The committee met at 9:13 a.m.

[N. Simons in the chair.]

N. Simons (Chair): Today we have a few agenda items, beginning with a report, Missing Pieces: Joshua’s Story, which was issued by the representative in October 2017. This is our opportunity to discuss it with the representative and the representative’s office.

With that, good morning, and thank you for being here. Please proceed.

Consideration of Representative
for Children and Youth Reports

Missing Pieces: Joshua’s Story

B. Richard: It’s a pleasure for us to be here, as well, for our weekly get-together, or so it seems.

I do want to begin by correcting the record a bit. MLA Throness asked me last week if I’d had a meeting with the Minister of Mental Health and Addictions. Actually, yes. I was preparing for this presentation. I noted that we had briefed three ministers together, and Minister Darcy was one of those ministers: Minister Dix, Minister Darcy, Minister Conroy. We briefed Minister Fleming separately. There were a couple of deputy ministers in the room: Doug Hughes of Mental Health and Addictions and Allison Bond of MCFD. So there were several other people. I think we maybe were…. I’d forgotten that last week, so I apologize, and just to make sure that’s for Hansard’s sake.

[9:15 a.m.]

Thanks for having us. I’d like to say that I really appreciate the opportunity to appear before members to talk about our work and to answer questions as best we can. A reduced crew this morning, as I’ve been told that we’ve got maybe an hour and a half or so, just to save the cost of hauling people across the way.

I have Alysha Hardy who is on this report as well — this more recent report. On Friday we talked about the Nick Lang report, of course, and that was an older report that was finished almost a year and a half ago now. Alysha was also the lead for this report, our lead investigator. She’s a senior investigator in our office — and Jeff Rud, who is our director of strategy and communications.

Moving to the Missing Pieces: Joshua’s Story report, which we released on October 4, 2017. Joshua’s case was one we felt we should investigate, as did the B.C. Coroners Service, which recommended that we do so as well. As is the goal with each of our reports, we wanted to learn from what happened to Joshua and to use that knowledge to recommend improvements, going forward, for other vulnerable children and youth in British Columbia.

The pseudonym Joshua was adopted out of respect for his privacy and the fact that he has a younger sibling and members of his family who were obviously quite sensitive about releasing his name. Actually, as I recall, they chose the name Joshua. His mother and brother chose Joshua as the name we should use for reasons that were comfortable for them.

I want to acknowledge his family’s deep loss. The report process was difficult for them, but they also believed that it was important for government to learn lessons from Joshua’s life.

Joshua was 17 years old when he took his own life by jumping from a construction crane on the grounds of B.C. Children’s Hospital, where he had been a patient for 122 days, or about four months. He’d had a difficult, lifelong battle with mental illness, but as his family told us, Joshua was much more than a teen with a mental illness. In many ways, he was a lot like other kids. He was an intelligent, caring son, and he possessed a sharp wit. He was kind, and he had a desire to help others. He loved his family, and he loved his cat. He had severe mental health challenges that had no easy answers.

In fact, after a long investigation that included 43 interviews with family members, community professionals, hospital staff and government employees, we can’t say with any certainty that Joshua’s death could have been prevented had he and his family received better services. What we can and did conclude, however, is that a truly clear and comprehensive youth mental health system in B.C. would have given him a better chance to deal with his challenging illness.

Joshua began showing signs of serious mental health issues before he was two years old. As an eight-year-old, he told staff at his school that he wanted to die and that “nothing could be done.”

He first attempted suicide at age 11 and completely withdrew from school as a young teen. Joshua did receive services. In fact, for much of his life, he had multiple professionals working to help him through B.C.’s education, health care and child welfare systems. In a way, that was part of the problem. There were a number of workers and professionals from a number of organizations but no single, comprehensive system in place to ensure that Joshua was getting what he needed.

Joshua’s mother first called the Ministry of Children and Family Development when, as a two-year-old, her son was hitting himself and banging his head on walls. A child and youth mental health worker advised her to call again if the behaviours persisted. This is a good example of how the system failed to provide early intervention services that may well have altered his life trajectory.

[9:20 a.m.]

Other services Joshua received as a youngster — in 2007, 2008 and 2009 — were withdrawn as soon as he showed any signs of improvement or when the voluntary mental health services were unable to successfully engage with him.

The system was sometimes slow to react. In January 2010, for example, a community daycare agency called MCFD to report that the 11-year-old had exhibited emotional outbursts that were concerning and had written a letter saying that he felt worthless and had tried to kill himself. Shockingly, MCFD did not follow up on this report for 16 months.

When Joshua began withdrawing from school in his early teens, it didn’t trigger a serious enough intervention. School officials tried to get him to return to classes, but they had no power to compel him to do so, and neither did his family.

There seemed to be no systemic recognition that his withdrawal from school was a sign of his significantly deteriorating mental health. The lack of a systemic response, services and service providers working together, again exacerbated an already concerning situation. In February 2015, Joshua was hospitalized after an attempt to kill himself. There was no secure child and youth psychiatric unit at the hospital, so he was admitted to the adult psychiatric unit — not an appropriate place for a youth his age.

This is symptomatic of a system that doesn’t have appropriate facilities for children and youth at their various stages of need. Twice when Joshua was discharged from hospital, in November 2014 and again in March 2015, he didn’t receive adequate community follow-up services because CYMH liaison carried a workload that was unmanageable for one person. After Joshua was hospitalized under the Mental Health Act in March 2015 for the second time in less than a month, he was eventually transferred from the adult psychiatric ward to B.C. Children’s Hospital.

