Natalie Jeffcott / Stocksy

Slow, Constant Erosion

The pandemic’s effect on the mental health of Alberta children

By Christina Frangou

As Alberta staggered under a third surge of COVID-19 in May 2021, Premier Jason Kenney announced a province-wide, two-week school closure. Immediately, up rose the chorus that has accompanied each wave of the coronavirus: What about the kids?!

Later that month, the Kenney government announced a panel, co-chaired by MLA Matt Jones and Minister of Children’s Services Rebecca Schulz, designed to address that question, or a version of it: How are children and teens being affected by the pandemic?

The co-chairs tapped Kelly Dean Schwartz, an associate professor of applied child psychology at the University of Calgary, to be one of the experts leading the Child and Youth Well-Being Review. Schwartz signed on with reluctance. He was busy, he told me, deep into the largest ongoing study of kids’ mental health in Alberta during the pandemic. He didn’t want to join a panel that required his time only to write a report that would go nowhere. “I have 40 years of skepticism built into my bones,” he said about his initial response. But the co-chairs assured him there was a genuine appetite for bringing together different ministries, identifying problems and finding solutions. So Schwartz came on board.

For six months he and colleagues met with different representatives of government ministries and interviewed parents, agency representatives, teachers and physicians. They read nearly 10,000 surveys submitted by the members of public, including more than 500 from kids and more than 7,000 from parents. As the panel later pointed out in their report, the survey, while valuable, captures a moment in time during the pandemic and the responses come from a group of individuals concerned about the pandemic’s negative impacts on children, rather than a representative sample.

The panel heard a lot of frustration. Adults, including 75 per cent of parents and 90 per cent of professionals who took the survey, said they saw a worsening of child and youth mental health. Just over half—53 per cent—said they could not access sufficient mental health resources for kids. Children and youth said they felt lonely and isolated without being able to interact with their friends. They missed sports, libraries and extracurricular activities, and their mental and physical health suffered as a result. Teens told the panel their school counsellors were overwhelmed and unable to support them. The Kids Help Phone received 38 per cent more calls and texts and chats from kids over a 12-month span between 2020 and 2021 than in all of 2019.

Kids from low-income families were hit particularly hard. Many already lacked the basics essential for well-being; not just computers and internet access for school, but enough food. “Agency after agency and school divisions” told the panel they had to increase funding for breakfast and lunch for children at the expense of other services, said Schwartz. The families who struggle with food security, the panel heard, are often racialized and Indigenous.

Racialized children and youth, particularly from immigrant and refugee families, were disproportionately affected by the pandemic. Before COVID-19, they faced racism, poverty and language and employment barriers, in addition to, for many, trauma related to their migration. The pandemic made these worse. The 270 Indigenous parents who responded to the panel were also more likely to report that their children’s well-being worsened significantly over the pandemic. That was true in each category of well-being: social, physical, educational and mental. And Indigenous and Métis youth were already at greater risk for poor mental health and well-being pre-COVID—five to six times more likely to die by suicide than non-Indigenous youth.

Teachers told the panel that students had lower motivation and more stress, anxiety, hopelessness, aggression, bullying, self-harm and suicidal ideation. The educational impacts of the pandemic remain unclear, the panel found, but the evidence to date suggests things are not going swimmingly. Standardized testing in Grade 3 showed statistically significant declines in literacy and numeracy.

75 per cent of parents and 90 per cent of professionals saw a worsening of child and youth mental health.

The Child and Youth Well-Being Review report reinforced what individual experts had been saying about children’s mental health in COVID-era Alberta.

According to Schwartz’s own ongoing study, which he and colleagues launched at the onset of the pandemic, the impact on kids in Alberta has been uneven. Over the last two years, at three-month intervals, the team has surveyed a group of mostly teens, ages 12–18, in Calgary and Edmonton. It’s a diverse population of youth, including 37 per cent who don’t identify as white. Still, Schwartz acknowledges that the survey doesn’t reflect everyone’s experience across the province. The study excludes young children and rural youth—two groups that may have experienced more hardship than urban teens throughout the pandemic.

