Taken from: http://www.thespec.com/article/554649


Amanda Wass was nine years old when she walked into her sleeping parents' bedroom with a knife in her hand.

Her mother, Gaby, woke to find her daughter standing over her, threatening to kill her.

"My husband had to tackle her to get the knife away," says Gaby.

School problems were chronic. One time, Amanda tied up a student at school. Another time, she put her fist through a wall.

She once lit a fire under her younger brother's bed while he was sleeping.

Sometimes she would run away and go missing for days while police searched for her.

There were times when Amanda unleashed the anger upon herself. Rows of sealed-over cuts mark where she turned a blade to her own arms.

"I don't know where it comes from," says Amanda, when asked about the source of her anger.

Now, there are only hints of that angry child. It's Friday night at the Wass household, an immaculate sidesplit in a tidy suburban neighbourhood in St. Thomas, near London.

For the moment, all is calm.

Amanda's father, Brian, settles around the dining room table as Gaby watches her daughter sprinkle cheese onto a small pita. She looks relieved. There were many months when Amanda wouldn't eat for days at a time.

Amanda is home for the weekend from a residential facility for girls with behavioural problems.

She spends five days of each week there because her behaviour remains erratic and at times violent.

Chaos has been a constant here since Amanda, now 15, was six and began flying into uncontrollable rages.

Gaby and Brian know their daughter's anger stems from a horrific childhood trauma.

She was sexually assaulted by a family friend when she was only four.

"He got six months (in jail) and my daughter got a life sentence," says Gaby.

They don't know if that trauma unleashed a predisposition to mental health problems.

What they do know is that after years of treatment by several mental health clinicians -- doctors, social workers and psychiatrists -- Amanda is still not well.

She was diagnosed with bipolar disorder, along with a host of other issues. It means her emotions will fly from super-energized to deep depression.

Running her hand through her hair, Amanda exposes painfully short, chewed nails that she has painted black with marker. No polish is allowed in the facility because one of the girls tried to drink a bottle of it.

This Friday night, she is in her manic state, marked, among other things, by a French inflection in her voice.

She suddenly bolts upstairs and begins belting out a Dixie Chicks song, one of her favourites.

"Never gonna hold the hand of another guy," she sings.

Gaby watches her daughter from the hall and offers a brief smile. Later, around the dining room table, she talks about the many nights she and her husband feared Amanda wouldn't come home, the many times they agonized about where to turn for help. "It's been exhausting," says Brian.

"If they'd had the services there from the beginning when our daughter was six, then the outcome would have been different," says Gaby. "Our daughter could have been different."

Like thousands of parents across the country who have a son or daughter with a mental health problem, the Wasses are asking the question -- why has the system failed our child so badly?

One in five children in Canada has some type of mental health problem. Even more startling -- only 20 per cent of those one in five children are getting the help they need.

That means many families, such as the Wasses, are struggling -- many on an agonizingly regular basis -- as they watch their child's condition worsen.

Former Senator Michael Kirby, chair of the Mental Health Commission of Canada, calls children's mental health services the "most neglected piece of Canada's health care system."

And for good reason. The system has been eroded by years of funding cuts, causing closures of long-serving programs, and long waits for services.


Disturbing Reports

Study after study has sounded the alarm on the severity of the problem. A landmark study by an internationally recognized Hamilton child psychiatrist, the late Dr. Dan Offord, discovered the one-in-five figure more than 20 years ago. It refers to the number of children affected in some way by mental health issues, among them anxiety, bipolar and attention-deficit disorders.

More recent reports include:

* Ontario Auditor General Jim McCarter's 2008 report that described the children's mental health system as a "patchwork of services," and said it lacks a clear mandate and standards.

*The province's Roots of Violence report released last November that called on the province to provide an additional $200 million for badly underfunded youth mental health services.

*The Office of the Provincial Advocate for Children and Youth report that revealed 90 children known to child-protection services died in 2007. It concluded that providing more co-ordinated mental health resources could have prevented some of those deaths.

Early diagnosis and early treatment are crucial to children with mental health problems. The personal cost to a child who doesn't get help early can be steep. They can develop behaviour patterns that set them on a downward spiral for life.

A child with learning problems who doesn't get help is more likely to drop out of school, turn to crime or drugs and alcohol, or become suicidal. Studies show that up to 40 per cent of incarcerated adults have some form of mental health problem.

The financial cost can be high. One report showed that preventing or successfully treating a single case of conduct disorder (that might involve violence, vandalism, truancy and running away from home) can save $1.7 million in lifetime costs of special education, justice and mental health.

