7/6/2011
Setting the Stage
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 E ti l that th t we bbe able bl to t identify id tif andd implement i l t best b t 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
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
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Child and Adolescent Mental Disorders – the 20% reality
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*
Disorder
Age of onset distributions of any mood disorders*
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
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
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
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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Number of Suicides by Age Group Canada, 20002003
Age of Onset of Major Mental Disorders PDD/ Autism ADHD
600
Anxiety Disord er Obsessive Comp ulsive D isord er
500
Substance Abuse 400
Anorexia Nervosa
2000
Major Depressive D isord er
2001
300
2002
Bipolar Disorde r
2003 200
Schizophrenia Bulimia Nervosa
0
10
20 Age
100
30 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
Source: DSM-IV, 2000
Take Homes
Recent USA Data: NCS-AS (2010) Disorder
Prevalence
Prevalence + (severe)
Anxiety Disorders
31.9%
8.3%
Behavior Disorders
19.1%
9.6%
Mood Disorders
14.3%
11.2%
Substance Use Disorders
11.4%
Most of the major psychiatric conditions begin during the 10 to 15 years following the onset of puberty: secondary/post-secondary Generally they affect about 20% of 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 than that to meet health and education needs of young people 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
Importance of Mental Health to Student Achievement A barrier to learning: Mental health disorders among Canadian youth
Extremely Important
Canadian Council on Learning, 2009 “Poor mental “P t l health h lth in i Canadian C di school h l children hild poses a significant i ifi t risk i k tto th their i 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.”
Veryy Important p 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
The Need for Collaborative SBMH
100
Tier 1
Schools
90 80 70 60
Targeted
50 40 Tier 2
30 20
Tier 3
Targeted
10 Targeted
0
Clinical
not at all
a little
somewhat
very
extremely Tier 3
Clinical
Educator Preparedness
Community
Getting our Acts Together, 2009
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!
Severe and Persistent Disorder
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.
Moderate Disorder Specialist CAMHC
Mild Disorder/ Di d / Demoralization General Health Care
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
Prevent Disorder or Impairment or Address Distress Facilitate Development
The school is also a place where mental health can be linked with other aspects of y health,, nutrition,, sexual health. health,, such as pphysical
•Family •Community •Institutions •NGOs
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
A Holistic Integrated Pathway to Care Model for Secondary Schools: A Canadian Example
Mental health promotion Early y identification Triage Intervention Continuing care
Integration Goals To promote mental health and reduce stigma through enhancing the mental health literacy of students, educators and parents. To address prevention and promote appropriate and timely care through early identification, triage and evidence-supported sitebased mental health interventions. To enhance formal linkages between schools and appropriate health care providers id (primary/specialty) ( i / i l ) 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
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
3
7/6/2011
School Mental Health Framework COMMUNITY
SCHOOL PARENTS
STAKEHOLDERS POLICY MAKERS
MENTAL HEALTH LITERACY ADMINISTRATORS
MENTAL HEALTH CURRICULUM
STUDENTS
TEACHERS
STUDENT SERVICES PROVIDERS
QUESTIONS
MENTAL HEALTH SERVICES PROVIDERS MENTAL HEALTH LITERACY SCHOOL-BASED HEALTH CENTRE PROVIDERS
PRIMARY CARE PROVIDERS
GATEKEEPER TRAINING
The End and the Beginning
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
4