Although B.C. Children’s was an appropriate place for him, as he received necessary acute mental health treatment, he was kept there for far too long. Joshua spent four months there, in part because professionals at the hospital and MCFD couldn’t initially agree on a safe plan for him to live post-discharge. This is a glaring example of the lack of step-down facilities in B.C. — those that would enable a child or youth to ease out of a hospital setting and prepare for a safe return to live in their community.

All of these examples show that although Joshua received a lot of services from a variety of professionals, he was not being treated by any kind of truly comprehensive, integrated system. What Joshua’s experience shows is that there are gaps in B.C.’s child and youth mental health system.

Among the shortfalls this report points to are the following: a lack of appropriate placement options for children and youth with serious mental health concerns, including the step-down services referred to in Joshua’s case but also step-up services, a place for youth who need help but perhaps not hospitalization; second, the difficulty B.C. families experience in obtaining long-term consistent mental health services for their children; third, the absence of a single point of accountability for child and youth mental health in this province due to the fact that services are delivered by a number of organizations that don’t always work well together.

We’ve previously pointed to gaps in the child and youth mental health system. Others have as well. These gaps need to be filled so that other children and families do not find themselves in similar circumstances going forward.

We ended up making only one recommendation: the creation of a truly comprehensive mental health system for children and youth in B.C. It’s a big one, for sure. If it sounds familiar, it’s because you have heard it from our office before. Different words, perhaps, but essentially the same request for a system that can competently cover the wide gamut of mental health care needs — from prevention to family support to emergency and acute care to step-down services.

[9:25 a.m.]

We recommended in this report that the planning and implementation of this system be led by the Minister of Mental Health and Addictions, and I was pleased to see her react in a very positive way to our recommendation. It was also a good sign that Minister Darcy supported the recommendation, acknowledging an integrated system is part of her mandate’s priorities and included in her mandate letter.

It makes sense for the minister to take on this work, in coordination with her colleagues in Education, Health and Children and Family Development. How effective the new ministry will be, when the resources are located in other ministries — most notably, Health — remains to be seen. We talked about this a bit on Friday. Perhaps next month’s budget will provide more answers.

The ministry has created a strategic framework for mental health, and I would hope that it is able to make substantial progress on it within the coming year. A comprehensive mental health system should include education and awareness initiatives, enhanced outreach and day treatment services, enhanced early identification and intervention services, community-based step-up and step-down resources, a means to prioritize complex cases such as Joshua’s and to flag and monitor those cases, a process to enhance cross-ministry and service provider collaboration and information-sharing, and a way to address regional differences and complexities across B.C.

This very committee recommended similar improvements in its 2016 report Concrete Actions for Systemic Change. There’s no question that we need a real system — a comprehensive, integrated system. It’s time to get on with building one.

I’m happy to take questions.

N. Simons (Chair): Thank you very much, Bernard. Appreciate that. I’ll look to the committee.

L. Throness: I have several questions. If you want me to ask one, I’d be happy to ask one, to start.

The first question I have is a very general one. What is the legal responsibility of the government for every child in B.C.?

B. Richard: For every child requiring mental health services? Is that specifically the question? I think it’s the same as it is for any person receiving health services in British Columbia: to provide quality health services and to respond to the needs as best as possible — certainly, as is provided for in various legislation. That’s the first point.

The other point I could refer to is the obligations that are contained in the UN convention on the rights of the child, which are more specific to children, of course. But all signatories…. Most countries in the world have signed the convention. Canada is a signatory, and provinces report through the government of Canada on their progress in meeting their obligation under the convention. So clearly there, there is a commitment to meet the health needs of children as well.

I think it’s a broad commitment to provide quality health services, whether it’s physical health care or mental health care. Legal obligations? I’m a lawyer by trade, but I won’t provide a legal opinion on that. Certainly, I think there’s a moral obligation to provide good-quality care.

L. Throness: I wanted to ask about the cohort of youth and children who might be needing these step-up and step-down services that you recommended in your report. How big is that cohort?

B. Richard: We can’t know for sure because not all cases come to us. What I can tell you, from my volunteer work with the Canadian Paediatric Society, is that this is an issue that is growing. I serve on the CPS’s Action Committee for Children and Teens. I’ve been on the committee for, I think, about three years now. I meet regularly with pediatricians, mostly on the phone.

[9:30 a.m.]

They’re reporting that they’re seeing more and more cases of anxiety and depression at younger and younger ages in their patients, and it’s growing by a significant amount. CPS has been fairly active, as well, in advocating for improved services. They’re often at a loss to respond.

We have, I think, reasonably good…. I’ve served, as well, for an advisory committee to a research project on youth mental health, based at McGill University. It’s a significant project — $25 million over five years, with 12 sites across the country. I think what I heard there, initially, was that we’re pretty good with early services, community-based services, but as soon as things get really complex and the need increases, we’re not as good at providing services. I think that’s true across the country, and I’m sure that it’s true in British Columbia.

We have a wonderful B.C. Children’s Hospital, for instance, providing, I think, equal to any such facility in the country. But in Joshua’s case, he became, in a sense, institutionalized after four months. Everybody agreed he shouldn’t have been there for that long, but they couldn’t come up with the right kind of placement. He could have been returned to his family, but they weren’t prepared, and unable to deal with him. So there was really nothing in between.

When we talk about a comprehensive youth mental health system, it’s one that offers services at all levels of need. That, I think, is the big gap now — the levels of need that are higher than community-based services but lower than institutional, hospital-based services.

L. Throness: I’m just wondering: how would a youth system be different than the adult system? I note that Joshua was held in an adult facility for several months. Presumably, it would be the same staff. It would be a different demographic of patient, but it would be the same staff working in different places. How would that facility for youth be different in a tangible way than the adult facility that he was in?