A report by Kinark Child and Family Services, a children's mental health service in Markham, showed it's far more cost effective to treat a child early. It estimated it costs about $2,400 a year to treat a child in a community-based mental health agency, while incarcerating a youth costs $90,000 per year, and a pediatric hospital bed is $900,000 a year.

Despite these alarming facts, funding for children's mental health services was frozen for years. Ontario agencies received no increases for more than a decade until 2004-05.

Since then, increases have been small, including last year's hike of 1 per cent. Agencies say that means many children are falling through the cracks.

Children's Mental Health Ontario, which represents almost 90 agencies across the province, estimates 11,123 children are on waiting lists for basic services.

Experts question why there are annual funding increases for physical health services, but not mental health services.

"While the ministry speaks proudly about money put toward housing and poverty initiatives, our sector has gone two straight years with no increase and only three base budget increases in 12 years," says Gord Greenway, program manager, Child and Adolescent Services, Public Health Services in Hamilton. "This translates into another cutback as costs have gone up for all centres somewhere between 3 to 6 per cent."

Experts say the problem is mental health disorders aren't taken as seriously as physical ailments.

"If you went to your doctor and he said, 'We've concluded you have a tumour, it's malignant and it's small and we could treat it today and your chance of survival is 80 to 90 per cent, but we're not going to do that. We're going to wait for a year while the tumour grows, your family life falls apart, surgery will be much more invasive and the success rate is only 40 per cent,'" says Dr. Pat McGrath, vice-president research, IWK Health Centre, a Halifax hospital that provides care to women, children and youth.

"That's what we do in mental health and it's absolutely intolerable."

Hamilton Centre MPP and Ontario NDP leader Andrea Horwath blames the funding problem on the fact that children's mental health services are not mandated (like physical health services), therefore there is no mandatory funding requirement.


Growing Anger

Horwath tried to push through a bill last year that would make those services mandatory. She was unsuccessful.

"It would create an accountability so that when the (attorney general) comes out with a scathing report that says programs are in disarray in the province, then there's some kind of accountability that it's the government," says Horwath.

Anger is mounting among professionals. Gordon Floyd, executive director of Children's Mental Health Ontario, recently asked Ontario child and youth advocate Irwin Elman to investigate whether there are provisions in the UN conventions on the rights of the child that are not being lived up to.

Elman is still looking into it.

"There's a huge sense of frustration that the arguments about the need and the fairness and humanity and even economic rationale don't seem to be producing any significant movement," says Floyd. "We're just saying this inequity in the way resources are being distributed sure looks like it's got some discrimination built into it."

Meanwhile, a recent study by his organization revealed the situation is further deteriorating because of the world financial crisis.

In Windsor, which has been hard hit by layoffs in the manufacturing sector, some agencies have seen a 50 per cent increase in the number of children and youth requiring services.

Floyd says the growth can be directly attributed to the increase in families dealing with the stresses of being out of work. The kids feel the tension and anxiety.

What worries experts most is that, while agencies wait for funding, children with mental health problems are missing out on much-needed early intervention. Presently, only the most serious, violent and suicidal children get help when they need it.

"The ones in the worst plight are the internalizing ones, the quiet, anxious, withdrawn ones," says Dr. Simon Davidson, chair of the child and youth advisory committee with the Mental Health Commission of Canada.

"They're the ones in more trouble, and they're also the ones we can help really quite well."

This creates an agonizing dilemma for professionals.

"If you know that there's a long waiting list, and you know that by and large the kid isn't an immediate threat to themselves or anybody else, they don't get referred," he says. "Parents are constantly being told 'your kid isn't severe enough, call us back if he's threatening people or violent,' so they're waiting and waiting."

Sometimes, even the most violent children don't get timely help. The Wasses say this was the case with Amanda.

She was 10 when, after months of searching for the right program, the Wasses thought they'd finally found a facility for her.

There was a catch. The facility only took Crown wards, which meant they had to abandon custody of their daughter. Advised by a lawyer this was only a technicality, they signed over their daughter.

"We thought we would drive her to the facility and still be able to see her," says Gaby.

Instead, social workers showed up at their door to take Amanda away in a scene Gaby compares to "a dog being picked up off the street and being taken to a pound.

"She was flailing, screaming and carrying on and grabbing onto our legs. It was one of the worst days of my entire life."

To add to their distress, the facility wasn't what she needed. Amanda later had to be transferred somewhere else.


