For Kimberly Moran, the closure of a mental health treatment program for youth in the justice system amounts to an equity issue.
"It should be that kids who have untreated mental illness, whether they be in the youth justice system or any other system, get the same level of care," the CEO of Children's Mental Health Ontario told QP Briefing. "And that’s not the case right now and it’s not fair."
Moran's comments follow the provincial government's decision to cut funding to the secure custody and detention program at the Syl Apps Youth Centre (SAYC) in Oakville that was providing intensive mental health care for youth in the justice system.
The program lost funding this spring alongside more than 20 other youth justice facilities in the province, but youth were transferred from the Syl Apps facility last fall when the Ministry of Children, Community and Social Services (MCCSS) launched an unrelated review. You can read more about the closure here.
Moran and other advocates now worry about what the loss of this program will mean for youth in trouble with the law and their communities. While the province cut the program as part of a cost-saving exercise, advocates say the move could cost the province more in the future. It also poses risks to communities and youth, with the head of two youth justice facilities saying there's been an increase in youth with severe mental health issues and increasing hospital visits as a result.
"It shouldn’t be that kids in the justice system get discriminated against, because so often they’ve come into the justice system because they have untreated mental illness," said Moran, adding that there's a higher proportion of youth in the system who are Black, Indigenous or racialized.
Moran pointed to her family's experience to highlight what she now sees as a divide between those who are in the justice system and those who aren't. Ten years ago, her 11-year-old daughter was "highly suicidal" and spent five months in a secure treatment program that provided her with 24/7 care through a mental health team consisting of psychiatrists, psychologists, nurses and other professionals. Even once she was able to go home, her treatment continued for several years.
"When kids get really sick like this ... it’s not a quick fix," said Moran. Her daughter is now 21, has just completed her third year of a nursing program and is working in a hospital with COVID-19 patients.
"With the right treatment, they recover, without the kind of treatment that she got she could be dead, and that’s what I worry about with these kids ... in the justice system who aren’t able to get the kind of intensity of care that they need," she said. "Why should my daughter who hasn’t gone through the youth justice system be able to get that kind of high level of care that she needs, but a kid in the youth justice system can’t? That’s not equitable."
Syl Apps also has a secure treatment program, which the government boosted funding to earlier this year through the Ministry of Health. Palmer Lockridge, press secretary for Minister of Children, Community and Social Services Todd Smith said "justice-engaged youth continue to have access to secure treatment programs at Syl Apps Youth Centre, should they have such identified needs and a court order or administrator approval for placement."
But while this is possible, "it almost never happens because the process is exceptionally cumbersome and lengthy," said Cathy Paul, the head of Kinark Child and Family Services, which operates SAYC.
Now youth justice facilities across the province are left trying to deal with youth who previously would be referred to Syl Apps without the resources they need, Paul previously said.
Palmer said youth in these facilities have access to mental health and addictions supports and that service providers can access additional money for things like assessments, counselling and treatment through the "Specialized Services Fund."
"I would never say that we have adequate mental health resources now in the youth justice system," said Joanne Lowe, executive director of the Youth Services Bureau of Ottawa (YSB), which operates both secure and open youth justice facilities. She said there were insufficient resources even before the Syl Apps program closed and that between the two YSB facilities, which can accommodate 32 male youth, they have access to 16 hours of psychiatry each month and two full-time psychotherapists.
Closing the youth justice program at Syl Apps has had an impact on YSB, said Lowe, because it means "a whole option for comprehensive specialized mental health service has been essentially removed from the system." And while there are other services available, they don’t provide the same level of treatment, she said.
"I just don’t understand it because closing any mental health services during a pandemic when we know that we’re seeing a rise in mental health needs and addictions needs just feels a little absurd quite frankly," said Lowe, who is also vice-president of mental health and addictions at CHEO.
It's no different in the youth justice sector, with Lowe saying there's been a "significant increase in our facility of young people suffering with acute mental health issues," some of whom she confirmed would have been referred to the Syl Apps program if it were running.
She explained that because judges decide where youth are placed, youth could have also been court-ordered into the Syl Apps program initially.
"Now kids are coming directly to us not ever having had the opportunity to be in Syl Apps and benefitting from the mental health services there," said Lowe, adding that they're also seeing "an increase in visits to the emergency department and of suicidality."
When it comes to mental health capacity, hospitals are "chock-a-block full," said Lowe, noting that while the length of stay varies, it's typically three to five days. A YSB staff member would need to stay with the youth since they are in custody and their "ability to interact with others is challenged by that," she said.
Asked about hospitalizations, Palmer said the "ministry requires agencies to report youth placements in hospitals for all youth within the youth justice custody/detention system," and that data shows "there has not been any increase in hospital placements."
"If they were in Syl Apps they wouldn’t actually have to be displaced to go to a hospital, there’s assessment and treatment services that were available to them," Lowe said. "The absence of that option means that regionally or locally communities are now expected to actually respond to those needs without any additional resources, without any additional capacity, so these kids are queuing up for services along with everyone else at a time when the demand [has] never been this high."
Lowe said her biggest worry is that they'll see an increase in deaths among youth in the justice system as a result of untreated or under-treated mental health issues.
Paul agreed, noting there can be "dire consequences" for youth and the staff at youth justice facilities without access to proper treatment.
"These are kids with very very significant behaviours as a result of their mental illness, they can be very aggressive, they can be very self-harming, the impact on communities, the impact on families is huge," said Paul. "It’s not a matter of if, it’s a matter of when — there will be a tragedy and there will be an inquest and government resources will get used on the inquest and the reviews when they could be used to actually build a program for these kids."
Moran said aggressive youth might have to be isolated at youth justice facilities, which can result in "decompensation of people with mental health issues," whereas at Syl Apps they would receive "wrap-around services" in the form of treatment that could help avoid hospitalization and "damage to youth if they were isolated."
She said the closure is risky for youth who might end up in hospital and for communities if highly aggressive youth, for example, exit the justice system and are just as aggressive due to a lack of mental health treatment. It's also more costly for the province if youth end up back in the justice system as adults or in hospital, Moran said.
"I think it was a mistake and I would like to see them rectify the mistake," Moran said of the government's decision, adding that she would also like the Ministry of Health to oversee mental health services of youth in the justice system. "We have a window of intervention with a kid now, why wouldn’t we take that window and give them the treatment they need because that’s going to change the whole arch of their life."
Health Minister Christine Elliott's office passed QP Briefing's request for comment to the Ministry of Health. The ministry did not respond to questions about the program closure, advocates' concerns over equity and increased hospitalizations and whether it is considering taking on the Syl Apps program and relaunching it, deferring instead to MCCSS.
Photo provided by Children's Mental Health Ontario