B. Richard: I have a friend who was the chair of the children’s committee of the Mental Health Commission of Canada, and he would say that the mental health system is the poor cousin of the health system and that the youth mental health system is the poor cousin of the poor cousin, right?

Using adult psychiatric facilities to serve children is really totally inappropriate. It’s not the same kinds of approaches, not the same kind of level of development, for children. The need to maintain close community connections is so important. Children…. We all expect, at some point, they’ll be able to return to their families, to their communities, to their friends. That’s not always the case with adults who are in psychosis. So it’s a different kind of practice altogether. It requires a different kind of response.

N. Simons (Chair): Do you want to…? Go ahead. I have some questions too.

L. Throness: Okay. There’s something on page 47 that you note in your report, called the Foundry project, which has a number of different centres for mental health and social services across B.C. Could these serve as step-up and step-down facilities?

B. Richard: I think the Foundry approach is quite good, and it’s been noticed. I heard about it before coming to British Columbia — for instance, with my work on the McGill research project — and I visited the site here in Vancouver. I haven’t been to all of the sites. I believe there are five now. I’m not sure, but it’s a growing number. I think it’s a very good initiative.

From my perspective, to be quite transparent, I think it’s still a bit more of a clinical kind of approach. I mean, certainly, it’s storefront, very accessible, street level — at least, the one that I visited here. But once you’re in the door, it really feels clinical.

[9:35 a.m.]

I think it’s an improvement from what exists now. Certainly, when you look at the overall system, I think we’ll save money, actually — some very good investments. People who would normally wait too long for these kinds of services might end up in crisis in hospital, where the cost is much higher to serve them. So I think, in some respects, it’s a significant improvement but not quite — I don’t believe, and I’ve had this discussion with the deputy from Mental Health and Addictions — the model that is required.

I’ve seen some good examples. I want to mention West Kootenay. There is a pilot project there. I don’t have the name with me, but I can provide it at a later date, Mr. Chair. I’ll send it to the Deputy Clerk. It’s a pilot, so it’s been around for about a year. They’re just writing a report from their experience. Their pilot is what I talked about last week as a one file, one child. It’s a number of professionals providing wraparound services — collaborating, sharing information, following a youth. In this case, a number of youths. It wasn’t a large pilot. But certainly, they are very excited about what they’ve done. They’ve been in contact with the new ministry. They certainly would like to continue.

I think that’s closer to the kind of model that we envisioned when we thought about Joshua’s life and what might have made a difference. Joshua was beyond, I think, a point where even the Foundry could be helpful to him.

N. Simons (Chair): Thank you for those responses. I have a few questions on the report itself.

It’s a sad case to hear about. We all hope that by talking about it, we learn something and improve services so that there’s a legacy of constant improvement. Our condolences are to the family.

The recommendation, I think, is obviously a good one. I think there’s a big step taken towards achieving that recommendation after many, many reports calling for such a move. I have confidence and I have hope that the new ministry will address some of the siloing that takes place in the service delivery system.

I’d like to turn to Joshua’s early life and a paragraph on page 25, specifically referring to his early life, when he was living with his mother. I’m quoting from page 8: “In March 2004, a concerned neighbour called MCFD to report that the boy’s babysitter left the children unsupervised for long periods of time.” I’ll skip ahead: “An MCFD social worker spoke with Joshua’s mother, who said she had used the babysitter for two years.” I’ll skip to the next paragraph: “Later in his life, Joshua reported substantial physical and emotional abuse by this caregiver. He said that the caregiver left him alone, forced him to do labour, humiliated him and physically abused him by poking him with sewing needles.”

Now, this is part of the chronology, understandably. My question is: what happened with the 2004 report? I know we’re talking a lot about the 122 days he spent and his final days in the hospital, but this is a six-year-old.

By the time he was six, he’d been abandoned. He’d been abused, physically and emotionally at least. Despite that, despite a report of a babysitter that looks like it’s worth investigating, there seems to have been no action. Only later did we find out the truth of that circumstance. So what happened early? Was there a family service file open at that time? This is 2004.

A. Hardy: I can give you a little bit of detail about that, a little bit of background to this.

[9:40 a.m.]

By the time MCFD began investigating that report, the mom had already stopped using that daycare provider. Unfortunately, in their investigation — we weren’t able to find any indications that the investigation wasn’t fulsome — there wasn’t sufficient evidence to establish whether or not it happened at that time. Joshua had not made any disclosures. There was no physical evidence. There were no witnesses. Given that Joshua was no longer with that babysitter, he did not receive any follow-up for that.

As far as I know, it wasn’t made the focus of any of his therapeutic interventions from that point on, until he began disclosing it at an older age. It definitely, I think, could have been a very formative thing that happened in his life.

N. Simons (Chair): I would suggest, possibly, that what it speaks to as well is a single parent with no supports, unable to access affordable care. We hear of current situations with parents with similar struggles. It speaks to the breadth of services that are required in order to support a child, and it’s not just the intervention of the ministry that’s going to satisfy that concern.

I thought, when seeing this in context of the report, that a lot of emphasis has gone into his, so to speak, institutionalization at the end of his life. But I think, in a way, the report seems to suggest that that had a significant impact.

If you look at the report, as well, when you’re talking about how much time he spent in the hospital, it seems like three-quarters of that time was dealing with treatment and therapeutic interventions and only very close to the end, like within three weeks of his death, were efforts being specifically made to find him a place to be other than the hospital. Is it possible that we’re overemphasizing the hospital stay as a factor? Could you maybe just answer that?

