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COMMENTARY: Children and youth in mental health crisis

Research and data have shown mental health among children and youth in mental health have declined during the pandemic, emphasizing the need for governments to cooperate and collaborate in prioritizing mental health supports.

On Oct. 19, 2021, the American Association of Pediatrics declared a national emergency in children’s mental health. They cited soaring rates of depression, anxiety, trauma and loneliness in American children and youth as reasons for this unprecedented declaration.

The picture is no less grim in Canada. Even before the pandemic, poor mental health was ranked second among threats to childhood in Canada. And suicide is the leading cause of death for children aged 10 to 14 in Canada and the second leading cause of death for youth aged 15 to 24.

Researchers in Ontario found that 70 per cent of school-aged children and 66 per cent of preschool-aged children experienced a deterioration in at least one of six domains of mental health – depression, anxiety, irritability, attention span, hyperactivity, and obsessions/compulsions – during the first wave of the pandemic. 

Effects were not equal among all children and youth. Mental health deterioration was worse in those with pre-existing mental and physical health problems, autism spectrum disorder and those living in adverse socio-economic circumstances and racialized communities. Higher rates of social isolation were also associated with worse mental health outcomes.

Schools provide a safe, predictable and structured space for children and youth with opportunities for regular contact with peers and teachers. School closures and public health restrictions took this away. Studies show that symptoms of depression and anxiety in children aged six to 18 increased in proportion to time spent in online learning.

Mental health problems can negatively affect learning resulting in lower school engagement, lower academic achievement, and higher school drop-out. Research shows that reading scores worsened during the pandemic, especially in younger children. A study from The Netherlands starkly revealed that “students made little or no progress while learning from home.” This effect is particularly true for students from disadvantaged backgrounds.  

Academic achievement aside, children missed out on school sports and other extracurricular activities known to boost physical and mental health. They also missed out on other key health services provided through schools such as nutrition programs, counselling sessions, specialized learning supports, and vaccination programs.

Children and youth are embedded in their families so it is not surprising that children from lower household incomes and lower parental education rates suffered from higher rates of mental health symptoms due to family stresses like parental job loss and food insecurity. Children whose parents were suffering mental health problems were impacted by their parent's difficulties and vice versa.

Children who suffer from mental health problems early in life are more likely to have future problems with education, family and social functioning. We need to prioritize their mental health now so that we have a healthy, well-functioning adult generation in years to come.

Educational and health professionals who work with children and youth need to take a family-centred approach. Children in crisis are often holding up a mirror to a family in crisis. Recognizing the root cause of a child’s problems – which may be parental job loss, depression or substance abuse – and supporting families to face this challenge will be more effective than a narrow focus on labelling children with psychiatric conditions and prescribing medication.

We can all play a role in supporting children and youth whether or not we work with them. A positive relationship with a trusted adult is a strong protective factor for adolescents and youth. Even adults who have short but regular, positive interactions with youth who are struggling can make the difference between crisis and resilience.

But it takes more than a village to raise a child. We need co-operation and collaboration at all levels of government – municipal, provincial, federal and Indigenous – to ensure that child and youth mental health and wellness are prioritized and supported.

A national strategy rolled out by the federal government with dedicated mental health funding will be key to reducing disparity in policy and practice across our country. Suicide prevention needs to be integral to the strategy, particularly to improve the lives of First Nations, Métis and Inuit youth and adolescent boys who are disproportionately affected.

Provinces need to ensure that continuous and timely access to culturally safe and appropriate mental health services are available to children and youth during all phases of this and future pandemics. School-based programs are key to reaching all children no matter what their background.

Knowing what we know about the adverse effects of school closures, provinces need to keep schools open safely during pandemics and other emergencies both for academic programs and for extracurricular sports and activities so vital for students’ mental and physical health.

All levels of government have to support access to adequate social determinants of health – sufficient income, decent housing, healthy food and freedom from racism and discrimination – to make sure that our children thrive during and beyond the pandemic.

Mental health priorities need to be embedded into pandemic and emergency preparedness plans from the beginning, because there is no health without mental health.

Vamini Selvanandan is a family physician and public health practitioner in the Bow Valley. Her commentaries appear in the Rocky Mountain Outlook on the third Thursday of each month. For more articles, visit