Promoting Child and Youth Mental Health in Atlantic Canada: Call to Action

Draft 2 – August 23, 2017

The Call to Action is a work in progress. The ASI Board anticipates that it will be finalized in mid-September.

 “When we think of mental health we often think of emotional difficulties and mental health problems and how we can resolve a crisis once it has occurred. This thinking demands an investment after the fact or ‘downstream’. ‘Upstream’ thinking means investing wisely for future success and addressing the broader determinants of mental health at a population level. We view mental health as a resource for all that requires a whole-of-government and whole-of-society approach. Although there is evidence to support an ‘upstream’ view, our current investment in policies and practice is ‘downstream’ and we will need a change in public and political support to think and invest differently.”  – ASI 2017 keynote speaker, Professor Margaret Barry, WHO Collaborating Centre for Health Promotion Research, National University of Ireland, Galway.

INTRODUCTION        

Raising healthy children is a responsibility of all Canadians. Supporting and promoting child and youth mental health is central to enabling them to become life-long, positive contributors to their communities and society. Strengthening policies and programs that support positive mental health for children and youth is vital to creating a sustainable and inclusive Atlantic Canada.

The Atlantic Summer Institute on Healthy and Safe Communities (ASI) has provided an Atlantic platform for inter-sectoral collaboration to promote child and youth mental health in the region. ASI hosted a Symposium on Child and Youth Mental Health Promotion in 2015 to bring together a broad range of groups – public, non-profit, academic and private sectors, including education, health, community services, justice and community organizations – to find ways to have a collective impact to improve child and youth mental health. The emphasis is on mental health promotion, through upstream investment for downstream benefits.

Building on the momentum from the past 2 years of ASI programming, which focused on emerging evidence and best practices that promote positive child and youth mental health in schools and communities, ASI 2017 was designed to generate a Call to Action based on evidence for polices, programs and best practices discussed and showcased at the event. Two documents have been developed to inform discussions, an Atlantic Profile of Child and Youth Mental Health and a Backgrounder on Child and Youth Mental Health Promotion that has compiled research and evidence from a variety of sources to inform policies, programs and practices that support child and youth mental health.

This draft Call to Action is emerging from the planning for ASI 2017 and offers a framework that can be filled in before the August event and at the event. The first public draft will be posted on the ASI website in mid-July, with communications going out to draw attention to it. The final version of the Call to Action will be released at the end of the event on August 23, 2017.

The success of this Call to Action will be in the hands of diverse stakeholders from Atlantic Canada, other provinces and territories, the federal government, and pan-Canadian organizations. Below we set out clear actions that can be taken up by various stakeholders to implement a more sustainable approach to promoting child and youth mental health.

 

 GOAL AND OBJECTIVES

The goal of the Call to Action is to build on existing efforts to create a more sustainable approach to promoting child and youth mental health in Atlantic Canada.

The objectives of the Call to Action are to:

  1. Catalyze concrete, cross-sectoral responses for mental health promotion.
  2. Influence decision making in Atlantic Canada and across the country.

PRINCIPLES

We are using these principles as guideposts to action. Detailed definitions are in the Backgrounder.

  • Equity
  • Inclusion
  • Cultural Safety
  • Life-course Perspective
  • Respecting Rights of Children
  • Respecting Voices of Lived Experience
  • “Mental health in all” Policies
  • Evidence-based Decision Making
  • Sustainability of Policies and Programs
  • Whole-of-government
  • Whole-of-society
  • Truth and Reconciliation Commission
  • Anti-racism and anti-oppression

ENABLING CONDITIONS

These conditions are required to achieve our goal.