With data now collected up to the beginning of 2022, their findings suggest that many Alberta teens are doing OK when it comes to mental health. Sure, they hate the pandemic. They really hate it. They’re frustrated. They’re sad and stressed. They spend untold hours staring at screens. They miss all the things the pandemic has robbed from them: graduations, after-school sports, dating, face-to-face time with their peers. Those are natural and normal reactions to a ghastly situation. “I kind of bristle whenever I hear people saying, well, most or all youth are really struggling or suffering or in crisis, because our study would suggest they’re not,” says Schwartz.

But many others are really struggling. “The analogy that we’re all in the same storm but different boats—that really holds true for youth,” he says.

About 30 per cent of kids surveyed by Schwartz are having a very hard time. They’re acting out in dangerous ways, such as substance use and self-harm. They can’t concentrate or focus at school. They have higher rates of self-reported anxiety and depression. Some of those feeling the harshest effects of the pandemic had a previous diagnosis of a cognitive or mental health issue, and their symptoms have worsened. The kids most likely to be grappling with poor mental health are often girls, and they’re in the teenage population, between 15 and 18 years old. They’re more likely to live in families that have experienced major financial pressure during the pandemic. As for the effect of school closures, kids who went through multiple quarantine periods also reported more problems with concentration and attention, or had higher stress reactions than youth who attended in-person when schools were open or who were online the whole time. In other words, uncertainty and irregularity—of which there’s been plenty—hurt their mental health.

At Alberta’s hospitals, schools and clinics, mental health services for youth are overwhelmed.

Schwartz’s findings are playing out in hospitals, schools and clinics, where mental health services for youth are overwhelmed. “Kids are coming in record numbers for support, and they have more mental health diagnoses than ever before,” says Sterling Sparshu, a child and adolescent psychiatrist in Calgary. Our mental health system for children and teens was already stretched thin even before COVID. The province didn’t have enough school counsellors or mental health therapists or child psychologists or family physicians, pediatricians or psychiatrists, or even hospital beds designated for mental health patients. A 2019 report by the Canadian Mental Health Association of Alberta found that mental health was chronically underfunded here compared to other jurisdictions, with youth ages 12–24 representing the most underserved population. The pandemic made everything worse.

To deal with demand, mental health professionals are now squeezing kids in where they can, even if it means directing them to services where children can be seen faster but the care isn’t tailored to their issues. For instance, the wait-list for kids with treatment-resistant ADHD is very long in Alberta, says Sparshu. These children often end up seeking help from pediatricians or adult mental health services, even though they should see specialists in ADHD.

With nowhere else to turn, kids arrived at emergency departments in record numbers last year for mental health care. Between January 2021 and September 2021, 2,378 youth were seen at the Alberta Children’s Hospital for mental health issues—up from 1,725 over the same period in 2018. Across the province there were 7,106 emergency room visits by youth for self-harming, compared to 6,252 in 2018. “We’ve been overwhelmed by the increased numbers in our ERs,” says Chris Wilkes, professor of child psychiatry and pediatrics at the University of Calgary. “There is so much suffering and compromise going on.”

Eden McCaffrey, a child psychologist who works in public and private practice and helps train family physicians to care for kids with mental health issues, says she’s seeing more severe mental health symptoms in the children who end up in hospital. “There’s a lot of eating disorders, increased depression, anxiety, a lot of self-harming and ADHD,” she says. Kids with mental health issues are ideally treated at home with community supports. “It takes a lot for kids to have to be admitted to hospital,” she says.

Pediatrician Roxanne Goldade runs a private practice specializing in kids with mental health issues. In her 26 years of caring for kids, she has never witnessed this level of need. “I’m exhausted. My staff are struggling. Parents will phone and say, ‘My child has been cutting,’ or ‘My child talks about suicide and they need to see the doctor now’,” she says. In order to see as many children as possible, Goldade books in patients an hour earlier in the morning than she used to, and she sees them over lunch and into the early evening. “We’re just stuffing patients in,” she says. But her wait-list never gets shorter. It’s now three months long.

Kids who did multiple quarantines at home reported more problems with concentration and attention or had higher stress reactions. Image by Alamy.

The crush on the province’s doctors and hospitals is being driven by storms on two fronts: on one side, the pandemic, and on the other, the absence of a strong, publicly funded, community-based mental health system for children. In an ideal world, children’s mental health care wouldn’t begin with privately paid psychologists, or even with pediatricians, psychiatrists, emergency physicians or family physicians. Care would start in the community and begin long before a child’s mental health becomes a case of illness.

