recommendation No. 10, which I do think is important and would like emphasized on the record with respect to mental health screening in school settings.

I do think that there is a large and important role for the education system. Our children spend more time in the school system — or as much, certainly — than in one-on-one time with their parents. So it’s an important place for mental health, to be sure. However, I think this recommendation is very, very important — about the lack of basis and about the harm that screening can do. I think people often really do not understand the serious harm that can come from screening.

S. Epperson: A young person gets labelled as mentally ill and then deals with that for the rest of their life. Also, it’s interesting that both the Canadian and U.S. task forces recommended against it.

M. Stilwell: It doesn’t have the criteria for the kinds of diseases that screening can possibly work. If you look at breast cancer, where we screen extensively all over the world, there’s still not agreement about whether that actually does the job.

I think that’s an important recommendation, and thank you for bringing it to us.

C. James: Thank you for your presentation. I think the additional piece I’d add — and I think you mentioned it in responding to Darryl’s question — is the quick fix that people always look for today. They want that fast answer, they want that easy answer, and medication seems to be that easy answer. I appreciate you bringing your report forward.

I also want to reassure you that during this process your comments have been echoed, in different ways, by many groups and organizations presenting. There has been great discussion around community and belonging and family connections and community connections that have come forward. I think there’s been a good discussion about that.

I just wondered. Your recommendation 8 talks about youth workers and programs and family supports. I wondered if there’s anything that you’ve seen in your work that you do or in your personal experience that you went through with your son — any support programs or anything you saw that you would recommend or would suggest had good, positive impact.

S. Epperson: Thanks for asking. First of all, I do want you to know that I have read the interim report of this committee, and I was really impressed, especially by what the youth had to say.

The importance of having a mentor or a navigator in hospitals and emergency rooms — I’ll tell you, folks, that it’s mayhem there. A young person shows up in distress, and what happens way too often is that that distress gets ramped up. Then they’re put in restraints and then thrown in seclusion. It’s an awful picture. There really needs to be someone there to meet them, greet them, help them and families navigate next steps, what’s going to happen.

Just a couple of things come to my mind about the second part of your question. There was something called a highs and lows choir, Earle Peach’s Highs and Lows Choir. All the people in the choir were people who were dealing with emotional and mental issues. I heard recently that they lost a bunch of their funding.

There was also an arts program called the studio down in Richmond, and it lost its funding. The West Coast Mental Health Network that’s comprised exclusively of
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peers, people in the system — produce their own great, great newsletter — lost a lot of their funding.

What I’ve been hearing over the past year or so is the defunding of peer advocacy organizations and groups, which, to me, flies absolutely opposite, flies in the face of what I’ve seen to be really healing and helpful. Instead, it seems like the money is going into screening, into drugs, into that quick fix.

Folks, I just have to underline this again. I guess this will be my closing shot to you. The disability rates are not going down. People are getting chronically sick. There’s no evidence, no biological or genetic evidence, that we’re talking about an underlying organic disease in most cases. The chemical imbalance theory is an urban legend, a myth. Psychiatrists are saying it themselves. Yet it’s in all the advertising. I hear it in psych assessment units. I see it all over the place. People are operating with an outmoded, outdated myth.

The disability rates are going to be going up. They’re going to continue to go up. I think that’s what’s happened is you’re seeing disability that’s caused — you know, neurological, physical, all kinds of distress and problems — by the massive overmedication of people. Doctors don’t know how to effectively, safely taper people off these drugs.

They don’t. You talk to Jim Wright at the…. That’s the other thing I’d recommend. Talk to Jim Wright, a pharmacologist who really knows what he’s talking about, about the effects of these drugs, clinical drug trials. It’s astonishing. It really is.

I really, really wish you well, because we’ve got an enormous challenge and an opportunity on our hand, but I really think that there are alternative approaches to this. I’m not just talking about parents being nicer to their kids and slowing down. I’m talking about evidence-based programs, like those in western Finland out of the Keropudas Hospital that are coming up with the best recovery rates in the world, and I don’t know if we know about it.

J. Thornthwaite (Chair): Thank you very much, Dr. Epperson, for your presentation. We very much appreciate it. I’d like to echo what Carole said. A lot of what you have said we’ve heard before, and we appreciate your point of view and putting your items on the record. I’m definitely going to take a look at them.

Our next presenter is the B.C. RCMP E division. We’ll get the switch going for a couple of minutes.

Good morning. We have Insp. Barb Vincent and Staff Sgt. Tom Norton with us. Welcome. We’ve each got your presentation. Thank you very much. I encourage you to take about ten minutes to give us an overview — we’ve all looked at your presentation — and then allow for 20 minutes afterwards for questions of engagement from the committee members.

B. Vincent: Well, good morning, and thank you for having us here today. If you’ve looked at the presentation, you’ll see it’s a little bit lengthy, and it’s a little bit of death by PowerPoint. I realize that. I normally don’t even speak by PowerPoint, but I thought it was important that you had kind of the totality of what we’re doing around mental health.

When Tom and I developed this…. We know that we do probably more with adult mental health, but we wanted to look at what we do with youth mental health as well. So I’ll just beg your forgiveness. I’ll actually plow through it fairly quickly. I know you have it, but I just wanted to talk. I think some of your questions may be answered as we go through the PowerPoint.

To start off with, Tom and I both work in an area called crime prevention services. We report to Assistant Commissioner Norm Lipinski. That’s in our core policing in British Columbia. Norm Lipinski is in charge of all general duty detachments in the province. Then there are a number of different units that report to him, and we’re one of them.

Within crime prevention services I have 11 different teams that work for me. The biggest one and the one that we’re putting the most energy into is what we’re going to speak on today, and that’s what Tom Norton, the staff sergeant and also my ops NCO, runs for us. That’s a team that’s comprised of domestic violence, mental health and youth strategies. We wanted to put those together and all under one umbrella. We thought it was better.

We have an analyst that helps us, and we look to different areas of the province that are maybe experiencing high rates of domestic violence, critical numbers of mental health calls and maybe high youth suicide rates. We go in, and we offer solutions for detachment commanders. We work with them. We mentor them through partnerships, etc. We work with them, perhaps with their health authorities. So there are a number of areas that we’re working with. That kind of sets the stage of where our team lands with crime prevention services.

If we move through the PowerPoint really quickly, you’re going to see in a couple of slides here that our reporting rates have gone up. We only took a sampling from 2010 to 2014, and we’ve seen an increase of 32 percent. I also thought it was important to just kind of mention right from the beginning that a lot of those mental health calls are substance-use calls as well — concurrent disorders. I know that you know that, but it’s important to flag that.

If we look at the specifics on the actual screen, you’ll see…. We refer to youth as zero to 17, but I have gone out and looked at zero to 25 as well for you. You’ll see there is that steady reporting for adults from 21,000 to almost 28,000 calls for service across the entire province and for youth zero to 17 from just over 2,000 to 3,263. So there’s just the screenshot of the youth, which is zero to
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17, rising steadily from 2010. It changes quite dramatically when you….

The reason I looked at these numbers, as well, is that we’ve just started working with the Child and Youth Mental Health Collaborative, and that’s the age range that they look at as well. That’s important to recognize: that the numbers rise in the youth category to almost 10,000 occurrences for that five-year period.

We have a number of provincial-level partnerships, and we’re really trying to work quite closely with these partners: Ministry of Education; the violence threat risk assessment — you’ll see it as VTRA; Ministry of Health; the Representative for Children and Youth. A number of areas. We work really closely with those provincial organizations, including the Rock Solid Foundation with UVic. We really promote the WITS program. That’s the anti-bullying program for kids. The Children of the Street Society force and the Crisis Intervention and Suicide Prevention Centre of B.C. So a number of provincial level partnerships.

That really changes when you get down to the detachment level because, of course, that’s really specific to the detachments. We can offer provincial guidance, and districts can offer district guidance. When it comes down to detachments, they have their own concerns and their own strategic partnerships that they utilize in those. But any number of these agencies would be involved in the partnerships, including the health authority partner, the justice partner, the restorative justice partner, social service agencies.

Then we do have a number of provincial mental health teams. We have three of the car teams that are out there. That’s in Prince George, Kamloops and Surrey. That’s when we actually pair a police officer with a nurse with lots of training in mental health, and they actually go to those calls, as they arise, for service. We also have a number of specific teams that are working with youth in Prince George, Kamloops, Surrey and then in some of the bigger centres throughout the province.

There are all different acronyms. It even takes us a while to figure out where they are, what they’re called and what they’re actually doing. I just thought I would give you a sampling of what’s out there as well.

I worked with Christina Southey with Impact B.C. and the child and youth mental health collaborative to try to narrow down where those local action teams are. I’m sure you’ve heard quite a bit about the local action teams that are working with the highest-risk mental health clients but child and youth–specific.

What we determined is that the RCMP is involved. I mean, those are really more grassroots coming out of the health authorities and different ministries than the RCMP, but we’re trying to work towards them now. In fact, Tom Norton…. I was telling you about the strategy that we’ve developed in our own team, which is the domestic violence, mental health and youth focus that we have. I have two sergeants assigned directly to domestic violence issues and one sergeant assigned directly to mental health issues.

Supporting that, we have a program manager in the public service category and also a corporal. Their full-time duties are ICATs, which I’ll get to a little bit later, which are the domestic violence high-risk information-sharing teams, and the local action teams, the LAT teams. What we really want to do is have more involvement in these teams, and we want to teach.

Those two people will be working with detachments. They’ll be looking at the local action teams. I’ve asked them to go out and look at where there are best practices with and without RCMP and then help and mentor our detachments to have some strategic partnerships with the local action teams.

You can that see in the five different regions we’re involved in some; we’re kind of working towards being involved in others. It’s either grassroots, and our detachments have relationships already, or we’re kind of coming in after the fact. But that’s kind of our baseline for where our local action teams and where our involvement is in them.

We do have specific police mental health liaison officers. They’re in our larger provincial detachments. That’s where they tend to be stationed the most, and of course, they take extra care and time to build the relationships with the people who suffer, those frequent mental health clients, and the habitual users of RCMP or police services, with mental health conditions, to make sure they get the help they need. They’re really focused on that longer-term solution — to decreasing the frequencies of mental health–related calls to the police.

We are working with the health authorities. In particular, at the end of the presentation, which I won’t go through, you’ll see that the Lower Mainland district has undergone quite an extensive review of their relationship and their work around mental health clients.

What they’ve done in particular is they’ve worked with the health authorities on a number of issues, which you’ll see. One of the big ways is that they’ve even decreased the wait time. They have a protocol signed with Fraser Health Authority to decrease the wait time. We were going into hospitals and waiting upwards of a lot of hours — six, seven or eight hours — with our mental health clients, and that’s not appropriate. So they’ve developed a protocol. We’ll probably be working with the other health authorities if we see problems coming up.

Then they’re looking to expand the number of assertive community treatment teams working with the RCMP, and they’re really looking at ways to do an analytical approach to the work that’s going on. We’ve changed some study flags in PRIME so we can have a more accurate reporting of what the mental health occurrences actually are.
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Some of the provincial solutions that we know are ultimately important. For me it’s particularly the first one, which is to develop those consistent practices and the policy for information-sharing at the highest levels of government between all the ministries. It’s fine to say in the detachment level you must share information — and I added slides later on — because you can share information around your high-risk clients and your high-risk victims.

But the fact of the matter is, when you get down to the lowest level of all the people that are on the street doing the work, they’re uncomfortable and they’re unconfident around sharing information. I think if there was a policy developed or there was an MOU at the highest levels of government, amongst the ministries, and that policy is cemented on information-sharing, it would add so much more credibility and confidence to the actual practitioners in the field.

The second point is to foster partnerships with the community service providers in the medical community. I told you that we have a corporal and a program manager assigned to working with our detachments around the ICAT training and the local action teams.

This is really hard work, because it’s much like conflict management in our detachments or within my office. It’s hard work — that human resource management. And that’s really what we’re asking all the strategic players and partners to do, and all the different ministries in the detachments — to have those respectful, strategic partnerships where they can appropriately share information for the betterment of their highest-risk clients or their highest-risk victims.

That’s hard work. That does not come easily. You yourselves will all know that to have those relationships requires a certain amount of humility, a certain amount of knowledge and understanding and being able to work with other people. We really believe…. What we’re trying to push in ours is that we’re working with our detachment commanders on the ground to mentor them through having those relationships.

Let’s face it. Our detachments commanders are type A personalities. It’s difficult for them to work with service providers and have those collegial relationships, but it’s the way we have to go. We’re enforcement-based, right? We can’t deal with it all. Our rates, as you know, are rising because there are so many mental health calls. But we can’t just go and put a band-aid on it and wait till tomorrow when we see them again. That fostering of partnerships with community service providers is critical but really hard work.

We also know that putting a police mental health liaison officer — that’s what that PMHL is — or a mobile crisis…. We have them in three areas. If that is required, we need to look at that. We’re examining that. That’s what our office will be doing more of.

We have right now…. There are a number of people in the Lower Mainland, the police mental health liaison network. Those are groups of people…. It’s not a very big group, but they’re all those police mental health liaisons that are all finally meeting and working together and strategizing and brainstorming their common problems and common solutions. Then, of course, we always know that decreasing the hospital wait time is really important.

On to the second page — a little bit more lengthy. This is maybe a bit contentious, but it’s really how we feel. Supt. Norm Gaumont from the Lower Mainland district was the one — on the last three pages of your slides that are doing the Lower Mainland district review — that’s been conducting the review. He’s the one that helped us with this slide here. He’s really been working hard on it for about a year. He wanted to be here today, but he has a pre-existing medical appointment he couldn’t get out of.

Some of the things that we were talking about are that if a youth comes into the court system, we really want court-mandated addiction treatment for the addicted youth prior to them becoming an adult, a prolific offender with concurrent mental health issues.

It’s so difficult for families and service providers to get that youth to care, but there is a window of opportunity if they come into the court system. And it’s not punitive. In fact, what we really want to do is get that youth an opportunity to not be addicted and then progress into adulthood and not have to deal with that as well. We really want to look at that again.

Then from our perspective…. This is just a wish list for us. There would be a governmental review of the funded civilian and government agencies who are mandated to provide youth mental health care. That examination would have to include looking at and identifying those established best practices and seeing what’s actually out there and seeing what’s working.

Then I think there needs to be a better coordination of the mental health services. I mean, funding dollars are not unlimited, so appropriate use of those limited funding resources. And then a reporting framework for the agencies that are receiving those funding dollars and providing youth mental health services, so a reporting framework with an actual structure to it about what difference it’s making. We need to see that on paper; government needs to see that on paper. That’s our wish list.

Then, of course, what we really believe is that funding is required to provide emergency and permanent shelter for those youth that are suffering mental health crises. They can’t be on the street in that revolving cycle. We’re enforcement. We pick up the youth. We try to get them into care. If it doesn’t, we’re going to pick them up tomorrow and we’re going to pick them up next week. That’s not appropriate.

We feel that there just needs to be an influx of funding to create permanent housing, shelter for them, job creation and youth independence to ensure that they are
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free from addictions and free from mental health issues as much as they can be, or allowed to manage it prior to adulthood. It’s just a little bit of a time.

I added information-sharing guidelines, the federal and the provincial, and know that’s what we work from. We really believe that if there are reasonable grounds to believe that compelling circumstances exist that affect the health or safety of an individual, it’s our duty to share information.

I like the quote, too, from 2008, the Privacy Commissioner speaking to a report tabled on youth suicide, that a life has to trump privacy. But we do have guidelines and authorities that allow us to share in those most critical situations around our high-risk victims and clients, for sharing of information.

J. Thornthwaite (Chair): Barb, sorry. Can I just interrupt? You’re about halfway. Recognizing that you’ve got another 15, maximum 20, minutes….

J. Thornthwaite (Chair): Yeah, because we want to have engagement from the committee members.

The crisis response — this is critical for us. If we could have, in MCFD and aboriginal MCFD, after-hours contact for police to get information on the clients suffering from a mental health crisis that are common clients with MCFD, that would really help us and support our taking that client to care, because we’d have a more robust information package for the clinic.

The other thing which we’ve heard time and time again is that those ERs and ER psych nurses really should be trained in youth mental health assessment. What’s happening is that the members, the police officers, are having to wait with a youth in crisis for a crisis response clinician to come from a neighbouring community. I mean, listening to the last presenter, having that help in the hospital as well could be covered off there.

We have specialized training. I don’t need to go through that. It tells you everything. We do some crisis intervention training. But the one thing I do want to mention is that we have been adding those youth mental health and suicide workshops throughout the province. We’ve been running them out of our office for the last 3½ years.

In fact, today we’re in Maple Ridge running one for about 160 service providers. We invite all the community partners, and they all hear the same message around youth that are struggling. They have panels with different community service providers. I have that for afterwards if you want me to leave even just what the agenda is on that.

One thing I want to mention is that we even get so far with all the service providers that come in — around 160 are there today, all the partners around youth mental health — that they’re even studying “Understanding the Teenage Brain,” with Gary Anaka. We do these workshops every year in every district — the same workshop so that everyone has the same message. The panel discussion is on managing youth in crisis. Then they have lots of work with Fraser Health Authority and learning about concurrent disorders, substance use and early psychosis intervention.

This is where we’d like to go. We’re not there yet, but nationally and provincially we’re looking at the five-day advanced mental health training. I’ve taken that. Years ago we used to do it. It’s wonderful training. The two-day enhanced training for a core group of first responders, then one day of nurses training for those that ride in the cars, just for their safety.

Really quickly, around domestic violence. We’re working with CCWS. We have ICATs, which are the interagency cases assessment teams. We work hard in the communities with the Community Coordination for Women’s Safety to deliver training for all those service providers that work on high-risk domestic violence victims. We’re on the ground working with them.

We know that domestic violence and mental health often go hand in hand, and youth are always involved. We’ve recently starting sharing statistical information with the Ministry of Children and Families. That’s been a win for us. That’s been going on about three months.

I thought I’d just flag for you here that I don’t really see any difference with the local action teams. The ICAT is a collaborative approach to information-sharing, and so are the local action teams with the Child and Youth Mental Health community service providers. That’s where we’re going.

That’s the program review. It’s all there. I know it’s a lot on PowerPoint, but I just wanted you to have it. It is a bit of a picture of where we’re trying to go. That’s as much as I could cram through that.

J. Thornthwaite (Chair): Thank you, Barb. And your slides were really, really clear.

D. Barnett: Thank you very much for your presentation. I think we’ve heard this over and over again: collaboration, coordination, more community-based programs, more funding, more this, more that.

How do you feel we get there? We know the problem. We know there are agencies out there that this is part of their mandate. We know there are organizations within communities that are working towards this — health authorities, etc. What seems to be the issue that people can’t seem to sit at a table together quicker and solve this problem?

B. Vincent: Well, it’s relationship-building. That takes time. That takes a lot of effort. That’s really what we’re
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finding around the ICAT training. It doesn’t come easily.

I really liken it back to managing my own office. There are conflicts in there. I have to be able to sit down and have those conversations with those people who are causing conflict. I have to be willing to do that, and that’s what service providers do. Do you know that nowhere in the ministries, any of the ministries, do we actually do that? We don’t teach that type of leadership.

In our organization we teach: “What do I produce that’s good? I want to advance in the RCMP. What do I do?” It never talks about: “How do I work with my community partners? How do I have those respectful relationships? What have I done together with a group of people?” It just has to come from all levels of the ministry. That has be taught at the lowest levels.

Right now I really think there needs to be that review that I talked about. What are the best practices out there? Where do the funding dollars go? What are we getting for there? What coordination is around that? Then, a reporting framework.

Again, that local action team. We are on the ground with our detachment commanders teaching them how to have respectful relationships. When attrition happens or transfers happen or changes of leadership happen, we have to be willing to go back in and have those same conversations. And they’re difficult.

Within our organization, our responsibility is our detachments, but I think all the ministries need to understand. Can you imagine if, at the highest levels, that information-sharing protocol was cemented so that part didn’t have to be worried about anymore? Then there was a review, and people felt that that money was going to those proper areas. Then each of the ministries were really working hard with their service providers out in the field, not just saying: “You need to have a local action team.” You need to make it work. That’s hard work.

T. Norton: I think probably my only comment around that is that we often fall along the path of being overprogrammed. I think the overprogramming and not being able to manage those expectations around what Barb has just suggested is a real challenge. One of those big challenges really does come from, provincially — at least, I can speak for the RCMP — the crushing administrative burden that we fall under, that we have to really struggle with.

I will say that again. That’s certainly public, because our friend Darryl Plecas has spoken and worked on that for a number of years in terms of his previous role. So that’s not a surprise that that happens.

I would also suggest that what Barb is just mentioning here…. When you talk about working together or having to work together, sometimes there just needs to be that legislative push in terms of the leadership here to make it work. Other than that, there’ll be a real struggle, because some ministries just simply aren’t that receptive to doing that. They’re working for themselves, and they’re trying to do the best job that they can. But there’s a real struggle, internally, as opposed to reflecting that outside and saying: “We can make this work together as a whole.”

D. Plecas: Thank you for the work that you’ve been doing, I know, for a long time. I should tell you that in my work on the Blue Ribbon Panel, looking at crime reduction, one of the things we learned as we travelled around the province is how much communities everywhere in the province appreciate the work that you’ve been doing around this.

The question I have relates to this growth that we’ve seen in cases over the last five years. As you provide in one of your charts here, that growth has been over a 50 percent increase in just five years. This seems really remarkable. I know if we go back ten years, that climb is going to be even much steeper.

That’s disturbing enough, given all of the efforts that have been put in place, all of the people working to do something about this. Despite all of that, we’re still witnessing this year-over-year increase. There are not too many things that we have in life where there is a 50 percent increase in five years. Then, of course, there’s the increase on the adult side too.

I guess one thing I would wonder is…. From your perspective, your experiences, can you tell us anything about what you think is driving this increase? That’s one.

The other part of it is that I’m wondering…. When I think of those stats, is it an increase in…? Obviously, it’s an increase in files. But is it an increase in numbers of people, or is it that we’re seeing more frequent fliers? Because, as you know, we hear of cases where the same person is visited by police 50 times in a year.

I think it would be helpful for the committee to know that. If there was some way for us to get those numbers on: are we talking different individuals?

B. Vincent: We absolutely agree with you. There are a lot of concerns around that. In 2004, I was stationed in Oliver. I went to a youth suicide, and his worker came up from the Downtown Eastside and said to me: “Barb, you’ve seen nothing yet. Wait for ten years and see the rates of mental health double, at a minimum, with the amounts of drugs and the makeup of the drugs that are out there right now.” We fast-forward 11 years, and we’re seeing that now.

Absolutely, some of the biggest things are that we have stronger and stronger drugs that are out there, we have more youth experimenting, and it’s easier to get. I don’t think we have enough assistance for them. We used to have secure housing. It’s not there anymore. That’s difficult, right?
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When you talk about the individual cases, I can get our analyst to look and see how many are repeats and how many are one-time-only. But I’m going to suggest that a lot of them are repeats. If you don’t have really strong relationships…. And a lot of this is criminality-based too, so it’s difficult. That’s why we mentioned that if you get to the court system, we’d really like mandated treatment. But if not, a lot of that has to be work that’s done with your collaborative approach — that relationship you’ve built with the local action team prior to criminality, getting those high-risk clients into the myriad of care that’s actually out there. But you’ve had to have developed that relationship with them prior to.

A lot of time with policing — Tom talks about the crushing burden of police out there — our detachment commanders are just overwhelmed with people that want to have partnerships with them. We’re trying to suggest high-risk domestic violence victims, high-risk mental health clients. Let’s work around just those two parameters.

But yeah, the lack of that housing that’s available. They’re out on the street. They’re living wherever. And they’re going to come into our contact the next day, the next day, the next week, the next month. And it’s not appropriate that we’re dealing with them all the time. That’s where we get such disenfranchised youth with police too. But it is the method in which the cycle is evolving right now.

I’m really glad that you’ve actually tied domestic violence into this discussion. I do think it’s important, and it’s not something that has necessarily come out of many of our presentations.

I am struck by the fact that you have, in this short presentation here, talked about the various sorts of teams that are available out there — car teams, YART teams, LATs, ICATs. I mean, it seems to me the lack of consistency is just glaringly obvious. We’ve heard that from communities and from families — about a sort of lack of consistency.

I can see that even in your universe, there are a whole variety of teams, and I think you rightly said that some of them do very similar things. I don’t know why that…. The lack of consistency there is, I think, a problem.

I’m curious about some comments you might make on lack of capacity. When you talk about court-mandated addictions treatment, we already know that there are not enough facilities. There not enough beds. There are not enough services for existing pressures. If you’re going to look at court-mandated now, how do you address the lack of capacity?

It seems to me in some ways that your discussion lands us in the middle of the issue, where you’re dealing with individuals once they have become engaged with the police system, rather than looking at the capacity for services and preventive services early on — early interventions that would keep them out of contact with you.

Do you have any comments on that? You haven’t touched on the issue of capacity. It’s always great to say we’d mandate it, but we don’t have what we need now. We’ve heard that universally in these presentations.

B. Vincent: I know. Those certainly are suggestions or our recommendations in a utopia. That’s what I would think about; it would be really nice. But again, our detachments are overwhelmed. We know that. We’re not mandating. What we’re doing is suggesting.

We watch our statistics rise. The only way to change that statistic rise in detachments — and they’re accountable to their district officers and, ultimately, Assistant Commissioner Lipinski — is to keep those numbers trending downwards. That is going to come with those partnerships around those high-risk clients and having those strategic partnerships.

So we may not say that they’re mandated, but you’re not going to get anywhere unless you have those partnerships. Our goal is to have those…. Yes, certainly, we can bring them in if they’ve hit the criminal system. We can bring them in and try to manage them, particularly if they’re youth. But if we have that respectful workplace already with all those service providers, there’s no reason why we can’t get involved and help with those recommendations, and prior to any criminality they’re moved into appropriate care. That is ultimately important.

You’re absolutely right. There’s a huge lack of any consistency. We know that. It was interesting for the two of us to look at the entirety of the names. We’ve actually gone out to Saskatchewan and looked at the COR and the hub model that the provincial government is working on there. We’ve briefly looked at the Ontario government and the work that they’re doing with the Ontario Provincial Police around the continuum of community policing. But that’s all out of the government level too.

That’s kind of where we would love to go, which is why I also put that information-sharing in there. Even if we could get the government, at the highest levels, to learn how to share information properly, and all the ministries, and then teach all their own people, funnelling down through their ministries, that would be critical right now.

One thing we’ve heard a lot, certainly in the health care system…. We heard it from the education system yesterday, and it’s clear that law enforcement has a similar broad kind of cultural thing, and that is that it’s highly, highly networked. The truth is you get your work done often through personal relationships. I suspect that that networking…. Underneath a lot of it is probably sharing
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information in code or unofficially that can help people do their jobs. So I think that your point about effectively sharing information and being allowed to do so would be helpful.

My point is that collaboration, we all know, takes a lot of time. It’s the first thing that’s stripped out of budgets. Budgets are all about inputs now, and it’s very hard to construct a kind of budget that makes space for the kind of collaborative work, one-on-one networking and relationship-building.

Do you think that you would have a way of figuring out what the cost of that work, which is really fundamental to making the rest work, is?

M. Stilwell: Yeah, so that you have a place in your budget. The fact is it does take time to build these relationships and networks.

B. Vincent: Thankfully, we have an assistant commissioner that actually agrees with the work that Tom and I do and understands that it’s really important, and he’s doing that as well at the higher levels, which is ultimately where we move forward as a province.

I couldn’t even begin…. That would have to be…. We were talking about that on the way here. That’s why we said that reporting structure, too, or that framework for everyone that’s providing youth mental health care…. Where are those funding dollars going?

Collaboration. You would have to have a big research department to actually look at — like an ACT team, the assertive community teams — all those client contacts prior to with every different ministry. How much did that cost versus how much does that collaborative team cost now, how can they manage, and what’s the projection for the future on cost? I guess that would be my only…. If you don’t know collaboration innately, it’s really hard to quantify that with a cost, I guess.