  • Common Language
  • Population Health Approach
  • Cross-sectoral Collaboration
  • Partnerships Committed to Common Goal
  • Capacity Building
  • Policy and Program Integration
  • Outcome and Process Evaluation
  • Collective Impact
  • Return on Investment
  • Knowledge Sharing, Translation and Mobilization
  • Data Infrastructure to Inform Policy and Program Development
  • Two-continuum model

CONTEXT

This year is a defining moment for Canada and its many nations. The Report of the Commission on Truth and Reconciliation is the ultimate call to action, and perhaps the most pressing. There are many other organizations at the national, regional and provincial levels that are focusing on child and youth mental health. This Call to Action builds upon and makes strategic links to many existing provincial, territorial, and pan-Canadian strategies and policy reports. The Backgrounder in preparation will provide a comprehensive overview of this work. A few highlights are presented here as context for the actions outlined below.

  • First Nations Mental Wellness Continuum Framework (2015) – Assembly of First Nations, Health Canada’s First Nations and Inuit Health Branch, the National Native Addictions Partnership Foundation, Native Mental Health Association, and other community mental health leaders.
  • Mental Health Summit: Mental Health Promotion and Mental Illness Prevention for All (2012). Hosted by Government of Manitoba and Healthy Child Manitoba.
  • Mental Health Summit Follow-up: Think Tank Proceedings Report (2013). Public Health Agency of Canada, Mental Health Commission of Canada, Manitoba Mental Health and Spiritual Health Care, and Healthy Child Manitoba.
  • Maximizing Social Impacts and Returns on Investment: Towards a Sustainable Prevention Infrastructure for Population Mental Health Promotion and Mental Illness Prevention in Canada (2014). Mental Health Summit Network.
  • Population Mental Health Promotion for Children and Youth – Topical Papers and Resources (2017) National Collaborating Centres for Public Health.
  • Positive Mental Health Toolkit, 2nd Ed. (2016), Pan-Canadian Joint Consortium for School Health.
  • The SEAK (Social and Emotional Learning for Kids) Project, funded by the Public Health Agency of Canada.
  • Positive Population Mental Health Surveillance Indicator Framework for Youth (2017). Public Health Agency of Canada.
  • State of the Child Report 2016 – New Brunswick: Office of the Child and Youth Advocate

All of these reports are pieces of the puzzle of child and youth mental health promotion. Taken together, a clear picture emerges. The Backgrounder puts them all together in one place for all to view.

ACTIONS

This Call to Action builds on the Mental Health Summit Network report, which outlines ways of building capacity and collective impact, choosing approaches for sustainable system transformation, advancing evidence on returns on investment for mental health promotion, promoting existing best and promising practices upon which future efforts can build, and implementing and sustaining programs, practices, and policies for promoting child and youth mental health.

The success of this Call to Action will be in the hands of diverse stakeholders from Atlantic Canada, other provinces and territories, the federal government, and pan-Canadian organizations. Below we set out clear actions that can be taken up by various stakeholders to implement more sustainable infrastructure for promoting child and youth mental health.

Policy

  • ACTION: For effective implementation of SEL programs, integrate them into school curricula.
  • ACTION: Increase accountability by using health economics modelling to assess health impacts and related costs.
  • ACTION: Have a dedicated, fully financed Health in All Policies Unit within departments responsible for mental health and hold departments responsible for managing health impacts.
  • ACTION: Educate policy makers to use the mental health continuum model (prevention, promotion, treatment, recovery) to support intersectoral policies and resourcing, linking upstream with downstream services.
  • ACTION: Monitor health impacts research related to the legalization of cannabis.

Program

  • ACTION: Find ways of linking mental illness prevention and mental health promotion with frontline mental health services.
  • ACTION: Create and promote system navigation services/supports to help children, youth, and families access and navigate programs and services across the continuum.
  • ACTION: Support youth voices and insist on youth participation in program and/or research design.
  • ACTION: Increase funding and build capacity for not-for-profits to conduct program evaluation.
  • ACTION: Implement Housing First approaches in Atlantic Canada.
  • ACTION: Apply principles of health equity, anti-oppression, and anti-racism to mental illness prevention and mental health promotion, and provide training to service providers and professionals so that all populations have equitable access.
  • ACTION: Support the implementation of the Truth and Reconciliation Commission’s Calls to Action, particularly those that focus on child and youth mental health and wellbeing, the social determinants of health, and educating non-Indigenous Canadians about the history of colonization (e.g. articles #57, #62, and #66).