A. Hardy: I think there’s always a challenge in our reports of balancing when we’re looking at whether or not the systems and the policies and practices of the public body possibly contributed to the injury and illness. There’s a challenge in balancing early childhood, which we know has a massive, massive impact on children in their lives and their development, with more material contributions later in their life. So when we’re drawing those connections for material contributions, it’s challenging to establish with a child who’s, unfortunately, deceased what meaning the early childhood instances had on that child or what impact they had on the child.

In Joshua’s case, you’re correct. There are a lot of different things that happened in his early childhood that quite likely did have a significant impact and influenced the outcome of what happened for Joshua. But when we’re focusing on what we can change now, when we look at where the systems are at now and what we can change based on his experiences, we weight it heavier on the end part of his life, because that’s where we’re looking at now for where we can change systems.

It’s hard to establish, looking back in 2004, what we could change now that hasn’t already changed since 2004 that would have altered the outcome, if that makes sense. It’s a little roundabout way for me to get to it. In terms of learning from what happened to Joshua and altering the outcomes for future children, hopefully, weighing our reports more heavily on the latter years of his life allows us to more clearly see where those influences could happen.

B. Richard: We also know that in the last four months he was receiving intensive treatment. He was in a hospital. Both MCFD and health professionals were well aware of his condition. It was the last opportunity before he took his life to find some kind of solution for him short of what eventually happened.

Yes, we focused on that, in part because we know there’s no better facility in British Columbia than B.C. Children’s Hospital, yet it was clear from our interviews with professionals and from looking at the documents that the professionals from MCFD and the hospital professionals were not able to agree on where he should go from there. I think they couldn’t agree because it didn’t exist. They would have had to build….

[9:45 a.m.]

Joshua had significant needs. I don’t want to understate that at all. In fact, I think when we released the report, reporters were surprised when I said that I wasn’t sure that it would have saved his life because his needs were so complex. But clearly, that was the last chance, and it had the highest level of care available in British Columbia. That was the last chance to make a difference.

Earlier on, we’re just not sure if it would have made that much of a difference. We think so. I mean, we believe that early identification, early intervention, can be significant. But in Joshua’s case, a pretty rare case exhibiting very problematic behaviour at age two, that’s rarer than what we normally encounter, for sure. I would say it’s so complex and acute that it’s hard to come to the conclusion on what other services would have done in other years.

N. Simons (Chair): That’s a fair comment. I think the theme that I see, probably in the last six or seven reports relating to a critical incident or child death, is the lack or the want of adequate resources. Here you have a mental health worker saying “unmanageable caseload for one person.”

It seems to me that many of the challenges that these health care or social services professionals were experiencing were the lack of ability to get their work done. They knew what they had to do. Somehow, they couldn’t do it. I think the recommendation that we find places where these individuals speak to each other is helpful.

Of course, we can’t predict the individuality. The cases are all so different. Every child’s case is very different.

B. Richard: Once we decide to investigate, we have to report. We don’t have all the answers before we investigate. We don’t have access, necessarily, to all of the information, because there was an internal B.C. hospitals report that we could not have access to under different pieces of legislation.

A. Hardy: Section 51.

B. Richard: Section 51. It most definitely would have been helpful to us if we’d had that internal hospital report, but we couldn’t have access to it.

J. Isaacs: Bernard, you mentioned that mental health is becoming more and more evident and raising its head, if you like, at earlier and earlier ages. Joshua certainly had that at age two, and it got very serious at the age of eight.

What do you see as the difference between child and youth and adult, and what would be the age range that you think would be appropriate? Then, if there are three different levels of care, are you envisioning three different levels of a comprehensive strategy for each one of those groups?

B. Richard: I certainly gave a lot of thought to that question before I came here, in New Brunswick. We wrote a report called Connecting the Dots, which eventually was translated into a system of care that is school-based, so that teachers are….

In fact, there is a week of mental health awareness, starting in elementary school, with modules prepared for teachers so they know how to appropriately talk about these issues with their students and how to identify, perhaps, emerging issues with students. You have to respond to that.

Certainly — clearly, I think, with this as it is with other things — the sooner you know that a child is struggling with either anxiety or depression, the better opportunity there is to be able to respond to it. So having a school-based system, called one child, one file, a sharing of information amongst other professionals — could be a public health nurse, a family doctor, a school resource teacher — so that everyone is aware.

[9:50 a.m.]

I think the vast majority of children who present with symptoms of anxiety and depression…. Those issues can be addressed early on. The rest of the system, of course, will respond through the top of the pyramid, the more acute needs of a much smaller number of youth. They progressively can become more acute.

You have to be able to respond at all levels in an appropriate way to the need that is exhibited, that the child presents with. I think there are examples of that around the country. I mentioned the West Kootenay pilot project, which is quite encouraging. There are good practice models around the country that are available.

Many people smarter than me have argued that if you don’t deal with these issues early, you’re inevitably going to have to deal with them later in the physical health care system, in the justice system, in addictions. One in five Canadians suffers from some kind of mental distress. Then clearly this is an issue that we’ve been sweeping under the rug for a very long time, not just in British Columbia but across the country.

A lot of work has been done to eliminate the stigma. I would argue that it still exists, that it’s not comfortable for us to talk about these things. When we released our Connecting the Dots report, we had followed seven youth for two years. I think I’ve told this story before. I know I’ve told it many times before. I don’t know if to this committee.

The mom of one of the girls that we had followed — it was one girl, six boys — came to me after the release of the report. She said: “I wish my daughter had had cancer instead of schizophrenia because nothing would have been spared to cure her cancer. She suffered from schizophrenia, so we weren’t comfortable talking to other family members. Services weren’t readily available. It was embarrassing. We had to tell our story over and over again at the school, at the public health office and at the hospital.” There wasn’t one single file of information, whereas with physical health, our files follow us wherever we go.

