Dr stan kutcher 2 slides

7/6/2011

Setting the Stage

Stan Kutcher, MD, FRCPC, FCAHS Sun Life Financial Chair in Adolescent Mental Health and Director, WHO/PAHO Collaborating Center in Mental Health Training and Policy Development; IWK Health Center and Dalhousie University

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Our Challenge and Our Opportunity There can be no health without mental health Essential that we be able to understand the domains and overlaps of: mental health; mental distress/demoralization; mental disorder Essential that we be able to identify and implement best evidence based interventions to effectively and costeffectively enhance both health and education outcomes Will require different thinking and different ways of doing – including knowing through learning, solution development, implementing and evaluating Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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Child and Adolescent Mental Disorders – the 20% reality Disorder

6 Month Prevalence (%) Age = 917

Anxiety Disorder

13.0

Mood Disorder

6.2

Disruptive Behavioral Disorders

10.3

Substance Use Disorders

2.0

Any Disorder

20.9

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Cross-national Comparisons of the Onset of Psychiatric Disorders: the about 70% by age 25 years reality Age of onset distributions of any anxiety disorders*

Age of onset distributions of any mood disorders*

Age of onset distributions of any substance use disorders*

*Data for Germany were omitted because of the narrow age range of the sample

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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7/6/2011

Child and Adolescent Health: GLOBAL Comparative Burden of Illness for Mental Illness: the cost and impact reality

Table: World: DALYS in 2000 attributable to selected causes by age

Ages 0-9

Ages 10-19

12

29

Malignant Neoplasms

3

5

Cardiovascular Diseases

2

4

Neuro-psychiatric conditions (including self-inflicted injuries)

Adapted from: World Health Organization (2003). Caring for children and adolescents with mental disorders. Setting WHO directions. Page 3, Figure 1. World: DALYs in 2000 attributable to selected causes, by

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Age of Onset of Major Mental Disorders PDD/ Autism ADHD Anxiety Disord er Obsessive Comp ulsive Disord er Substance Abuse Anorexia Nervosa Major Depressive Disord er Bipolar Disorde r Schizophrenia Bulimia Nervosa

0

10

20

30

Age Source: DSM-IV, 2000

Number of Suicides by Age Group Canada, 20002003 600

500

400 2000 2001

300

2002 2003 200

100

0 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85- 90+ 14 19 24 29 34 39 44 49 54 59 64 69 74 79 84 89

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Recent USA Data: NCS-AS (2010) Di d Disorder

P Prevalence l

P Prevalence l + (severe) ( )

Anxiety Disorders

31.9%

8.3%

Behavior Disorders

19.1%

9.6%

Mood Disorders

14.3%

11.2%

Substance Use Disorders

11.4%

Take Homes Most of the major psychiatric conditions begin during the 10 to 15 years following the onset of puberty: secondary/post-secondary ll they h affect ff about b l Generally 20% off young people Globally, these mental disorders contribute about 1/3 of the burden of disease – mortality, morbidity! More than: HIV/AIDS; TB; respiratory diseases; cardiovascular diseases and war/violence COMBINED! In Canada many who need care do not receive it –health care system not set up to meet needs: lack of integration with systems “where the kids are” Improving mental health (health promotion) is important but we must do more g ppeople p than that to meet health and education needs of yyoung Early identification, diagnosis and proper effective treatments of mental disorders have substantial positive effects: RECOVERY and PREVENTION!

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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7/6/2011

A barrier to learning: Mental health disorders among Canadian youth Canadian Council on Learning, 2009 “Poor mental health in Canadian school children poses a significant risk to their academic development and puts them at greater risk of dropping out of school, substance abuse and suicide. Schools are well positioned to be at the vanguard of public health strategies designed to prevent and detect mental health disorders among young people.�

Importance of Mental Health to Student Achievement

Extremely Important Very Important Somewhat Important A Little Important Not Important 0

10

20

30

40

50

60

70

80

90

100

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Concern about Student Mental Health 100 90 80 70 60 50 40 30 20 10 0 not at all

a little

somewhat

very

extremely

Educator Preparedness

The Need for Collaborative SBMH Tier 1

Schools

Targeted

Tier 2

Tier 3

T Targeted t d Targeted

Clinical Tier 3

Clinical

Community

Getting our Acts Together, 2009

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Severe and Persistent Disorder

Moderate Disorder Specialist CAMHC

Mild Disorder/ Demoralization General Health Care Prevent Disorder or Impairment or Address Distress Facilitate Development

•Family •Community •Institutions •NGOs

Addressing C and Y Mental Health Needs: Schools the Opportunity Promoting the health of children and adolescents in schools has been an important goal of WHO, UNESCO, UNICEF, and other international agencies since the 1950s: there is no health without mental health!

The school environment offers a relatively simple and cost-effective way of reaching youth, since most young people spend at least 30 hours a week in the classroom.

The school is also a place where mental health can be linked with other aspects of health, such as physical health, nutrition, sexual health.

Good Mental Health is a LEARNING ENABLER: applies to youth with a mental disorder as well Entire scope of mental health interventions can be provided in one location or school can be linked to best provider – identification of mental disorder KEY – as is ongoing support Important to approach this with flexibility based on best evidence while also dependent on local circumstances: as long as the PRINCIPLES and COMPONENTS are maintained

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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7/6/2011

A Holistic Integrated Pathway to Care Model for Secondary Schools: A Canadian Example

Mental health promotion Early identification Triage Intervention Continuing care

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Integration Goals To promote mental health and reduce stigma through enhancing the mental health literacy of students, educators and parents.

T address dd i andd promote appropriate i andd timely i l care To prevention through early identification, triage and evidence-supported sitebased mental health interventions.

To enhance formal linkages between schools and appropriate health care providers (primary/specialty) To provide a framework in which students receiving mental health care can be seamlessly supported in their educational needs within usual school settings.

To provide best evidence based, end-user inputed, best learning enhanced and evaluated materials to support each of the necessary components.

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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School Mental Health Framework COMMUNITY

SCHOOL PARENTS

STAKEHOLDERS POLICY MAKERS

MENTAL HEALTH LITERACY ADMINISTRATORS

MENTAL HEALTH CURRICULUM

STUDENTS

TEACHERS

STUDENT SERVICES PROVIDERS

MENTAL HEALTH SERVICES PROVIDERS MENTAL HEALTH LITERACY SCHOOL-BASED HEALTH CENTRE PROVIDERS

PRIMARY CARE PROVIDERS

GATEKEEPER TRAINING

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

QUESTIONS

The End and the Beginning

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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