I think one of the things that we would probably want to impress on leadership, ours primarily, is first of all to have a really good understanding around the concept of time. Having had that…. Barb and I understand that. We have a really good appreciation for that — the cost around time, energy and money and what that looks like. Factor that in and impress on our leaders, specifically like you just mentioned, what that would cover. You would add on top of that the resource base required to get the job done. That has another cost on top of that.

That’s an absolutely huge struggle, even if you were to follow the number of themes that we’ve looked at in terms of what you’ve just heard and the themes around: what would that success look like? You’ve probably heard that before. What exactly does it look like?

How much further upstream would you like the police and law enforcement to go to be able to do what you’ve just suggested in terms of dealing with calls that come to our attention before they come to our attention — the prevention side, which is an absolutely huge, huge part. I’m sure you’ve probably heard this before.

Mental illness is not a crime. Where we come in, in terms of law enforcement is that people who are mentally ill do commit crimes, and then it comes to our attention. So how do we get past that and get beyond that and look past the faces that we meet to be able to deal with that more effectively?

J. Thornthwaite (Chair): Thank you very much for your presentation, the time that you took to present to us and the time that you took to come here. Common theme, and we really appreciate it.

J. Thornthwaite (Chair): Our next presenters are already here. Welcome. We’ve got Bev Gutray, the chief executive officer, and Jonny Morris, senior director, planning and public policy, from the Canadian Mental Health Association.

Just a reminder. We are running about ten to 15 minutes late, unfortunately, but we will give you your half hour. So around ten minutes for a presentation, just to allow the committee members to have engagement with you afterwards, would be ideal.

B. Gutray: Thank you very much. We really appreciate the time to come and speak with you.

We only have three slides. My second slide already has an error because it’s a different presenter than what we did. This is not Tara Wolff; this is Jonny Morris. I am who I say I am.

Our whole presentation this morning is really about the fact that throughout the mental health system, whether we’re talking about the adult system or the child and youth system, we are making choices of where we spend money. Right now we would say that we’re spending it — we’re following the RCMP, which is just great — in policing, we’re spending it in jails, and we’re spending it in unnecessary hospitalizations for children and youth.

What we want to present to you today is how to get in front of that. If we were talking about cancer, we would be talking about before stage 4. So our presentation real-
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ly hones around that really early intervention piece, before stage 4.

You have got a presentation. We’re going to talk to you specifically about one program — Confident Parents, Thriving Kids — and how that is a platform for a provincewide transition and a provincewide collaboration, etc.

There are also two other programs that are ready at the early intervention stage. Many people are very familiar with our Bounce Back program, which is a telephone-based delivery program. It’s anchored in CBT, so people who call in use those skills. Right now we serve approximately 5,000 British Columbians — just recently featured in the Globe and Mail series.

As well, we have capacity to extend that program without spending one more dollar. Without spending one more dollar we could extend that program to youth as far as the age of 15. Right now you have to be 19 to access the program. We could extend it and be part of a broader-based system.

The province is already invested. The proof is in about the effectiveness of the program and that it works well.

The other one, which I’ve shared with Jane, is a youth intervention. We just have a pilot. It’s Blue Wave Youth. This is a course-based program. It’s youth and adults working together as a team to deliver CBT skills to youth. When we developed this — it’s evidence-based as well — we did a call-out for youth to be involved in that advisory committee. We had 75 youth from across the province who wanted to participate. We chose eight.

The good news about the program is I thought we were going to be doing a program that is sort of web-based, and our advice from youth is they wanted to be face to face. They wanted the group. They wanted friends. So that’s where we are, and I can talk about that at a later time.

Confident Parents, Thriving Kids — what it really does is it provides that early intervention platform for parents. It’s a program that’s based on parent choice and parent-directed, and it’s parents who begin to see the signs of their young child really struggling with behavioural problems. It’s showing up in family occasions. I’m sure many of you have been witness to those kinds of situations. It’s showing up in schools. The young child actually doesn’t want to go to school anymore because they become alienated. They are not included.

Parents are very motivated to find the right help. The truth about parents getting the right help is that for the most part you have to operate in a service delivery system that operates Monday to Friday and during core business hours. This program is delivered remotely through telephone. It operates six days a week, and it operates early morning and late evening hours. For example, right now the most sought-after time slot is 8 p.m. — not a surprise to anybody around the table and not a surprise to us. I feel very honoured that we have that ability.

I also feel that we’ve worked very closely with the Ministry of Health and the Ministry of Children and Family Development on bringing this evidence-based program to B.C.

What it offers is…. Although we do a telephone delivery around early intervention, because of the training and the research components that really are embedded in the program and underneath it, we’ll be in a position where we can train existing child and youth mental health providers — whether they are in a family service agency, whether they are at an aboriginal friendship centre, whether they are part of school — to actually deliver the same kind of evidence program under their own brand with their own kind of language with a cultural lens on top of that.

That’s why we went to this model. We really like the idea that the full community transfer respects the populations of B.C.

I’m going to stop talking there. Oh, I’m just going to add one point. To date, just for example, we’re part of the child and youth collaborative. Because of that, we’ve been presenting on this program. You’ll see in our presentation referral patterns around 60, 80, etc. As of June, as a direct result of those presentations, our referrals from physicians and pediatricians to this program are at 120. The demand is high, and the need is high, and we want to be that support to pediatricians, physicians and parents. We want to be embedded in parent choice.

I’m going to stop talking. Jonny is going to take you through the highlights, and then we’re going to have a conversation.

J. Morris: Good morning, committee members, and thank you for the opportunity to speak with you this morning. I’m not going to go into the program details in too much detail. I think probably some of the research findings, especially in the wake of our colleagues from the RCMP, will be of significant interest to you.

One of the key things about this program is that it’s very accessible. Parents dialling into this program have a weekly coaching session with a coach who has been trained and supervised by a mental health specialist who oversees the program.

What they’re learning through this program are some really basic family management skills — how to give good directions; how to make sure that children receive positive and negative consequences and learn that their behaviour can shift and change; and lots of very strength-based pieces around how to regulate emotion, how to do well in school and how to do well with siblings. There’s lots of detail, and we can provide more material to the committee as we move forward.

As Bev was saying, physicians across this province are huge fans of this. I really heard the comment from Maurine earlier about this integration. Are we doing lots of siloed work or actually talking together?
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One of the beautiful things through the collaborative is that people are actually talking together. MCFD knows about our program. So do doctors, through PSP, the practice support program. So actually, we have a program that’s leveraging existing bench strength within the system. Currently we have a very small subset of parents that we’ve recently interviewed, and 90 to 100 percent of those parents say that they’re experiencing resolution of the presenting problem, so it’s very, very significant data.

You heard from Dr. Charlotte Waddell yesterday about a range of evidence-based programs, the Incredible Years and Triple P. One of the things that we’ve been chatting with Dr. Waddell about is actually this program, the program we’re describing, which is actually called the parent management training Oregon model program. It gave birth to many of the programs that you’ve heard. It was one of the progenitor programs, which means that they’ve been able to gather lots of data. I know the next set of statistics will likely be of interest to Dr. Plecas on your committee.

The program that we are implementing here in B.C. and hope we can proliferate at a provincial level has been implemented across the U.S. at state levels. Kansas and Massachusetts being some good examples. Actually, the entire country of Iceland has integrated this program into their education and health system.

In Iceland they’re currently seeing reductions in antisocial behaviour at a population level. Those folks aren’t actually making contact with the police at all because they’ve been directed out of the system. Over time we would anticipate that those same pieces would happen here.

The other thing that I think is very significant is this program has undergone a number of randomized control trials. Over nine years, in one study for this program, young people were 60 percent less likely to be arrested by the age of 14. So you’re seeing significant reductions in arrest rates. That 50 percent statistic from earlier, of the growth in mental health contacts — what would it be like to actually reverse arrest rates by 50 percent, with the kind of implementation that we’re doing in this program?

One data caveat is that those RCTs were based on face-to-face interventions and at a group level. So we are doing our own research program to make sure that we can study that in the same way.

The last piece of research that I’ll just comment on for a couple of minutes is that often when we think about these programs, we think about changes at the child level. This program clearly does have change at the child level. There’s a lot of potential for this program to make savings to public services later on. I think that’s been a big thrust of the conversations you’ve been having at a provincial level.

One of the beautiful things about this program is that it also exerts changes at the maternal level. One of the key findings from the RCTs that have been done in the U.S. with our colleagues who created this program is that they’ve seen maternal depression rates improve. They’ve seen maternal arrest rates improved, and they’ve worked with some of the hardest to serve. We work with a mild to moderate severe public. They’ve worked with very severe symptoms.

So maternal depression improvements, maternal arrest rates, and perhaps very significantly, 20 percent of moms in one study were lifted out of poverty simply by virtue of participating in this particular initiative.

I just wanted to provide…. I’ll turn back to Bev to see if she has any closing remarks. We can, of course, give you some more details about actually what happens on the telephone.

Bev was mentioning this idea of full provincial transfer. Often when we talk about licensed programs, you have a company that actually makes lots of money, because you’re paying licensing fees. What we’ve done here is actually invested, with the support of MCFD, into the development of this program. In 2018, pending certification, CMHA will have the ability to actually be what’s called a governing authority. We’d actually have the capacity to sit with staff in MCFD, within the education sector, with health authorities, and train them up in this program ourselves. So you’d actually have a made-in-B.C. solution in three years, much like what’s happening in Iceland and Norway.

At that point you would actually start to incur savings, because within those caseloads you’d have an MCFD clinician working in Kitimat or Revelstoke who’d actually be able to deliver this program to groups as part of their existing caseload. That’s typically how this program is implemented. What we’re doing is a pure implementation, with 8½ people in Vancouver delivering this program across the province purely, with nothing else as part of their caseloads.

B. Gutray: Just to add to Jonny’s comments. It would be really limiting if all we ever do is the telephone program. It’s valuable, but it’s limiting. The real opportunity for British Columbia is not only in ourselves being in a sort of a training governing authority in three years but so could other organizations three years post. So if it was the aboriginal friendship centres, they could. If they wanted to, they could go that route.

That’s what we like about it. We’ve looked at lots of programs before we landed here. Where we believe we get caught is ongoing licence costs that you don’t control, or you may set out a licence for a couple of years, and then it gets away on you. This program doesn’t have that. It has an initial investment, but it is about ownership in the community.

I really like the fact that it’s been adapted in so many different cultural contexts, with very sensitive cultural adaptations being made by people who participate in those programs. And it makes sense to me. It makes sense
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to me that we don’t want to be sitting, three years from now, with 120 families waiting for a telephone-based delivery. I mean, the reason you do early intervention is so that you do it quickly, you do it fast, and you help people. They get back their life, and they have the choices that they need.

Parents are motivated. We’re all motivated — parents, grandparents — for the best of our children and youth in this province. I think that when it is full provincial delivery, the telephone-based delivery will be…. We won’t have a wait-list because the people who are in the more moderate to severe range will be seen by existing agencies with exactly the same approach. It will just be in a higher range.

But one of the other pieces, just because I think you’ve probably heard lots about waits and delays and disintegration in our systems of care…. Arguably, one of the things…. I just want to list through some of the goals of this program and its potential.

I think we know that the current sitting government and also the opposition and all of you are very committed to evidence — that evidence base, that you’re yielding the maximum return on taxpayer investment. I think, given that this program is designed to improve parenting, there’s an intersect with domestic violence as well and on improving parent and harmony in the home around that.

This program is also designed to reduce internalizing and externalizing behaviours. Those are those acting-out behaviours, and also some of those problematic behaviours where young people have a hard time self-regulating or self-soothing.

One of the other pieces that we haven’t emphasized and we should is that this program is actually designed to reduce and prevent substance use — so back to Inspector Barb Vincent’s comments about how do we prevent the need for even having mandated court for young people who live with an addiction. This program has actually been shown to reduce substance use in a number of its studies — and also academic performance.

We can comment much further, but we’d love to hear your questions and engage in some dialogue with the committee. Thank you for your time.

I live in rural British Columbia where we are fortunate enough that we do have Canadian Mental Health Association offices in our communities with wonderful workers — a lot of collaboration and a lot of work.

This program that you presented here today sounds good, probably is very good, but the question that I have is: will you be collaborating with organizations that are out there already doing much work in the communities with this issue?

B. Gutray: Absolutely. I mean, we’re not meant to be alone. We’re just part…. We’re one of the players. Our role is very much around the early intervention and supporting parents.

In addition to that, we actually have all kinds of other organizations that we recommend parents to see, and our collaboration has been very central with the Ministry of Child and Family Development and with the Ministry of Health, as well as the collaborative.

J. Morris: Just a follow-up on your comment there. Within the Child and Youth Mental Health Substance Use Collaborative, CMHA sits at a number of the steering committee levels, alongside the FORCE and other youth-serving organizations. There’s been a lot of collaborative effort there.

Really, it’s back to the question that was raised earlier — by yourself, I think: how do we figure out this, kind of, wall that we’re up against? There is enough work to go around for us to share this work, and really probably what’s required is a collective impact approach — that we really actually bring a collective intelligence to this very complex set of issues sitting in front of us and start to collapse many of these very artificial silos that exist in government and in the non-profit sector.

I think the answer to your earlier question is for us to work together — very much so.

M. Karagianis: Thanks very much, Bev. Nice to see you. One of the things I note here is you talk about the fact that your funding for this program is insecure at this point, or….

B. Gutray: Yes. I mean, that’s our world sort of. We live in that world. We’re used to that world. We’re very grateful that we’ve been supported through the Ministry of Health as well as the Ministry of Child and Family Development as far as granting.

There’s been a grant. It hasn’t been annualized. That’s really what we’re struggling with now, and we’re hopeful. The program makes a big difference to children and families that are waiting on waitlists of MCFD. We’re hopeful. That’s all I can say.

M. Karagianis: Well, certainly part of our task will be to look at the whole variety of presentations we’ve received
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and try and look at what kind of recommendations would we make that are doable, that meet the end goal of what we’ve consistently heard, which is early intervention and prevention, and this is very much a preventative program.

But I do think it’s important, as Donna has outlined, that collaboration provincewide has been pretty important. I mean, I would think your organization is in a particularly good position to be able to connect with every community and to begin to put some consistency in place on some of these issues, because the lack of consistency is what we’ve heard from families.

M. Karagianis: One of the things I believe we’re going to have to come out of this forum with is some recommendations to government on how we resolve that. For families to be able to access service — that’s the most important thing. Getting a lot of groups of people together to talk about great collaborative efforts doesn’t help families out there who can’t get service or who can’t get early intervention or who are not being brought into that preventative model early enough. I think that’s really important.

B. Gutray: If I could just comment. For members who may not know, there are 14 branch offices across B.C., and in the past year we provided services to more than 100,000 British Columbians. In our branch community offices they work in partnership. We have over 30 services that are actually dedicated at the community level through our branches.

As far as the consistency issue, absolutely. I mean, that’s why we’ve really landed on this parent management training program, because it does guarantee a consistency. Whether you’re on the phone or, what we hope, whether you’re face to face at an MCFD office or whether you’re in a school, it will guarantee a consistency in approach of what a parent will receive.

J. Morris: Just one follow-up comment. I think what we’ve read and heard from many families is about wait times and that long wait that can go on for long periods of time. One of the things that we’ve ridden on with Bounce Back, which is on depression for adults, is that you get contacted within three to five business days, and that’s the same standard here.

You get referred through your doctor, and your doctor makes that referral across. That referral doesn’t disappear into a black hole. We have a coordinated approach where that parent will have contact very, very immediately so that they know what to expect and when their treatment program will start with this program.

J. Morris: There’s an ongoing — back to the information-sharing piece — very strong feedback loop to the treating physician, so you’ve got an integrated primary care model there as well.

D. Plecas: Hi, Jonny and Bev. Nice to see you again, and thanks for the great presentation and the good work you do.

One of the things I couldn’t help but think, in listening to you and listening to you times before…. This is perhaps a bit of a stretch here, but what about the notion of having cog skills, life skills, in public school? To some degree, we have this of sorts. We’ve heard some people present here previously that talked about what we could do.

I look at what you’re doing, and I know it’s fairly targeted, but it seems to me you could make a case that everybody needs this — certainly, if we’re talking about being preventative. And thinking about your chart up on the screen, why do we do that?

J. Morris: I think you’re absolutely right. This program, at a universal level, given our mandate around that mild to moderate…. I mean, one of the premises of CMHA is universal access. We really want to get people at a population level.

Probably, to respond to your question more directly, and we’ll submit this in a separate submission…. Living Life to the Full is a program that really gets to those like skills, the basic skills that we all need to mobilize ourselves, get over humps of inactivity, take action, problem-solve, arguably, for young people who, when they get to transition — transitions have been a big theme of your work too — get to university and college, perhaps haven’t had that experience of those problem-solving skills. So how to move through some of that paralysis.

Living Life to the Full is a program that RCTs and other studies have really shown to be very efficacious in moving that forward. This could actually be readily embedded into the education sector — Confident Parents, Thriving Kids and Living Life to the Full, absolutely. We’ve had lots of good success with that, trying that out in that school-based setting — and arguably, college and university too.

B. Gutray: If I could just make one comment. With the Confident Parents, the average age of the child is 5.5 years, so we are hitting at a very early intervention point. The other part of the discussion — and I’m sure you’ve had these presentations — is that without an intervention, these children sometimes don’t remain in school or they’re home-schooled. We want to get in front of that. We really do.

D. Donaldson (Deputy Chair): Thank you for the presentation. So 850 families and a budget of $1.4 million. Doing the quick math, that’s $1,000 a family. That seems
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to be a pretty minimal amount when we’re talking about a preventative program, so congratulations on that part.

The part about the full community transfers. What interests me the most, coming from a small town and knowing about somebody far away on a telephone not perhaps being most informed about what local services are available…. Part of that was that you talked about how it could become part of the existing caseload of a front-line worker or bringing the training to community organizations like friendship centres, which I think is fantastic. But have you had the discussion with…? Maurine has brought this up in earlier questioning. Is there the capacity there to add another element to the front-line workers’ workload?

B. Gutray: Our vision is that this would be most targeted at workers who already have children or parents in their caseload that are struggling with behavioural problems and they’re using a variety of methods. So the investment is in their knowledge and skills. Does that address your question?

J. Morris: I think the follow-up to Bev…. As Bev was mentioning earlier, through this implementation we’ve had to rely on very strong partnerships with MCFD and the Ministry of Health, so they’ve been fully apprised and in the loop, up to very senior levels within government. I think that conversation has happened, and I think there’s been strong interest from within the parts of government like MCFD in exploring what that capacity could look like.

If you’re seeing people individually around disruptive behaviours, we know that putting those folks into a group and the peer support that can happen in a group can actually be more efficient than seeing people on a one-on-one basis. So I think that capacity question probably isn’t fully resolved, but it’s definitely a key part of the vision moving forward. Hopefully, we’ll get close.

C. James: Thank you for your presentation. Good to see you. You talked about wait times and the challenges, and I think the program has a lot of potential to address a lot of the pressures that people are feeling. I think, as well, the early intervention, catching people early when they’re asking, when they’re reaching out, when they’re frustrated by how they deal with their child or how they deal with their child’s behaviours, has real strength.

The other piece around the telephone, to touch on Darryl’s point. In some cases I think that helps address stigma for some parents who are afraid to go to MCFD. I mean, we hear that in our offices: “I wouldn’t go to an MCFD office. I wouldn’t appear there. I’m afraid to.” Or “I’m worried about my kids, what it’ll look like.” So I think in some ways there’s a real strength to the opportunity for people to first reach out in that non-threatening way, to be able to get the supports.

But I wondered: if someone, just to give an example, right now goes to their physician, and they say they’re having behaviour challenges with their child, they’re worried about what’s going on, what would be the wait time now to get into this program? What would be the process for them, if they were in a community somewhere, to be able to access the opportunity? Are there wait times for them to even access this kind of program?

B. Gutray: I mean, with our existing staffing complement, the very first phone call really is about the BCFPI. That is administered pre and post, throughout. From that, then there’s a determination of whether someone is going to take the brief intervention, which is six. Right now our numbers are looking at two-thirds of parents who go through the full program delivery. That’s 14 sessions. That’s a lot. We were hoping that that would be more balanced, maybe 50-50. But we’re at two-thirds, one-third with the brief intervention approximately three to five days post-BCFPI.

J. Thornthwaite (Chair): Thank you very much for your presentation and all of your work. Keep it up. And thank you very much for preparing and taking the time to come and present to the committee.

J. Thornthwaite (Chair): Our next presenter…. Apologies to Dr. Steve Mathias. We know we’re late, but come on by, and we’ll get started as soon as you’re ready.

Steve, you’re going to provide us with something, right? We don’t have anything.

J. Thornthwaite (Chair): We’re giving everybody a half an hour. We ideally want ten minutes of presentation and then 20 minutes for engagement, hence the reason why we’re running 15 minutes late. But we’re giving you half an hour.

S. Mathias: I very much enjoyed the CMHA presentation that I just sat through, and I very much appreciate all the work that they do.

My name is Steve Mathias. I’m a psychiatrist at St. Paul’s Hospital. I’m also an outreach psychiatrist, so I’ll be flying into Quesnel tomorrow for two days of pro-
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viding services to MCFD in Quesnel. I’ve also provided services in Prince Rupert as well as Kamloops and the Portage therapeutic community outside of Keremeos.I’ve also worked at the Maples Adolescent Treatment Centre.

So I come from a place of working both with the Ministry of Children and Families as well as the Ministry of Health. If it was a term you would use in Canada, I’m a board-certified child and adolescent psychiatrist as well as a diplomat of the American Board of Addiction Medicine. So those are my sort-of credentials.

I’m here today on your invitation. I very much thank you for allowing me to come today. I’m here to speak about the idea of integrating health and social services together for youth. I want to give you an idea in terms of our own real-life experience when we have to access services.

When we have to access federal services, we typically go to a place called Service Canada, whether it’s for a passport or whether it’s for a birth certificate or anything that has to do with the federal government. There are offices set up. There are some that are virtual, and there are some very much on-the-ground, real offices set up in this province for us to get those services.

Similarly, those offices exist for the government. If you have certain things that you need from the government of British Columbia, you go to those offices.

It’s funny, because youth access services in a very similar way. They want to go to one place to get their needs met. They’ve told us that again and again and again. So what we’ve done in Vancouver is created an integrated health service hub, or centre. Chair Thornthwaite was there for its opening.

I’ll give you an example of how it works. We had a young person come in, referred to us for the first time. Based on the referral, we knew that she had some issues with hearing voices, some psychosis — not severe, by any stretch of the imagination. She also had some substance-use concerns. Her physical health was something that was noted as being something to talk about.

On interview, we had a nurse practitioner, a psychiatrist and an addiction counsellor in the room with her. As it turns out, she’d been smoking cannabis for about seven years, had developed some psychosis in the last couple of months and had had three therapeutic abortions in the last three years.

We had a nurse practitioner discuss birth control methods and also do some counselling around safe contraception. We had an alcohol and drug counsellor be able to discuss with her cannabis use. And we had a psychiatrist who was able to prescribe an antipsychotic medication, which, in that moment, she needed.

That was all in a 45-minute appointment. You can imagine what it was like for that young person. In the real world, what would happen, typically, is that it would be a three- to six-month wait to see a psychiatrist. She would book an appointment to see a nurse practitioner a week or two later. She would go, probably, to another centre to see an alcohol and drug counsellor.

The fact that we were able to do that in a room together gave her a sense that she had a team working with her, gave her an ability to understand how each of those conditions or issues interplayed with the other and left her basically with the words, “This is a one-stop shop; I can’t believe this exists,” as she walked out the door.

Not dissimilarly, we had a young person come in for a mental health follow-up and say: “I need to see an income assistance worker because I would like to get into treatment next week.” As you know, if you’re a young person, the only way you can get into treatment is if you’re on income assistance. We had an income assistance worker in the office at that time. She was able to visit with that income assistance worker and within seven days was in a treatment centre.

That’s the type of outcome that we want in this province. We want young people to be able to walk into an office, sit down with a person they trust and if need be, halfway through an interview, be introduced to someone else who’s going to help them with their needs. We can do that in this province, but it takes effort to integrate those services.

I think there were some questions from the panel before about collaboration and working together. How do we do this? This is what my presentation is today.

We all know about the numbers. We all know that only one in four youth typically seek help. That’s something that we’ve heard again and again. We may have as many as 300,000 youth in this province who need help when it comes to mental health and substance use. But frankly, the number doesn’t really matter that much.

Some youth need help for birth control. Some youth need help for primary care. Some need help with income assistance. Some need help with mental illness. Whatever it is, what we want to do is turn this on its head and talk about how we serve youth. How do we educate youth to become consumers of services? Really, that’s the question.

Youth right now believe that the place to get mental health support is an emergency room and a walk-in clinic. That’s not quite what we want. Similarly, they don’t know that going to a family doctor might be the place where they can get support for mental illness and substance use. They also don’t realize that an alcohol and drug counsellor might be trained with mental health training. It’s up to us, somewhat, to start educating our young people in terms of how to access services.

There are some very real statistics about intervention. You’ve seen that along the way as well. Conduct disorder is one obvious way of saving money, so there’s a focus on the judicial system, obviously, and early intervention for conduct disorder. There’s also a very real number, which is saving money by decreasing the severity of mental illness.
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We’re not necessarily looking for a cure, folks. We’re looking for young people to be able to recover. We’re looking for people to be able to function. I, as someone who has had a long-standing anxiety issue and has had depression in the past, can function quite well with anxiety. It’s something I’ve come to terms with. That was part of a recovery model.

We don’t necessarily have to worry about curing all these youth. We have to help them function, and that’s something that is very key. That is really where a lot of our savings can happen. So we have to work within a recovery model.

The need for integrated health is tenfold in a lot of ways. There’s a large unmet need in our target population. There’s often confusion about where to find services, and I’ve highlighted that already.

Services are patchy, but in this province they exist. We have invested quite a bit of money in services, whether it’s in Health or MCFD or social services, but the services are often uneven, there’s little measurement of outcome, and there’s quite a bit of stigma and poor public awareness of where those services exist. As we’ve talked about, a lot of our services exist in inconvenience stores. That’s something to keep in mind.

I always look to the Ministry of Health for direction when I make my decisions. They came out with a white paper on primary and community care in B.C. They’ve cited that locally based teams that are grouped around primary care and natural geographies offering 24-7 services as standards and complemented by highly flexible and responsive community social services are what’s needed.

They then went on to say that when all components are present, the approach is expected to lead to transformative system change with reductions in hospital admissions. Those are the words of our own ministry, and that’s what we believe in as well.

When you look at a model that has incorporated that belief…. You can look at Headspace in Australia. You can look at Jigsaw or Headstrong in Ireland. You could look at Headspace, as well, in Denmark. Headspace is, in fact, a one-stop shop. It has mental health, physical health, alcohol and other drug services, vocational and educational support. The latter is really important because that is about recovery. That is about getting kids re-engaged and reintegrated after sometimes being off line for a couple of months or a couple of years.

Key features. It’s a youth-focused program. It’s integrated. I gave the example of what integration looks like on the ground. They’re youth-friendly locations, and this is key. I really believe in this. We can’t keep asking our youth to go to adult facilities, because they’re not youth-friendly and they’re not going to keep the youth coming.

There’s youth participation in the design, and there’s strong community and school connection. People know where to go, what to expect, and they’re connected with the highest level of services. There’s a broad reach.

They’ve got rural sites that are smaller than others, just like we have Service Canada sites in some of our rural communities. They also have some programs that are targeting 12- to 17-year-olds while others target 17- to 24-year-olds. They also have a strong cultural connection to the aboriginal population in Australia as well as special programs for LGBT youth.

This is the waiting room of a Headspace, a lot of lime green. These are two more waiting rooms. Most of you would feel kind of uncomfortable sitting in one of those waiting rooms if you were waiting for your GP. You’re not quite sure who would come out the door if you’re waiting in that waiting room. But youth enjoy this type of space.

Organizational features. They’ve got a strong brand recognition. This is the second leading brand in Australia identified as being linked to mental health services after Beyond Blue. Beyond Blue has been around for over 20 years. They’ve got an ability to scale up. We’ll talk about that in a second. There are close to 77 centres across Australia now. They have access to a centralized data collection and reporting service. That’s something you can do when you build it from the ground up. We have that opportunity to do this now. They’ve got lots of community engagement.