I think there’s a need for a much more comprehensive approach to mental health, in the same way that we respond to physical health. When we don’t do it, we pay a bigger price, ultimately.

N. Simons (Chair): I’m just going to get back to some of the description from your file. Obviously, you’ve reviewed files.

In his early life, Joshua’s situation was reported to MCFD six times between 2007 and 2010 — six reports, including some evidence that he was physically punished. I don’t know whether you call that abuse or not, but he was physically dragged or perhaps hit. We don’t know.

What I’m noticing is, perhaps…. Maybe it’s just because we can’t go into more detail in the file. There didn’t seem to be a lot of services — the ministry providing the parent — that they expected the parent to fulfil and to monitor the parent’s ability to fulfil. It seemed to be that all the interaction with the professional services was when the mom requested it. Can you speak to that a little bit?

A. Hardy: I can. It was a combination, I think. The ministry initially did recommend the family preservation worker after the initial call. For the majority of that time period, either the mother reached out or the ministry reached out to that worker, because the mother and that worker had a really good connection.

I think, especially for a mother like Joshua’s who was really struggling to meet her child’s needs, who was a single parent who was trying but obviously having difficulties, having that personal connection really allowed her to work and feel safe in working. Clearly, with the calls continuing on, all the issues weren’t solved, but both she and the ministry were using the similar family preservation worker through that time.

I think the challenge, which comes through during that time period, is that, unfortunately — and it was the same with the mental health services to Joshua — whenever the family was doing well or when Joshua was doing well, the services retracted.

[9:55 a.m.]

That’s obviously due to systemic limitations where there are so many families waiting for services. If a family is doing well, those services need to go on to the next family. With our current burdened system, they can’t carry on with the family indefinitely when there are other families on the list.

With Joshua’s family, again, when mom was doing well, when Joshua was doing well, the services retracted. When mom or Joshua wasn’t doing well, either she or the ministry would reach out and they’d come back in for short-term help. But what the family really needed, in this case, were long-term, consistent, comprehensive services for both Joshua and for his mom, who, again, was really trying but limited in what she could do.

N. Simons (Chair): Did you get the sense, in speaking to mom, that she was sometimes resistant to services because of the failure of previous services?

A. Hardy: In speaking to mom, that wasn’t my sense. I don’t want to speak too much for her. She’s a very capable lady at speaking for herself. In our interviews with mom and in our follow-up discussions with mom, I think it was more that her frustrations were, occasionally, that the services couldn’t meet the needs that she was expressing — if that makes sense. She was seeing these presentations for her son. For example, he’s locked in his room every day, all day, for hours. Could she get services? Yes. Could she get services that fixed that? No.

I think that was sort of the balance of…. I never got the impression, from speaking to her, that she was resisting those services. It was that it came to a point for her, from talking with her, that she was so fatigued from the services not working that she almost gave up. She was just tired, and she couldn’t fight that fight anymore.

J. Rice: Would you say that that’s common within the Ministry of Children and Families, that they may have services offered but they’re mismatched for what the needs of children are? Is that something we need to work on?

A. Hardy: I think there could always be more robust services for families. I think each case highlights some unique aspects, and when you look at it on an individual basis, it’s hard to say if that’s a huge, systemic problem or if that’s a problem for this one family. But I think if you look at the work that our advocacy team does, it does come through that it’s a challenge for families to access the services that they think they need.

It might be the case that the ministry feels that there are services that are better suited for those families than what the family thinks they need. It might be that the services are limited. It may be that they’re in a region where they can’t access them. So I think it’s always better to have more services for families.

B. Richard: There’s been an acknowledgment of that. In last year’s budget, in fairness — I think it was February — there was a significant lift in terms of the counselling mental health services — so an acknowledgment that there was a need there. Whether a year after…. Recruiting professionals is a challenge as well. Clearly, we see….

I think I mentioned on Friday that we have parents who call because their children are waiting for assessments, and the wait time is as long as two years in some regions. If you have a child that’s experiencing some distress and mental health issues but you don’t know what the problem is, it’s difficult, as a parent, to live through that. And when you have to wait a year or a year and a half or two years for an assessment, that’s pretty significant.

Obviously, there’s a need for more resources in the system. I think there’s a step in the right direction, started in last February’s budget. I really think the new ministry is providing more acute focus on these issues and coordinating services, because the system does operate in silos far too often. Information is not shared. There are all kinds of issues.

My sense…. Obviously, it’s already been two and a half years since Joshua passed, but there are ongoing efforts. The Foundry is new since that time, as well, and is growing across the province. So I do think there are efforts, but we’re still short of where we should be, clearly.

N. Simons (Chair): I’ll just add, if I may, that the two-year waiting for an assessment isn’t just a neutral waiting room. It’s two years of deteriorating relationships, entrenchment of particular ways of doing things. So it’s not just the wait. It’s the fact that while you’re waiting, things get, sometimes, worse.

[10:00 a.m.]

R. Singh: Just following up on that, the gaps, we know that mental health is a very complex issue. It is not like other physical ailments, where you have one treatment which will work on everybody. Every case is unique.

Hearing the story of Joshua, when mom is saying that she’s not getting the services that she required…. Do you think there was a gap in doing the proper assessment? Is there some kind of lack of training or — because it’s a unique case, and every case that’s coming out is different — not enough time or not enough funding to do the proper assessment and find the proper diagnosis?

A. Hardy: Joshua did receive psychiatric assessments during the same time period that you were referring to. From 2007 to 2011, he was receiving psychiatric assessments and services. Further down the road when he became quite entrenched in his home, one of the major challenges in him getting assessments at that time, from what was going on, was outreach, really. He would not leave his house.

