Just-released data reveals cost of delays in mental health care for Canadian kids

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According to a new report, long delays in getting children and youth the mental health care they need costs Canada $4 billion every year — and that's a conservative estimate, the authors say.

Researchers behind the new report, called "Nurturing Minds for Secure Futures," wanted to model the actual toll on the health-care system should youth continue to face high rates of anxiety and depression without improvements to the system.

They found that delaying treatment of mental health isn't just detrimental to the patient — it can be pricey for the health-care system as whole.

"This report serves as a clarion call for action on behalf of Canada's children and youth," Emily Gruenwoldt, president and CEO of Children's Healthcare Canada, said in a press release. "We have the opportunity to rewrite the future. If we act promptly to invest in and right-size health systems serving children, we not only improve their physical and mental health outcomes, we also save health systems and families billions of dollars."

At least 800,000 and up to 1.6 million children and teens living in Canada may be struggling with a mental health disorder, the report estimates. The lower end of the estimate reflects a 12.7 per cent prevalence of mental health disorders in children found in an international study, the report stated.

The upper estimate was put together to reflect that mental health disorders are known to be under-diagnosed among children and teens, and that the rate of children and teens who experience a mental health disorder is likely to be closer to one in five.

Authors added that research has shown that Black, Indigenous and LGBTQ2S+ youth are often disproportionately at risk, with a lack of timely access to care only exacerbating the problem for all youth.

FINDING THE COST OF POOR MENTAL HEALTH CARE FOR YOUTH

So what is the actual economic impact when we fail to put resources towards addressing this issue?

To create a dollar value, researchers modelled three types of costs – health care, community and productivity or indirect – to put together a "cost-of-illness" outlook.

Health-care costs include the price for emergency department visits, prescription drugs, in-patient hospital stays and other medical costs.

Community costs included those associated with the criminal justice system, social services, family support and provisions for mental health in public schools.

Indirect costs referred to the lost income that results when a person has to put an undue amount of time towards managing their mental health themselves due to the lack of proper access to health care. In the case of children and youth, this meant looking at the lost income of parents when they perform a higher level of caregiving for a child who isn't receiving proper support in our society.

Researchers drew on data from Statistics Canada and the Canadian Institute for Health Information, as well as international sources where needed in order to build the model estimating these costs.

They also surveyed scientific studies on the prevalence of different mental health disorders to get a better idea of how common these issues are among children and teens. Researchers assumed a prevalence rate of nine per cent for anxiety or depression in their model, a number which they say reflects the rising risk among children and youth observed during the pandemic.

The modelling found that our patchwork systems for managing anxiety and depression among youth mean this group is costing Canada $3.5 billion through publicly funded systems.

The report also estimated an additional $280 million in lost parental income and $120 million in education and justice systems.

"If Canada invests in mental health care services and supports to reduce the prevalence rate of anxiety and depression disorders to pre-pandemic levels, the costs would decrease from $4 billion to $1.5 billion per year," the report stated.

Researchers noted that those who struggle with poor mental health in childhood are likely to struggle with their mental health as an adult as well, meaning early intervention could lead to greater resiliency by adulthood.

A GROWING PROBLEM

Over the past two decades, mental health struggles have gotten steadily worse for youth in Canada, according to the report. In 2003, around 76 per cent of youth aged 15 to 30 reported having good mental health. This dropped to 60 per cent by 2019.

During the COVID-19 pandemic, the situation only got worse as youth struggled to deal with societal changes that stoked anxieties in all ages. In 2020, pediatric mental health visits to the emergency department increased compared to pre-pandemic years, even amid an overall decrease in children being admitted to the hospital as the general population sought to avoid health-care setting due to COVID-19.

But although need is increasing among children and youth, many are not getting the help they need, the report noted. Wait list data from Ontario alone in 2020 found that the average wait time for counselling and therapy was 67 days. In some cases, wait times for intensive treatments were up to two and a half years, which researchers called "essentially irrelevant" if a person was in crisis.

The report drew on numerous scientific studies to estimate the prevalence of mental health disorders in children. The evidence of 12 studies combined, including more than 53,000 children, found that roughly five per cent of children aged four to 18 experienced an anxiety disorder of some type, for instance.

At least 290,000 children and youth in Canada are estimated to have a diagnosed anxiety or depressive disorder based on the latest data from Statistics Canada in 2019, but researchers say their work has shown this is likely underestimating the issue, particularly since many cases go undiagnosed, and there's limited data on underserved areas such as rural and Indigenous communities.

"The combined extent of prevalence, persistence, and breadth of impact of living with unmet mental health needs is arguably unmatched by most physical health conditions," the report stated. "Yet, Canada's health funding framework favours spending on physical healthcare over mental healthcare."

The authors added that Canada's spending target for mental health in 2022 was nine per cent of Canada's total health spending, which they argue is "not enough."

The report outlines a set of recommendations for how to address the urgency of the problem, including developing and funding a national child health strategy, dedicating resources towards outcomes-based programs to aid vulnerable populations and establishing a national data strategy to keep track of statistics surrounding youth mental health care.

"Timely access to mental health services for children is crucial, and the current challenges are exacerbated by longstanding issues and the impact of the pandemic," Chad Leaver, director of health and human capital at the Conference Board of Canada, said in the release. "Addressing mental health needs requires not just catching up but surpassing pre-pandemic efforts to ensure swift and comprehensive support for children and youth."