Goldade says the best mental health care system functions like a pyramid. At its base are schools, where families are supposed to be supported by a team that is alert for potential issues in students. Schools would have readily available counsellors and support staff to help individual children with learning disabilities, speech issues and behavioural problems—things that can leave lasting scars into adulthood if left unaddressed. School staff would be able to teach and model mental health literacy, which requires time and energy, two things in short supply in schools at present.

The next level of the ideal pyramid is publicly funded psychologists. In Goldade’s dream, there’d be no restriction on the number of visits. “Right now you can get six sessions and that’s it, you’re out,” says Goldade. “Nobody gets fixed in six sessions!” At the next level of care, a child can access family physicians and pediatricians for mental health care; above that, psychiatrists. At the very top of the pyramid is hospital care, the last stage in an integrated system. Goldade says she’d be delighted if her patients could get help long before they saw her or a psychiatrist or needed hospital admission. “If we could empower families and the schools at the bottom end of that pyramid, we would serve them so much better,” she says.

In her view, mental health care should function like cancer care, where patients generally move seamlessly through levels of care with different disciplines of medicine and community supports working together. As it stands now, in mental health, it falls to parents and caregivers to navigate a system consisting of a patchwork of programs designed for kids, but parents have no one to help them figure it out. Families are forced to pick through a hodgepodge of government services and agency programs, all while managing the stress of having an ailing child and the challenge of being a caregiver during a pandemic, when school might or might not be available this week. “I hear parents who are really, really struggling and have been doing the best they can,” says Sparshu. “They feel frustrated trying to navigate a system that’s incredibly complex.”

Tarita Carnduff, a mother of five in Camrose and a former public health nurse, has spent more than a decade trying to find the best options for her kids, two of whom have learning disabilities and another who has mental health issues. She says they can’t get the help they need in schools. She pays out of pocket for one child to see a psychologist, spending $400 each month to cover two private sessions. She’d like to send at least one other child to a psychologist but can’t. “I can’t afford to have more than one child being seen by a psychologist,” she says.

The school-based mental health system, which was never robust, has over the last three years been eroded by cuts. In spring 2020 the UCP government stopped funding the Regional Collaborative Service Delivery (RCSD), a partnership among schools, AHS, Social Services and community stakeholders. The RCSD oversaw delivery of services such as mental health supports, speech language therapy and occupational therapy in 17 regions across the province. The funding was redirected to school boards through grants—a change made, in part, at the request of school authorities. But that shift disrupted how these services were delivered and led to the removal of AHS mental health therapists who had been working directly in schools—severing a connection between schools and mental health professionals.

“My first wish to address kids’ mental health is to bring back the school mental health system. Please bring it back,” says U of C’s Chris Wilkes. “We just don’t have the frontline services in schools that could keep kids from needing care in emergency rooms.”

Most children and teens spend five days a week in school under the eyes of adults whom they generally trust and who get to know them well. Image by Alamy.

It makes sense that schools play a vital role in kids’ mental health. Most children and teens spend five days a week in school under the eyes of adults whom they generally trust and who, in turn, get to know them well. Teachers and other school staff can pick up on changes in a child’s behaviour early, leading to early intervention that can stop the spiralling consequences of neglected mental health or cognitive issues. Logistically, school-based services are relatively easy for families to access. Maybe a parent can’t get time off work to take a child to see a therapist in the middle of the day or they can’t afford the $180 (or more) per hour for private therapy. “It’s not that parents don’t want help for their kid,” says Schwartz. “They just can’t get it.”

He says that 8 out of 10 kids who do get support for their mental health receive it in schools. It’s often done informally—a teacher, librarian, speech pathologist or counsellor assists a child who’s struggling. Before the pandemic, a teenager who’d come to Canada as a refugee told me that, with her teacher’s encouragement, she used to write notes to her teacher about what she was feeling as she adjusted to life in Calgary. This had really helped.

In rural Alberta, schools might be the only regular source of mental health supports for kids.

In rural areas of the province, schools might be the only regular source of mental health supports for kids, says Leigh Wincott, a pediatrician at the University of Alberta who also works in rural and remote areas. Many northern Alberta communities lack mental therapists, child psychiatrists, pediatricians and even family doctors. Schools try to fill the gap, but they don’t have the supports they used to. “Schools have also lost a lot of their financial resources,” says Wincott. “They have to make some hard decisions about where to put resources.”