He was not a small child. You can’t take a 16-year-old and physically force them out of a locked room, short of the Mental Health Act and apprehensions. So I think, at that time, there was certainly a lack of assessments of what was going on for him. I’m just not sure how, in our current system, that would have been responded to without, like I said, very intensive outreach, without somebody who was there every day, trying to get him out.

Meanwhile, his mother had to work. She had another child. She had no options. I think our current system wouldn’t be resourced to meet those needs that he had at that time, if that answers the question.

J. Isaacs: My experience right now, because I have folks like this coming into the office, and it’s getting to be more and more…. In some of these cases, especially where there is a serious mental health issue, the relationship with the family and the social workers often breaks down over time and sometimes, actually, even ends. So there’s no more support.

The one child, one file may not work for everyone. I think Rachna kind of pointed that out. But do you recommend that this comprehensive strategy would include a strategy for those individuals and families who may not respond to the support that they’re offered?

B. Richard: Certainly, and we talked about this issue on Friday a bit. We talked about secure care and more robust ways of getting treatment to resistant teenagers, particularly. I’ve had four resistant teenagers myself, but at a different level. I know it can be a challenge. Particularly for a teenaged young person who’s struggling with mental illness, it’s hard to imagine how difficult it could be.

I know that parents — moms, in particular, in Toronto, on Saltspring Island.… I’ve read stories of mothers saying, “If only we could have provided secure care to be able to engage in treatment, to start my son” — or daughter — “on the right path,” whether it’s for addictions treatment or extreme mental health treatment or, frankly, young teenagers in the sex trade, for instance, who have been lured into the sex trade. In Alberta, for instance, secure care is used in those instances as well.

I’m supportive of secure care but with very, very clear boundaries and comprehensive services so that it be time-limited, that there be step-down services available and comprehensive services available — so that it’s not just an issue of getting someone sober for two weeks and then releasing them into the environment. It’s just not going to work. I think, to some extent, it’s a very harsh response in our way of seeing our democracy and our civil rights and all those things.

[10:05 a.m.]

Certainly, I’ve been convinced by parents who have struggled — we met two of them on Friday — and seen, lived through the deaths of their children, thinking that given an opportunity…. It’s, perhaps, hope beyond hope. Of course, if you’re a parent, you never give up on your children. So I fully understand them. But I think in those jurisdictions where they have tried those kinds of solutions, they’ve had some success. It’s not perfect. It’s not a panacea, but they’ve had some success.

S. Furstenau: I was wondering if you could expand a bit more on the recommendation — the idea of having a Mental Health and Addictions Ministry. It says: “lead the planning and implementation” of a full spectrum of mental health services for children in partnership with MCFD.

Can you elaborate a little bit on what your vision for that would look like, ultimately? Would it be…? MCFD, right now, has the child and mental health funding bucket. Would it be moving that funding bucket over to the Ministry of Mental Health and Addictions? How do you see that working in the most effective way?

B. Richard: Well, there have actually been several reports, and we’ve talked about it several times — a couple of Legislature committees, including this one, the committee on health, I believe. Your colleague, Jane Thornthwaite, who chaired, I think, that committee at some point, prepared a report along the same lines, with the same kinds of recommendations.

Because mental health is so different than physical health, and the approaches are so different, it requires a system where…. The easiest way I can describe it is to always use those words that people understand: one child, one file. It is comprehensive in the sense that all service providers are involved together. They all feed the same file. They all get their information from the same file. Information is readily available. The system allows them to do that.

There’s, in some cases, legislation that allows that to happen. So wherever a child is found in the system as they grow older, everyone knows what their needs are, what they’re presenting with, if the situation is worsening or not. They collaborate. They talk together — like group family conferencing in child protection. They share information, share strategies, share responses and collaborate with one another.

It’s counterintuitive in a sense. Well, I can’t say it’s counterintuitive, but it goes against the way our system is constructed. I think it’s very intuitive, but our system is built on silos. Departments are budgeted separately. They guard their budgets very closely. Any of you who have had the privilege of serving as ministers, for instance, will know that that’s the case. Deputy ministers — their role is to manage the resources they have.

My sense is that the new ministry is struggling a bit with that, as we speak — that the Ministry of Health is not engaging as easily as they hoped they might. I mean, they’re looking for new resources rather than spending resources that are available, differently, more collaboratively. So it’s a different kind of approach than what we’re used to, for sure, but it’s emerging in other jurisdictions in Europe and other provinces.

I really think that it’s the way of the future for mental health care and comprehensive…. That’s why we didn’t want to…. We could have made 100 recommendations, but we thought, “Let’s try to push the reflection towards a comprehensive system,” knowing that there are different variations on that theme — circle of care, wraparound services, child-centred services.

There are different ways of talking about it, but essentially, it all comes down to a comprehensive, integrated system of care, much as it exists in physical health care. We talk about the circle of care in physical care, where information is readily shared. Now, the strategies are, in a way, perhaps simpler, because there are at least cures for most everything, or at least strategies to respond to everything.

[10:10 a.m.]

Mental illness is, in a way, a social illness in that it affects more than the patient. It affects his or her own surroundings, the family and extended families.

L. Throness: I want to just point out that this report, as in the last one we looked at, pointed out the importance of a navigator. That’s something that we need to highlight.

My question relates to what I thought was a gap in the report. Joshua spent literally years in his room alone. He spent thousands and thousands of hours on video games. But there was nothing in the report regarding what video games he played and how that might have impacted his mental health. Could you speak to that?

A. Hardy: I actually wasn’t the lead investigator at the start of the report, so I will do the best I can to answer that question. I wasn’t a part of the investigation plan.