The capacity for knowledge exchange through the collaboration with other sites is huge. I run a centre in downtown Vancouver. There are four other centres in this province, and right now we’re creating a network for the very first time and exchanging information. It’s amazing, because we’ve been collecting data for years independent of one another. When we get together, we actually find out that we have the same challenges.

The comment that people say — “Well, Steve, you’re dealing with a different population when you’re in downtown Vancouver” — is utterly false when you talk to the people in Abbotsford. The folks in Abbotsford are dealing with the same population I’m dealing with. They’ve got homeless youth. They’ve got youth with sexually transmitted diseases. They’ve got youth with mental illness. They’ve got youth with substance use. They’re very, very similar sites. They may just have different numbers.

This is what it looks like in Australia, and they do plan to have 100 of these across the country.

The funding in Australia was very different, because it was federally funded. It was a big whack of money. It’s about $190 million from the federal government on an annual basis. That’s why I’m here. I’m asking for $190 million. [Laughter.]

There’s also eheadspace, and eheadspace is on-line access to both chat and a real counsellor in real time. This is the area that’s growing for them. They also have on-line dissemination of material.

Look. There’s a word — headspace. For some folks, they find that word really, really scary, because it means they lose the identity of their program somehow. All it is, is that they’ve introduced a word into the youth lexicon, so that when youth say, “I need this,” they can turn around and say: “Well, go to Headspace” or “Go to the Headspace website” or “Go to eheadspace.”

It’s just a word. We can’t be afraid of words, because we’ve created words for other things. When you think of subway, what do you think of? When you think of hostelling association, what you think of? When you think of Service Canada, what do you think of? There’s a suite of services that come with that term.

I think that that’s what we need in this province — to develop a brand that explains that there’s a suite of services that are accessible behind that brand. They’ve got a strong social media presence. You can see their use of Facebook on this page.

They’ve got community awareness. They run barbecues. They go to schools. They have a strong youth advisory committee that goes into the schools and works with the schools and the youth to explain to them what the services are at Headspace. There’s lots of awareness-raising here.

You start looking at this, and the first thing you get the sense of is that there’s no stigma. By doing it this way, by promoting it this way, by branding it, the first thing that falls is stigma, because now you’ve got a word to use to talk about it.

This is an aboriginal webpage or program, called Yarn Safe. One of the things I would highlight is that the artwork in the background is very specific to the aboriginal communities in Australia and also represents a shift in their branding. They’re rebranding already, as they go along the way.

Most of the artwork that you saw…. The lime-green waiting room was 2007, 2008, 2009. They’re already starting to turn to the earth tones, and they’re starting to show this kind of doodling in the background in a lot of their artwork because that’s what youth today respond to.

This is something you have to go through. I’m not sure when was the last time our ministries kind of rebranded themselves to be youth-friendly, but if you’re working with half-generations, it really needs to be every six to eight years.

Results. I’m going to be forwarding a package of three-year results coming from Headspace, but it’s effective in youth with mild to moderate mental health challenges. What they’ve done now is they’ve added epicentres to these health centres. Early psychosis intervention, which is considered severe mental illness, is now being linked into 16 of these Headspaces. Youth can go in for mild to moderate presentations but will also be able to get help with their more severe illnesses.

So 48,000 young people have been reached in person, with an average of 6.8 visits per person. An additional 28,000 youth have been reached through the eheadspace program, and that was 2013. These are large numbers. I mean, when we’re talking about how to access services, these are large numbers.

General satisfaction is quite high with the centres. Most of them are above 4 on a Likert scale of 1 to 5. Obviously, this is something that they’re evaluating, and they’ve had further evaluation looking at…. It’s over 80 percent. Pretty much across the board, 80 percent felt that they got help, and they felt better after leaving. Eighty percent of parents felt good about the support they got. Eighty percent of folks felt that they knew more about their presentation than they did before they came in. Some of those numbers are actually closer to 90 percent. So there’s a high level of satisfaction, which is also critical.

And political selfies are very much part of the opening of each one of these Headspaces.

International models exist in other jurisdictions. Ireland, Denmark and the United States have some of these programs. Again, this will be in some of the documents I’ll submit to you. This is the website from Denmark, and this is the website from Ireland. Ireland has ten of these. It’s interesting. Ireland’s population is about 4.2 million, right? Sound familiar? And they’ve got ten of these. It gives you a sense of what it looks like.

The question really comes up: how do we adapt this concept to British Columbia? Well, interestingly, we have dozens of nascent clinics already. A lot of these clinics already exist in British Columbia.

The Victoria Youth Clinic has been in existence for years now. It sees kids aged 12 to 24. They have youth-focused primary care. They have a little bit of psychiatry. They have some counsellors, and they’re on site. They run a great program. They see, I think, over 2,500 youth a year.

Abbotsford has a clinic that’s a mobile clinic, and they also see youth. They struggle because from one month to the next they’re not quite sure where they’re going to be. They’re MCFD-funded.

Kelowna has a Connected by 25 program that’s led by CMHA, but they’ve also brought in partnerships. So they’ve got a lot of housing support workers that work there. They have other services provided there, and they’ve got a psychiatrist working there as well.

Prince George has a program run by the YMCA, and it has been in existence for close to 20 years — a very similar kind of centre.

These centres exist. It’s just that they’re not necessarily integrated with each other, and they’re not integrated with other services locally. So a sexual health clinic in Surrey that sees 8,000 young people a year doesn’t really
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have a strong connection to mental health services, primary care or social services. What they can deliver are sexual health services. That’s it. But anyone working with that population would tell you that about 60 to 70 percent of those kids walking through the door will have some mild to moderate mood and anxiety issues that could be dealt with on site if they were integrated with other folks. There’s lots of opportunity here.

But these clinics have a precarious existence. Many are funded by time-limited grants. Most are established for single or dual purposes. They exist within silos, and they often — as the Parkgate Community Centre in North Vancouver does — ask their youth to sit in stairwells in their community centre while waiting to get their birth control. I don’t think we should be doing that, and I think we can change that.

But that’s what a lot of our youth are doing. They’re going to community centres for a two-hour or a three-hour clinic, and everybody knows why they’re there. They have no confidentiality when they’re waiting to see a physician or a nurse.

We also have a virtual clinic that already exists in this province. I’m not sure if anyone here has heard of Equinoxe. Equinoxe has actually partnered with CMHA, as far as I understand, with the Bounce Back program. You can get a doctor on line. If you have an MSP number, you can get a primary care physician to see you on line.

What they’ve done is they’ve actually leveraged that to get other professionals working with them. This service exists here in British Columbia. It’s a service that started in Montreal and has come here. It’s underutilized, but it is something to think about when you think about rural and remote communities.

There’s unmet potential. The question is: who can access it? It’s not designed for youth. They have access to adult psychiatrists, not child and adolescent psychiatrists. Funding is a precarious model, because it’s based on percentage of family doctor fees rolled into non-physician salaries, user-pay for psychologists. It’s interesting, because the platform is there. We have it, but it needs to be bolstered.

We also have help phones. We have the Kids Help Phone here in British Columbia. We also have the youth-in-crisis line, so we have two lines in British Columbia for youth to call. But here’s the issue: it’s confusing, and they’re unlinked. It’s not clear who a youth calls for help.

The Kids Help Phone is underutilized. It only has 75 percent of youth that you would expect to use it using it. It’s anonymous, so it’s not linked to on-the-ground services. The on-line chat closes at 8 p.m. because their call room is in Toronto. It needs to be rebranded if it’s going to be in British Columbia, because when you call in, you realize that you’re calling and talking to someone who is in Ontario. Youth in B.C., which is the other chat, is limited in scope, and it’s volunteer based.

We have these services here, but I think what we need to do is really think about how we adjust and bolster them to provide us with what we need for the young people.

We also have great anxiety pages. We have Mindcheck, which is another screening page, and we have Bounce Back. The problem is right now we’re asking youth to know what they have wrong with them to access some of these services. Youth don’t always know that, and they don’t necessarily want to enter it thinking, “Oh, I have a mood and anxiety disorder. I’ve got to go to this web page,” right? They often come in saying: “I want to get birth control” or “I’d like to talk to someone because I just broke up with my boyfriend.”

What we’d like to do, and what I propose doing, is to develop a stepped care model in this province. This is something that’s been done at Memorial, and I think it really needs to be done here in British Columbia. As a panel, you’ve heard about all of these various initiatives, and I think what needs to happen is that we have to have some understanding of how everything fits in.

We’ve talked about health and social service centres for youth. There’s one on Granville Street that’s been opened as a prototype by the province, and there are also several in other cities. We have primary care, public health, mental health and substance use. Having those under one roof is really helpful. We also have income assistance and housing. Think about having several of these in the province. Think about having these hubs in each health authority, maybe three or four, where youth can go in and get these services on site.

We have life skills and peer support — again, evidence-based, and we want a recovery model for the youth. There’s a social media presence as well. Think about having a network of these hubs in the province. You have hubs in Victoria, Nanaimo, Duncan. You have some in Smithers. You have one in Prince George. You have one in Quesnel, Kelowna, Kamloops.

They could be a large centre, like ours on Granville, or they could be moderate sized, or they could be small, open maybe two afternoons a week, like a Service Canada building. Through that door you would be able to access the services that you’re looking for.

Think about these services being linked to a call line that has a branding that is similar to the on-the-ground services so that when you call the phone line, you actually have someone who can link you in to services on the ground, who can tell you where to go or who can direct you to virtual services on line.

Really think about how a virtual clinic can lend itself to the work here — so for the rural, remote communities, how you can have youth accessing the help phone and then being directed to see a physician through an on-line service and getting support there, or seeing a psychologist through that portal. Then if they need further support or they actually need to see someone face
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to face, it’s a drive in to the clinic or to the health centre to see someone.

What we want to do, going back to the stepped model of care, is to think about having assessment either on line or in a virtual clinic as the first step, having informational websites as the second step. Think about this: having families aware that this model exists, that the stepped care model is actually something that’s been designed for them and has been branded for them and that’s easy to use.

Think of a second step or a third step where kids need a little bit more help, so they have interactional apps or interactional websites, and this might be something like the CMHA and what they’re offering with Bounce Back. They would have on-line coaching, again, offered in this province. As a step 5, you would have group support and virtual care, and that group support could happen on line or it could also happen in a health centre.

Then, if need be, as the severity increases, you would get individual therapy in one of these health centres or, again, virtually. Finally, you could get intensive case management and acute services if need be.

I really believe that we can build the best system in the world. I know that sounds crazy, but I think we can. We can because we have so much already on the ground, but it’s just not integrated and working with each other. I don’t think it would take a lot of investment to make a real difference and to get youth in this province knowing where to go when they need help.

The steps that I would take in this direction would be to grow a stepped care model; to brand the stepped care model; to connect service hubs, existing and aspiring, and to build them up; to rebrand, bolster and expand on existing help lines; to simplify, strengthen and evaluate the virtual therapies; to develop a minimum data set so we know exactly what’s working and what’s not working and to feed it back into the system; and to advance our health system policy discussion through health authorities in provinces.

Finally, I would recommend liberating the technology. InputHealth is really interesting. I don’t have any kind of financial investment in InputHealth, but it is literally a one-stop technology. In our shop we can replace seven different technologies with this one.

We are often limited, when we’re providing services on the ground, by technology. When you have integrated health services on site, they’re often using three or four different technologies. Giving them one and being willing to go in that direction…. This is not expensive. This is $275 per physician per month. It’s not a lot. We’re talking less than $4,000 a year.

This is something that could very much help with the integration, but we have to think outside the box when we’re doing this.

D. Plecas: Steve, always a pleasure having you here to talk to us, present to us.

I was just thinking about this Headspace initiative. I mean, the whole concept of one-stop shopping — when I hear about that, I’m always reminded of the Nike commercial. Like, let’s just do it. I mean, it makes so much sense.

One thing I think would be helpful for us — you know, if we’re thinking about considering this as something we really ought to do — is looking at what’s happened in other jurisdictions. Like, we’ve got Australia. It’s been there.

It would be really nice for us to have in front of us…. What are the outcomes? I know you provided some. But I’m thinking about, for example, here in British Columbia we just had somebody tell us that we’ve got a 50-plus percent increase in police calls in the last five years. I’m thinking that we shouldn’t be seeing the same kind of increase in Australia and some of these other jurisdictions. What are some of the other ways this is showing itself to be very impactful downstream in terms of some of these other things?

I know doing comparisons is complicated sometimes, but there seems to be enough of this going on around the world that if we could just have something which would provide a picture of: “Look, here are the long-term benefits here.”

S. Mathias: Right. Well, I mean, the long-term benefit, quite straightforward, is…. The estimates are for every dollar you spend on early intervention, there’s about a $3.60 return, and every dollar you spend on prevention is about a $5 return.

We can make it super complex, or we can look at it in a really simple, straightforward…. There’s no end to the types of questions we can ask — right? — when it comes to: can we decrease police calls? Can we decrease emergency room visits? Can we decrease ambulance calls? Can we decrease school dropouts?

All of those questions can be answered. But really, the issue is that we need to put money into prevention and early intervention, and the downstream consequences will take care of themselves. We will see decreases in emergency rooms. We will see decreases in ambulance calls. It’s just that we have to put that investment in prevention and early intervention.

D. Plecas: I so often have said to others: “Look, invest a dollar today.” Like, whether it’s $3, $6, $7 as a return. On some things it’s over $20. But for some reason, that doesn’t resonate with decision-makers.

D. Plecas: I’m thinking what they need to say is: “Yeah, I’m saying it’s going to save you $7, and let’s look at some things which are…. Never mind the savings. Look for
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yourself. Here are the number changes.” In theory, we should expect, if what you’re saying is valuable, that we should arrest these increasing numbers we see in people presenting themselves to the system. We should see a reversal of that. Presumably, in other jurisdictions there is some of that already happening.

S. Mathias: Quite frankly, though, when you look at…. And this is part of where we’re…. We are cutting edge. The fact that we’re having this conversation is cutting edge, because Headspace has only been around since 2007, 2008. That’s only about six years. You’re not going to see population data in five to six years. You’re just not, because there’s been a phased-in rollout, right? It’s very difficult to measure that at this point. We’ll see it in ten years. We’ll see it in 15 years.

It’s similar with suicide prevention. We will see a drop in suicide rates in ten to 15 years. We won’t see it in one to two years, because we have to phase this in; we have to build this in. It’s going to take half a generation to two generations to do this. That’s part of the answer to this as well.

Thank you, Steve, for the presentation. And thank you, I think, particularly for the end of your presentation, where you talked about the existing services that are very similar to what’s going on, how you could actually coordinate it.

I think often people will take a look and say: “Oh, Headspace. That’s going to solve everything. Let’s just put Headspace in every community, and it can be a quick fix.” It’s really the principles of Headspace that I hear you talking about: the one stop, the services available, the child focus, the collaboration. We have the ability in our communities to put that together.

Just a quick question around the cost. You mentioned the cost of Headspace in Australia. Do you know if that included the services? I think that’s key here. Just having Headspace does nothing. Having access to all the services when they go to Headspace is really key. I wondered if you know about the…?

S. Mathias: Here’s my thought, right? I think that this is a public-private partnership waiting to happen in this province. We know that we have philanthropists. Since I’ve opened the centre, we have had lots of philanthropists come forward and say: “How do we open one of these up in other spaces? In Victoria? How do we open one up in Surrey?”

I think the bricks-and-mortar space is a combination responsibility of municipalities and philanthropists. I think you have the ear of municipalities when it comes to this type of model. I think you have the ear of philanthropists. You have an interest.

In terms of the operations, there are already lots of services in operation that aren’t integrated and aren’t working together. Now, make no mistake. This is not about co-location. This is about integration. That’s why I put the InputHealth at the end. If there’s one role for information technology in all of this, it’s to help services integrate with each other. You have to have a spirit of integration. That’s done through collaboration.

We have lots of services already on the ground. Then, quite frankly, we need to invest in some operational services to bolster those, to bring things together. In speaking to the Ministry of Health, there’s interest in nurse practitioners. Could you imagine one of these centres in each community with a nurse practitioner responsible for youth health?

You have psychiatrists who can bill fee-for-service. That’s not necessarily something you have to worry about, but you do need some sessional coverage for that. Then you would want a crisis response team linked to any of these services to provide support. Often those crisis response teams exist already. Each community, I think, needs to have a scan of what exists and start to look at….

This is a process. This is going to take time. I mean, you want to transform a system. You don’t put a bunch of money in and expect an organization to take over and do what you need them to do, because it’s going to upset a lot of other organizations who are already invested in this area and it’s not going to lead to transformative change because it’s not going to lead to collaboration.

You want people working together. That’s why I like the stepped model, because all it does is say, “You know what? Steve, you’re the psychiatrist. You’re level 7 and 8. Don’t start seeing kids when they’re coming in at 2 and 3,” which is what happens a lot right now. Or if you’re a counsellor: “Hey, listen, you’ve done it. You’ve gotten to step 4, but this kid’s a step 6, 7, so let’s move them up to step 6, 7 and let them see Dr. Steve.”

That model also has to exist. I think it’s a combination of private dollars, existing dollars that are leveraged from the health authorities and from the ministries that are on the ground right now and some top-up operational dollars to make this happen.

D. Barnett: Thank you very much for your presentation. Of course, I keep harping on collaboration and cooperation and how we get there. I’m getting really old, and I’ve heard this for many, many, many years. It really concerns me. The dollars and cents that we spend trying to collaborate and coordinate don’t give services on the ground to the people that need the services. We have to somehow get to a better place, and our mandate should be the quality of life — period — for all.

My concern is that I love everything I’m hearing, through this committee, that we need to do this, but I need someone to tell me that they’re all willing to step up
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to the table as quick as possible, pool resources, and let’s move forward. That’s what I’d like somebody to recommend here. How do we get there quickly?

S. Mathias: Donna, I appreciate what you’re saying, because I think that’s exactly what needs to happen. Sometimes it’s money that makes that happen, to be frank. Leveraging a collaboration, so offering real dollars in terms of capital investment — this is where I say municipalities and philanthropy can come in — real dollars in terms of investment and technology upgrades to services that are willing to collaborate, to show that they’re going to work together, I think, is the way through this. I think you have to incentivize folks to work together.

S. Mathias: You get it in Williams Lake. And it’s funny because a lot of the smaller communities get it because they have to, right? Quesnel gets it. It’s amazing what their collaborations look like. But in some of the slightly larger centres they don’t get it, so we need to incentivize them to come and work together and then identify…. I think we have to be quite frank. We have to identify what’s missing for them when they do decide to come together.

If they start working together and they say, “You know what? We’re working together, but we still don’t have anyone providing psychiatric services because we don’t have a budget for it,” we have to be prepared to listen to that because that budget is not going to materialize out of nowhere. They need to be able to have a venue or a conduit where they can identify what’s missing.

Similarly, if that community centre is saying, “Listen, we’ve got all these kids coming in. We have 2,600 kids coming in. It’s not the right place for them,” we have to be willing to say: “Okay, you know what? We want to build a site for them.” We have to give communities an opportunity to tell us what they need and then support them around it, not necessarily just implementing a model on them.

D. Donaldson (Deputy Chair): Just a quick comment, a quick question. You referenced nascent clinics that could be scaled up or are already doing work in perhaps one of the areas that we’re concerned about. I also think — and I’m sure you know — that there are lots of those informal clinics existing, and they’re not even called clinics. They’re places where kids go — I know a lot of them — in communities, especially small communities, where they know that the door is open and somebody will tell them how they can get help.

Those aren’t resourced. Those are people doing that off the corner of their desk, and I think that’s another area, when you’re talking about adjusting and bolstering, that has to be recognized. Those are the places that could be scaled up as well.

I guess my question is…. On your last slide you laid out a pretty good action plan. Who do you think should be responsible for championing that within government and within government ministries? How do you see that unfolding to get some action on this?

S. Mathias: Sorry. I thought I was speaking to you guys about this. I thought you were.

D. Donaldson (Deputy Chair): Well, we’re going to make recommendations around that, yeah.

S. Mathias: I’m happy to, quite frankly. I think psychiatrists should. I think counsellors should. I think the services on the ground right now should. I certainly know that the network of health centres that we’ve created would champion this idea.

To your point in terms of how there are already some of these community centres or community spots where youth go. I think those need to be bolstered, but they also need to be linked into something greater. If, as a community, we can just highlight….

The challenge with this is that it steps on toes. This model steps on toes. There are a lot of organizations that fight with each other for funding. We get that. There needs to be an easing of that somewhat. We need to be able to say: “You’re not on a one-year contract. You’re going to be on a three-year contract. Go and do your work, and we’re going to help you evaluate.”

We need to provide, I think, built-in evaluation services for these guys. We can’t leave it up to the agencies to evaluate their work. They’re often doing it off the side of their desks. Sometimes it’s the best resource agencies that can evaluate, but it doesn’t necessarily mean that they’re doing the best work, so we have to facilitate that process.

If you belong to this association or this network — call it Headspace; call it Youth Count; call it B.C. Youth; call it whatever you want — you’re going to be able to access the resources that are required to evaluate what you’re doing and to examine your blind spots.

D. Donaldson (Deputy Chair): I don’t think I explained myself well enough on the question. Somebody in one government ministry has to take this, and government ministries fight with each other.

S. Mathias: Health. I’ll tell you why. It’s because this youth population that we’re talking about are using emergency rooms, and that’s a Health issue. They’re using walk-in clinics and primary care, and that’s a Health issue. That’s where they’re going. They’re using drugs, and that’s
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a Health issue. All of the services right now that they’re using, whether we like it or not, are predominantly Health services.

They should probably be accessing some MCFD services, but MCFD, as we know, is really specialized for providing secondary services. They’re not in the primary care game. They’re not in the stepped model game. Right?

What I like about the idea of a stepped model of care is that you would say: “MCFD, you’re going to provide services at that 6, 7, 8 level, and we’ve got to find other services or other opportunities — like CMHA, like on-line apps and like primary care — to provide services at that 2, 3, 4 level. That’s why I think it has to be Health. But you put me on the spot.

J. Thornthwaite (Chair): Thank you very much, Steve, for preparing your presentation. I understand you’re going to provide us with the presentation at a later date.

Apologies to our next presenters. I know we are running late. We have Grand Chief Doug Kelly, from the First Nations Health Council, and guests coming up.

Welcome. Perhaps you could introduce your guests as well. Were you going to provide us with a presentation?

D. Kelly: I will be speaking, and we’re going to submit materials later, although we do have a slide up there that I’ll probably speak to a little bit.

Good morning, everybody. My name is Doug Kelly. I’m an appointed Grand Chief. Some of you will have very nice pensions when you leave politics. In my communities we become Grand Chiefs. That’s about the extent of our pension plan. I got mine early. I’ve been doing this work for a very long time.

I’m also an elected Tribal Chief for the Stó:lō Tribal Council. I am our tribal council’s representative to the First Nations Health Council. When we get to 15 of 15 for the First Nations Health Council, they’ve asked me to serve as their chair.

I was chatting with my colleague on the First Nations Health Council from the Interior, Wayne Christian, this morning. I told him where I was going, and he said: “Can I come?” I said: “Absolutely.” So Wayne is joining me this morning.

I’m holding in my hand a commitment stick. I received it on May 5 this year. Wayne received a similar one. I carry mine with me to remind me of a promise I made to Chief Charlene Belleau, to Irene Johnson, who made a presentation to chiefs and leaders gathered in Vancouver at our assembly. She asked us to do everything in our power to end violence against aboriginal and First Nations girls and women. She asked all the chiefs and leaders to stand and to commit.

We heard from one of our elders, Ti’ te-in, Shane Pointe from Musqueam, that the first job of a leader — and you hold those jobs — is to make sure that children are safe. Every one of you shares in that job — every one of you. The way that you make children safe is to make sure that the women are safe.

So if you’re serious about the mental health of youth and children, then you better start taking care of the women. You’re not doing that now. You’re not taking that responsibility to make sure that women are safe. You know that; I know that. You’re ducking the challenges around policing. We hear today that there is a certified class action suit against the suits in the RCMP because the women in the RCMP don’t feel safe. We have some significant problems with government, government institutions, ministries, around safety. So you have a big job ahead of yourselves.

Let me start with giving some advice to Donna, who was looking for it earlier from the other fellow, and he didn’t have any. Well, I do. You ask: how do we make this work on the ground? I’ll tell you: you’re doing it now. You’re doing it now through partnership accords between each of your regional health authorities and the regional members of the First Nations Health Council.

The way that the B.C. government has structured health service delivery is through five regions: north, Interior, Fraser, Vancouver Coastal, Vancouver Island. Now, it doesn’t work neatly for our geopolitical realities, but we make it work. We’ve asked our chiefs and leaders in each of those five regions to sort out for themselves three representatives to the First Nations Health Council. We’ve done that. Wayne is one of three from the Interior. I’m one of three from the Fraser. What we have achieved is a written regional partnership accord with the Fraser Health Authority, the Interior Health Authority, the Northern Health Authority, Vancouver Coastal Health Authority and Vancouver Island Health Authority.

I work with Michael Marchbank, the CEO of the Fraser Health Authority, his vice-presidents and members of the board to make shared decisions about those services you were talking about, Donna. That’s where those decisions are taken. We take them together. What are our priorities? Mental health and substance use is number one. It’s not just number one in Fraser; it’s number one in all of the other regions as well. So it’s up to us to talk about our issues, to talk about our opportunities, to talk about what’s working, to talk about what’s not working and to make decisions to make it work.

That’s where we’re at now. We’ve had those places at those tables, and we’re beginning to make some headway. I understand that our good friend Joe Gallagher, the CEO of the First Nations Health Authority, has been here and has made a presentation, so you know about the work of the First Nations Health Authority.
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The First Nations Health Authority is supporting every one of those regional tables. The First Nations Health Authority provides services to all of our citizens living in each of those areas, but we have to do it in partnership. We have to do that work together. What we’re doing at those tables is we’re integrating health services. Before we achieved that agreement in 2011, Canada would say: “Well, we provide these kinds of services if we feel like it. It’s at the pleasure of government.”

The province would say: “Well, we provide these services to British Columbians, unless you’re a status Indian living on reserve.” Then tough titty. “You’re somebody else’s responsibility. You’re not ours.”

That’s changed. There’s no more bunfight over jurisdiction. We don’t talk about jurisdiction, as a result of our agreement with Canada, British Columbia and First Nations in British Columbia. There’s no more fight over jurisdiction. We’ve simply set the table. We pool the resources, Donna. We look at what the priorities are. We look at what the plans are. When we need to make change, we make change.

So what did we learn last week when Perry Kendall and Mary Ellen Turpel-Lafond issued their most recent report? You learned that you don’t have data that you need. You do not have the information to confirm some of the problems that your gut is telling you are a problem but you don’t know for sure. You don’t have the data you need to make good policy decisions, to make good spending decisions.

Part of that is because of Canada. Part of that is because of what’s going on in terms of these crazy laws you have, in part created around not sharing private and confidential information. But for the most part, it’s because there’s no cooperation between Canada and British Columbia. That’s what it boils down to.

What we’re doing is we’re working on that. In that tripartite agreement we have a commitment for an annual meeting with deputy ministers provincially and federally. We’re meeting regularly with B.C. deputy ministers. Victoria’s much closer. It’s really easy for us to get to and from Victoria. It’s a lot more challenging to make it back to Ottawa, a lot more challenging to get federal deputies to the table. But we are making progress in British Columbia with the deputy ministers.

At our last meeting, on February 6, we had seven or eight deputy ministers all sharing common concerns that you’re talking about today, all of them understanding that with their narrow ministry mandate, with their narrow programs and conditions, their rules of funding, they can’t respond to everything.

They’re beginning to realize that as open-hearted and as willing as they might be, they can’t fix those issues on their own. So we are now developing and designing a quarterly meeting between our working group of the health council, one per region, that we call the collaboration and partnership working group. It’s real — a collaboration and partnership working group.

We’re going to be meeting quarterly with all of those deputies that talk about these kinds of issues, Donna. We’re going to be talking about how this program doesn’t work, how it’s too narrow, we can’t access it, there are silly rules. There’s a purpose to it.