Long Waits

There was once a belief that mental illnesses progressed along the same path, no matter what treatment was offered.

"So the best we could do was to be there and help people when they fell. That is no longer our understanding of those illnesses," says Dr. Ronald Zipursky, vice-president, Mental Health and Addiction Services and Chief of Psychiatry at St. Joseph's Healthcare Hamilton.

"We know whether it's anorexia or schizophrenia or bipolar or depression, we know how to get the vast majority of people better from these disorders, so why not put our energies upfront when we can get them better, as opposed to seeing them 10 or 15 years down the line at which point it may impossible to make their symptoms better."

Still, Zipursky says long wait times and a fragmented system mean it can take a family five years to get help.

"Those are critical years in terms of education and all aspects of personal development. If you lose those years you are likely to be permanently disadvantaged and get them on a permanent trajectory."

Mental health disorders should be treated the same way as illnesses such as diabetes, says Zipursky.

"We don't put all our energy into kidney transplant and amputation. There's a huge amount of effort into education around diet to make sure the illness is not disabling."


Brain Development

It was 1999 when Dr. Fraser Mustard co-authored a groundbreaking report that showed how much a child's environment influences his or her brain development in the early years, including the period in utero.

Mustard said those same studies also showed that adverse early human development can lead to poor cognitive development. That, in turn, can affect a child's performance in school and lead to significant behaviour problems, even poor physical health.

"That's why it's hugely important that we identify problems early," says Dr. Jean Clinton, child psychiatrist at Hamilton's Offord Centre for Child Studies.

Early diagnosis also provides a window of opportunity in brain development to help children develop, to change the trajectory.

"Rather than thinking that a child with ADHD (Attention Deficit Hyperactivity Disorder) has deficits, I think about what skills is that child lacking, and what are the skills we can build up," said Clinton.

Because the brain is a work in progress, it's especially important for children to get help early.

The first step is for parents to be heard. Most families who suspect their child has a mental health problem head to their family doctor -- someone who often gets minimal training in pediatric mental health.

The doctor may prescribe drugs that are ineffective or, worse, exacerbate the problem.

Don Buchanan, knowledge translation officer for McMaster Child Health Research Institute, has found that experts don't pay close enough attention to parents.

A typical scenario, says Buchanan, is where parents take their child to the family doctor because they recognize their child has a behaviour problem.

Doctors may minimize what a parent tells them, or tell them the child will outgrow it, says Buchanan.

Parents then have to "pester" the doctor for several months before they agree to make a referral to a specialist.

"Then the parents wait three to six months to talk to a clinician who says to Mrs. Smith, 'guess what, little Johnny has a behaviour problem.'"


Stigma

Making parents' voices heard isn't easy, say families who feel they are judged and blamed for their child's problems.

Sarah Cannon, of St. Catharines, is bombarded with hate mail and angry calls each time she does a media interview about her daughter Emily, who was diagnosed with bipolar disorder.

Emily started showing symptoms as a toddler. She'd spin about so wildly she'd fall uncontrollably to the floor.

She also became fixated on shiny or soft surfaces, and compulsively put things in her mouth. Once in an elevator, she rushed forward and licked a stranger's corduroy pants.

In Emily's mind, the soft, bumpy texture was too much to resist.

"She was wild in a way that looked like she was feeding something inside of her, like she needed to do this to get it out," says Cannon.

Despite the hate mail, Cannon has refused to be silenced. She has recently been appointed executive director of Parents for Children's Mental Health, a parent advocacy group.

"I don't understand why it's not more of a priority. It is not OK that children are dying."

Parents such as Diane Simon, of Cottam near Leamington, tried to make change by joining boards and organizations, and speaking out.

Simon's son, Cale, was diagnosed with bipolar disorder when he was nine. He committed suicide six years ago at 16.

She thought she'd found a way to have her voice heard. Instead she felt patronized, as if she was the token parent.

She quit and turned her energy to speaking to parents. Serious health problems, however, have forced her to take a break.

"I promised my son I will keep fighting for kids like him, but I have to do it in a way that's going to be most effective."

Society loses out when parents are silenced. As Zipursky says, "Mental illness has been so associated with shame that not only do people not talk about it, but they don't know anything about it."

Then there's the denial. "There are a lot of Canadians who do not believe that children and youth suffer from mental health problems," says Davidson.