My understanding is that although that was clearly a very, very concerning part of his life, the investigation was limited in scope to reviewable services and the policies and practices of public bodies. From my understanding, the investigator didn’t consider the video games to fall under reviewable service at this time. While the mental health and mental illness aspect of his video gaming was addressed — the obsessive behaviours, the depression, the isolation — the specifics of video games were left out of the scope of the investigation.

I do apologize if that was seen as a lack.

L. Throness: It may be something for the representative to continue to consider in the future — to have some kind of study on the impact of video games on youth and child mental health. Millions of hours are being spent on video games, and we’re seeing the instance of mental health problems rising. I don’t know if there’s any causal effect whatsoever, but I think it’s worth a look.

B. Richard: That’s a good point. While I can’t recall that video games specifically came up with the Canadian Paediatric Society, social media certainly come up a great deal. Teenagers spend dozens of hours a week with their cell phones under their pillow. If there’s a sound, they have to check. So they lose sleep, they become more anxious, and they are subject to ridicule, assessment, social judgment from peers.

It’s a significant change in societal behaviour. Certainly, pediatricians tell me they’re very concerned about that. I would say that video gaming is an extension of that — certainly, the obsessive nature of it. Very good point. We’ll keep that in mind.

N. Simons (Chair): Laurie wants to follow up.

L. Throness: One more question, Chair.

There’s an enormous amount of good will toward children and youth. So the idea that the recommendation for better mental health services for them has gone unanswered for many years and has been made over and over is probably due to the cost of the recommendation.

Are you saying, in what you said in the question before from the previous questioner, that you think the services that are necessary could be provided under present budgets, or would they require a whole new raft of spending?

B. Richard: Yeah, I think both. I think there’s a need for more resources, given the wait times for assessments, for instance, and the need to recruit more professionals to do that. But certainly, I do think that what’s currently being spent could be spent better as well.

The last part of that answer is that if we take a longer-term vision of the issue of mental illness by investing earlier in life, we will save expenditures in the future. Invariably, we find now…. All of the studies confirm that, for instance, in prisons, a growing number of inmates are also suffering from mental illness and addictions. Look at the homeless population.

Certainly, we’re finding that if these issues are not addressed at the appropriate time, they will come back to bite you later on. The costs will be borne, inevitably, by all taxpayers through the health care system, the justice system and the prison system.

[10:15 a.m.]

I really think there are three answers to your question.

J. Isaacs: If you were going to include or expand the secure care model that you were referring to, in those extreme and serious cases, would we have to make any changes to the Mental Health Act in order to implement that?

B. Richard: I’m not sure about that. We don’t currently have secure care in British Columbia. There’s a bill — it was referred to on Friday — that was tabled but not voted on last spring. There are good models, and I think it requires some work.

I would suggest, if the government decides to move forward or another…. Gordon Hogg, I think, moved the last bill. If a member should decide to move a similar bill and it were adopted, I think it would require significant public input, including what kinds of legislative changes would be required, what kinds of services would be required.

There are some good models elsewhere. We could learn from those and have the right kind of system to meet the needs of British Columbians. I don’t claim to be an expert in terms of what legislative changes would be required, but I would think there would be a need for more study.

N. Simons (Chair): On that issue of forms of care to provide care, there was a policy change, probably about ten years ago, in the Ministry for Children and Families, which would not allow the use of a voluntary care agreement unless protection concerns existed. Previously, when a parent was at their wits’ end and unable, in their own mind, to provide the necessary care, it didn’t require the ministry to say: “You’re incapable, officially and legally, of looking after this child.” It allowed for the parents to receive services for their child without….

We talk about the stereotypes and the stigma attached to mental illness. There’s also a stigma attached to having the ministry involved. When the ministry is involved, the stigma can accelerate with court action. There was a time when voluntary care agreements allowed the relationship between the social worker and the parents, and the child’s relationship with the social worker, to be not ramped up and not put into a state of conflict.

There was no court involved. There was an agreement. The ability to cancel the agreement existed. And if the social worker felt that the cancellation of the agreement would result in a problem, that would be expressed.

The voluntary care agreement or the special services agreement didn’t seem to be offered. It seems that only the day after the health officials at B.C. Children’s Hospital wrote to the ministry saying, “This child needs step-down services,” was the day that mom agreed. Now, mom had to agree that she was unwilling or unable to look after the child. When you put that bar so high, you wonder. Is it possible that in other circumstances, if a parent wasn’t feeling so threatened by that designation…?

A voluntary care agreement in a level 3 home with sophisticated mental health providers as the sole caregivers…. It’s expensive. But we do have the capacity in the existing system for step-down services. We have level 3 homes. We have level 2 homes. We have level 1 homes. We have regular homes. We have restricted homes.

The sad part here is the father said that in a heartbeat he would have been offering, and nobody seemed to include him. We’ve seen that in the report we talked about last week as well. When there’s parental discord, that is sometimes a significant impediment to good communication. And that good communication…. It sometimes prevents good results. I’m not saying that it was necessarily the primary issue here.

Can you speak to the issue around the voluntary care agreement requiring a finding or an expectation of a protection concern being present?

[10:20 a.m.]

A. Hardy: I think, in this specific case, the social worker assigned and his team were looking at the file primarily from a youth-centred approach because of the age of the youth and the interest in having him buy in. That would be the word I would use.

The mother was quite clearly communicating as early as March, prior to MCFD even becoming involved, that she did not believe that her home was a safe place for Joshua to come back to. But the assigned MCFD team, in their youth-centred approach, which was an approach that I think was very well-intentioned to get to know Joshua, to build a connection with him, to get him to buy into what they were serving…. It was a well-intentioned approach. It just might not have been the most appropriate approach in this case, because you are looking at a youth who was seriously mentally ill and who may not have had the capacity to recognize what would have been a safe placement for him to go.

