Violence is uncommon for youth with mental health conditions, but critics say more support is needed

For families supporting a young person with a mental illness, experts say it’s important to remember this: violent behaviour is rare — and support is available.

“It’s fair to say that kids with mental health challenges are more often the victims of violence than they are the perpetrators of violence,” says Dr. Peter Szatmari, who heads the Child and Youth Mental Health Collaborative at the Hospital for Sick Children, the Centre for Addiction and Mental Health, and the University of Toronto.

“We have to remember that aggressive behaviour is uncommon in kids with mental health issues. But nevertheless, it’s something we need to think about when we are seeing high-risk kids and we need to prepare and develop preventative and more acute interventions for those kids that might be at risk.”

That conversation has thrust itself anew on a grieving city. On Sunday, a man described by his family as suffering from psychosis killed a 10-yearold girl and an 18-year-old woman.

He also wounded 13 others in a Danforth Ave. shooting spree. The attack also left the gunman Faisal Hussain, 29, dead. “While we did our best to seek help for him throughout his life of struggle and pain, we couldnever imagine that this would be his devastating and destructive end,” the family’s statement said. Dr. Leena Augimeri of the Child Development Institute watched the tragedy unfold on television in horror. “I feel just terrible for those impacted by this violence, those who lost their lives and those who are not well as a re-sult of it,” she told the Star. “We don’t know what kind of help he received,” she adds of the shooter. “If he did get the help, the system failed him. And then it failed everybody else.” Augimeri is the CDI’s director of the Stop Now and Plan ( SNAP) Scientific and Program Development and the Centre for Children Committing Of-fences. While the relationship between between mental health and vio-lence is complex, she says the research shows early intervention gives kids the best chance to overcome challenges and lead healthy lives. The SNAP program was designed 33 years ago to teach ccchildren with mental health is- sues how to better regulate their emotions, improve selfcontrol and reduce “aggression, delinquency and anti-social behaviour.” A review of the program has shown it cut crime by 33 per cent. “What the research has told us is that low self-control in kids leads to problems later in life,” says Augimeri. But understanding — and addressing — mental health also requires looking at the broader social issues a child may be confronting, she adds. “There’s so many things that could be impacting them like poverty or trauma or learning disabilities or racism. These are all different factors that can impact healthy child development.” Many parents may struggle to recognize when professional help is needed, or may not know where to turn. “Parents are the most important resource and parents need to be sensitive about when to become concerned,” says Szatmari. “Kids go through ups and downs all the time. Those ups and downs tend to be relatively of short duration and won’t interfere with the kids’ functioning.” Where it becomes a concern, he says, is when the troughs last longer than a couple of weeks, or when they impact children’s ability to get along with friends, do well at school, participate in recreational activities, and interact with family members. In those circumstances, he says it’s important not to chalk things up to “bad behaviour” or “being spoiled.” “That’s really part of the stigma associated with mental health challenges within kids, that it’s explained away as a problem of the kid’s character or personality rather than a health problem.” Szatmari describes the services available to young people with mental health conditions in Ontario as a “fairly — not perfectly — but fairly well-organized system going from primary care all the way to specialist care to help kids with their services.” But there are gaps. An estimated one in five children and youth in Ontario will experience some form of men- tal health problem. And five out of six of them will not receive the treatment they need, according to a 2015 report called the Mental Health of Children and Youth in Ontario: A Baseline Scorecard, Institute for Clinical Evaluative Sciences. “It’s pretty clear that the budget that’s allocated to child and youth mental health doesn’t meet the demand that’s out there ,” says Szatmari. While the Progressive Conservatives er vat ive government has promised $1.9 billion over 10 years in new mental health funding—tom at ch $1.9 billion over a decade in federal money years in new mental health funding—to match $1.9 billion over a decade in federal money—Health Minister Christine Elliott said previous Liberal spending commitment sin that area are being cancelled. In March, former Liberal premier Kathleen Wynne pledged $2.1 billion for extra provincial mental health programs over the next four years. Elliott said the government would be “building capacity for mental health programs and services, working with police and other first responders to make sure thatt hey get thet raining that they need ,( and) building housing .” NDP Leader Andrea Horwath expressed concern Tuesday that mental health funding “is going to be watered down now .” “I worry about that, because herein Ontario, we’ve got 12,000 children and youth who have been on waiting lists for mental health services for 18 months. That’s not acceptable, and it hast os top ,” Horwath told reporters. Horwath emphasized she’s “not opposed to making surett that police have proper train-ing .” “His( Hussain’ s) family ... talked about his mental health situation and the fact that not withstanding all attempts he was not able to get the help and the services” he needed and “that was one piece of the situa-tion .” In addition to adequate fund ing, Szatmari says Ontario can use the resources it already has more efficiently. “The emergency room is frequently frequently used as a way of getting access to mental health services for kids but it’s a very inefficient way to get service,” he said, add- ing it’s important to use family doctors or pediatricians more effectively. Not everyone accesses existing resources equally, he added. “It is true that more marginalized communities aren’t accessing the services as much as we would like them to,” he said. “We need to understand what mental health challenges look like in those communities because they’re different and are driven by different mechanisms as well.” While there’s been an “exponential growth” in research on the care and treatment of kids with mental health challenges, Szatmari says there is more work to be done. “There’s still important evidence gaps. We need to support research into this area which is under-researched compared to adult mental health, for example, or other physical diseases in kids. But certainly we’re in a much better place today than we were 10 or 15 years ago.” The bottom line, says Augimeri, is that evidence-based, culturally sensitive mental health programs can change a child’s life for the better — and by extension, benefit the social fabric of their community. “But if we don’t get these kids to the door in a timely manner, their chances of getting the help they need decreases every sec- ond,” she said.

“Here in Ontario, we’ve got 12,000 children and youth who have been on waiting lists for mental health services for 18 months.” ANDREA HORWATH NDP LEADER