When we transferred all of the funding from Ottawa to the First Nations Health Authority — one of my colleagues calls it policy liberation — Treasury Board had all kinds of silly rules for how we could spend money, what we could spend it on, what we couldn’t spend it on. We negotiated an agreement where we knocked all those silly rules out.

The only rule that we have to follow is that money is spent on our people, addressing their health care needs. It’s as simple as that. That’s what that agreement commits to. We’ve committed to it. Our chiefs have committed to it. The government of Canada committed to it, and so did the province of British Columbia. We no longer have silly rules getting in our way, and it makes a big difference.

You have a challenge as a committee. You have multiple ministries with multiple programs and services. Every one of them has stupid rules — every damn one of them. And guess what, folks. You created them. You’re focused more on process than you are on outcomes. Remember that. That’s the one thing that the fellow before me said that I did agree with. Evaluation and outcomes — no one is monitoring it now.

I would argue that…. I’m not sure I’m right. I think there needs to be more investment, strategic investment, but I think we need to look at where money’s being spent now, and I think we could spend it better.

I think if we bring together, as we will…. In the next three, six, nine months we’re going to be bringing multiple deputies to the same table with us, and we’re going to start, Donna, pooling those resources. We’re going to start integrating a governmentwide response to the very challenges and issues that you’re talking about now. We’re going to be acting on it while you guys are talking about it.

But you can help us. You can help us. You can start slapping Treasury Board. I don’t mind saying it. De Jong needs a slap every once in a while to wake him up, to start getting him to think differently. Because I’ve been one of the ones slapping around the head, I know he learns. He listens, so he learns. He will begin to understand that if you begin focusing less on the rules and more on the outcomes, and investing accordingly, you will achieve change.

I am told that I sound like a dictator, that I sound like a know-it-all. I’m really not, but I do know my own work. I do know my own business. I just turned 55 yesterday. I’ve been doing this work for 35 years. There isn’t a program in my community that I have not had hands on building. There isn’t work in my community that I’ve not had
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a hand in changing. When I tell you my experience, it comes from the truth.

Some of the things that we want to do at this table, we’re now beginning. Early next month I’ve got a meeting with federal deputies. The same approach that we’re taking with B.C. deputies — helping them understand that we can help them with their challenges and their issues in a productive, ongoing process that’s focused on outcomes — we can do the same with the federal government. It’s going to be a little harder. They’re further away, and they think they know even more than the provincial deputies, and you know what I’m talking about. We’ve got some challenges there, but we will get there.

I see coming in the next year a joint federal and provincial deputies table that works with us on a ten-year wellness strategy, where we’re talking about children to start with. Our vision statement is all about healthy, self-determining, vibrant B.C. First Nations, children, families and communities. How do you achieve that vision statement without knocking down all those silos, between the ministry of that and the ministry of this, between the department of that and the department of that? We have to knock down those silos. With those deputy ministers tables, we can do that.

What we’re going to be working on in the next year is an integration of services model that you’ve never seen before, that the B.C. government has never witnessed before. It will work. That’s the other thing I agreed on with the fellow that was before me. People are going to get pissed off. You will discover, if you’re serious and you’re listening and you’re serious about change, that there are more people that want the status quo than there are people that want transformative change. Don’t kid yourself. There are more people happy with the way things are. You are going to piss people off if you really want change. But if you want change, give it to us. We’ll make it happen.

We will make it happen. We’re going to change the world, because it’s our people that are suffering the most, Donna. All of those First Nations aboriginal communities in every one of your constituencies — they’re the ones that have it hardest. That’s why we do the work that we do.

It begins with making sure that every one of you is taking care of and making sure that children are safe. That begins with making sure the women are safe. I challenge you to keep that in mind. I challenge you to make sure that you reach out to the First Nations Health Council. If you want to know what’s going on, if you want to know what’s going to work, we’ll help you with that.

The final piece about data. I started with this. One of our colleagues is Gwen Phillips, from the Ktunaxa — one of Wayne’s colleagues from the Interior. She’s working on a data governance project, because government often wants to look at things. They want to evaluate whether they’re getting the results that they’re after, but they measure the damnedest things. They might make sense to you, or maybe they don’t even make sense to you, but they make sense to somebody, some bureaucrat somewhere. That’s what you track. It’s not real for us.

We’re beginning to design our own data structures, our own models — the kinds of data that we want to capture, that we can monitor so that we know we’re making progress. That’s where we’re headed. We’ll run into problems with Canada, like we always do, but we’ll get them to where we need to get them.

W. Christian: [A First Nations language was spoken.] My Indian name is Wunuxtsin. It means big voice that speaks the truth. I’m the Chief from Splats’in.

I first want to say that to be here and to talk about what we’re talking was really important. I’m also the tribal chief for the Shuswap Nation Tribal Council. I think Donna knows. She’s in part of our territory in 100 Mile.

This issue around mental health and youth is really critical. We’ve reviewed some data at the tripartite First Nations committee with the province, the federal government and ourselves around the issue of youth suicide. As you know, in the aboriginal communities it’s quite high. The astonishing thing is that 80 percent of those suicides are children in care. If we start examining the children in care in this province, 50 percent of the children in care are aboriginal.

You start adding all this stuff up. Then, if you look at it in the context, I think, of the families and what Grand Chief Kelly is talking about in terms of healthy families and women, and that context. Then look at the Truth and Reconciliation recommendations.

I don’t know if any of you have actually read those. It would be useful for you to read them. The first one that they talk about is child welfare. It focuses around how Canada and British Columbia have to start changing the reality on the ground in terms of recognition of our jurisdiction. Our laws for our families and for our children — that’s what this is about.

You, as a province under the constitutional domain, purport to hold jurisdiction for children and families. Our community disagrees with that. We have our own legislation, in place now since 1980. We’ve looked after our own children and continue to look after our own children. So I think if we’re going to change the dynamic on the ground, it really is around reconciliation through recognition — recognition of our laws, our jurisdiction, our structures — and coexisting with yourselves and your processes.

Grand Chief Kelly’s talk really is about collaboration on the ground, partnerships on the ground. How do we begin to build that? We can’t do that from top-down approach. We know that. I think it’s really important.

Donna, what you’re talking about is: how do you make this happen? It is around those regional partnerships. It is around: how do we interact in the regions and bring it closer to home?
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We operate under seven directives. Number 1 is community-driven nation base. The second one is to improve services. The third one is to improve decision-making. The fourth one is around developing collaboration and partnerships. There are a number of them that really look at how we actually increase economic and human capacity

It’s notwithstanding our title and rights issue, the aboriginal interests of the communities. We don’t get involved in that. That’s a political issue for communities to take hold of jurisdiction of those things. The other one is to operate at a high operational standard.

So I think in the context of today, when you talk about mental health and addictions, what’s behind you and behind us is the Growing Up in B.C. report that came out, by Dr. Kendall and Mary Ellen Turpel-Lafond. It really lays out, if you will, the well-being of children — not only aboriginal children but children in B.C. and what we need to focus on.

The first one, mental health and what you’re talking about — physical and mental health. Right? Family economic well-being. Child safety. Child learning. Child behaviour. Family and peer and community connections. If you take broad strokes and a comprehensive picture, it is about how we start making those connections and integrate those services on the ground in these areas.

The bottom line is that this is what I think we need to start looking at, quite honestly — an economic model, what I would call a social return on investment. If we start investing….

We’re looking at, with KPMG right now, a model. Like, how do you actually begin to look at…? I heard the gentlemen talk earlier about you invest so much, and then there’s a return to this. I think we have to start thinking about it, if you will, in terms of the business model. How do we actually put investment in, on the ground, so that we can change the reality down the road?

That’s the job of us as leaders and your job as leaders and us working together on this. I think, really, that’s where we have to go. I think Grand Chief Kelly talked about a lot of these sorts of dynamics and how we have to start collaborating on the ground with regional partnerships. That’s where things are going to change. Our structure that we have will accommodate that, and we will make a change in this province. So that’s where we’re moving towards.

D. Donaldson (Deputy Chair): Thanks for the presentation. Good to see you guys here.

I have read the 94 recommendations, and I’ve read this report as well. I just wanted to make sure that you know that.

One is around the relationship between First Nations Health Council and First Nations Health Authority. I’ll just put this out, and you can correct me. Is the Health Council more concerned with the policy-governance side and the Health Authority the operations? If that’s the case, then how is that relationship formalized between your two organizations?

The second is the transfer of the federal funds that have come over or are coming over. Was that a siloed approach, was it just the funds related to health, or was it across all federal government ministries that relate to children’s wellness — for instance, the enhanced prevention focused approach dollars? I mean, were you able to negotiate the entire package, which is a holistic approach?

D. Kelly: First question. The First Nations Health Council is a provincewide leadership advocacy organization. At the same time, the 15 members of the Health Council of this political leadership organization are the members of a non-profit society known as the First Nations Health Authority.

As members, we can change the name of the society, and we did several times over the course of the development of the authority. We can amend the bylaws, and we have many times as we began to work towards achieving the highest governance standards that we, as partners with Canada and British Columbia and chiefs, wanted to achieve. We can appoint, and thus dis-appoint, the board of directors. We can and we do accept an annual audit. We can and we do accept an annual report.

The reason I say it the way I do, Doug, is this. Chiefs have said they want an ironclad separation between the politics of our work and the ongoing business operations of our work. In our tripartite agreement between Canada, British Columbia and our chiefs, we’ve said there’s going to be no mixing of politics and business. In our bylaws the council can give advice to the First Nations Health Authority, but we can’t give it directives. It’s really clear.

On the other hand, our chiefs were also concerned about rogue societies — groups that have good intentions. They get started. They start getting all kinds of money coming in, and pretty soon it’s all about the money, and it’s not about the services and the clients. We didn’t want that to happen either.

That’s how we tied the two together. It’s our political leadership advocacy group that also wears another hat that’s called the member of that authority. We can never lose that. The First Nations Health Authority will never become a rogue society.

In the work that we did, it was all around health and the offer that Canada came to the table with. Canada came to us and said…. Wayne and I were there. Canada came to us probably about eight years ago and said: “Have we got a deal for you.” They wanted to just transfer it over the way it was. The federal representative had a sign made up: “Under new management.” He was ready to just give it to us.
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We weren’t there yet, Doug. We had to engage our leadership and bring them there. In the course of a couple years of dialogue, we got them there. But they had questions. They had questions about certainty of funding. They had questions about that policy liberation. So it’s exclusive to health.

The fear that has come now…. And you’re very gentle in the way you raised the question. Charlie Angus could learn something from you. He is the federal MP that stirred up a mess, and the mess is this. There are people running around telling everyone that Doug Kelly is negotiating the transfer of the federal First Nations child and family services program to the First Nations Health Authority. Doug Kelly is here, and he can tell you that he’s not doing that. What I am doing is the advocacy work that I just described to you.

How do you achieve all of those things that are in behind you unless you change things? You can’t. We have to change the way the feds look at investment. We have to change federal policy.

Right now directive 20-1…. They only fund an agency to apprehend children. There is no prevention, Doug. Is it any surprise today, under that policy then — it’s about 30-some-years-old —that you have more children in care today than you did at the height of the residential schools? It shouldn’t come as a surprise. It’s a direct result of a federal policy that doesn’t work.

Am I negotiating the transfer of that? No. I don’t have a mandate to. But what we’re working on is a ten-year wellness strategy where we’ll get direction to tackle those things, Doug.

In our work, in our engagement — we have an engagement pathway — we engage at the sub-caucus. We have 15 sub-caucuses, and we have five regional caucuses. We engage at the 15 and at the regional caucus levels. We engage over two years, and we’ll get marching orders. That’s how we do our health work.

When we talk about wellness, we’re talking about healthy children and families. It includes mental health and all the things you’re talking about. We’re talking about housing. We’re talking about clean drinking water. We’re talking about sanitation. We’re talking about recreation. We’re talking about things that your communities take for granted and many of our communities do not have.

Those are the kinds of things that, when we talk about wellness, we’re going to be looking at. We’re going to have every deputy, federally and provincially, on the same page as us. I’m optimistic, but I think we can do it in the next six to 12 months.

So, Doug, we’re not there yet. But eventually chiefs are going to say: “We want improved children and family services, and it should look like this.” At that point I will be banging on doors, and I will be negotiating arrangements but not before. Does that put it to rest for you?

D. Plecas: Grand Chief Kelly and Wayne, Chief, I loved your presentation. You’ve got a level of confidence and inspiration which makes me want to stand up and cheer and a very can-do attitude.

So I guess two questions. One is: how long do you expect it’s going to be before we can say, “Look, we’ve got some outcomes here and some good outcomes to demonstrate that this has worked”? Secondly, what do you both perceive as the biggest challenges in your getting to where you want to be?

D. Kelly: Okay. I’ll start with the first one. Wayne, you can think about the second one. I’m just kidding. Here’s the way I’d answer that. And thanks for the question.

We’re already achieving change. One of the things that we agreed to in our tripartite agreement was the Medical Services Plan premiums.

Now, some 25 to 30 years ago a federal bureaucrat cut a deal with a provincial bureaucrat. Never mind what the rules say. The rules don’t actually allow a federal bureaucrat to transfer non-insured health benefit money to the province to pay a tax. The rules don’t allow it, but they did it anyway.

We stopped that agreement twice. I did. I’ve had lots of jobs over the years, and I’ve always been on health issues. I stopped that agreement twice. The feds reinstated it twice. I stopped it, and the province managed to persuade them to get it again.

In this agreement we reached what we call a sub-agreement on Medical Services Plan premiums. Now, we know there’s a cost to the system, and we know that to be a good partner we’ve got to be wary and understanding of one another’s interests. We’ve got to be prepared to hold one another accountable.

What we did is we said: “We’re not paying a tax. We’ll make a contribution to the cost of the system for our citizens.” So $15 million goes per year in each of the last two years. I think we’re just starting the third year of a three-year agreement where that contribution is made to Victoria, and it goes into the Medical Services Plan premiums revenue. So $5 million is held aside, and it’s invested into primary care projects consistent with the legislation for the Medical Services Plan.

What happens then is that when we spend that $1 million on primary care services, whether it’s a new physician or a newer way of getting physicians into our communities or whether it’s getting nurse practitioners into our communities, it’s picked up initially by our start-up fund. Ongoing costs are picked up by the Medical Services Commission when that money runs out. So it’s ramping up our direct and immediate access to primary care.

We’re already starting to see the outcomes, because we now have control of our money, and we want to hold our partners accountable. And you can be assured we’re holding our partners accountable. We’ve already made an impact there. We’re starting to now, in terms of how…. When the Representative for Children and Youth issued a report about Paige in Paige’s Story….

That was the hardest document I’ve ever read in my life. The toughest thing to do was to read that. Now, I can tell you that I read every other one of Mary Ellen’s reports twice. With Paige’s Story, I couldn’t do it. I could barely do it once. What happened was that because of this work and how much of it ties to the health system, we’re going to start working with the CEOs to make sure that where Paige was failed, where the system failed Paige, we’re going to be holding our partners accountable.

We’re already there. We are ready in a place where we’re going to make sure that we follow our seven directives, especially around No. 3, which is “improve services.” We’re already there. We’re already having an impact.

The next set of challenges. I told you earlier about the forces for status quo. They never go anywhere. You know, when you win a war, you’ve won the war, right? Well, in the battle for transformative change, the forces of status quo — we’re not actually allowed to kill them. They’re still there. They’re always going to erode. They’re always going to write letters. They’re always going to be stirring it up. Why? Because they’d rather leave it the way it is. That’s the toughest challenge.

What’s the toughest challenge for you, then? Standing up when most of the voters belong to the forces of status quo. You’re going to want power, but you’re not going to want to offend the forces of status quo. “Don’t worry about it. Just let me do it.”

I’m serious. That’s the biggest challenge — the forces for status quo. And they’re everywhere. They’re in your caucuses. They’re in your parties. They’re in the ranks of deputy ministers. They’re in the ranks of the civil service. They’re in the ranks of the folks that come and present to you. They’re everywhere.

Some folks are doing very well by the system. They make a damn good living the way the system is. Do they care about outcomes? Not particularly. We? We have a job to do, and we’re on the job.

J. Thornthwaite (Chair): I’ve just got to interrupt. We’re actually over now, but we do want to listen to what you have to say. Donna also has a question, and now Carole does as well.

The second one, I would say, is really the challenge for yourselves, the political will to change the fiscal reality on the ground. That’s the issue you’re going to be faced with, with the status quo response. People want to maintain their own services, their own budgets, their own — if you will — income. How do you begin to realign…?

I understand, like, in British Columbia the Downtown Eastside receives millions of dollars for services. Is it working? I’ll ask you that question. Read Paige’s Story. Your challenge is: how do we start changing that reality, from a policy and a legislative perspective?

D. Barnett: I’d just like to thank you for coming. Darryl basically asked the same question as I was going to ask. The one thing that I would like to see, in our regions, is how the MLAs can collaborate a little more, have a little more discussion, etc., and become more engaged.

D. Kelly: You know what? We were talking about that outside as we were waiting for our turn to come in and present. We have to do what we’re doing here. We need to come back and tell you what we’re doing so you know what we’re up to. We need to do the same in Ottawa. We need to inform the various MPs and their various committees about what we’re doing. They need to hear what we’re working on.

It also makes really good sense when we’re in a particular regional health authority and you’re all dealing with them. Why wouldn’t we create that space? We meet regularly. We can do that. We can create that opportunity to talk about the various issues, the various policy proposals and the kinds of solutions that we’re coming up with. They do vary, right? They do vary.

Our colleagues, Ernest Armann, Leah George-Wilson and Maria Martin are Vancouver Coastal. We’re meeting with folks on the Downtown Eastside. We just came from a celebration. That was last Friday. We’re beginning to reach out to the folks in the Downtown Eastside and talk about some of the things that we’re talking about here. We’re on that job too. I just to wanted to make sure you knew that.

C. James: Thank you for your work. You’re presenting your current work, but I know this has been a lifetime for both of you, as I know from my work.

I’m glad you mentioned child welfare. Having been in that system, working in that system, I think there are a lot of lessons to be learned for how that devolution happened and the strengths and weaknesses of that and the challenges that are still there. I’m really pleased to hear you talking about lessons and things learned from that process.
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One of the challenges around the status quo — but also ongoing, I think — based on the silos of funding, is the issue of on and off reserve and the challenges that that creates. Certainly, I’ve seen it in the child welfare system around where funding is and isn’t. I’m imagining that the same kinds of challenges will be created in the health system. I just wonder what kind of work is being done within the health authority to try and break down that huge silo.

D. Kelly: I appreciate the question. What we’re doing in health — we have to do in other areas. In health, love them or hate them. I’ve met people of both particular persuasions around former Premier Gordon Campbell. Gordon Campbell, when we launched the new relationship a decade ago, talked about the need to make sure that provincial policy serves every British Columbian regardless of where they live. That began to knock down what I said earlier about that artificial bunfight about who serves who, when and where. That was, in theory, eliminated a decade ago. But in practice, we still have problems.

In health we don’t have that. In health, because of our agreement, we’re working to serve all of our people regardless of where they live. That’s the marching order our chiefs have given us. It doesn’t matter where you live. If you’re in British Columbia and you’re First Nations, aboriginal, we have an obligation to do our best to help you.

What we’re working towards…. In time we’ll have one policy, one standard. We want to do the same with those other very important streams of programs. Whether they’re federal or whether they’re provincial, we want to achieve that same standard, Carole. That’s where we have an opportunity, through the two structures, of annual deputy minister meetings, provincially and federally, so that we can — and we will — get there.

J. Thornthwaite (Chair): Thank you very much, and I would encourage you, when you’re having these meetings, to let your local MLAs know. How would we know, unless you tell us? Then, we can help from our end as well. I’m sure many of us, particularly in this committee, would like to be involved.

Thank you very much for your time and your presentation. I’m very impressed that you had no notes. We really appreciate what you’re doing. Keep up the great work.

We actually have somebody coming to present at one o’clock, so we don’t have that much time. Lunch is in that room. Please be back by one o’clock.

J. Thornthwaite (Chair): Good afternoon, everyone. I’ll bring the committee back to order because we’re trying to keep on time. I’m not doing so that successfully, I might add, but we’re going to try for the afternoon part.

In front of us we have the B.C. Psychiatric Association. We appreciate you coming in. I have here Dr. Matthew Chow, Dr. David Smith, Dr. Carol-Ann Saari and an intern that I guess you’ll introduce later.

The committee has been hearing, more or less, ten-minute presentations and then allowing 20 minutes for questions, answer, engagement. That seems to be working out well, so don’t go overboard, because the more time that you take, then the less time for engagement or questions.

C. Saari: Thank you. I’ll get started. I’m Dr. Carol-Ann Saari. I’m a child and adolescent psychiatrist, and I’m the current president of the B.C. Psychiatric Association. We’re here representing the section of psychiatry. I’m not sure if you’re aware, but it’s the largest section of specialists in our province. We have, I think, somewhere up around 800 psychiatrists.

One of the reasons we wanted to come and talk to you is because I think psychiatry has a very unique perspective, particularly around child and youth mental health. The reason for that is partly because of the way that we work.

Many psychiatrists work in multiple different settings. If I look at my own work…. People ask me where I work, and I say: “Well, where don’t I work.” I have so many jobs. I work through the Ministry of Children and Family Development in the community. I also work through the Ministry of Health. Through that I work in a community setting. I’m in an out-patient clinic in a regional hospital. I’m in an out-patient clinic at a provincial hospital. I cover call in a regional hospital and in a provincial hospital. I also support people in in-patient units. I work in a private setting. I see patients in so many different settings.

I think psychiatrists have this perspective because we’re front line with children and families, and we’re seeing them in so many different times in their progression through our health care system. Just like them, sometimes we get equally as confused by how hard it is to navigate that system.

Sometimes I will see a patient in my office and do an assessment and then want to refer to myself at the next place, and I can’t see them in the next place because there are different priorities and there are different processes there. So I have to say to them: “I’m sorry. I can’t see you again. But at some point you might be able to go see a few other people, and then eventually I’ll come back and I’ll be your treating psychiatrist again.” Hopefully, that will work out for them.
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This is why we’re here to talk to you, because we feel like that confusion and all of these different levels make it harder for our young people to get the help that they need.

D. Smith: Okay. Thank you very much for having us here. David Smith. I’m a psychiatrist in the Okanagan, and I do child and youth mental health and adult mental health and also have a similar perspective as Carol-Ann has in that I also see patients in these various settings.

This is an extremely busy slide. Try not to lose yourself in it. It’s here to make a point about some of the challenges that we have.

Now, I want to say up front that this is a challenging presentation for us. We work in child and youth mental health. We work with the Ministry of Children and Family Development. We have extreme respect and appreciation for what our colleagues and what many of the individuals do within that ministry. It’s a great ministry, and there’s a lot of wonderful work that’s done there.

However, the question was posed: what is it that we can do that are concrete and practical solutions to enhance mental health outcomes for children within this province? So we feel a moral obligation to speak what may be an inconvenient truth here in regards to the system and what is happening at this time.

If you look at this slide, this was done and was part of the child and youth collaborative. I’m sure you’ve heard from them and about them a number of times. This was part of the nidus of that program — doing a journey map of one youth in the Interior who was going through trying to seek mental health services. Again, without losing yourself in it, you see that they’re going to the schools. They’re going to the pediatrician. They’re going to the family doctor. They’re going to the emergency department, back out to the community again, back in to see the psychiatrist, back to the hospital, back into the community and finally into the forensic system to get the help that they need that’s there.

You can just even imagine how baffling and how challenging and how overwhelming this is for youth and for families. And every time they go back and forth…. The hospital is under the Ministry of Health. When they’re back out in the community, they’re under MCFD. So different mandates, different standards, different philosophies of care, different systems, different computer platforms. Everything is different as it goes back and forth.

An example. I saw a youth in the hospital just a couple of weeks ago. I’m trying to follow them up now in the clinic at the MCFD office. When I do that, then I request the records, and they say: “Sorry. They were supposed to sign those at the hospital before they came, so they can’t come.” We say: “Okay, yes. But can we…? We need them here anyway. They’re my records. I dictated them.” “Sorry. We can’t do that. We have to get signatures.”

Then I go back for another visit for a follow-up, and again at this time it still hasn’t happened. The family is still frustrated and looking at me like: “What’s wrong with you, and what’s wrong with your system? Why can’t we even get these simple records here to be able to work with?” It’s just that frustration back and forth.

I also refer children back out to see me in the community, but because they’re seeing a private counsellor in the community, they’re not allowed to see me as a psychiatrist at the child and youth mental health office. Now, even though they may meet that mandate for moderate to severe mental illness — they need the medications; they need that follow-up of a specialist’s care — they’re again not able to receive that care because of just quirks within the system and the differences there.

Another youth I saw at the hospital. This youth has an addiction issue as the primary issue, but underneath I know that there’s post-traumatic stress disorder. So I have to refer them to an addiction clinic, which is under Ministry of Health, but I know that probably within a month or two we’ll be getting down to the PTSD issues. But if I transfer him now, they’ve just barely developed trust with a counsellor through the addictions clinic. Now these youth, who are often our most vulnerable youth, are struggling again to be able to build trust and are often lost in the gaps and the chasms that exist in this incredibly fragmented system. That’s our challenge at this time.

This is a slide here…. This is the child and youth collaborative, and what we’ve done is develop ten different working groups to try to look at how we deal with some of these challenges to our access and transitions in care. Each of these are major working groups that are trying to move forward with this process and try to help with trying to build these bridges that are needed.

I also have at the bottom there, which is not one of the working groups, actually probably the biggest barrier to care: the significant fear and avoidance that we have with particularly the most vulnerable, often those who are lowest socioeconomic groups, those who are First Nation groups, who are afraid to go to a child protection office to receive mental health care.

I could tell you repeated stories of families who don’t get the care, don’t receive the services. Then, of course, we know things escalate down the road. They end up getting into addictions. They end up getting into the sex trade or the east end of Vancouver or whatever else happens, again and again, because they’re not getting the care that they need.

What you see here is if we were…. We made a proposal back in the fall — and it was one of the submissions to this committee — around the realignment of child and youth mental health into the Ministry of Health. It was moved from the Ministry of Health to the Ministry of Children and Family Development, as you probably well
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know, back in ’97 under the Gove report recommendations related to a child protection issue. It wasn’t a child mental health issue per se.

We’ve got this anomaly of it being put into a social ministry, into the Ministry of Children and Family Development. We’ve been struggling with that misalignment and with those barriers and gaps ever since. If we were to move back, then you can see struck out there all of the different working groups that we have that would just virtually evaporate if we were to make that change. Then most of the other working groups…. As you see, I’ve just put them in smaller letters because the efforts would be reduced significantly, including the biggest barrier of all there: the fears and avoidance of child protection offices.

What you see here is just a recommendation that we had made of realigning child and youth mental health back into the Ministry of Health. We feel that this is really the fundamental shift that needs to be made. We could come and talk to you all day about lots of other programs and systems that we could do. We could talk about telehealth, and we could talk about health care in schools. All of those are absolutely invaluable and wonderful and needed. We could talk about ways of getting the family and children into the centre of care and developing programs that help with that.

There are lots of those that are wonderful. We want to support those, and the committees will continue to move forward with those. But the foundation, the fundamental piece that we need, is that alignment back into the Ministry of Health to be able to deliver services so that there’s this continuity, cradle-to-grave care. You can imagine the idea of taking seniors mental health and saying we’re going to carve it out of Health and put it into another ministry and then the care of trying to go back and forth with the medical doctors and the care and the services and trying to do that type of thing.

We’re asking that you would consider, seriously, reviewing and looking at the feasibility and the options with that. Thank you.

M. Chow: I’m Dr. Matthew Chow. I’m a child psychiatrist in Vancouver, and I’ve done outreach psychiatry to very remote First Nations communities throughout northwest B.C. and elsewhere.

Our recommendations are simple. We’re recommending a single ministry stewardship for child and youth mental health — that a child that has asthma or a broken leg or cancer gets care from the same place and the same ministry as they would get care for mental health issues.

Reallocate funding to child and youth mental health so that it matches what is currently allocated to adult mental health, which is in the range of $88 per capita.