I’m not sure if it would even require a policy change or an understanding change on MCFD’s part about how to use a VCA or how they can use a VCA, or whether it would lead to or need step-down beds that would remove that ministry stigma altogether. If the step-down beds were offered by a different ministry or through a different system than that child protection system, that also might remove that stigma, where Joshua may not have wanted to lose his mother or feel like he was losing his mother or come into care. But if it wasn’t that into-care system, with the stigma that does come with that, it may have been an approach that could have worked better for him.

N. Simons (Chair): There’s a current policy requirement that protection concerns exist for a voluntary care agreement to be signed.

A. Hardy: I think, in this case, it might have been more of a misunderstanding about whether or not there were protection concerns. In our investigation, it was quite clear that it met section 13 and that the mother was not able. So we didn’t really focus on whether or not it could have happened without protection concerns, because, from our view, there were protection concerns under section 13 of the CFCSA. Although the mother was willing to care for Joshua, she was not able to meet his needs. She was stating that, and the hospital was stating that. So, for us, it should have already been able to meet that bar.

N. Simons (Chair): It says here: “The day after the letter was sent, Joshua’s care team, including BCCH, MCFD and iYos held a conference to discuss the plan for Joshua. At that time, Joshua’s mom stated to all involved that she could not care for Joshua, given his needs.” It doesn’t seem to me, until then, which was mid-July, that offers of voluntary care were even on the table.

A. Hardy: Although she was communicating it, I don’t think it was being heard by the team. The team was approaching it, again, from a well-intentioned place but from a place that wasn’t really hearing what the mother and the hospital were saying until they sent that letter that made the impetus for things to move.

N. Simons (Chair): Yeah, I get that. I think there’s a serious problem requiring protection concerns to exist in voluntary care agreements. Especially when you’re working with vulnerable communities, that stigma sometimes is the foremost issue in the mind. Look, for example, at our Indigenous community that has faced a systemic removal of children from families in the residential school system.

Now we have more children in care than were ever in the residential school system, yet the policies of the ministries must apply on reserve, in First Nations communities. So you have social workers in First Nations communities who want to provide support to a family and maintain a relationship with that family in the community, and you’re required to use the most heavy-handed approach because you don’t have access to less intensive involvement.

For example, there was a time where a parent would say: “I’m really struggling. I’m having trouble getting through this patch. A friend of mine passed away or what have you. I really need time.” A good social worker would recognize that this parent needs a break. If they’ve approached the social worker that the parent needs a break, what are you going to do? Say: “I’m sorry. There are no protection concerns”? Well, not yet. If you provide that person with the ability, without outside pressure, to resolve a temporary situation, that’s an incredible tool to have.

[10:25 a.m.]

When you remove that tool, the parent knows that you’re either going to be involved in support services that you’re going to have to go to all the time, or you’re being threatened. And in Indigenous communities, there’s no point…. Like, courts, removals…. It doesn’t solve any of the issues. It almost looks like an attempt of government to fix problems, as opposed to allowing the circumstance to exist where problems can heal themselves.

I don’t know where this is going, other than that I think the use of voluntary care without protection, without that determination, would be a useful tool.

B. Richard: I get your point, Chair. We’ll have a look at it and think about that, perhaps, in other…. There’s no shortage of cases for us to look at where we can consider that point. What we’re seeing is, I think, not obvious in this specific case — but perhaps. We’ll take a second look at it but also look at it more generally.

N. Simons (Chair): Yeah, I’m sorry. That was more of a…. It fed off this report, but it’s a more general observation. I really don’t know enough about this case to say that, but I just point that out. It was referred to by the representative, and I think, a necessary, important point to touch on.

J. Rice: I appreciate your passion there, Chair.

N. Simons (Chair): Well, it’s just an observation. We were talking last week about how you’ve found some communities where there are no removals. There might be care agreements, and I know that….

B. Richard: There are care agreements.

A Voice: Informal.

N. Simons (Chair): Yeah. When there are care agreements, and there are no removals, you have a much better circumstance to get healing. If you have community social workers from the community, the last thing you want to do is ruin those relationships. I have some more ideas, anyway.

B. Richard: I totally agree.

N. Simons (Chair): I want to just thank you, Alysha and Bernard and Jeff, for being here and for your helping us understand this really important report, which I think we all learned from. We’ll do our best to ensure that government policy is informed by what we’ve learned today.

Thank you to the members for your questions and for your responses.

B. Richard: Thank you as well, Mr. Chair. And thank you to the members. Some very good questions and food for thought for us as well. I’m tempted to say, “See you next week,” but maybe two weeks.

N. Simons (Chair): A couple of weeks, yes.

Okay, we’ll have a recess for five minutes.

The committee recessed from 10:27 a.m. to 10:42 a.m.

[N. Simons in the chair.]

Deliberations

N. Simons (Chair): We’ll resume on agenda item 2, a statutory review of the Representative for Children and Youth Act and deliberations. We do this until lunch, and where we start is part 3.

Before we do this, I need to have a motion that we go in camera. Moved by Sonia, seconded by Rachna.

The committee met in camera from 10:43 a.m. to 1:49 p.m.

[N. Simons in the chair.]

N. Simons (Chair): Thank you very much. Excellent discussion. I look forward to our next meeting.

Thank you to Hansard. Thank you to Alayna. Thank you to Susan and the Clerk’s office. Safe travels.

A Voice: Motion to adjourn.

N. Simons (Chair): Motion to adjourn, seconded. We are adjourned.

The committee adjourned at 1:49 p.m.