Dr. Ian Manion agrees. "We don't want to believe as parents that our kids can be depressed. We don't want to believe that our kids can be suicidal," says Manion, executive director of the Provincial Centre of Excellence for Children's Mental Health at Children's Hospital of Eastern Ontario.

"We're more likely to understand when there's a physical illness."

Others believe there is a deeper root behind this crisis in children's mental health, that the failure to make change stems from society's attitude about children.

"I don't think we're a culture that values children very well," says Elman, Ontario child advocate. "We look at the multiyear increases in the rest of the health budget that are averaging 6 per cent a year, and we compare that to children's mental health and we say, this isn't fair. There's clearly a different priority going on."

Clinton says the fact that Canada doesn't have a universal child-care program is further proof of how little we value our children. "Where in the country has anyone said: 'Who's looking after our kids?'"

The Canadian Psychological Association is trying to get those questions answered. It is calling on Ottawa to work with the provinces to implement an integrated program of enhanced mental health services for children.

If the situation doesn't change, the World Health Organization estimates by 2020 mental illness will be one of the top five causes of death and disability in the young.

Meanwhile, parents continue to struggle, many in the quiet of their homes.


Routine

Darkness falls as Gaby turns on the motion sensor above the front door. She checks that the 911 panic button under her bed is on.

It's a routine she follows every weekend when her daughter comes home in case Amanda has one of her violent outbursts.

"It's just what we do," says Gaby.

Amanda wants nothing more than to come home, to sleep in her own bed and be able to play with her beagle, Dallas.

If Gaby and Brian acted from their hearts, this is where she would be. But years of violence and chaos have taught them not to act from their hearts, even though it's their daughter.

On Sunday night, they will drive Amanda back to her residential treatment centre.

"I feel like for Amanda it's almost too late. There have been 10 years of failed attempts," said Gaby.

"As much as I love her, my other concern is for all the other kids coming up behind her, and there's lots of them."

ddavy@thespec.com

905-526-3317

Sarah Cannon, of St. Catharines, is bombarded with hate mail and angry calls each time she does a media interview about her daughter. 'She was wild in a way that looked like she was feeding something inside of her, like she needed to do this to get it out.'

DENISE DAVY was awarded the Michener-Deacon Fellowship, Canada's premier award to encourage the pursuit of public service journalism. This is Davy's third national journalism fellowship.

Davy is currently nominated for a National Newspaper Award, and recently won an award from the Registered Nurses Association of Ontario for her series last year, Waiting for Care, on local children's mental health services.


The Numbers

*Up to 20 per cent of Canadian youth are affected by a mental illness or disorder -- the single most disabling group of disorders worldwide.

*Approximately 5 per cent of male youth and 12 per cent of female youth, age 12 to 19, have experienced a major depressive episode.

*The total number of 12- to 19-year-olds in Canada at risk for developing depression is 3.2 million.

*Once depression is recognized, help can make a difference for 80 per cent of people who are affected.

*Mental illness is increasingly threatening the lives of our children. Canada's youth suicide rate the third highest in the industrialized world.

*Suicide is among the leading causes of death in 15- to 24-year-old Canadians, second only to accidents; 4,000 people die each year by suicide.

*Schizophrenia is youth's greatest disabler as it strikes most often in the 16- to 30-year age group, affecting an estimated one person in 100.

*Mental disorders in youth are ranked as the second highest hospital-care expenditure in Canada, surpassed only by injuries.

*In Canada, only one out of five children who need mental health services receives them.

Source: Canadian Mental Health Association


Where to Get Help

These are 24-hour emergency help services for children and youth who have a mental health crisis.

*COAST: Crisis Outreach and Support Team: 905-972-8338

*Kids Help Phone: 1-800-668-6868

*Hamilton Police Victim Services: 905-546-4904

*Suicide Prevention Crisis Line: 905-522-1477

*Telecare Burlington: 905-681-1488


Ask Your Questions

Go to thespec.com Monday to talk to child psychiatrist Dr. Jean Clinton, who specializes in early childhood initiatives. Log on to Spec Live at 1 p.m., or send in your questions earlier to citizen@thespec.com.

Monday from 1 to 2 p.m. at thespec.com

Public Forum to discuss children's mental health

When: Wednesday, May 6, 7 to 8:30 p.m.

Where: The Spectator auditorium, 44 Frid St., Hamilton

Panel: Deb Matthews, child-youth minister; Simon Davidson, child-youth mental health centre; Gordon Floyd, Children's Mental Health Ontario; moderator Denise Davy; and parents

Phone: 905-526-3535 to register