No new money means that…. We anticipate that the savings from reducing the inefficiencies, the time wasted on different working groups, misalignment of strategy, different health record systems would actually lead to this being a cost-neutral effort. Clearly, there would be some costs during the transition period.

Finally, our third recommendation is to protect that child and youth funding so that it does not become eroded or used for any other purpose except for our most vulnerable children and youth and their families.

That’s all we have for our formal presentation. We’d love to answer your questions.

You’ve come clearly with identifying…. Part of the question that we’ve had all along is: where should the responsibility for these services rest? I’m personally kind of torn.

Listening to what you have to say, I just have a couple of questions. Some challenges with moving everything into the Health Ministry are issues around rural and remote communities that don’t have enough doctors, don’t have enough services, don’t have enough sort of clinical opportunities for those youth there.

The second piece, of course, is we hear over and over again that the early intervention and prevention level is best located, I think, in schools rather than the health care system, although certainly, if you’re talking cradle to grave, there may be some other opportunities there. What are the barriers to that?

How do you prevent the funding from falling into the sort of highly politicized health care constraints in regional districts and all of that? There is a lot of politics attached to that. How would you see that funding falling into that huge black hole that is health care funding and the politics of health care funding around the province?

M. Chow: Yeah. I’ve basically practised much of my career in the rural and remote field. The Ministry of Health is acutely aware of the issues surrounding rural and remote care. In fact, their policy papers demonstrate that that’s one of their top three priorities, actually, going forward for the next three to five years — rural and remote care.

They have a strategy for addressing that, and it’s a combination of recruitment and retention issues but also tactics, in terms of information management, information technology, telehealth, electronic health, on-line therapy. All of these things are sort of happening within the rubric of the Ministry of Health.

Unfortunately, children and youth are being left out of that because they’re in a separate ministry. That is not
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under their purview. I sit on a number of provincial committees that look at these things. We’re figuring out ways so that in Prince Rupert you can see your surgeon, and the surgeon is in Vancouver. But we’re not really looking at anything for child and youth mental health, because they’re not on our radar. They’re not part of our responsibility, and that’s an issue.

I think that would be something that would be addressed so that we could move forward together to deal with the rural and remote issue. We simply can’t do that right now, not particularly effectively.

D. Smith: I think from a perspective of prevention and promotion, we fully advocate for that and support that, and working with schools I think is where we need to be. Teachers are seeing them more hours of the day than their parents are, or than anybody else is, and they are often the ones who can best identify those early sorts of concerns and flags that we need to be watching for.

I think that we can absolutely work together in that process. Whether we work on hub models or whatever else we do, there are lots of opportunities for doing that. We have in Kelowna right now Dr. Jim Ketch, a family doctor who is going into the high schools there and screening kids and working with them, doing both cognitive behavioural therapy as well as medications when needed, and is able to help identify and work with both those youth and their families in a very early way.

We’ve also looked at other ways of trying to…. How do we bring the families in very early on and work on…? For example, through emotion-focused family therapy, we can work on putting the family right in the very centre of the care and the services and delivery and the healing that is needed for those children and their families.

M. Karagianis: David, can I just add to that that one of the concepts we heard which has been very, very attractive to us around this table is the idea of one child, one file, which is what they’ve done in New Brunswick quite successfully. How does the health model deal with that aspect of it as well?

D. Smith: I think we’re already consolidating. Right now we’ve got a file at child and youth, a file at adult health with addictions or at the hospital through the Ministry of Health, or else we have another one. So we’re already consolidating with that. I think that we can easily work with that through looking at agreements around information-sharing and signing releases of information and those sorts of things.

We’ve been doing that very actively with the Ministry of Education, with our schools, with our programs. With some of the new on-line platforms that are available, this is very doable to have that one file.

C. Saari: I just want to kind of bring it back to the idea that when we’re talking about mental health, we’re still talking about a health issue, right? We are trying to put it all under one ministry. Why do we think the Ministry of Health makes sense? It’s because it is part of health. I don’t think anybody would just think of health as only about your physical health. It has to have that other part to it as well. Putting it under one area doesn’t mean it precludes us from working with the Ministry of Education. What it’s saying is that we can’t separate it.

Mental health is now kind of divided. These kids are on two sides of ministry lines, and it’s the same person. We’re saying: why are they looked at through one lens if they go in that door and they’re looked at through this lens if they through another door? It’s really all the same thing.

What we’re just trying to propose is that we try and get rid of that barrier. Just make it easier for these people — for all of us, really.

M. Karagianis: The funding — preserving the funding and protecting the funding.

C. Saari: The funding protection. I don’t think there’s an easy answer to: how do you do it? If you look at the budget lines for the different health authorities, you already see that mental health has a smaller part of that budget.

In our submission we sent in some of the numbers that showed how much money actually goes towards mental health. It was actually included. I don’t know if you guys still have these. In the Ministry of Health right now about 5 to 8 percent of the health budgets — and that’s a big range — is allotted to mental health. And that’s all of mental health. That’s not even the child and youth portion. When you look at the budgets for MCFD, about 6 to 7 percent is allotted to child and youth mental health.

In both of these areas it’s not a high priority. What we’re saying is when things are not a high priority, it’s easy for them to be kind of siphoned off. What we would want is some kind of ring fencing to be put around the funds to say this stays with these youth and recognizing that prevention is what we need in order to stop this ongoing cycle that we’re into, which is where we have a health care system that’s reactive.

We’re helping people when it’s far beyond an easier fix. We’re waiting until these kids are so complex that the cost of them is so much higher to help support.

M. Chow: We should also mention that, as one of the three key priorities of the Ministry of Health, primary
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and community care for those with chronic illnesses but also mental illnesses is one of the key priorities for the ministry. I would expect that over the next three to five years you would see some of that ring fencing start to take place to protect mental health.

There’s increasing recognition that people with mental illness, whether it’s depression or schizophrenia or bipolar, actually cost the health care system far and away more than their counterparts that do not. There is this recognition that we need to protect that funding if only to preserve our ability to offer other services to other people.

C. Saari: Well, yeah, not to mention the idea that, for those who have mental illness, they are at greater risk for all physical health illnesses. That’s a risk factor. To have depression or anxiety is a risk factor to end up with a physical health disorder.

M. Chow: Yeah, someone with depression is twice as likely to die from a heart attack than someone who does not have depression. It’s shocking. You know, depression is actually more dangerous for you in terms of heart attacks than smoking or being overweight.

C. James: Thank you for your presentation. I’m just going to follow up on Maurine’s questions. I’m glad you presented this issue, because it’s something I think all of us have been grappling with, and I don’t think there is an easy answer. I think it is something we’re going to have to struggle with and, obviously, government is going to have to struggle with.

I think the issue of integrated services is critical. Where the sole responsibility sits to be able to make sure that those services are integrated really is key. I’ve certainly heard the concerns around MCFD and child welfare and the stigma for people to be able to access services and supports there. But I’ve also heard the flip side and the concern that if it’s all moved into the Ministry of Health, it becomes a medical model. It becomes diagnosis-based rather than dealing with a lot of the prevention work.

Coming back to the small percentage of challenges around bipolar and schizophrenia and diagnosis versus the large percentage of people whose children initially struggle with depression or anxiety, how do we make sure it doesn’t become a medicalized approach only to the issue of youth mental health?

I guess I’m interested in hearing from you around that issue and around integration. Do you believe that providing an integrated approach is going to happen more easily in the Ministry of Health than it does in the Ministry of Children and Families?

D. Smith: If I can start with that, thank you for raising that, because it’s such an important point. I think it’s a myth and sometimes, frankly, fearmongering. Our approach to care is biopsychosocial. That is really what it is. That means that we are automatically looking at that whole person and how we get the best care. What we want to do right now is stop dividing the brain-body barrier that has been falsely put into our psyche and into our culture for so many years. We want it to be integrated together and working together.

That means that our services are not…. We’re not talking about just prescribing medications to kids. What we’re talking about is being able to advocate for and have all of the necessary resources that are needed — individual therapy, family therapy, play therapy if it’s needed — but also, if they need to go to the hospital, being able to utilize that resource. Whatever is needed along the way.

We are by no means advocating just pushing pills. It is really around the critical importance of taking that holistic look. Sometimes that’s missing where it is. We have to look at that piece, particularly if you’re saying: “Where does it belong?” I don’t think there’s ever going to be a case made for MCFD managing the hospital acute units. So if you’re looking at trying to have it integrated in one, there’s only one place where it can really fit in order to put all of those pieces together.

M. Stilwell: The exchanges you just had, I think, were helpful. I actually am happy to see you make this recommendation. I think one of the results of these hearings is that we hear that mental illness is not some ethereal idea about just feelings and emotions. It’s your organ of functioning, and it’s not working. It is an important human organ. I do think you’re on the right track, and I hope you’ll persist in that.

To the second point about the medical model, I think you addressed a lot of the myths. The fact is that you have to have diagnosis. You have to know: “Is my child mentally ill or not?”

What I hear — I’ve said it many times — is that some of the models in the community that have great programs and are well-meaning and the programs themselves function…. The parents’ experience is that there were barriers to their child getting the care they needed — that there are non-medical people screaming and creating barriers and waiting lists. I’d like to hear about your experience, whether you work in either or both of those kinds of models.

My second question is about transitions. One of the things we heard about — and certainly, you have talked about it in the materials — is that the peak incidence of mental illness is 14 to 25, which is exactly the wrong time to be transitioning people. I would like to hear what kinds of discussions, if any, you have had with either ministry.

Obviously, any deadline…. You could be diagnosed when you were 24.9. Then the next day they say: “Oh, it was nice meeting you, but now we’re going to put you somewhere else.” The whole idea of transitioning from youth and adult for the issue of mental illness is, clearly, potentially disastrous. I’d like to hear about that too.
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C. Saari: I could probably speak to both of those. I have run into the situation where I get frustrated with, as you said, non-medical personnel making decisions on whether or not this patient should be seen by me.

I have been recently in a situation where we consulted with the ministry. The Ministry of Health was consulting with the Ministry of Children and Family Development about a young person who was very complex, who was dealing with traumatic issues as well as substance-use issues and had been through the foster care system. It was really a very high-risk person.

They had come to us to say: “Do you think they need to be seen by a doctor?” I was like: “Today? They should have been seen by a doctor many years ago.” But when they said: “Well, we talked to somebody.” It wasn’t a physician ever, but that person said: “Well, no, it’s just trauma and drug addiction. That’s not a mental health disorder.” That I would disagree with, because I work in a provincial youth concurrent disorders program where I see young people with mental illness, PTSD and addiction every day.

I also work with the transitional-age youth, because our clinic sees kids from 12 to 25. We struggle with this all the time, especially with those transitional-age youth. They often show up at 18, and MCFD will not offer them any services because they’re eventually going to be leaving their system. So they’ll wait for a year before we can even refer them to adult services, and then adult services have a different mandate than child services. So these young people have nowhere to go.

As well, I struggle with knowing the resources, because we have to be able to juggle both of them. We’re working all of the time, trying to bring together addiction services and the Ministry of Health, then social services through MCFD and then, as well, child and youth mental health services. So I’m actually trying to bridge together three different groups as well as our clinic.

We struggle a lot. I think that partly shows why we can’t see as many youth, because we spend so much time. With all of the phone calls and the setting up meetings and all of that stuff, it just becomes wasteful, and the youth are the ones that are suffering for it.

D. Smith: If I can just say, the B.C. Pediatric Society has supported this recommendation — and the B.C. Psychiatric Association, several divisions of family practice, the Vancouver police department. It’s something that’s seen as a barrier and a challenge.

In particular, you say 70 to 80 percent of individuals who will have a mental illness will present between that kind of 15- to 25-year-old age range. When you know that…. Again, trust is paramount at that stage of life, and particularly if you’ve got mental health issues and all the stigmas that go along with that.

They’re just barely building trust and confidence and starting to get some help in one system, and then they have to jump into a whole new system. You can imagine, again, the huge gaps and the losses that we have. So many of them, at that point, are then lost to addictions and the street and all sorts of other untoward outcomes because of that huge barrier of transitioning systems at such a vital, critical, vulnerable age.

J. Rice: Well, my main question has been answered, and that was the same question that Carole posed. I think you’ve elaborated on that in this question. But I have one question. I’m absolutely of the mind that we look at the body as a holistic thing and the mind and the body are not separated. I’ve always struggled with the fact that we separate mental health in its own little silo.

Saying that, I’m really curious to know: why do people with depression have twice as likely a chance of a heart attack? What’s the link, and how does that happen?

M. Chow: Well, the simple answer is it’s a mind-body link. It’s that the brain and the mind are not separate from the body. People that are experiencing a panic attack can exacerbate their asthma. I just saw a young woman this morning whose anxiety has exacerbated her postherpetic neuralgia, which is a very painful neuropathic condition. So these things are linked.

We don’t entirely understand exactly why or how it happens, but we’ve got very smart people that are crunching the numbers and doing the statistics that can show us that if you have depression and then you go and get a heart attack, you’re more likely to die from that heart attack. You’re going to have a more lengthy period of recovery. If you have schizophrenia, you’re going to die ten to 20 years younger than your counterparts without schizophrenia, irrespective of whether you smoke or get cancer or take poor care of yourself. These are shocking statistics, but they’re out there.

Do we know exactly why? No. What we do know, though, is that when we treat these people…. For example, in giving appropriate therapy to someone with depression who’s had a heart attack, we actually improve their cardiac outcomes. That’s an important thing to be looking at.

D. Smith: That treatment may be medications. It may be counselling. It may be family support. It’s all sorts of different treatments that are needed. We’ve shown that even psychotherapy changes the brain. It changes how it functions and the morphology. So it has to be that holistic approach to helping them.

M. Chow: To echo what he said about treatment, I mean, I have a prescription pad in my office. I’ve been seeing patients all day today. I haven’t used it once. I’m just as likely, as a child psychiatrist, to spend my time on the phone with a school principal to help coordinate an independent education plan or a modified educa-
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tion plan for someone. I’m just as likely to be spending time talking to a police officer about a person at risk. I’m spending time with parents to help them understand how to help their child with attention difficulties. I haven’t even reached for my pen yet.

C. Saari: I spent the hour before I got here trying to teach sleep hygiene — you know, going to bed at the right time and getting up at the same time every day. She wanted something to knock her out. I said: “Well, that’s not going to work. You have to get a right schedule going.”

D. Smith: I work in an eating disorder clinic, and I do family therapy. I work with the families, trying to help them to support their children to recover from eating disorders — wonderful families who are dealing with a very challenging situation. I do counselling with them.

C. Saari: I think, going right back to psychiatry, we are medical doctors — that is true — but our training goes across all psychosocial therapies as well, right? That’s a big part of what we do in psychiatry. For five years of training, we learn all different types of therapy.

M. Chow: Sadly, to carve us off and say, “Well, mental health is out here in a different ministry,” it actually diminishes health care. It diminishes our colleagues who are surgeons and family doctors and medical specialists because they lose out on that comprehensive view of the patient. They forget that mental health is really important when we’re off working somewhere else, not as part of the health care system.

J. Rice: Should we not read this book that a previous presenter gave us about the over-medicated…? What are your thoughts? Have you read this book?

J. Rice: Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, Robert Whitaker.

M. Chow: I’ve read that book. I’m actually an admirer of Dr. Whitaker’s work. I think he’s actually done a great service to people. I encourage both my colleagues and my patients to read very widely, both pro- and anti-psychiatry books like this and other books by folks at Harvard — for example, Harvard Medical School.

I think the problem is when we overgeneralize. When we say to people that all drugs are bad, I think that’s dangerous. I think when we say that only drugs should be used for mental health, that’s dangerous as well. I think the more holistic, balanced view is the way that works for people and helps them get better and that we need to sort of avoid extremism. But certainly, I would never discourage someone from reading something like that, because I think it’s useful knowledge.

D. Barnett: Thank you very much for your presentation. Until you actually deal with somebody who has anxiety or depression, you don’t really understand mental health. If you do, then you understand it. To me, cancer is cancer, and depression is depression, and they’re both the same. They’re just in a different category. To be honest with you, it’s easier to have cancer because we can either cure it or not. Depression can be a lifelong situation if you don’t get the right treatment, and the right treatment is not medication, in most instances. So I commend you for what you do.

I have a question — why in 1997 mental health was taken out of Health. I have never checked into that. Maybe you can explain that to me. I believe it belongs there, in my own personal opinion, because it is a huge health issue. As you said, it’s greater than some of our other diseases that we recognize and that we ensure get proper treatment.

D. Smith: I think it is part of that stigmatization, that it’s seen as separate somehow. We wouldn’t do that with another disease, but somehow with mental health, we’ve moved it out. It really is.

C. Saari: Well, the Gove report came out of, I think, a really great intention. The intention was to try and move all services under the Ministry of Children and Family Development. The way that it was a bit shortsighted was that it didn’t really take into account acute medicine, acute psychiatry, in-patient psychiatry and that health model where the Ministry of Children and Family Development really doesn’t have a foot in the hospitals. They’re not able to kind of get in there and have the same level of participation within the hospital setting.

The idea was to try and move it over. There was this plan, but I don’t think the plan ever really materialized. Parts of it went over, and then other parts just didn’t, and we’ve been living in this system where it was kind of a half-done measure that never went all the way. Even if you go back and think about…. Could that even come out successfully, knowing that you were never going to be able to integrate the hospital care, the in-patient care, into this? Perhaps it was not a well-thought-out plan in the first place.

Also, this idea of the transition point. Maybe that wasn’t really considered back then when we were suddenly looking at the 16-, 17-, 18-, 19-year-olds who often are first-time presenting when it comes to mental health. And then just trying to get involved with a treatment plan and then having to have it cut off right when they’re starting to make some progress.
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D. Smith: I think the other piece that wasn’t really fully conceived of, also, is what is an inherent conflict of interest — having child and youth mental health in an office that’s child protection and what is perceived by so many parents, particularly those who are most vulnerable, as something that’s very threatening and unsafe to them.

J. Thornthwaite (Chair): Thank you very much for your presentation and for preparing your presentation to us as well as taking the time this afternoon to come and talk with us and engage with us. We very much appreciate it.

J. Thornthwaite (Chair): Our next presenter is Dr. Wilma Arruda, from the B.C. Pediatric Society.

W. Arruda: I want to thank you very much for inviting me to present today. I want to introduce my guest, for sure. I must say my brain has been somewhere else because my daughter is getting married in 2½ weeks. I’m sorry that I invited Stephanie and forgot to tell someone to make a little sign for her.

I’m Dr. Wilma Arruda. I’m a community pediatrician from Nanaimo. I’m also medical director for child, youth and family health in Island Health, and I am the chair of the advocacy committee for the B.C. Pediatric Society. With me today, supporting me and very helpful, is Stephanie Stevenson, our executive director for the B.C. Pediatric Society.

Thank you, again, for inviting me. You can see that the title of my presentation is “The Barsby Project: The Journey to School-Based Youth Mental Wellness Begins.” I will apologize from the beginning because I was told I only had ten minutes, so I’m going to march through these quickly. This is a shortened version of a presentation that I gave to the Child and Youth Mental Health and Substance Use Collaborative in April. I did send that longer version ahead, so I suppose you might have an opportunity to look at that, if you’re interested.

This is really just a review of the process, the journey, that we’ve gone through with respect to the Barsby project, and I’ll tell you a little bit more of that in a second. Also, this idea is an initiative of the B.C. Pediatric Society in the sense that we have a project on physician engagement or connectedness to schools. So it is associated in that way.

Our vision is to develop, implement and evaluate a collaborative and sustainable model of school-based health services in an inner-city school in Nanaimo. It’s called the Barsby project because the school is actually John Barsby Community School.

Why do we need school-based health services? Well, we know that there’s ample and growing evidence linking access to school-based health centres and improvement in academic performance indicators, such as fewer absences, higher educational aspirations, attainment of grade-level outcomes, higher graduation rates — all of this through the improvement of health outcomes overall.

I cut down some of the data to support this. There’s definitely quite a lot more in the research — although it is an up-and-coming field in research, so I think we’re still going to learn an awful lot.

We also know that there are a number of school-based health centres in the States. We don’t have as many in Canada. The American literature on the outcomes of school-based health centres in high schools clearly illustrates improved health of adolescents in the medical, mental health and educational domains.

That’s take us to: why Barsby? This is a picture of John Barsby Community School. It’s in south Nanaimo. It is in an area of Nanaimo that is what may be considered more socioeconomically disadvantaged. We know from the human early learning partnership and the EDI scores that young children from this region of Nanaimo have the highest percentage, 47 percent, of vulnerability in the Nanaimo-Ladysmith school district. That’s considering the physical, social, emotional, language and communications skills development.

We also know that John Barsby school has 697 students: 29 percent of them are self-identified as aboriginal; 16 percent of students have an identified special need; and many of the students, on a daily basis, are accessing food in the school.

We also were able to do a student survey. The principal of the school was very motivated and went from classroom to classroom, getting the students to complete a survey. We found out some interesting things. One of the most interesting things was that even though many students said that they had a family doctor or a nurse practitioner as their primary caregiver, very few of them were actually attached to that person and tended to go to the emergency room or to a walk-in clinic if they needed health services — or actually not at all, seeking no help at all.

We have a student representative on our working group. She told us a story of a friend of hers who was in a car accident, was injured and had quite a lot of pain following the car accident but never once went to get any help for that.

We do know that many children and youth and their families that live in this area have difficulty accessing health care. They often don’t have their health needs met. We know that providing health services in a school will give us timely, appropriate, close-to-home health care, which will help mitigate the lack of appropriate health service delivery and create a health care safety net for this vulnerable population.
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What could the health services look like? I think it’s really important to step back and say that we already know that within this school there are a number of wellness activities that go on. Those are services that are provided by child and youth mental health therapists and substance-use counsellors. There’s a dental program and so forth. So we want to ensure that we will be fully integrated and partnering with those already existing wellness services. I’m saying “wellness” because we actually call our centre a wellness centre, trying to avoid the terminology “clinic.” Every time somebody uses “clinic,” we say: “You have to put $25 in the jar.” We haven’t made any money yet, but it’s a standing joke.

We really want to provide those health services. That would be direct health care by the most appropriate health care practitioner. I want to thank the previous presenters because they certainly brought up some very key points that I think have helped me come to this topic quite easily. We want the most appropriate health care practitioner, and that may not be a physician or a nurse. It might be a mental health therapist or someone else within the existing services. But we would be able to provide an opportunity for all of these to come together.

That would allow us a continuum of care, and I’m focusing here a little bit more on the health services, specifically. But a nurse, a nurse practitioner, a family physician, a pediatrician, a child and youth psychiatrist — all of these would have an opportunity to run a clinic, I guess, within the wellness centre.

We also know that there will be opportunities for fully integrated interdisciplinary assessments and management of general health concerns — sexual health, mental health, developmental and learning difficulties and chronic illness. And of course, it’s very important that we provide education and health promotion opportunities to the students, the staff and the community.

We also recognize that putting the “health” back into mental health is definitely important. Again, that topic was discussed just a few minutes ago, and I don’t need to spend a lot of time speaking to that point. But we do know that many times we expect that students will come in with a more minor health concern, and the more major mental health concern will become apparent. It will allow us the opportunity for early identification, early assessment and, hopefully, early treatment.

We are, therefore, breaking down those barriers. We know that there is stigma. Youth just finished talking about stigma. We know that child and youth mental health clinics are located in a different location far away from the school. They are associated with child protection teams. There is a lot of stigma. There’s a lot of difficulty. The students don’t want to go there.

As well, the medical providers are also located in a separate place — again, another challenge to get to those services. By providing a school-based health and wellness centre, we know that those students can now self-navigate. Our space actually is right beside the counselling offices, so the students can move in from the hallway, or they can come in through the counselling office. Therefore, there’s more privacy. They don’t have to worry about their neighbour sitting down in the chair beside them or their parent being close by. This will, of course, provide wraparound care.

We know that we can’t do projects like this without teamwork. I’m not going to go through this list. It’s quite long, as you can see. But over the course of the last year we have had a significant interest in this project. These are the agencies and organizations that have come together, all of them very devoted to this project. I can speak further to those later if you’re wanting that information.

Just to walk you through a little bit of our process in the last year, I guess I’ll start by saying that Bob Esliger, who I call my partner in crime, is now assistant superintendent of school district 68. He has been my partner in crime for many years. We’ve talked about a school-based health centre of some sort for probably about ten years. In fact, when we looked back at documents, we saw some documents supporting this for probably 20 years. The stars have lined up, as we say, and in the last year we’ve been able to make progress.

Last spring we developed a working group. We had immediate interest from the Nanaimo Division of Family Practice and the GP for Me initiative, and they became partners. I was asked to present to the school board last June, almost a full year ago. That was to ask for space and also for partnership. In October the board approved a space.

We were able to get a small amount of funding from the GP for Me initiative, and a further amount of funding is expected through the Child and Youth Mental Health Substance Use Collaborative.

By January we were 31 members, with 15 organizations represented. By January we were meeting about once a month. We’ve become what we now call the local action team, which is a team that you may be familiar with through the collaborative work. We’ve formed actually more than seven subgroups. I call these our worker bees. They go off and work like crazy for a month and then come back and tell us what they’ve done.

We have developed plans to renovate the space to suit the purpose. Even today, potentially, those renovations may be beginning. We just were waiting for the final sign-off between Island Health and the school district.

As I said before, we completed a student survey. We have a temporary coordinator in place. We’ve submitted a proposal for a nurse practitioner. We have six GPs and family practice residents set up, ready to work. Now that it’s the end of the school year, we expect to be starting our services in September.

I just want to highlight a few successes that we’ve had so far. First of all, we have a broadly representative
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group of partners and champions. We’ve had some funding opportunities which I didn’t expect. I always call it my Christmas present. We have the commitment of key decision-makers in the partners, with a common vision. We have commitment from the school district. As I said before, our stars lined up, so the timing was perfect, and most of the time we have good communication.

In fact, there have also been challenges along the way. That’s to be expected. The process has been a little slower than we wanted. Sometimes we have to be sure that my common vision is the same as your common vision, so we have to ensure that we have a common vision amongst our working group and also a clear understanding of what we’re planning. We don’t want to be stepping on toes, which happens once in a while.

Of course, how do you eat an elephant? Well, one bite at a time. So slowly, we’re moving forward. Of course, sometimes good communication is a challenge.

I always want to say, at this point, that I have spent many hours on this initiative. I don’t want to spend a lot of hours on something that’s going to die in a year or two when the funding dries up. To me, sustainability is absolutely important.

I’ve just identified some of those things that I see are keys to sustainability. Physician compensation and physician support are absolutely key, and the collaborative has actually done quite a lot of work on this. We’re very happy that some of that work has been done for us. I’ve identified here a connector person, and I can explain that in more detail later, if necessary. This is someone that will help the youth, at this point, access the services.

We need to make sure we have trusting relationships within the school and also within the community. Unfortunately, we do need to have some funding. There will be ongoing operational costs, but I see that this funding amount should be fairly small. Of course, we need to regularly go back and review our common vision and goals and make sure we’re all on the same page. We have to have good communication.

Our immediate plan at this time is to provide services directly to the school population, the students. Our vision within one to three years is to provide services to the families of the students and to the community and to provide those sorts of community-based health services in a one-stop-shop kind of model. We know that this will have to be not within the school specifically, for some of the safety concerns regarding the students, but somewhere very, very close by so that we have that relationship and association.

We also hope that some of these ideas will expand to other schools in our district. In fact, it already has. This initiative has triggered conversation between our public health people and our school district, and there is now an initiative to have more public health nursing in our high schools, starting in September. It’s already triggered that.

Just to finish off. School-based health centres exist at the intersection of education and health and are the caulk that prevents children and adolescents from falling through the cracks. And that’s it.

D. Donaldson (Deputy Chair): Thanks for the presentation. Lots of hopeful initiatives in there. I have a number of questions. I’ll try to just throw them all at you at once, and you can try to figure out how to answer them, if at all.

The partnerships. I’m just trying to get a picture of how it’s operating right now. I didn’t see Ministry of Social Development and Social Innovation there. If a kid comes in and wants help with income assistance or housing — I know it’s a secondary school population, but just wondering about that aspect.

