The focus of mental health awareness is typically on adults, but the roots of so many mental illnesses begin in childhood.

Anxiety disorders, severe aggression, post traumatic stress disorder and other conditions often show their first signs when children are kindergarten-aged. Other conditions manifest during the tumultuous teen years, such as bipolar disorder, schizophrenia and eating disorders.

Yet the struggles of children and youth with mental illness are often ignored and their needs underserved. The Mental Health Commission has estimated that 1.2 million Canadian children and youth are affected by mental illness, but fewer than 20 per cent receive appropriate treatment.

That's despite studies showing the longer children wait for proper diagnosis and treatment, the greater their risk of developing serious mental disorders as they get older.

Dr. Jaswant Guzder, an associate professor of psychiatry at McGill University in Montreal says, "People don't realize that many of major mental disorder start in childhood. By the time they reach teens, one-quarter of lifelong disorders are already diagnosed."

Kids can learn to manage their mental health conditions if they are offered therapy early. But the demand for treatment is high, and the wait for services can feel interminable.

Help for complex disorders

But there are programs that are working for children.

Guzder is the director of the Childhood Disorders Day Hospital at Montreal's Jewish General Hospital. There, kids as young as five, up to the age of 12, with serious psychological or behavioural problems can have up to a year of intensive therapy.

The Day Hospital program is for kids with complex diagnoses such as anxiety disorders, oppositional defiant disorder, ADHD and learning disabilities, whose parents and teachers can no longer manage them.

"These children are the ones who are just not functioning in school," says Guzder.

For three to four days a week, the children enter a classroom setting at the hospital to work with special education teachers and take part in social skills training. They do art, music and play therapy with occupational therapists, and weekly family therapy with psychologists, while the other days of the week are spent at their regular school, so they can remain integrated there.

By bringing together psychologists, psychiatrists and social workers, an entire team of professionals and the child's family can assess the child and develop a therapy plan.

While this intensive "multimodal approach" isn't new, there is a pitiful shortage of such programs in Canada. Even the Day Program at JGH, which is the largest for anglophones in Quebec, can only accept 83 children per year.

Still, Guzder says many of the families who could benefit most are reticent to seek out programs like hers. It's often not until the child is threatened with school expulsion that they realize they need help.

Parents often believe that behaviour and mental health problems in their kids are their fault -- the result of "lazy parenting." But the causes of mental illnesses and disorder are complex and Guzder says no one in her program seeks to lay blame.

"It's not a question of bad parenting. I think that's a stigma," she says.

"When a child has (difficulties) or trauma, or learning disabilities, or other complicated reasons why they're not functioning, our agenda is not to blame families. It's to strengthen them, and to give them the tools they need," she says.

Transitional Care Program

After six to 12 months in the program, children and their families typically make great strides in understanding their conditions. But the greatest stress can occur when it's time to return to regular life.

The prospect of returning full-time to school can be stressful for everyone -- for the child, who will lose the structure and guidance of the day program; for family members who may worry the child will regress; and for the school and teachers, who may be worried their resources will be stretched too thin to manage a child with special needs.

That's why just over 10 years ago, JGH created the Transitional Care Program to help kids reintegrate. While most child psychiatry programs offer some kind of follow-up care, this program is a full six months long and uses a team of specialists dedicated solely to transitioning the child back into their regular routine.

The program, funded for the last two years by a grant from Bell Let's Talk, sees social workers visit both the child's school and their home. They help to advocate for parents as they work with the schools. The Transitional Care team also will stay in the classroom to watch for any behaviour difficulties during the transition, and work with teachers to pass on techniques to help the child.

It's often through the Transitional Care program that problems are spotted.

In one instance, the Transitional Care Team noticed that a boy's father was not stepping in when he acted out -- even when the boy hit his mother. Through discussions, the team learned that the father actually respected his son's defiance, and was subtly communicating his support by not intervening. Team members were able to work with the father to encourage him to assume his authority and to dole out appropriate consequences for negative behaviour.

Guzder says the JGH Transitional Care Program sees parents as partners in helping children with mental health challenges. That's why they also work to help parents find ways to manage their own stress and to find ways to take breaks, since the challenges of mental illness are often exhausting.

In some cases, Guzder says, parents want to stay in close contact with the Transitional Care team. Others prefer less intervention -- and that's okay too.

"We always put the parent in charge because we serve the parents," says Guzder. "This is not a forced treatment program; it's voluntary. And it's for the parents to decide if they feel this kind of intervention is helpful."

The program has seen dozens of success stories, says Guzder, who says parents often remark they can't believe how much their child's condition or behaviour improves after treatment and transition.

"Almost always, they are very grateful," she says.