The Alberta Teachers Association (ATA) said its members are reluctant to speak on the record about how they see the pandemic weighing on students’ mental health because they’re worried about their jobs or about being seen as criticizing school boards. But the ATA has conducted regular surveys of teachers throughout the pandemic. In November 2021, 79 per cent of teachers told the ATA they were moderately or extremely concerned about student mental health, particularly anxiety and depression. About 85 per cent said children in their classes were struggling to learn.

Given the state of things, many teachers feel beaten down and burnt out. They feel the effects of a multi-layered crush brought on by the ongoing curriculum debacle, contract negotiations, ballooning class sizes and, on top of everything else, the pandemic. Three-quarters of teachers in the most recent ATA survey said they’re worried about their own mental health. COVID-19 has kept them on a rollercoaster ride. They’re facing classrooms with more kids than in the past and kids with more complex and diverse needs.

“I keep telling [my colleagues] that the cavalry’s not coming,” said one teacher who asked not to be named. “Nobody is coming to say ‘You’re going to get a counsellor at your school or have additional supports in your class.’” The pandemic means extra duties for school staff, including making online lessons for students at home and managing contact tracing. Eighty per cent of principals in the province have performed contact tracing for their school, which can take as long as three hours for a single case.

Phil McRae, associate coordinator for research at the ATA, questions why no additional supports have been provided by our provincial government to schools during the pandemic. “If they’re truly concerned about mental health, why don’t we have more counselling available in school?” he asks. “It’s been a slow, constant erosion of support.”

The Child and Youth Well-Being Review Panel released its report just before Christmas 2021 with 10 recommendations for the provincial government. They called for new supports designed for children and youth, along with a review of existing child and youth mental health programs to bring them into alignment. Schwartz said Alberta’s existing resources for youth mental health are too disconnected and hard to find. “If I don’t know about them,” he said, “how does a family who’s not in this field begin to know about them?” The panel called for changes to make it easier for families to access help. They want better broadband internet services and “more equitable access” to devices such as laptop or tablet computers.

In their report, Schwartz and colleagues said schools can and should play an essential role in caring for the mental health and well-being of students. To do that, schools need more support. “I’m a huge proponent of school-based mental health services,” said Schwartz. He added that the recommendation to turn schools into hubs for mental health services is not designed to foist more responsibilities onto teachers. It’s intended to take pressure off. “Right now [teachers] feel like they have to be the social worker, the psychologist, the nurse,” he said. “Let’s allow them to just be the teacher.”

Schwartz believes the province needs to focus on “go-to structures”—services in places where children and teens already are. Those places are schools. Schwartz wants schools to provide wraparound services such as psychologists, mental health therapists, speech therapists and even nutritious meals for kids from lower-income families.

Everyone who spoke to me for this story recommended the same thing: Schools should be a hub where kids can receive support for mental health in addition to being places of learning. It’s not enough for the government to say it’s keeping schools open to protect kids’ mental health. That’s the bare minimum. We truly protect kids by getting services and care to them, and the best place to do that is schools. The buildings exist. The kids are there. The services are the missing component. And kids do improve when they receive good care. “There are safe and effective treatments for mental illness,” says Sparshu. ”Although there is a lot of suffering right now, there’s still hope.” 

For its part, the Kenney government says it will review the recommendations and create an action plan, to be released “this spring.” At least one expert remains skeptical. “To accomplish these recommendations there would have to be a shift both in how we think about services and how we coordinate child and youth services,” said the U of C’s Chris Wilkes. “Most importantly, financial support is required. I see no evidence that children and their well-being and mental health are going to become a true focus for this government.”

The two UCP MLA co-chairs who organized the review announced the panel’s report at a December 2021 press conference at south Calgary YMCA, where the sounds of rubber balls squeaking on gym floors below echoed up into the microphone. The pair’s words did not inspire hope that this government will build a community-based health system designed to support kids over the long term.

“Our kids need help right now,” said Minister Schulz, “which means our strategy will focus on the immediate action without tying our hands for the future.” In the meantime, wait-lists are growing.

Christina Frangou specializes in reporting on health, medicine and social issues and has won a National Newspaper Award and two National Magazine Awards for her feature writing.

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