What about the kids that aren’t in school that are in the catchment area? Are they welcome to come in? You talked about some of those issues, I think. The gap when the school is shut over the summer — how is that being handled? And I think the connector person is really key. We just heard from Dr. Steve Mathias, saying co-location is not integration. Is that connector person really that integral part of integration, rather than a co-location model?

W. Arruda: Okay. I’ll see if I can remember all those. You started off with the partnerships. Very good point. The Ministry of Social Development is certainly an interesting partner to bring in. I must say that the partnerships developed as they were interested. It’s not that we really solicited most of that. They came forward, saying they were motivated and wanting to be participating in this. We really haven’t closed the door on that.

But we are frequently talking about who else should be at the table. So you know, I will bring this back, and we can have that conversation for sure. It’s not that we’re closing the door. We simply are just letting this evolve in a way that’s actually going to support the project but also support the interests of the people that are at the table so that they feel they’re getting something out of that as well. Good point.

W. Arruda: Oh, right. Yes, we’ve thought long and hard about people outside of the school accessing services in the initial start-up. In fact, the safety of the school students has become sort of the key part of our discussion.

We know that, as we move forward, we have to tread a little bit lightly. We can’t just blast in there saying: “We’re doing this.” This has to be a relationship and a partnership. The safety of the students and the safety of the staff is very important. At this point, we are limiting to the
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students, but as I said, we do want to expand beyond the students and into the community.

We do have other things going on in our community that are addressing, actually, those students that aren’t in school. We have other projects that I’m involved with that are addressing those needs. I see, again, with my partner in crime and other people that are similar partners, these ideas are emerging, and we will be trying to address that as much as possible. We can’t always capture everyone, but we’ll try to address as much as possible.

I think you brought up the gap in the summer holidays. Our intention really was not to necessarily close the doors over the summer. We had had some preliminary conversation about what that would look like had we been providing services already for a period of time. But because of organizations and how they have to sign off and some of that political struggle, we haven’t been able to provide that service yet.

We felt at this time, given the circumstances, that we wouldn’t provide the services till the fall, but we will then hopefully have next year to determine what things will look like, given that the summer months come up. It’s not that our intention would be to close the doors but more that it’s just the timing at this point.

W. Arruda: Oh, yes, the connector person. Well, this comes from…. I’ve done some work with our friendship centre for a few years now. These are very marginalized families that often cannot access health services in any other way.

I’ve gone to the point where I identify somebody who can be that person to help them get there. That sometimes is someone from the friendship centre. It might be a counsellor from the school. It might be a teacher. It might be a family friend. It might be a social worker. I see this connector person as absolutely key in helping support the process.

Absolutely, co-location does not mean that you’re integrated. To me, that theme or that value or that goal of being fully integrated is very, very important, and it’s very important to our group. That’s why I spoke to things like developing trust and building relationships and being involved and participating.

Part of the space that we’ve developed is just an open area, We hope to have couches, coffee— things like that— so that it will hopefully become a place where kids want to come, where other organizations want to come and bring their people. We hope that it’ll become a sort of comfy place. That will build those partnerships and those relationships and those trust situations.

D. Barnett: No. We know who is here. In your proposal when you say “the elephant in the room,” who is the biggest elephant in the way?

W. Arruda: I think that that’s changed. It started off, as I said, maybe the school district trying to, especially for me…. I used to be a teacher, but I’m no longer a teacher. I’m a pediatrician now, so I’m coming from the community saying: “I think we should do something in the school.”

Stephanie will speak to this, because we’ve had other pediatricians interested in similar sorts of situations. Often the school goes: “Whoa, wait a minute.” They’re worried about what that means. Sometimes it’s because of money.

At one time the school district was that elephant. Do they feel that this is working for them? Especially the school itself — the principal, the vice-principal — having them feel that this was comfortable to them, that this was something that they would have value from but not have this sudden extra burden put upon them.

But I think that’s changed. We’ve now had other organizations and other components being the elephant — one being the fact that we didn’t know what our relationship would be in terms of having this space within the school. Who is the owner of that space? Who takes care of the cleaning? Who takes care of making sure that it’s maintained and doing the renovations? That has led us through a process. We thought we could just share that and have a sort of partnership agreement.

In the end, it ended up that the lawyers thought that it was best to have us leasing that space from the school district. That took several weeks — actually months, probably — for them to all figure that out. That’s why we’re waiting for the last sign-off on that in order for us to start the renovations.

Probably right now our biggest elephants are things like what came up in the previous discussion. How do we share this record? It’s not even a medical record. Who gets to look at that information? Who shouldn’t get to look at that information? How do we have consent? Where does it get stored? One of the working groups is actually working to figure that out right now.

The other one is…. Earlier this week we had a meeting to talk about how the flow of the service will be. Who’s going to work in it? What time are they going to work in it? How do you access? Do you need an appointment? Do you just come in if you feel like it? As we go along, we realize there’s another elephant each time. But we
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have to work through it. Each elephant has its own elephants, I think.

J. Thornthwaite (Chair): Thank you very much, Wilma. It was really a pleasure for you to come in and present to the committee.

We did hear of another model — more advanced, obviously — in New Brunswick. They’ve got almost 50 percent of their school districts that have adopted a very similar model that you’re referring to. We definitely, consistently have heard in this committee the importance of schools in the issues with regard to child and youth mental health.

Oftentimes when you can get them help in the schools, they don’t need the services later. So good on you for doing this and being very persistent in ensuring that this model goes. It looks like you’re expanding very well. Good luck, and thank you very much for taking the time to come and present to us.

Our next presenter is Dr. Jeffrey Schiffer and Deborah Abma from the Focus Foundation of British Columbia.

We’ve got a half an hour for you. What we’ve been recommending is that people take ten minutes or so — we’ve got your materials; people have read it — and then take ten minutes to initially give us an overview and then give the committee the opportunity to engage and then ask questions. We’re trying to keep everybody on track.

D. Abma: We don’t have a Power presentation. For the sake of time, we didn’t do one. I wish I could actually take you to all of our centres today, which would be a fantastic thing, and you could see our environment.

Today we’re really fortunate and very pleased to be here. My name is Deb, and this is Dr. Schiffer. Dr. Schiffer is, unfortunately, a bit under the weather — the joy of having toddlers that share. So I’m going to make our presentation. But he promised he would be here, and not make the mad dash to the washroom, to assist me with the questions.

I, also, am privileged to have another board member that’s here, Bruce Jackson in the back of the room, as well. Our organization has a dedicated group of individuals who help make possible what we’re doing today.

I’m going to share our presentation, and then we really look forward to your questions. I so enjoyed hearing the questions you were asking the last two presenters. We’re looking forward to that.

The Focus Foundation was founded in 1975 as a youth advocacy organization, taking a holistic and therapeutic approach to supporting British Columbia’s most vulnerable youth. We started from the viewpoint that the theories needed to be put into practice and solutions needed to be provided.

Many of the youth that we encountered felt they did not fit into the traditional system and were buffeted about by life circumstances, different learning capabilities or behavioural challenges. The work that we set out to do was difficult, but we knew it was too important to fail.

Working from an organic framework, we set out to engage youth and their families and to gain a better understanding of their life connections and family systems. Our programs, and eventually our Whytecliff agile learning centres, were based upon natural development and growth models.

Through our Whytecliff centres, accredited secondary independent schools by the Ministry of Education, and as a mental health and addiction centre by CARF, we have had notable success addressing challenges in mental health and supporting educational success among youth who are at risk physically, mentally, psychologically and socially.

Over the last decade and a half our centres have developed broad community partnerships and evidence-based approaches. Theory has translated into practice through a concrete methodology that has resulted in a unique style of management, community engagement, partnership and intervention.

More recently Focus has been synthesizing decades of experience, partnership feedback and client testimonial into a plan to re-vision Whytecliff learning centres as community hubs, integrating community services to increase efficiency, impact and reach.

The work we do is crucial not only to the youth we support but to the community at large. The work is intensive, tailored to each individual’s needs, and expansive, including family support, individual education plans, recreational activities, counselling, addictions treatment and practical implementation like transportation to assist in overcoming barriers.

Our team of dedicated professionals — comprised of educators, family and youth workers and community experts — work from a clear vision and therapeutic approach. A low staff-to-student ratio, ability for immediate intervention and a tailored solutions-based approach provide youth with the environment and necessary tools to regain emotional equilibrium and gain the confidence, skills and passion to move towards a positive future.

This process is supported through immediate intervention provided by our family and youth workers who play an active part in the daily support that we provide to our youth.

Today we would like to discuss the process of revisioning Whytecliff schools as service hubs, with a specific focus on how this model can address a growing youth demographic within our centres — namely, our aboriginal youth.

Aboriginal youth represent the fastest-growing, most culturally diverse and most rapidly urbanizing population in Canada. With the recent release of the 94 recommendations of Canada’s Truth and Reconciliation
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Commission, it is also clear that as survivors of colonization and residential schooling, they face some of the most complex challenges.

On average, 40 percent of our youth across the two Whytecliff Learning Centres are aboriginal. In 2014 our youth population was comprised of 67 percent aboriginal in our Burnaby location, and 61 percent of those students were in foster care. Among the most vulnerable subset of youth in British Columbia, addressing mental health requires a development of integrated and evidence-based models that are culturally relevant to and restorative for diverse aboriginal youth.

Intergenerational trauma resulting from colonization, residential schooling and the child welfare system, such as the Sixties Scoop, often manifests in aboriginal youth and their families as challenges in mental health. Evidence-based, trauma-informed practice has been shown to address intergenerational trauma in ways that often alleviate these mental health service challenges. Programming grounded in aboriginal cultures and land-based practice is also especially effective in this regard.

The culturally relevant urban wellness program, CRUW, at VACFASS, is one example. CRUW was founded at Vancouver Aboriginal Child and Family Services Society and is currently in its fourth year. The program brings aboriginal youth in foster care together with other diverse new immigrant youth to support positive identity development, emotional and cultural competency, youth leadership and the development of concrete skills to support the transition out of care and into independent living.

The program has a retention rate of over 85 percent. The aboriginal focusing-oriented therapy programs, running internationally, are helping to reframe trauma and bring forward indigenous tools for addressing mental health. Indigenous, land-based, culturally relevant therapies help in the struggle for intergenerational healing.

Programs include AFOT, indigenous tools for living groups for adults and children, to help each with trauma management skills and decolonization issues like shame and intergenerational trauma and to build on intergenerational resilience and indigenous perspectives. Together, these programs produce evidence-based findings that we hope to integrate into the practices of Focus Foundation that we have developed and refined over the last 40 years.

In particular, Dr. Schiffer is interested in contributing and further developing our curriculum and our practices and approaches addressing aboriginal youth and their needs at our Whytecliff Learning Centres. During the 2013-2014 academic year, between our two centres — located in Langley for the Fraser Valley and in Burnaby for the greater Vancouver area — we collectively supported over 90 youth. All of our youth have special needs and learning challenges. They are between the ages of 13 and 19, and we were proud to award 27 Dogwood diplomas. Ninety-five percent of the youth who enter grade 12 at our centres graduate with an over 80 percent attendance rate.

Through partnerships with organizations like VACFASS and bringing innovative knowledge and approaches forward from programs like CRUW and AFOT, Focus is taking a holistic approach grounded in natural development growth models, with an emphasis on strength-based practice rather than on the deficient model. Our visioning-based approach builds on strengths in therapeutic environments, mobilizing behavioural interventions to support vulnerable youth in culturally relevant ways.

That’s a little bit about us in sort of a nutshell, and where we’re headed in the future. I’ve also included, actually, in her own words from one of our graduates…. I’m pleased to say that she does come back and share her success with our students. In fact, she was just there a few weeks ago.

We’ve also supplied some additional information in articles there. Also, our theory to practice — basically, what we started from and how we integrated that.

J. Thornthwaite (Chair): Thank you very much, Deb. You’ll find it interesting that we just had, just before the lunch break, Chief Doug Kelly from the First Nations Health Council and Chief Wayne Christian, who talked a lot about what society in general, all levels of government as well, have to do for First Nations. They also did quote what you had quoted as far as truth and reconciliation, so it’s timely that you mentioned it.

They also did talk about the way of being, and I liked what you included in your package: values and ethics in educational administration. I appreciate that.

M. Bernier: Thank you very much for the presentation. I hope you feel better soon, and thanks for sticking with it so far.

I’m sorry if you had the information in here. I didn’t see it. But how does your funding model work?

D. Abma: That’s always an interesting struggle, to be honest, for us. We are accredited as an independent school, so about 40 percent of our funding comes from the Ministry of Education. As I mentioned to you, 100 percent of our youth that we serve do have special needs, ranged from level 1 to level 3, so we have funding from there.

We do have a very minimal sliding-scale tuition. One of the things that we find is that families who do that pay-for-service type of philosophy…. “If I’m investing in this, then there may be more support that way.” So there’s a very low level as far as that, because we do run therapeutic programming.

The great news is we have a very supportive community. We’d love to have it grow. We have partners like Variety, The Children’s Charity; the CKNW Orphans
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Fund — organizations that kind of go on, and that’s part of what’s on my desk and also on Bruce Jackson’s desk.

It’s a constant struggle for us. Our funding is the big elephant in the room for us, to answer that question.

D. Abma: I work for the foundation. Most of the staff work for the schools. Yes, we are a non-profit organization.

D. Abma: I write lots of grant applications, definitely. We apply for specific programs. For example, we run a fitness and nutrition program. We found that for many of our youth, because we originally started as a program for young offenders, transportation was an issue. So 40 years ago that’s how our program actually started.

Fifteen years ago, because we work on an organic model, it was actually the youth we were supporting who came forward and said: “I’m getting all this support in a variety of areas that I need, but I’ve not finished high school.” It came from conversations that we were having with the youth that we were supporting that we eventually applied to be able to become an independent school.

M. Bernier: Thanks for that information. I appreciate it. Thanks for what you do too.

C. James: I think you just answered the first question I was going to ask, which is that the foundation started in ’75, and you moved into creating two schools in the ’90s and early 2000s, and why. I don’t know if there’s anything else you wanted to add on that.

The other question I’d have is: where do most of your referrals come from? Where are most of the young people connected to your program? Do they come from ministry referrals, parents…?

If you came to our Langley centre, one of the things that you would see commonly is our community youth detachment of the RCMP officers that are right there. We believe in the collective whole in supporting the kids. So some of our youth detachment may make a recommendation and say: “Mark, I sort of see you a lot of the time. You’re not a bad kid, but perhaps you need some additional support in your life. I just wanted to tell you about this really great program that’s in town that you might want to go and check out.” That’s one way that referrals come about.

School therapists. Perhaps they’re not able to support the child fully in their school environment. Maybe it’s showing up as a behavioural challenge when it’s actually other issues but that’s what’s presenting at first.

This year was an exceptional year for us. We saw a huge referral from peer to peer actually walking in. I watched it firsthand. A group of teenage kids would walk in, and they’d say: “You know what? My friend Sam graduated last year. He’s not doing crystal meth anymore. He’s not doing these things, and he got help from you guys here. So whatever you guys are doing, I want to be here.”

Grandparents are a huge way. There are also some from various ministries. A lot of pediatricians are also making referrals to us now.

C. James: How would those young people be funded? If it’s an independent school and there’s a portion of a fund that has to be covered off, how do they get funding?

D. Abma: Well, we sit down, and we do an intake process, which would be with our program director and our principal. Also, our family worker would be part of that. We look at each child as an individual. Our desire and goal is not to turn a child away. Our thing is that where there’s a will, there’s a way. We do sit down with whatever those support pieces are in their life and see what they’re able to…. But we have criteria.

We also have criteria that if they’re just thinking we might be a cool place to hang out, then perhaps going back to their high school is where they need to be. But if they’re needing additional support and they meet our criteria and they’ve tried all their other avenues, then that’s definitely when we want to be supporting them.

Then we set about looking at: what are the costs for us, and how can we cover that?

D. Barnett: Two of my questions have been answered, with my colleagues here. But what age group?

D. Abma: Thirteen to 19. We’re hoping to expand that and provide additional, as we go forward in the future. Many of our kids are on the verge of aging out. This year our board has made the decision, with the support of our leadership, that those kids who were on the cusp — we’re going to hang on to them. Some of them have had to…. We’ve helped them get additional supports, so they had to put their education piece on hold, but we’re not letting them go.

D. Donaldson (Deputy Chair): Thank you for the presentation. I’m particularly interested in the initial sentence of one of the paragraphs you had here. “We’d like to discuss the process of revisioning Whytecliff schools as service hubs.” From the aspect of children and youth mental health, you talk about helping students get additional support.

Is that directing them to services within Burnaby or Langley that are outside of the school? Is your discussion
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of revisioning as a hub to be housing those services and having an integrative model within the school?

D. Abma: A couple of parts that are there. One of the things is, as I mentioned, we look at each child as an individual. I’ll give you an example. One of our students who came a few years ago was extremely angry for a lot of variety of reasons, dealing with some issues. We spent a lot of time looking at him. Our staff is qualified in working with trauma and anxiety. Our program directors and….

After sitting down with him — also our therapist that comes into our school and works with the kids — it was the fact that we needed to reach out to the community and get some family counselling for him. Actually, his mom was brought into that, and he was able to work through some of those issues that he had, together with his mom in being able to provide that support.

That’s just an example. For some of our kids, we need to reach out into the community and perhaps put them into an addiction centre. We work together. To give you an example of one of the situations that happened, our program director in Langley…. We had a student who came to us, and she had had an incident that happened the day that she had come for a tour to our school. She had decided that she wanted to come. Her parents were thrilled about that.

She actually ended up in the hospital and was there for a prolonged amount of time. During that time our program director went to the hospital every day to meet with the team of supports that were in the hospital. We started her education piece. He started meeting with her regularly, developing a counselling session with her through there. Then in turn, the hospital came and visited, and we integrated it together that way.

There’s not a one-model-fits-all for the kids that we support. We try to really look at each of them as the individual and identify what their concerns and issues are and provide the right support for them that way.

Now, you asked me another piece. We talk about revisioning and a service hub. One of the things that we also realized is that we needed greater help when it came to supporting our aboriginal youth, which is why we actually sought out Dr. Schiffer to able to come and join our board to provide extra support for our kids that way.

As we grow into the future, one of the things that we see is that we do have youth who come to us at that critical age of 18. They may not be getting the support that they need in other ways. I heard that addressed in one of the earlier presentations. We want to make sure that those kids don’t get lost. We want to make sure that if they’ve started with us but they’ve not been able to complete all of their education because they’ve needed to stabilize, we can hang on to them.

We’re in the beginning stage and process of what that hub will look like for a variety of reasons, be it legal services that the kids would need, community connections, mentoring; whether it’s connections with medical community, be it mental health, be it medical services and physical aspects. Those are the beginning pieces that we’re looking at. Basically, the very pieces that we’re putting in place for our kids today that we’re serving, that’s what we looking to carry on. Does that answer…?

J. Schiffer: No, I just think that mostly it’s capacity-building through community partnerships. One great avenue for that is a lot of the referrals for the Burnaby campus are coming from Vancouver Aboriginal Child and Family Services Society. I’m the special projects officer there at VACFASS. We’re sending a lot of our aboriginal youth in care to that Whytecliff campus.

Part of that revisioning is just thinking…. We’re serving about 500 families from 30 different aboriginal cultures and associated language groups. When you’re grappling with that diversity, how can we be innovative in terms of creating a service hub that can acknowledge all of those different aboriginal cultures and form cultural connections?

Part of that is also revisioning practice and curriculum within the schools but then also reaching out to make connections to land-based communities and reserve communities and other extended family connections that we know are so important for supporting the youth in success.

D. Abma: We right now do not have a waiting list. Actually, can I go back to one more question on that as well? One of the things that we have…. I think, Carole, it was your question: where do our referrals come from? Jeff and I have both worked with these youth, which is a really great thing.

One of the referrals comes from siblings. We have one remarkable graduate. She has ten siblings who are in various foster homes. She has seen the impact of what this program has done in her own life, so she has made sure, through connecting with them, that they’ve been connected to our program to be able to get various support. Actually, one of her younger siblings has been in the CRUW program with Jeff. I just wanted to come back to that.

We expanded because we did have a waiting list. That was where we had opened our Burnaby campus. To be honest, it’s a situation…. The need is great, but often we’re a very small staff with a lot of work to do. So we in the last two years have really been getting the word out into the community more. We would love to have a waiting list because we want to be able to grow and support more families in the community through doing this.
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J. Thornthwaite (Chair): Thank you very much, Deb and Dr. Schiffer, for coming and for all the work that you do to catch and rescue these kids. We very, very much appreciate it. Thank you very much for the time that you took to come and present.

Our next presenters are from the Provincial Health Services Authority — Connie Coniglio and Jana Davidson. Welcome.

C. Coniglio: We did bring you something, a little package. It’s going to be distributed.

Hello, everyone. My name is Dr. Connie Coniglio. I’m from the Provincial Health Services Authority. I’m the provincial executive director, and I work with the children and women’s mental health and substance use programs.

J. Davidson: Good afternoon. I’m Jana Davidson. I’m psychiatrist-in-chief for the children’s and women’s mental health programs for PHSA as well as division head for child and adolescent psychiatry at the University of British Columbia.

C. Coniglio: With the time that we have today, we have a couple of things that we really want to share with you — three things in particular. First of all, we’d like to talk about the PHSA role in the B.C. continuum of care for children and adolescents with mental health and substance use concerns. Then we’re going to talk about our proposed hub-and-spoke model and provide you with a bit of detail about what that means from our perspective at the PHSA. And then we’re going to talk about opportunities that we feel we can take for leadership in relation to improvements to the system of care.

J. Davidson: One of the privileges we have is that the services we’re responsible for at Children’s and Women’s Health Centre are provincial, and we take our role as having a mandate for providing child and youth mental health services to children, youth and families throughout the province very seriously. We do that in a number of ways.

We do that through our clinical programs, our in-patient work and our out-patient programs. We also lead and facilitate networks provincially that join service providers in child and youth mental health around the province to meet quarterly and share ideas, knowledge exchange practices, to improve care for children and youth.

We’re tertiary-specialized. What does that mean? I’ve stated it publicly, and it’s a thought and an idea that we embrace wholly. We do not have exclusion criteria within our programs. We are the last stop in the province. We expect to treat the most complex, highest-need children and youth in the province.

Our program very much is moving to how we can help this child and their family, resolve the problems and bring the experts within our purview in to try and facilitate that.

We have provided and will continue to provide opportunities for care providers, in terms of learning and leading practice and training opportunities in psychotherapies and new and leading-edge psychotherapies and the development of psychotherapies for specific populations that we’ve brought forward into British Columbia, and will continue to support the spread of those through the province.

Very much family-centred. We were the first to have parents in residence and youth in residence in our programs, through the Kelty, which Connie will speak to later. We have fully embraced trauma-informed practice, which we’ve been rolling out.

We have nationally recognized academic teaching for child and adolescent psychiatrists. We’re seen as one of the top programs in the country, and we’re working toward very innovative, integrated clinical research.

That’s the role that we see ourselves playing in the continuum. We very much appreciate and value the relationships we have with our provincial partners, both regionally and provincial at large.

C. Coniglio: Just one thing I wanted to add to that is our leading role, nationally and provincially, in knowledge exchange and health literacy.

Jana mentioned the Kelty Mental Health Resource Centre. I’m hoping you may have heard of it. It is a provincial hub for health literacy for children, youth and families and has a very well-recognized reputation in B.C. with families, and also across the country, in terms of the great work they do with public education, system navigation and supports for families who are working with the system of care.

I’m going to say a bit more about that. There is actually some information in your package to support some of that.

J. Davidson: Given that we’re the academic centre and we’re charged with the provincial mandate of providing complex tertiary care for child and youth mental health, we do see ourselves as positioned very well to participate in a hub-and-spoke model. That’s what we’re trying to build currently, using the vehicles we have currently available to us, including the collaborative and the care advisory network to do that. We’ll continue to do that.

We take our role in capacity-building very seriously and have looked for innovative ways of doing that, both at an individual practitioner level as well as a program level, for clinicians throughout the province. It’s a firm belief that children in Dease Lake have the right to the same level of care as the child that lives in a house across the street from our programs. We’re really trying to work very collaboratively with the province to do that.
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We do have a role to play, I believe, in both developing, disseminating and enhancing uptake of standards, ensuring that there is a consistency of care provision throughout the province, and providing outreach for training and capacity-building provincially.

We have worked hard to develop our telehealth program and see ourselves as having a central role in the delivery of telemental health services provincially for children and youth — both a coordinating role, because I think it’s equally important that regions are able to deliver some of this themselves, and to ensure that there’s a provincial coordination for the delivery of telehealth services to rural and remote so some aren’t overserved, leaving some underserved.

We do that through telehealth. We do it through telephone consultation. We’re developing innovative practices currently around providing professional consultation to care providers from our specially trained experts — not just psychiatrists but others — by telephone throughout the province.

Part of the work that we do, in terms of hub and spoke, is also knowledge translation. I’m going to let Connie elaborate on that in terms of her role.

C. Coniglio: Some of the work that we do attached to our health literacy portfolio is very much a hub-and-spoke model working at its best. There’s a provincial resource centre, the Kelty Resource Centre, that sits at Children’s Hospital, but it’s basically a virtual resource centre.

What we do is work with regions and with communities and individuals all across B.C. in order to ensure that resources, information and supports are disseminated across the entire province.

The hub sits at the hospital. Some of the expertise is there, and some of the centralized types of resources are there. But in reality, the dissemination is really critical. We have connections all across the province, with child and youth mental health teams, with practitioners, with physicians, with families, etc. — the FORCE and other family groups. We work through those groups and with those groups collaboratively to ensure that there’s information, resources, system navigation and supports distributed across the province.

We love that model. We believe in it very strongly. We’ve had a lot of success with it. We believe it’s a part of the future — to build capacity around that hub and spoke, both from a knowledge exchange and a knowledge translation point of view but also from a clinical point of view. As Jana says, telehealth — which we’re going to say more about — is a big part of that.

J. Davidson: How do we expand the reach of specialized care in the province? I think that’s a really important question. There’s a lot of expertise located in the Lower Mainland. It’s very difficult to get people to move into rural and remote areas as single practitioners in child and adolescent psychiatry because they don’t have a community to support them. By “community,” I mean peers.

But there are lots of ways we can do that. One is positioning ourselves as central coordinators for telehealth. We’ve taken the lead, on behalf of the Ministry of Health, in developing telemental health standards for the province. PHSA took that work on, and those have yet to be fully distributed, but we’re using them effectively.

We are also looking at teleconferencing, as I’ve stated. Then we’ve done some additional work in our outpatient programs looking at how we improve the opportunity for specialist consultation and shared care for mental health teams across the province with our experts in child psychiatry at B.C. Children’s and really leveraging and helping them manage these children and youth closer to home — getting good care and the right care at the right time in their home community.

The other way that we’re looking to expand is actually to expand access to psychiatric consultation for family physicians and pediatricians. We’ve had some interesting conversations with the First Nations Health Authority as well. We’ve done that a couple of ways.

We were the first program in the province to actually provide, provincially, rapid access to consultative expertise. All the psychiatrists at Children’s Hospital are on the RACE line and make themselves available on a daily basis, Monday to Friday, eight to five, for telephone consultation when needed by family physicians and pediatricians.

We’re hoping to expand that by delivering telehealth to their offices. We’re looking at opportunities to develop that as proof of concept in terms of providing care for children, youth and families directly to those offices and then working with those practitioners to support them in delivery of that care in their local community.

As mentioned, we certainly see ourselves positioned and have participated in the development of guidelines, both nationally and provincially, and of best practice. We’ve done that in a number of areas, eating disorders being one of them and looking at monitoring for children and youth who are on particular medications that can affect their metabolism. We’ve participated in the development of national guidelines and the rollout provincially. We see ourselves as continuing to have that role, to work with our provincial partners to disseminate that information.

I think there’s also a role that we have around oversight and leadership, which Connie can expand on.

C. Coniglio: With regard to the capacity-building piece, we have a strong ability to provide leadership in terms of the uptake and oversight of standards and guidelines in child and youth mental health and substance use for the province.

As Jana said, we’ve done a fair amount of work in that area. We have the expertise to develop resources and develop these types of standards and guidelines and also to lead dissemination of them and work collaboratively, obviously, with partners all around the province around the uptake.

