1. www.pspbc.ca Life Span and Mental Disorders

2. 2  …70% of mental disorders onset (diagnostic) prior to age 25 years  About 80% of mental disorders in young people can be effectively treated in primary care Life Span Framework

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4. 4  Disturbances of normal brain function  Identified by primary functional disturbance › Depression = disorder of mood › ADHD = disorder of cognition  Never limited to one brain function  Life span differences › How disorders present depending on individual’s age. Mental Disorders Depression Behavioral Cognitive Physical Emotion

5. 5  Age › Proxy measure of brain development  Treatments › Impact brain systems › Age related differences  In therapeutic efficacy  In treatment outcomes  Proper age specific › Diagnosis › Therapeutic activities › Treatment Mental Disorders

6. 6  Social circumstances play strong roles in addressing mental disorders Mental Disorders Peers Institutions Workplace School Family Complexities of neurodevelopment Impacts of environment

7. 7  Most burdensome health disorder › Children and adolescents  1/3 GLOBAL burden of disease in youth  Higher in Canada › Less malaria, dengue fever, HIV/AIDS, TB Epidemiology Child and Youth Mental Disorders

8. 8 Table: World: DALYS in 2000 attributable to selected causes by age Child and Adolescent Health Global Comparative Burden of Illness for Mental Illness

9. 9  Majority diagnosable before age 25 yrs › Pervasive development disorders › ADHD › Separation Anxiety Disorder › Depression › Obsessive Compulsive Disorder › Social Anxiety Disorder › Panic Disorder › Schizophrenia › Bipolar Disorder › Anorexia Nervosa › Bulimia Nervosa › Substance Abuse Epidemiology Child and Youth Mental Disorders

10. 10  Pattern of Illness › Found globally › Consistent across Canada  15 – 20% ages 1 – 25 › Require professional intervention  About 80% can be properly diagnosed and treated in primary care with appropriate methods Epidemiology Child and Youth Mental Disorders Anxiety ADHD #1 5% 4% 10% Depression

11. 11  Prevalence of mental disorders › Know your area › May be higher rates in:  Isolated Communities  Inner city low socio-economic neighborhoods  Refugee populations Know Your Setting

12. 12  Legal Issues  Parent - Child Relationships  Conflict in Custodial Situations  Confidentiality  Engaging the Family  Parenting Overview  Developmental Transitions Child & Youth in Context

13. 13  Age related differences in legal status › May impact treatment of children and youth  Be aware of age specific legal directives › Age of consent to treatment › Guardian status › Involuntary confinement › Duty to report › Roles, rights and obligations in custody cases 1. Legal Issues

14. 14  When in doubt consult: › Provincial Professional Assoc. › Consult knowledgeable peers › Legal opinions › Canadian Medical Protective Association  Document in patient record: › Advice that was sought › Where it was sought › Details/process of the advice 1. Legal Issues

15. 15  If concerned, seek advice › Knowledgeable peers › Mental health consultant 2. Parent-Child Relationships www.freedigitalphotos.net

16. 16  Inter-parental conflicts › Can interfere with care of child  Refer to mental health services and legal aid  Explain course of action to all parties  Note discussion and outcomes in patient records 3. Conflict in custodial situations www.freedigitalphotos.net nuttakit

17. 17  Limitations of confidentiality – e.g. risk of harm  Depends on capacity of the youth  Share on a "need to know" basis as part of the care team  School districts determine policies around written consent Grappling with CONFIDENTIALITY

18. 18  Two encountered issues: › Teens want confidentiality  From parents, school, etc. › Parents want confidentiality  From each other or children  Discuss privileges and limits › Legal issues in different jurisdictions  Potential for significant harm to self or others › Make clear to children and parents 4. Confidentiality

19. 19  Imminent risk of harm › Legally defined actions put in place  Including involuntary committal  Be aware of cultural norms and expectations › May differ between parents and youth › Contrasting views and expectations  Keep best interest of child/youth › Advocate on their behalf 4. Confidentiality

20. 20  Parent to parent confidentiality  Parent to child confidentiality  Legal requirements and professional guidelines › Advice from peers and professional organizations  Drug or alcohol use › Requires discussion › At what point does use require informing of others? 4. Confidentiality ID: 453592 www.stock.xchng

21. 21  Child is abused or neglected  Client might seriously harm self or others  If court order or legislation requires information  If required for continuity of healthcare Limits of Confidentiality

22. 22  Helpline for Children › 310-1234 (free – no area code required) › 24 hours/7 days › Do not have to give your name  Immediate danger › 9-1-1 or local police  Resources › Ministry of Children and Family Development › www.mcf.gov.bc.ca/child_protection › See “Handbook for Action on Child Abuse and Neglect” Abuse or Neglect Concerns

23. 23  If making a child protection report: › Speak with a Child Welfare worker  Should you/how to inform child/youth  Should you/how to inform parents/guardians  Protect child/youth’s safety and well being  May or may not disclose reporting to child/youth Breaking Confidentiality

24. 24  Get the family involved and ask for their help  Involvement is dependent on: › Nature and strength of relationships › Willingness of family members › Understanding of mental disorder › Acceptance or denial of condition › Beliefs or ideosyncratic opinions about causes › Nature and treatment of problem › Presence of a mental disorder in the family › Expectations of provider and treatment › Family history of interaction with health/mental care › Cultural or Socio-economic factors 5. Engaging the Family

25. 25  Reduce stigma  Normalize applicable diagnoses/conditions  Validate reactions to the diagnosis  Social and support networks through peer counseling/support 5. Engaging the Family

26. 26  Education  Clarification of Roles and Responsibilities  Feeling at Home  Knowing Your Limits Principles for Engagement