Practices

  • ACTION: Advance the whole-of-person, whole-of-families approaches for the promotion of health and safe communities, situating children and families in their social, political, economic, and environmental contexts.
  • ACTION: Improve outreach to marginalized children, youth, and families to increase access to prevention and promotion programs and mental health services.
  • ACTION: Invest in paid peer support and peer mentoring for positive mental health promotion.
  • ACTION: Be humble, create safe spaces for learning, be careful not to shut people down, and be comfortable asking questions.
  • ACTION: Ground the education and training of professionals in the lived experiences of the social determinants of mental health.

Research and Knowledge Exchange

  • ACTION: Bridge Western and Indigenous knowledge through two-eyed seeing; honour, respect, value, make space for other ways of knowing.
  • ACTION: Value narratives and stories as evidence, being open to what constitutes knowledge and evidence and what gets privileged in certain contexts.
  • ACTION: Work alongside children and youth as experts of their own lives.
  • ACTION: Develop multi sectoral indicators on health.
  • ACTION: Use common indicators to measure short term and long term collective impact of mental illness prevention and mental health promotion.
  • ACTION: Create and report on common indicators for child and youth mental health and frame outcomes within a rights-based approach.
  • ACTION: Create interdepartmental and inter-jurisdictional agreements to share data and indicators that illustrate factors that contribute to health.
  • ACTION: Publicly report on child and youth mental health indicators, including positive mental health indicators, on a regular basis.
  • ACTION: Improve data sharing across jurisdictions by enhancing training, increasing funding, building infrastructure in adherence to national and global standards
  • ACTION: Increase support for diverse research methodologies, including community-based and participatory action research.
  • ACTION: Promote economic literacy for people to better understand macro-economic, structural issues that impact public health.
  • ACTION: Create a clearinghouse and sustained infrastructure and funding to maintain the sharing of data and knowledge in the Atlantic region and beyond. Work with other models and existing networks.
  • ACTION: Educate the public about child and youth MIP and MHP and the long-term benefits to communities and society.
  • ACTION: Build on the momentum of the ASI symposium’s Call to Action by presenting on the outcomes at other regional and national conference and events (e.g. CMHA National “Mental Health for All”; CAMET).
  • ACTION: Ensure that cultural, racialized, linguistic, socio-economic, gender and sexual identities, and other diverse populations are represented and addressed equitably in research agendas.

Networks

  • ACTION: Enhance partnerships between academia, communities, and the public sector to strengthen data collection and research.
  • ACTION: Introduce yourself to someone you don’t know in another sector that can contribute to your work.
  • ACTION: Seek opportunities though network activities to advance a shared agenda (e.g. CAMET, NCC Forum).
  • ACTION: Use networking mapping tools to understand and expand your network.
  • ACTION: Partner with business communities to advance knowledge exchange efforts.
  • ACTION: Work with Atlantic provincial governments to convene an annual forum on child and youth mental health, building on the Call to Action and other related sector policy priorities.
  • ACTION: Build an online Community of Practice for promoting child and youth mental health.
  • ACTION: Establish an Atlantic Canada child and youth mental health network committed to supporting and implementing ASI’s Call to Action.

 

APPENDIX 1 – CONTEXT

First Nations Mental Wellness Continuum Framework (2015) was developed through collaboration between the Assembly of First Nations, Health Canada’s First Nations and Inuit Health Branch, the National Native Addictions Partnership Foundation, the Native Mental Health Association, and other community mental health leaders.  The Framework identifies ways to improve service delivery to First Nations and provide culturally-safe supports. We can learn from First Nations and use this framework for working together to promote child and youth mental health for all Canadians. Key themes from this framework woven into the ASI program are: leadership, cultural ways of knowing, resilience, strengths-based, across the life span.