You can develop standards and guidelines, but what happens with them if there isn’t a process of working with your partners to ensure that people understand those guidelines and what to do with them? And then there’s follow-up and working together to ensure that they’re put into practice in areas around the province.

That capacity-building includes training and supervision. There’s academic teaching involved in that, which we have a footprint in at the hospital. Then we have, of course, the quality assurance piece, which is something that we’ve been working on with PHSA for quite a long time.

J. Davidson: One of the things that I’m interested in and that I think I have a role in, both as division head at UBC and also as the lead for child and adolescent mental health at PHSA, is looking at the idea of a provincial recruitment strategy for child and adolescent psychiatry. One of the things that we’re working on together with Doctors of B.C. and the B.C. Psychiatric Association is actually the development of a survey to get us: where are we in terms of current state? Who are the practitioners? Where are they? How much are they working, and how much time are they spending in child and adolescent psychiatry? Then we can develop a recruitment and retention strategy that makes sense for the province. That’s another initiative that we’re prepared to take on and are taking a lead in.

In terms of what it looks like to expand the reach of specialized care beyond the proof of concept that we’ve talked about in terms of getting out to GPs’ and pediatricians’ offices and whatnot, to fulsomely do that provincially, there are going to be additional resources necessary to support that work. Part of that is going to include the need for a comprehensive assessment of current state for telehealth and what’s currently available and where it is.

In terms of the provincial coordination of that role between ourselves, the regions and MCFD, I think that that’s possible. We’re very happy to take that on. It will involve some scale-up in infrastructure cost. We’re not in a position right now to expand our reach without that support. As well, we know that there are technology and telehealth costs at the sites that we’re delivering to — we’re prepared, but they also need to be prepared — and some human resources as well as memorandums of understanding with various stakeholder partners.

We’ve initiated that work quite effectively with MCFD in the north, where we’ve worked closely with them to provide telehealth to the north. Kids in Prince Rupert now have faster access to child and adolescent psychiatry, I am very pleased to say, than kids in Vancouver, and that’s through the telehealth program. It’s not sufficient, but it’s a marked improvement over what they had, which was nothing. And it has had a positive economic benefit in that it has reduced referrals to the adolescent in-patient unit in Prince George. These kids are getting treated faster and in community and avoiding hospitalization.

C. Coniglio: One of the things that you asked us about was stigma reduction. We are very interested in stigma reduction, and we are quite involved in doing that work in the child and youth world in British Columbia.

One project that we’ve been working on that we chose to bring to you today —this is something that we are quite involved in already but would like to expand tremendously in British Columbia, as we believe it’s got lots of legs and it’s an evidence-based approach — is the stigma reduction work around schools. We are involved in the delivery right now of an annual youth summit that is run by youths, facilitated by youths and presented to youths, high school students, that we do in collaboration with a donor partner, the Canucks organization at Rogers Arena.

The Mental Health Commission of Canada has become heavily involved with our project as an exemplar. They’ve brought funding to the project this year to pilot it across B.C. We would like to continue to expand that work. There’s a lot involved in expanding that work and doing stigma reduction in schools across the province through a youth summit model. The model that the Mental Health Commission uses is called Headstrong. It’s also known as TAMI in Ontario — talking about mental health.

We’re doing it in British Columbia, leading it and expanding it out to schools around the province, school by school, and we’re scaling up as we go. But it does require more resources to really fully implement it. It involves an annual youth summit with youth speakers with lived experience of mental health challenges who are trained in evidence-based approaches to speaking about mental health and are supported to do that work.

There are follow-up activities and regional events in schools and school districts across the province. And of course, there’s a pre- and post-evaluation strategy that’s tied to it to look at what happens. What difference does it make? Does it actually reduce stigma?

As I said, we’re already doing the youth summit at Rogers Arena. We’ve been really fortunate to get support to have it there and to bring about 1,500 high school kids together each year. We’ve done it for three years. But now we’re expanding into the whole province and wanting it to roll out in schools.

Youth who are coming to the youth summit at Rogers Arena are now going back to their schools and their communities and doing activities as follow up. We want to
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formalize and put more into this to deal with stigma reduction in high school environments particularly.

Just as Jana mentioned about our previous work, there are some resources required to do that scaling. We would like to have regional coordinators and youth peer coordinators across B.C. There’s project management involved. There’s travel support involved for youth and for folks involved to go to the summits. If we had a summit in Prince George, youth from across the north might perhaps want to attend and would need to get there. There would be activities in schools around the north, but there would be a regional activity.

Then, of course, there would be grants for school initiatives in local communities, because this is about youths finding ways to do it themselves with our support, leading it and having funds to support them to do anti-stigma activities in their own environments with this infrastructure around them. It’s a proven method. It’s evidence-based. It’s being utilized in jurisdictions in other countries.

We have been doing great work in B.C. in this area, and we would really like to expand that work. We feel it’s a bit part of a stigma reduction strategy. There are many parts to a stigma reduction strategy, but we thought we’d just bring you one thing today.

J. Thornthwaite (Chair): We’ve got about 12 minutes left. I’ve already got two people that want to ask questions. Are you just about finished?

Recruitment and retention issues for rural-remote aside, you’ve described that you have an outstanding residency program. Yet how many fellows are you getting per year? Why aren’t you getting more?

J. Davidson: Partly, we have capacity to train four subspecialty residents currently. The model is governed by the postgraduate dean’s office in terms of funding and making funding available for those subspecialty residency spots.

Currently the funding is not guaranteed year on year. So we’ve been working hard through the collaborative and other vehicles — myself and others, with Roger Wong — to try and cement that funding so that we’ve got guaranteed funding going forward, but it’s not currently in place.

M. Stilwell: It would seem to me that if you have a need and an outstanding program….

J. Davidson: I believe that part of it is that this is considered subspecialty training, and there has been very much a focus in terms of primary care that has directed some of the postgraduate training moneys. We’re a subspecialty within psychiatry. Although if you were to ask general psychiatrists if we are a subspecialty, well yes, but we’re primary for children and youth.

My second question. This is very operational and very specific. We have heard at this committee and I have heard in the community from providers and people seeking care that they have been told at the doorway to access that they cannot have access to a program because they don’t live in the health region. Is that the policy, and what can a person do about that?

J. Davidson: That’s an excellent question for a regional health authority. It does not apply to the PHSA. We have a provincial mandate, and all of our programs are provincial, regardless of in-patient or out-patient.

M. Stilwell: If a family or a child was turned away from a service and they were told, “You live in the wrong health region,” who should they call?

J. Davidson: Yeah, no, I don’t have a problem with that. I mean it’s very, very clear what our mandate is, and we are provincial, whether that’s our out-patient programs or our in-patient programs. They may have a conversation about, perhaps, this unit that’s closer to home — if you’re an adolescent — might be a better resource for you. But we don’t have exclusion….

M. Stilwell: That’s the second part of the question. Do you have to….? I mean, one of the Canada Health Act criteria is portability, and one would assume that portability is not just interprovincial but that you have choice currently in where you want to go for your health care. Is that the PHSA policy for mental health?
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J. Davidson: Well, we’ve positioned ourselves as tertiary. We have a tertiary mandate. We have responsibility for providing child and youth mental health care for the 12.6 percent that have a diagnosis in this province.

We like to support children, youth and their families in connecting with resource providers in their community, where that’s appropriate, and then support those resource providers if they require additional expertise through our services. Does that mean we don’t see people for what might be seen as secondary care through the Ministry of Children and Family Development? No, it doesn’t. I mean, we do see those kids, and we refer them back to the ministry offices for ongoing mental health care in their communities, where appropriate.

On our in-patient units we try and work very closely with teams that are referring kids to our units to avoid hospitalization where we can, because a hospital is not the place you actually want a child to be. You want to try and support them.

M. Stilwell: This relays to out-patient programs. Sometimes these people live closer to the place that isn’t in their region, right?

M. Stilwell: You could live across the bridge from Richmond, but Fraser Health, for example….

M. Stilwell: Anyway, I just want to clarify that, number one, the principle is that you do not have to attend care in your health authority for mental health services.

J. Davidson: I want to make it clear that I can’t speak for the regional health authorities. Nor can we speak for the macro regions of the Ministry of Children and Family Development where community mental health care resides. What I can speak to are the services within the Provincial Health Service Authority, which have a provincial mandate, and we welcome children, youth and their families from all over the province. We see that as our role, and we support them in that.

D. Donaldson (Deputy Chair): Thanks for the presentation. Of course, I fully support your goal of consistency across service delivery areas because Dease Lake is in my constituency. I have three quick questions. Two of them are relationship-based, and the third is around data.

The adolescent psychiatric assessment unit at the University Hospital of Northern B.C. What’s PHSA’s relationship to that?

PHSA and the First Nations Health Authority. When it comes to mental health services for children and youth, what’s the relationship there?

The third is on data-collection — I think it relates to standards and guidelines — of one of your agencies, the B.C. Children’s Hospital. I’d be interested in knowing the percentage of First Nations of the children and youth who have accessed mental health services in the last year at the B.C. Children’s Hospital or have been seen for a mental health condition in the ER — what the real numbers are in the last year and where they came from.

J. Davidson: Okay. I’ll tackle those in reverse order, and you may have to help remind me. I apologize.

We know that First Nations are under-represented currently in our services, particularly our ambulatory services, and that’s very concerning to us. We’ve reached out to First Nations Health Authority, and we’re having preliminary conversations with them about how to better work with First Nations and bring them into the services that we offer provincially and ensure that they’re getting equal access to care.

I think it would be true to say across all areas of health that there’s under-representation for our First Nations children and youth, which is unfortunate. There has to be improved bridging. We’re working on that and trying to find ways to actually provide this better care to them, either in their communities or working with ways to make our programs welcoming for that population.

PHSA has taken a lead in cultural competency training provincially in working with First Nations, aboriginal persons. All of our staff are trained in that currently. So that’s one thing.

In terms of actual numbers, I apologize. I don’t have those top of mind in terms of the numbers presenting to the emergency department.

D. Donaldson (Deputy Chair): I take comfort in knowing that it would be available. Are they?

J. Davidson: I’m not sure that they capture ethnicity as a data point in triage. I’d have to look into that to find out.

J. Davidson: Yep. That was the one question. The first two questions you’ll have to review for me again.

D. Donaldson (Deputy Chair): Do you have a formal relationship between PHSA and the First Nations Health Authority when it comes to mental health services for children and youth?

J. Davidson: Not formally currently with our programs, although I will tell you that we are developing one. We are working with First Nations communities in the north, and we’re doing that in partnership, through MCFD through our telehealth programs. We’ve gone
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into six different First Nations communities to provide psychiatric service via telehealth. We’re looking at ways to expand that currently.

J. Davidson: It is not. It is part of Northern Health. How we work with that particular unit…. All referrals for in-patient services go to the adolescent psychiatric unit in Prince George for the north.

If there are young people, for whatever reason — they’ve got medical complications that require the full services of Children’s Hospital or they’re very psychiatrically complicated — they will refer them directly to us. We accept those referrals from them into our adolescent unit.

We’ll accept referrals from the Prince George APU, although I have to say it doesn’t happen that often. If they’ve actually got a young person admitted to their in-patient unit who’s proving to be highly complex and they need increased services, they’ll transfer them down to our adolescent unit. That’s the relationship, and we have that relationship with each of the APUs around the province.

J. Thornthwaite (Chair): I’ve just got a quick question. You’d said “no exclusion criteria,” but we’ve heard, in our deliberations, that there is a shortage of beds of residential care for youth with mental health. I understand that at Children’s Hospital the cutoff in age is 16 — not even the 18-year-olds.

We also know that the residential facility in Keremeos was closed, and there’s a recognition that there’s a gap there with regard to the beds, I guess, in the Interior. Could you comment on that?

J. Davidson: I’ll comment on the parts, and I’ll refer to Connie for Keremeos, okay?

There aren’t residential beds in this province — full stop. The beds that we currently have available within our purview are what would be considered acute care psychiatric beds. We have a six-bed psychiatric emergency stabilization unit that takes young people from the B.C. Children’s emergency department.

If they’re a new presentation for mental health crises at that emergency department and 16 years of age and younger, they come through. If they are patients that are currently involved with services at B.C. Children’s Hospital and they’re 17 or 18 years old, we make arrangements on a case-by-case basis to manage those emergently in our CAPE unit, and we’ve done that.

The child unit is 11 and under. It’s a ten-bed unit, and our adolescent unit is 12 to 18. Each of those units is longer stay — about 28 to 33 days, on average. We have a 14-bed, in-patient eating disorders unit, and the average length of stay there is around 90 days — 68 to 90 days, depending on the case.

None of those would be considered residential care. The only residential service we currently oversee that’s active is the Looking Glass residence, which is for eating disorders, youth and young adult, and that’s 17 to 24. That’s off site. We took over management of that in August of last year.

The Crossing at Keremeos closed March 31 of this year. There were licensing and model-of-care issues that came to our attention. We took over the oversight for the Crossing at Keremeos April 1, 2014, and we became aware that there were some issues associated with the operator and what was happening at the site. We were forced to put our own manager in there November 1, and admissions stopped at that point because of licensing.

We worked very hard to try and resolve the issues, but the vendor who was operating there chose to leave, and the facility shut down on March 31. We’re in discussions right now with the Ministry of Health and with the health authority partners about the replacement for that.

That facility closed because we were concerned about the quality of care, the model of care and the licensing issues, and the operator wasn’t able to really meet what we were asking for in terms of the delivery of care. It has created a gap. It is residential care. We’re very concerned about it, but we couldn’t leave it open, and we’re working on an alternative.

J. Thornthwaite (Chair): Would that alternative be in that same site or somewhere different?

C. Coniglio: I’m not sure where it will be located. That’s under discussion with the ministry and the health authorities right now.

D. Barnett: The existing facility is a privately owned facility? It’s not owned by the ministry, the one in Keremeos?

D. Barnett: How long are discussions going to carry on, and when do you feel we’ll get an answer? This is a facility that was very highly used, and we really need another facility.

C. Coniglio: Right. The Ministry of Health is leading the discussions about the next steps. My understanding is there’s a commitment to making some decisions
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quickly and moving forward. I can’t speak to exactly the timeline, because it is their process, and the PHSA is a partner in the process. We are meeting shortly with the health authorities about what the next steps are going to be. It’s not intended to be a long process.

I do have responsibility for arranging customized solutions for any youth who come forward in the interim while Keremeos is closed. My role is to find solutions for those youth in terms of residential placements, and we have been doing that.

It is a gap for a small percentage of children and youth in terms of what would be most helpful for them to maintain their safety and their well-being, because they’ve got complex presentations.

The other potential gap in this province, and I think it’s one that needs to be explored, is that for a smaller percentage of children and youth, whether secure care ought to be made available. It’s not something we move to as a first option, for sure. There are many issues that need to be considered around individual rights and oversight, but there is a small percentage of young people who, for a variety of reasons, are at extremely high risk in this province and, without secure care, remain at high risk because we don’t have the capacity to provide them the safe environment and the help they need. That is an issue and a gap in the province.

M. Stilwell: Eating disorders in boys and young men. It’s great to hear about the beds for eating disorders. Are the numbers disproportionate, though?

In other words, in terms of the spectrum of the kinds of young people who need care for 25 to 60 days, is it disproportionate, or is that reflective of the need?

J. Davidson: It’s a little bit difficult to answer that question. If you look at our overall occupancy rates, it justifies the beds.

We deal with those that are quite ill — and younger and younger. There are boys. About ten percent of the population is boys. In fact, I’m very proud that one of our research psychologists, who’s also a clinical psychologist, just received a substantive grant to actually look at eating disorders in boys.

J. Davidson: Yes they can, in our in-patient program, our day treatment program for children and youth. They are also welcome in the Looking Glass residence, because they are impacted and need to be treated as well.

We’ve been at 14 beds and six day-treatment spots in our child and adolescent programs since about 2009. Principally, there are times when we are not at capacity, for sure. We like to be able to admit very quickly when kids need to be admitted. So far, from referral to admit, we’ve maintained it at five days because that’s appropriate in this illness.

J. Thornthwaite (Chair): Thank you very much for your work and also for taking the time to come and present to the committee. We very much appreciate it.

C. Hampson: I’m Christine Hampson from the Sandbox Project, and we have Dr. Bhamani and Dr. Stan Kutcher on the line as well.

J. Thornthwaite (Chair): Hi there. I’m Jane Thornthwaite. I’m the Chair of the Committee, and I’ve got our committee members here, on the other side.

Sorry, we’re running a bit late. We do have somebody going to present to us at 3:30. I thought I would just encourage you to get started right away. We got your package, by the way.

C. Hampson: Excellent. Thank you very much, and thank you for this opportunity to present by phone and for fitting us in. Thank you, through you, Madam Chair, to the rest of the committee.

Let me start by saying that the Sandbox Project is a national charity whose goal is to help make Canada the healthiest place in the world for children and youth to grow up. The way we are focused on doing that is through collaboration and involving all sectors in the sandbox: corporate, not-for-profit, parents, teachers, government and citizens. We’re focused on four key areas: injury prevention, growing healthy bodies, environmental health and mental health.

On the phone with me today are the co-chairs of our mental health working group, Dr. Stan Kutcher and Zak Bhamani. Stan is from the clinical research side and Zak from Telus Health, from the corporate side. You’re going to hear from Stan right now about a concrete and practical solution to enhance youth mental health services and outcomes in B.C., which is the mandate of your hearing today. I’ll turn it over to Dr. Kutcher.

S. Kutcher: Thank you again to the committee. You have the first slide in front of you. What you see here is a very unique approach to addressing youth mental health care needs. I want to be specific about that. It is youth mental health care needs.

In 2015 one in four young people in Canada who need mental health care actually receives it. B.C. numbers are
[ Page 576 ]
similar. When I was in medical school in 1975, it was one in four. So although we have done a lot of good things, we have not substantively moved the goalposts on youth primary mental health care, which is really essential for improving equitable access to affect evidence-based care for all mental health needs for young people.

You can see on that page that what we have is a group of partnerships, and we are now at the point in our process where we are comfortable in discussing with government some potential solutions to that overarching and substantive problem.

I’ll go to the next page, which is called “Evolution of youth mental health record.” It’s really not so much a record as a system of care. You see a number of steps along the route. We are now in step SYMHI, part 2. What we have done is we have built on the idea of this solution for youth mental health care, and we have focused it in primary health care.

We know that 70 percent of all mental disorders can be diagnosed before age 25. About 60 percent of them are mild to moderate in intensity, and all those can be effectively treated in primary health care.

Now, just to be really transparent about this, the program that we have developed owes a lot to the PSP program in BCMA and British Columbia that you have now going, where you’ve trained about 40 percent of all family doctors in B.C. I have been very involved in the development of that program since its inception.

If you look to the next page. This is called “Interrelated and critical component.” We have a number of principles, and we are using an electronic interface that brings young people and their health care providers together — again, focusing on primary health care. It has to be usable for the youth and the provider. The user experience for the young people has to be very positive. If they don’t like it, they won’t come back to it.

The solution has to be integrated into the usual way that primary health care providers do care, and we’ve learned an awful lot from the rollout in B.C. about how to actually make this work. We have taken those lessons and put it into this electronic solution. We know it has to be adopted by both young people and the care providers equally, and now we are actually moving the initial concept and the initial work up to scale so that by phase 3, we’ll actually be ready for scaling out.

The next slide is called “Practise,” which everybody will remember is a word that means “do, learn and then do again.” Every phase that we have gone through — we’re now in phase 2 — has been built on learnings from the phases before it and improving the product and improving the intervention as we move forward.

How will success be measured? That’s the next slide. What we see here…. In phase 2 we are looking at a number of different success measures. We expect all these to come out very, very positively. Phase 2 is now being run in Ontario out of the Hotel Dieu Hospital, with Queen’s University. We have that well underway and well in hand.

The next page is “How will success be measured in phase 3?” We currently have a CIHR grant application in the eHIPP project for phase 3. What you see here in terms of outcomes…. We are actually going to be looking at care outcomes for young people. We’re going to be utilizing and looking at how young people use mental health literacy. We’re going to be embedding some of the on-line cognitive behaviour therapies for anxiety disorders and depression for young people. Actually, we’re going to be using the two B.C. programs that you’re probably well familiar with, the one for youth depression and the one for youth anxiety.

We will be providing on-line and face-to-face provider training based on two different types of programs which are both accredited by the Canadian College of Family Physicians. As part of the qualitative research, we are going to be looking at input from service providers and input from administrators and policy-makers to see how these approaches and this kind of electronic youth mental health care intervention can actually potentially be scaled up.

The next slide is “What would it take to expand and scale up?” There are a number of components that we are wanting to look at here. Certainly, for us, British Columbia would be an ideal site for a provincewide scale-up as opposed to a small, site-based scale-out.

This is for a number of reasons. One is that frankly, B.C. is leading nationally in terms of its thinking about youth mental health. This is really an innovative approach which links an electronic system of care for young people and their providers. Secondly, this project owes a great deal to the work that I have already done with the B.C. PSP program with the BCMA. We really need to look at a government-involved and government-partnered activity that can last for about five years so that we will be able to actually have a pretty good understanding of how the program can actually work to improve mental health care outcomes for young people.

I’m going to just flip to the very last page, which is the phase 2 solution overview. Basically, what we have here is an electronic interface available as a mobile app and as a web-based portal. But it’s not an app. It really is a youth mental health care system. On the youth side of the equation we have a variety of self-care tools and measures building on the Wagner chronic care model, because as we know, mental disorders are the chronic diseases of young people.

Much of this involves the youth taking responsibility for their own self-care, incorporating best evidence-based self-care interventions in diary format, being able to monitor specific outcomes important to the youth and to the provider over time, with links directly to best-in-class mental health literacy resources for young people and their families and, as I said, links directly to cognitive
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behaviour therapy approaches for anxiety disorders and depression actually based on the B.C. capacity.

On the provider side we have all of this information stored in the provider’s web-based portal. In addition to what I have just told you about, we also have a whole host of diagnostic tools and measurement and outcome monitoring tools which have been extensively field-tested and validated in primary care practices. Primary care providers like using them, and they learn very quickly how to use them so that the entire care interface is driven by suggested guidelines on the best evidence. But the providers use these tools to help them direct their treatment and to help monitor patient outcomes.

All this can sit on an electronic health record, but it isn’t necessary to sit on a health record if that’s not available.

Additionally, in the provider portal we have education programs designed specifically for providers so that they can go and enhance their knowledge in specific areas. This also includes an ongoing provider library, with key articles referenced for their use.

All in all, what we have here is a very innovative, very forward-looking solution to the problem of equitable access to effective care for young people. We are focusing on what is called high-volume, low-intensity mental health care needs. Those are mild to moderate disorders which can be effectively treated in primary care. These really are attention deficit hyperactivity disorder, depression and all the various anxiety disorders.

We have put together a completely integrated electronically, youth-friendly and provider-friendly mental health care solution that should be able to make the impact that we hope it to make. We have already done research on this, with good and positive outcomes. We currently have research ongoing. We expect the outcomes there to also be positive.

We really believe that it’s not necessary to reinvent the wheel. One of the challenges, of course, in the Canadian health care approach is that, province to province to province, people don’t often take up interventions and innovations that can work effectively. They always try to reinvent what’s already there. We’re hopeful that what we are providing and what we are creating will make sense to you and the committee and that it might be a consideration for the future of British Columbia. It’s part of its national leadership in youth mental health care provision to consider participating in this particular direction.

I’ll end my quick spiel there and turn it over for questions and further discussion — or comments from my collaborators.

D. Donaldson (Deputy Chair): Hello. Doug Donaldson. I’m Deputy Chair of the committee. Thank you for the presentation. I appreciate the high-volume, low-intensity approach that you’re explaining. I have three quick questions, once again, on the Sandbox Project approach.

Here are my three questions. When you talk about primary mental health care, can you describe the Sandbox approach about how the community is part of that primary mental health care? Are non-medical interventions part of the primary mental health care that you discuss? And how will success be measured in phase 3? Under “Utilization of the health system resources: number of scheduled and unscheduled health visits,” do those include health visits outside the medical system?

When we talk about primary health care, we mean all primary health care providers — physicians for sure, but not only physicians. This is a model that I think would be very familiar in British Columbia because of the role of the collaborative and the approach that the collaboratives have taken to involving the entire community. In fact, this is part of an entire pathways-through-care model which I have developed and is being applied in different provinces across Canada and internationally that links the schools and health providers and communities together in a seamless, integrated, horizontal manner. Clearly, this involves not just physicians.

The second issue is the interventions that are provided. There is data — and I will send that to you — from the PSD program which shows quite clearly that physicians are actually providing non-pharmacological interventions first. That’s what they’re taught to do, and they’re getting good success with it. They’re using pharmacotherapy as per guidelines for those kids who are not responding to the original psychological or psychotherapeutic interventions for anxiety disorders and depression.

For attention deficit disorder, clearly there’s actually no question that pharmacotherapy is necessary but not sufficient. Again, they’re taught how to use the medications properly and not treat kids who likely don’t have the disorder.

D. Donaldson (Deputy Chair): How about the utilization of health system resources as to how success will be measured?

D. Donaldson (Deputy Chair): I’ll pass, then, on to whoever else wants to ask a question.

J. Thornthwaite (Chair): We did get feedback from some of the presenters previously, just following up on what Doug said, about the so-called overmedication of children and youth with regard to treatment for mental illness. I guess the concern was that there seems to be an environment in the medical community for medication as opposed to non-medical or non-medication treatments.

How easy is it to teach something like cognitive behavioural therapy in the telehealth way of doing things?

S. Kutcher: What we’re doing here is we’re linking young people electronically to existing cognitive behavioural therapy programs for anxiety disorders, which is the AnxietyBC program, and for depression, which is the Dealing with Depression program.

We also have taught the clinicians how to do supportive cognitive-based interventions in their offices and support the kids as they do this, because we thought the data on taking on-line interventions was better, much better, if they have physician support to do that and not just let the youngsters go off and do it themselves.

I’m very aware of the B.C. medication data. I was on the advisory committee for CIHI that did that report, which I’m sure you’re all familiar with now, recently released about two months ago on terms of the use of medication. Certainly, we want to make sure that when medications are used, they’re used properly, because they can be very effective when they’re used correctly, and we want to ensure that they’re not used incorrectly. This program actually really focuses on helping physicians understand which medications to use when, and when is the right time.

We very much appreciate your presentation, and thank you very much for taking the time to prepare your presentation and also the time to actually speak with the committee members.

S. Kutcher: I’m actually in a little fishing village called Herring Cove, on the road, in Nova Scotia.

J. Thornthwaite (Chair): Nova Scotia, okay. Well, thank you very much for your time.

Our last presenters of the day — welcome — are Todd Ritchey, and we’ve got Bill Adair as well. They’re going to be talking to us about the Answer Model.

What we’ve been doing through the last day and a half regarding the whole format is…. We’ve had your handouts. We’ve looked at them. Talk maybe for ten minutes. If you want to do any examples, that would be helpful, but the benefit is for the committee members to be able to ask questions and engage with you for the other part of the presentation. I just wanted to alert you that a lot of them have to bolt right at four. So if, for instance, we are going over a little bit…. Don’t feel bad. People have got planes to catch, etc. That’s why we have it till four.

B. Adair: We’ll go through the PowerPoint as quickly as we can and get to questions.

T. Ritchey: Well, you called it the Answer Model. We’re calling this the connected classroom, neural alignment and authentic rewards. I’m Todd Ritchey, and I’m an addiction specialist. This is Bill Adair. He’s a teacher.

T. Ritchey: We’ve been working together on this now for about four years. The problem, as we see it, is that we’re in a disconnected world. In the absence of what we say are authentic connections, it’s almost a certainty that children are going to make unhealthy attachments. With the experiences that they are dealing with now in the schools, they do very little to alleviate the problem. As a matter of fact, we find that with a lot of children sometimes the current education model is actually traumatic.

So what are authentic connections? These are the authentic attachments that we’re hoping will move children towards healthy emotional and psychological well-being.

