Abstract

Improving access to mental health services for youth and parents

Child psychiatrists are among the mental health professionals that are well positioned to provide mental health services to young people with major mental illnesses and their families. However, there are not enough specialists to meet the demand (1). Although the exact number of Canadian child and adolescent psychiatrists is unknown, the Canadian Academy of Child and Adolescent Psychiatry has 350 members whose practices are based disproportionately in cities with medical schools. It has been estimated that Canada has one child and adolescent psychiatrist to every 6148 young people with mental health needs (2) - a shortage likely to get worse (3). In Ontario, it is unlikely that the situation has improved since 1987, when the Ontario Child Health Study (4) reported that 18% of the province's children and youth met the criteria for at least one psychiatric disorder (as defined by the Diagnostic and Statistical Manual of Mental Disorders, third edition [Revision] [5]), and two-thirds of this group met the criteria for two or more disorders. Only one in six young people with a disorder had received intervention for it in the preceding six months (4). Access to these scarce resources continues to be impeded by several factors: long waiting lists for youth psychiatrists, the geographical distribution of these professionals (chiefly in large urban centres) and the frequent discomfort of families at the prospect of seeking mental health care (6,7). Another serious impediment to access to the few resources available is that a child or youth's psychiatric disturbance is not what usually determines referral to a mental health professional. Social functioning, school-related issues, the family's socioeconomic status and other problems that are not always associated with major mental illnesses may strongly influence referral (8).