Mental Health Summit: Mental Health Promotion and Mental Illness Prevention for All (2012) led by Healthy Child Manitoba, the summit drew more than 300 delegates from across the country, including service delivery, policy and research, as well as representatives from provincial, territorial, Indigenous, federal governments, and national organisations. The post-summit report proposes a blueprint for a “pan-Canadian framework for the collaboration, implementation, scale up and sustained commitment to evidence-based mental health promotion and mental illness prevention.” Key concepts and themes from this report woven into the ASI program are; life course approach, collective impact, evidence-based implementation, and equity.

Mental Health Summit Follow-up: Think Tank Proceedings Report (2013).  Public Health Agency of Canada, Mental Health Commission of Canada, Manitoba Mental Health and Spiritual Health Care, and Healthy Child Manitoba. The goal of the Think Tank was to identify and recommend those mechanisms which not only facilitate the exchange (communication) of evidence among and between jurisdictions, but which also provide support for the development and scale up (“the how”) of MHP-MIP innovation and best practices within and across respective Canadian jurisdictions. It provides a blueprint for successful scale-up of effective mental health promotion-mental illness prevention innovations and best practices.

Maximizing Social Impacts and Returns on Investment: Towards a Sustainable Prevention Infrastructure for Population Mental Health Promotion and Mental Illness Prevention in Canada (2014). Mental Health Summit Network. Provides a pan-Canadian framework for the collaboration, implementation, scale-up, and sustained commitment to evidence-based mental health promotion and mental illness prevention.

Population Mental Health Promotion for Children and Youth – Topical Papers and Resources (2017) was published by the National Collaborating Centres for Public Health (NCCPH). This project addresses a need for resources to help clarify terms, concepts, roles and responsibilities related to population mental health promotion.  Key concepts from this series woven into the ASI program are: life course approach, health equity, indigeneity and diversity, population health promotion.

Positive Mental Health Toolkit, 2nd Ed. (2016), developed by the Pan-Canadian Joint Consortium for School Health, is comprised of five online modules that have been updated to reflect recent Canadian research, and to identify promising practices occurring in diverse contexts across the country.  The PMH Toolkit also provides a means of measuring positive mental health practices.  Key concepts from this toolkit woven into the ASI program are: strengths-based approach, social and emotional learning, resilience, connectedness.

The SEAK (Social and Emotional Learning for Kids) Project, funded by the Public Health Agency of Canada (PHAC), has created a vision document that represents the input of a cross-section of leaders, decision-makers, and practitioners who share a commitment to social and emotional learning (SEL) programs across Atlantic Canada.  Building on the PHAC Innovation Strategy’s program design, the document offers a detailed strategy for inter-provincial collaboration to scale up SEL programs in Atlantic Canada. Key themes from this report woven into the ASI program are: leadership, scale up, whole school approach, strengths-based, equity, partnerships, teaching and learning.

Positive Population Mental Health Surveillance Indicator Framework for Youth (2017), produced by PHAC, provides a comprehensive national framework captures high quality information about risk and protective factors affecting mental health outcomes for youth (12-17 years) across four related domains.  The 26-indicator framework was developed in consultation with stakeholders working in mental health surveillance, programs and policy. It will continue to evolve as new data becomes available.

State of the Child Report 2016 – New Brunswick: The eighth annual report is the undertaking of the Office of the Child and Youth Advocate.  It contains more than 200 data indicators, based on a child rights and well-being framework.  The 2016 report focuses on children’s mental health.  It is notable for its comprehensive look at factors that build resilience, while also examining persistent gaps and risk factors for positive mental health in children.  It is a strong example of a good practice.

 

Drafted by: Malcolm Shookner, Christopher Canning, Lara di Tomasso, Barbara Broom, Andrea Simpson, Joanne Elliott, Patsy Beattie-Huggan, Kathleen Murphy, Christian Whalen, with input from ASI 2017 participants.

August 23, 2017

APPENDIX 1 – CONTEXT

BACKGROUNDER