The disconnection and emotion addictions are sort of a new concept that we’re introducing, and those would be attachments to unhealthy emotions, beliefs and behaviours. These things, of course, exacerbate and deepen not only the mental illnesses and psychological problems but also the conflict and the psychodynamics in the classroom. Of course, the mentally ill children are probably the most disconnected of all.

For us, this is going to seem almost bombastic, the claim that we’re making, but we really say that the number and the quality of authentic connections directly correlate with emotional well-being and academic potential. This is a really simple statement for a very well-vetted scientific concept, a very well-supported scientific concept, that’s based on our book, The Answer Model.

B. Adair: Okay, traditional teaching models aren’t really working. They never really have. The challenges that they have in the classroom — autism, ADHD — go beyond what a teacher can do with the teaching models that they have, and they don’t have the support that they need to do it in the way that we’re trying right now.

Disconnected children are emotionally unprepared for challenge. They lack resiliency. They will always choose easy, comfortable or unhealthy. They engage in
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behaviours that bring emotional pain to themselves and to those around them. Connected children make good choices. They know and — this is important — can feel what authentically matters to them.

Studies show, of course, they’re happier and healthier, share healthy relationships, do better academically, contribute to the lives of others, choose to avoid unhealthy behaviours, and they love learning. Teachers get that, but the question is: what is connection? They don’t necessarily know what that is. Our definition is simple. Connectedness is a measure to which one aligns their daily life with authentic action, belief and reward. It’s not a thing. It’s not a project. It’s a way of life.

Okay. This is the next one. What is authentic? It begins with physiology. Hunter-gatherers — their brain physiology evolved to reward connections that contributed to tribal success. It was a matter of survival. Everything in their life was about connection. They nurtured connection every single day.

That got them two things. First off, if they lived aligned with these beliefs, the tribe survived and they thrived. The second thing was they were happy and healthy. If they were disconnected, that would throw them into a survival mode. It was a very serious issue.

Fast-forward into the future. Go into the classroom of children. Really, they are 99 percent hunter-gatherers. They have two things that are different. The first one is that they don’t have survival to motivate them to connect. The other one is that they live in a world that doesn’t nurture connection. In fact, it does the exact opposite thing. Where does that leave them? In a disconnected state, which throws them into survival mode. The four p’s here are our little model that we use to remind teachers and students of where their authentic self lies.

Some schools try to do good things, which on its own isn’t authentic. Other schools go a little bit further, and they start to talk about things like self-esteem. “I am good. I am brave. I am smart.” But when you say that to a kid and everything in their life, all of their experiences, says something opposite, it’s meaningless. It might even drive them further away from that truth.

But if you can take an authentic action — and what we really try to do is tie it to a meaningful, authentic feeling; we wind up that feeling — that action becomes believable, because feelings are real. If you feel it, you believe it, and then you want to do it again.

T. Ritchey: One of the things that we introduce — and it’s a significant something that we’ve established through the Answer Model — is there are two drives. We say that there are only two drives in all of biology. There’s the addictive drive, which pulls us away and disconnects us, and then there’s the homeostatic drive. These two drives are competing to influence the lives of our kids.

The addictive drive leads kids to disconnection, throws them into survival mode. It leads to different types of emotional pain, false self-payoffs. Of course, what we’re trying to establish with this new type of model in the classroom is to reinforce and support the homeostatic drive, which is really about using connection to create emotional, psychological well-being and balance in health and also better academic performance.

Now, connected is not that easy. In a modern culture we have a lot of competition. Disconnection seems to have an edge here. We take a look at technology, culture and educational disconnection that seems to drive some of these false self-beliefs and behaviours. But ultimately, the thing that drives the kids down the most is what we call emotional addictions, which you guys might be calling mental illness. We call them emotional addictions. That tends to exacerbate the circumstances.

Now, teachers have always somehow intuitively known that kids get a payoff from dysfunctional behaviour. We just want you to know that current neuroscience is really backing that up. The payoff really comes not from the behaviour but from the emotions, the negative emotions, that follow. What we claim is that they actually get biochemically addicted to those powerful or painful negative emotions. When we say “addicted to,” that means that unconsciously they start to pursue that.

When a teacher understands this new model, the teacher can see dysfunctional behaviours for what they really are: an unconscious drive to unhealthy emotional payoffs. They can plan strategies to break the addictive cycle. They can avoid emotional control dramas that seem to feed all of these addictive patterns. Maybe most importantly, they can actually see children as something greater than their dysfunction, greater than the label that we’ve put on the kids.

Again, this is a bombastic claim, but we say in a connected classroom our particular understanding of mental illness, dysfunctional behaviours and learning disabilities comes from simply a perspective of disconnection and emotional addiction. To the degree that you’re disconnected is directly correlated to the amount of dysfunction, mental illness and so on and so forth.

B. Adair: Every child wants to contribute. Every child wants to learn. Every child wants to be great. Every child wants to be connected. A child that’s disconnected might deny that. Teachers might not believe it. But it’s an undeniable truth of their biology that every kid wants to be connected, and they need to be connected.

The connected classroom is not another teaching strategy, behaviour management program or a socioemotional unit.

T. Ritchey: What we feel like it is, is a very innovative teaching philosophy built upon the most current understanding of neuroscience and human behaviour. Also, importantly, it’s a therapeutic teaching model that
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specifically targets student wellness, connectedness and emotional addictions in an everyday classroom. This is the enriched environment of the connected classroom. We feel like an understanding of how to facilitate and create this enriched environment is the primary driver that balances the brain and changes things for these kids.

We really are talking about neuroalignment here. These connections, facilitated in a way, actually make changes in the brain, make positive connections in the brain. We call this the associative neural network. Ultimately, it’s important to know that this function is really a by-product of a brain out of balance, with an imbalance in biochemistry. This, we feel, will make a significant stride in rebalancing that.

It’s interesting to me, because my best friend here has been a teacher his whole life, and I’ve been doing counselling and therapy. I see the distinct advantages that he has as a teacher, being able to control the environment. In this structured environment there’s an advantage over doctors. There’s an advantage over therapists and counsellors. This structured, controllable, safe environment is a place to practise these skills of connection on a daily basis. He can see these kids, and if it’s implemented throughout the entire school, then this is happening class after class.

They get an immediate feedback and check-in for healthy behaviours or unhealthy behaviours. It’s an opportunity for everyday healthy connections that are reinforced. It’s these small moments, day after day, that make a big change over a long time. Then maybe most importantly, this healthy peer-to-peer support is an untapped resource for emotional healing.

B. Adair: This is basically the model of how you create a classroom. It’s important to note: this is an actual how-to. We’re not talking about connection. This is what you do. It’s not just a how-to model; it’s a powerful how-to model.

What it really is, is it mimics what we believe is the most powerful, addictive intervention model that exists for drug addicts, alcoholics, gamblers. Those are the most disconnected people of all, with tough false self-beliefs to attack.

What Todd has done in his therapy…. He would talk and tell me about his morals. I would get so: “Maybe that might work with the kid that’s fearful in class. Or he’s anxious.” So I took what he has done, and I put it into a classroom setting. Then the magic started to happen. Five years later it’s my passion in life.

This is it now. This is the final step that makes it an everyday thing. This is a lesson plan that teachers would use every single day.

I just finished my first run-through with a student teacher, the first full-on where I’ve had the model fully set. This is what he did every day. The results were amazing. It took him no time at all to pick it up. It’s just a few add-ins onto what teachers already do. It’s just supercharging it in that authentic connection way. It’s designed to trigger all these authentic payoffs, as often and as powerful as we can, in a lesson every single day.

All those little red arrows that we’ve had — those are our differentiators that we do differently. It’s easy for teachers to do. And what they’re going to find at the end of all this is that all those management problems that they have…. Kids are going to take care of them for them.

I find myself watching my class now taking care of each other, and it’s the most joyful moment that I have as a teacher. I have to say that regret has been a big part of me putting so much work into this. I think back to kids that I’ve missed — because this is for all children — and it makes me sad. But when I see that fearful girl diving into a pile to get that ball, pick it up, run and fall down and get up again, it just makes me excited to work harder and perfect what we’ve got going here.

T. Ritchey: I just wanted to reinforce…. Before we turn this over to you guys to ask some questions, I want you to recognize that this is a model that we claim is preventative in nature. We know that in the last couple of days you guys have probably been listening to a lot of great ideas on how to fix the problem. What we’re saying is that we would like to help fix the problem that’s existing now, and we think the model will do that, but more importantly, we would like to implement this into the schools at a very young age and use it as a preventative measure so that these kids become healthy and balanced. The safest place for them to be, the healthiest place for them to be, is going to be in the classroom.

D. Donaldson (Deputy Chair): As a former animal behaviour specialist, lots of what you talk about rings true. I think that the emotional connection, too, like Gabor Maté stresses, is evident to a large degree in the model you’re presenting.

A question I had was: have opportunities for professional development days availed themselves to you yet?

B. Adair: A couple of years back, when we were just starting the model, we had done a few workshops. But really, at the time we did a keynote in West Van.

B. Adair: And we’ve done small workshops with that, but the model wasn’t full developed like it is now. We did a few workshops at my own school. I’m a physical education teacher, and our entire department has a full buy-in on it. That’s the pilot project that’s been real and powerful.
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T. Ritchey: Skeetchestn and KIB — they’ve invited me into their schools as well.

B. Adair: We’re here now because we have a model that’s tight. It’s ready to go. We’re looking for a champion to help us promote. Of course, we would need some….

C. James: I was going to ask the same, similar kind of question. Has it been piloted in any other schools? You mentioned you started off in your own school and your own classrooms. Has it been looked at anywhere else?

The second thing is: can you give us a couple of examples of how this would change a classroom? A teacher day to day looking at a lesson plan and introducing the connected piece to it…. What difference would that make? What would you see differently in the classroom? What connections?

B. Adair: The biggest fundamental change is this — and we alluded to it in the slideshow there quickly: connected children can make good choices. You know what authentic…. They’re ready to share, they’re ready to learn, and they’re fearless. And what that allows them to do is take over learning. A teacher becomes a facilitator instead of a manager.

For example, I’m going to…. This is being a physical education teacher, just to frame it. If I’m teaching a golf lesson, the lesson isn’t about golf or hitting the ball. They’re not going to get marked on hitting the ball. What the lesson is going to be is a specific target to peer connection, as in: “You are going to be a coach. That’s what your job is today, and you’re going to assess yourself at the end of the day on how well you coached.”

I will speak to the coaches. You’ll have steps 1, 2, 3, 4. “Golfers, hold your finish.” Meanwhile, they stand back, and they’re coaching. We give them the skills on how to talk, how to speak and how to cheer each other on. But really, while the person is up there golfing…. We all know that when we golf, we get super-nervous, and we swing, and we miss. But really, they’re thinking about being a coach instead, and so they’re free of that anxiety. Nobody’s judging, and they just have to hold their finish. That’s what they’re reinforcing throughout the whole lesson.

It’s a move away from task-oriented. You know, we all hear about process versus product. This is the ultimate version of that. Every day at the start of the class, if you look at that lesson plan up there — personal and peer connection — there’ll be something targeted there from those four Ps. It might be about being brave. It might be a specific thing like, for golf, to be a great, supportive coach. That’s what they’re going to get assessed on in the end, not their golf swing per se.

Their assessment isn’t even on the technical part of coaching. It’s how they feel about being a great coach. If they go home at the end of the day and they say, “Mom, I was awesome today; I made a difference in another person’s life today,” they’ll say 95 out of 100. It’s unbelievable how accurate kids are. They’ll say: “No, I wasn’t full on. I was only a 72.” It’s beautiful to watch. Most of the time they judge themselves too low.

But I have to tell you, coming back to this assessment thing, that when it comes to assessing authentic connections, it’s such a powerful motivator. It’s taking it away from the task itself. I’ll hand this out. For PE we do a big leadership thing. We have a leadership checklist for kids to do — and all of these smiles. This is a version that our science teacher has taken. He uses this for science labs. At the end: “I feel really good about my teamwork today.” It’s a powerful, powerful thing. They own it, and it’s not about the task. That’s probably the biggest swing.

T. Ritchey: If I could add to that, Carole, to me it’s sort of like this five-step strategy where it’s about full buy-in. First of all, we want the administration to buy in and lead this to the teachers. Then we want the teachers to buy in and express this to the classroom. What we’re doing is making some sort of a bold proclamation that things are going to be different. But it’s not different. When we call it a therapeutic model, we’re not saying that teachers at any level have to be therapeutic or do any sort of counselling. As a matter of fact, it actually will reduce the amount of counselling that they would have to do. When the children buy into….

What the teacher is going to create is a safe environment where we remove status hierarchies, where we create peer-to-peer dynamics in the classroom and put groups of kids together that might not normally be together. In that group, you might have someone who’s very academic. You might have a class clown. You might have four or five different types of kids, and then you can actually set up your lesson plan that day to reinforce some sort of an advantage that one of those kids has so that they can take turns sort of being the star, so it’s not always the academic kid teaching other kids how to do math. Sometimes it’s the kid who’s the class clown who is going to teach the other kids how to stand up and do a presentation fearlessly and what it is that they do to do that.

They still, then, prioritize these stamping true self moments, true self-discovery and support of their peers, and then, secondarily, comes the lesson plan. It’s not that the
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teachers won’t be teaching the lesson plan. They’re still going to teach it the same way that they would before, but instead of going around the classroom and correcting the mistakes that the kids are making or answering the raised hands by answering product instead of process, they’re just going to go around and reinforce process. “You’ve got a group here. You guys already understand to some degree. You work that out.”

The teacher will go around and say: “Okay, here’s an example of somebody doing fearless….” This kid who was really good at…. The class clown was teaching somebody how to dive in fearlessly and do a presentation and specifically addressed the ESL student in a way where she got up and she did it. Then the teacher goes around and reinforces that, stamps that behaviour.

B. Adair: They get it, though, and that’s a powerful thing. “You made a difference today.”

One of the big ones is the special needs kids in class. They’re an asset, and it’s a beautiful thing. They’re kind of like a beacon for an opportunity for kids to step up to the plate.

In our PE department kids that have always come down with an SEA don’t come anymore. There’s no reason for them whatsoever. I had one little girl, Julia. She didn’t speak ever. What does every special person that comes from a learning centre want? They just want to be part of a group, and that’s a powerful draw. All of a sudden, when it was peers giving her the ball, she started to speak. At the end of the day I can say to the kids: “You made a difference in that girl’s life.” I did a video of her, and I sent it home to her mom. She cried. It was amazing — from a kid that only rolled the ball back and forth, to an SEA, to somebody that was shooting baskets. It’s beautiful.

T. Ritchey: To reinforce that, to me it’s not just the special needs kids. This is how a classroom changes. Any kid that has some sort of a need — whether it’s ADHD or anxiety or depression or whatever — becomes an actual opportunity in a classroom now instead of an extra strain on the teacher.

B. Adair: Bullying can’t survive in an environment like this. We actually had one boy who came from middle school. I would call him the most hated child in the school. Teachers couldn’t stand him. Kids couldn’t stand him. What did we do? This is what we try to do — take those kids and put them in a healthy, connected environment. So we took him — a grade 8 — and threw him in a grade 11 fitness class.

The fitness class is all about support. They’re like personal trainers that cheer each other on. There’s no place for his dysfunction to flourish. He can’t call out a grade 11. He actually tried it the first day or two. They just said: “We don’t do this.” It immediately stopped. There was just no room for it. Then he was starting to learn how to cheer.

You take dysfunction. It can’t live in this kind of healthy environment. If you’re focusing on the environment…. As a teacher, I’m not doing anything. The kids are doing it. They want each other more than anything. It’s the most important connection, especially for teenagers. They can do ten times better than what I could even dream of doing. I mean, with my big ego from past years, it would have been all about me. I’m nothing compared to what they can do. That’s the most powerful piece of this. When the kids own it and they’re sharing, it’s wonderful and it’s magic.

T. Ritchey: I think the key, also, is how it potentiates the brain. How does it really change the brain? How can it take the brain out of survival mode, where the limbic region is activated, and actually start to dial up and turn up the neocortex so that the memory centres are improving? The prefrontal cortex and my ability to cognitively process is improving. These are the things that we’re seeing as the bell curve starts to disappear.

I’m going to be bold and say that I believe…. This is conjecture right now. It’s my hypothesis. If we could implement this into the school systems instead of all these measures that we need to put in place to deal with anxiety that’s going through the roof and depression that’s going through the roof and all of these learning disabilities that are going through the roof…. All of these challenges — we’re trying to find a way to deal with them with some form of a bandage effect, because it’s after the fact.

B. Adair: I would have to say, just jumping in, that especially in high school there are some great programs — the Red Cross with the anti-bullying. It’s right in line with this. Kids are learning the skills, and they go speak to classrooms. That’s beautiful. But it’s still a one-off, and then they’re gone. It’s living a connected life in a connected classroom every day that actually changes the way a kid thinks. It attaches them to authentic actions, and those negative, addictive behaviours just disappear. They can’t happen.

T. Ritchey: The bolder part of that claim, really, is that we actually feel like dramatically, drastically, you would see a reduction in mental disabilities. We would see a drastic reduction in anxiety and depression. You literally are changing the brain and creating a balanced brain, then a balanced body and then a balanced kid.

B. Adair: One of my biggest roadblocks, where I’ve been careful and I’ve stepped back…. I’m a PE teacher and: “Oh, it’s easy in PE.” You’re connected in every moment in every way, every part of your life. In high school the big battle is: “Oh yeah, but we can’t just forget about curriculum.” But the argument is going to be that connected kids are going to learn better and are going to learn faster.
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Teachers that already do this…. At my school, to be honest, they’re doing versions of this. Because of our workshops before, they’re starting to call it their own thing. I haven’t jumped in on it yet.

I threw a lesson out to our Japanese teacher. This is what she did. She’s super academically oriented. She has them work for seven minutes, whether she’s speaking or they’re speaking. Then it’s three minutes off, where they share a story. They might do it in Japanese. They might do it in English. But they connect — boom. Then it’s back to seven minutes. She will undoubtedly say that production goes up in those seven minutes, even though you’re losing three.

Meanwhile, in those three minutes they’re starting to speak Japanese anyway, when they’re talking to a friend, and they’re less anxious about it. It can happen in every class. On the back of that one, the Japanese one, I’ve got what could happen in math, what could happen….

The beauty is that if we get to run a pilot project in a school, teachers will get this as soon as they understand how emotional addiction works. They’ll use this template, and they’ll come up with every idea imaginable. It’s just a tweaking of what great teaching is already. It’s just a refocus on: what is our personal peer connection every day, and how is that going to be assessed at the end? The assessment really is: how is that behaviour being attached to healthy feelings? That’s what we’re trying to do.

M. Bernier: Thanks, Bill and Todd, for your enthusiasm and for bringing this forward. Obviously, a lot of the people who have presented to us…. Even as a committee, we’ve talked. How do we get to kids earlier? How do we get to people earlier? Obviously, the school system is going to play a major role in that. So we’re very encouraged by everything you’re trying to accomplish there. Thank you for that.

It made me think. This committee was mental health and addictions. Sometimes we lump those together. Sometimes we need to think of them separately.

When I’m listening to you talk…. I would say maybe fringe mental health issues — ones that maybe aren’t visually apparent or noticed by anybody but are underlying — turn into addictions issues. I’m putting words in your mouth, I think, now. But if we don’t get kids early enough, the bullying, the depression…. Those are things that maybe, if they were caught and treated differently and earlier, could otherwise possibly suppress the future outcomes of the higher issues around addictions.

A lot of times we’ve always said: “You have a mental health issue, which leads to addictions.” We have to remember that that’s not always the case. There are differences between the two.

B. Adair: You can have a mental health issue and still be connected. It’s not a guarantee. In our book that we’re writing, we’re basing it on Todd’s stuff. Every addiction starts with an emotional addiction, which is a type of disconnection, and it perpetuates from there. That’s why we’re targeting healthy living. It’s a preventative measure from dropping off the deeper addictions.

M. Bernier: Yeah, I can see, obviously, that engagement, helping the people on the mental health side, definitely.

A question I have for you…. You’ll have no argument from me about how we have to maybe start looking at educating differently. At what point do you think, as a teacher yourself…? Educating the educators. At what point do we actually get in there — let’s say, as a committee or on recommendations or as a government — and say: “How do we change the curriculum?” What do you think we should be doing differently?

I don’t want to say it’s the cookie mould approach that we’ve had over the years. If somebody wants to be a teacher, they go to university. They have their passion, which is great. We train them, and then off they go. Then we hear about things like this afterwards, about the what-ifs and “Should we be doing things a little bit differently?”

B. Adair: Well, the advice is that this is a model that works. It’s in place. I’ve run it through with a student teacher already, with incredible success. Now, it is about educating teachers, because they’ve done the same thing the same way. The pushback is: “Here we go. One more thing.”

But when you have an understanding of it from a workshop of looking at dysfunction as an addictive behaviour, it just makes it so much easier to understand what’s going on and create lessons to actually manifest differences.

T. Ritchey: I think if we had an opportunity to get even one school to have complete buy-in and adopt this process, we could do a flagship process. I think that it would be really easy to see the differences.

B. Adair: This is a lot of work. We both have jobs. My life revolves around it, and it does because of what I have seen happening. We have 100 percent buy-in in the PE department, because they see every day that they are making a difference in the lives of children. It’s kind of that you’ve got to see it to believe it.

The hope is, with workshops, we get a pilot project. We have it on video. I have a few videos, one of Julia playing basketball. I have another one of a fitness workout that kids run 100 percent. There’s no way, as teachers, we could even come close to the same energy and the same connection. You won’t see one kid off task for 45 minutes of gruelling exercise.

It’s a “see it to believe it” thing. We’re hoping that we can get support to run workshops. So far, what we’ve
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done, the couple of workshops that we’ve done…. I have to get my teachers to cover my classes or my principal to pay for a day off. That’s not going to happen anymore. Todd has a very busy schedule. He needs to take a day off. So we need help with that.

T. Ritchey: Billy is writing the book right now. We’re co-authoring this book. Finishing that book, having a workbook that will give you step-by-step-by-step procedural approach, having ancillary support on a website, having DVDs, and so on and so forth so that even if we’re starting with one school…. We could actually be there a lot, but we want to have the supports in place so that they know exactly what to do.

T. Ritchey: It really is a simple concept that has to be implemented on a daily basis. It can’t be something that you try for a week and go: “Okay, I’m starting to see some changes.” It really has to be a day-after-day-after-day thing.

B. Adair: Back to the simple. It doesn’t matter if I’m dealing with a bully or somebody with anxiety and autism. It’s all the same thing — connection, connection, connection. And health and wellness come about.

T. Ritchey: If I could also say that…. You know, we took ten years co-developing a unified model of human behaviour with a neuroscientist and an anthropologist and really have a deep understanding of human behaviour, and this is a whole new concept. We’ve discovered a core mechanism in the brain that we say drives all dysfunctional behaviour.

It’s interesting, Mike, that you were talking about addiction and separating it from mental illness. In fact, we don’t. What we do is we say that all mental illness is driven or perpetuated by this particular core mechanism of the brain — a hyperreactive stress response. This hyperreactive stress response manifests in a variety of different ways in different people in different experiences.

It’s very, very complicated, but we’ve been able to simplify this process and incorporate it into a classroom. The teacher doesn’t have to know anything at all about the brain or what’s happening in the limbic region. It’s just really about this connected classroom.

The evidence that we have is ten years in the field of me working with severely mentally ill people and severely addicted people and treating them the same way — with no label, with no judgment and with the same model. Of course, you’re just taking my word for it now, but there’s a lot of anecdotal and case study and corresponding evidence and a lot of testimonials that we have that would say….

I might go and work with somebody who has an eating disorder, and I’ll do an intensive 20-hour weekend with them, say, with a little bit of support on the back end, and they fundamentally change. But I don’t just go in and deal with one person. What I do is go in and deal with the family. So Billy saw that Todd goes in and deals with the support network, the family dynamics. He shifts everything in the family dynamic and then deals with the internal milieu of the person and gives them a sense of some sort of empowerment, understanding their physiology and the things that they can do to feel changes about that.

He took that and started implementing that into the classroom, which even has a bigger support network. It’s not just ten people or five people in the immediate nuclear family or extended family. It’s the 20 or 30 kids, peers, that actually on some level have a greater influence than even parents would.

J. Thornthwaite (Chair): Thank you very much. We very much appreciate you coming in.

You’re not the first ones that have come and talked about connectedness with regards to the school kids. The majority of the presenters have made recommendations that involve schools, so we know that schools are the centre of where we have to start fixing the system. We appreciate that, and we appreciate you providing us with all the materials, which, of course, will go on the record as well.

I just have one question. When we spoke the last time, you mentioned that Forbes article, and (a) I’d like a copy of it.

J. Thornthwaite (Chair): And (b) could you just briefly tell the folks that are still here…?

T. Ritchey: Yes, it’s really important, actually. There are a couple of different articles that are sort of showing different things in the education realm. Again, it’s just sort of about the type of networking that we do and the types of connections that we make. I can go into that one a different time with you, Jane.

The one that Jane is talking about is…. Fortune 500 did a study. Back in the 1970s they took a list of the 13 skills that were the best predictors for
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success later in life — best for education and for financial and career success. This list of 13 skills. Then they also took a list of those same 13 skills, and they reassessed them. Where did they fit today? In 2014 where did those skills fit in the list of importance in terms of predicting success?

Well, you would be able to easily guess — and Jane actually did — Nos. 1, 2 and 3. In the ’70s they were reading, writing and arithmetic. Those were the best predictors for career and financial success later in life. Reading, writing and arithmetic in 2014 placed No. 10, No. 11 and No. 13 on the list. They’re still on the list, but they’re way down on the list.

Here’s the interesting thing. No. 1 on the list was ability to work with a team. Teamwork — No. 1 predictor for success. No. 2 predictor for success is creativity and problem-solving. No. 3 is interpersonal skills.

These kids now are going to go into a workforce where every three years their career is going to change, on average. Things are happening. Half of the jobs that those kids are going to be taking don’t exist yet. That’s how quickly this marketplace and these career opportunities are changing.

To be adaptable, to be resilient, to have a high social IQ — these are the critical pieces. That’s reinforced now by an economic magazine. I think it’s also important to get the parents on board and understand this, because they’re driving the teachers to keep teaching reading, writing and arithmetic.

B. Adair: They have to be liberated from marks, grades and tasks as all things that are important. The connection is the important part for the whole person. The new curriculum that’s coming out and all the competencies — they talk about all these things, but there really is no how-to.

That’s why I’m so excited. This is the how-to. As I said, it is the most powerful how-to, we believe, for mental wellness and health. We’re looking for a champion.

T. Ritchey: Thanks so much for your time. Thank you, committee. Thank you, Jane.

J. Thornthwaite (Chair): We’ll do our report probably in July, because we’ve lost some people here. So let’s put that over until July, if everybody’s okay with that.

Hansard Services publishes transcripts both in print and on the Internet.
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7) B.C. Psychiatric Association	Dr. Carol-Ann Saari
	Dr. Matthew Chow
	Dr. David Smith
8) B.C. Pediatric Society	Dr. Wilma Arruda
9) Focus Foundation of B.C.	Dr. Jeffrey J. Schiffer
	Deborah (Deb) Abma
10) Provincial Health Services Authority	Connie Coniglio
	Jana Davidson
11) The Sandbox Project	Dr. Stanley Kutcher
	Dr. Zak Bhamani
	Dr. Christine Hampson
12) The Answer Model	Todd Ritchey
	Bill Adair

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

1) Cariboo Action Team	Dr. Glenn Fedor
Cariboo Child Development Centre Association	Nancy Gale
2) Rev. Dr. Steven Epperson
3) B.C. RCMP “E” Division	Staff Sergeant Tom Norton
	Inspector Barb Vincent
4) Canadian Mental Health Association	Bev Gutray
	Jonny Morris
5) Inner City Youth Mental Health Program	Dr. Steve Mathias
St Paul’s Hospital
6) First Nations Health Council	Grand Chief Doug Kelly
Shuswap Nation Tribal Council	Chief Wayne M. Christian

REPORT OF PROCEEDINGS(Hansard)

SELECT STANDING COMMITTEE ON CHILDREN AND YOUTH

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
CHILDREN AND YOUTH