Calgary doctor calls for return of AHS mental health supports in schools as ER visits spike

This story is Part 3 of a five-part series looking at the state of youth mental health resources in Calgary.

One of Calgary's leading doctors in charge of youth mental health services says he thinks fewer children and teens would end up in the emergency room for mental health concerns if there were more robust psychological services in schools.

Youth visits related to mental health to the Alberta Children's Hospital emergency room have jumped by nearly 40 per cent since 2018, says Alberta Health Services.

Before 2020, AHS collaborated a lot with Calgary schools to provide mental health supports, says Dr. Chris Wilkes, who is the outpatient section chief for child and adolescent mental health and addictions in the Calgary zone for AHS.

"We were consulting with [thousands] of adolescents or children and providing service in schools," said Wilkes.

But it has changed because of funding cuts made by the province, he says.

• Want to learn more about this project? On Tuesday, Jan. 11, CBC Calgary reporter Lucie Edwardson will answer your questions live about her five-part series Kids in Crisis. You can submit any questions you have here or comment below.

"Where do those children go now? Well, they go directly to either family doctors who are already busy and restricted in the numbers they can see because of COVID — or they'll go to our emergency room, which is what we think is happening," he said.

Funding model changed

Wilkes said the government made a mistake in February 2020 when it changed the education funding model. It cut funding to the Regional Collaborative Service Delivery (RCSD) — a grant that supported a wide range of specialized needs, including special education programs and occupational, physical and speech-language therapies supports. 

According to Wilkes, under the Regional Collaborative Service Delivery, Alberta Health Services funded about 20 full-time equivalent social workers, psychologists and other members of multidisciplinary teams to consult with Calgary schools and teachers. It let them more quickly point students to appropriate services, both at school and in the community, he said.

"They were available to consult with schools if there was a concern with students and allowed for a timely intervention with these children and adolescents. By doing that early on, you got a good return on investment," he said.

Since the change, funding for services previously provided under RCSD now go directly to school boards through a composite grant called the Specialized Learning Support (SLS) grant, which also replaced the Inclusive Education grant and a variety of other grants. 

Alberta Education said this change would give school authorities greater control and oversight of the delivery of these types of services — essentially leaving it to them to hire or contract the services at a district level.

"But schools are also restricted and have their own cuts and they have not been able to deliver the service that we used to provide in schools, so that certainly exacerbated the pressures that we see in the emergency room today," said Wilkes.

"We are getting squeezed by children and adolescents needing more services than we have capacity to deliver."

Schools report increased need

Both the major school boards — the Calgary Board of Education and the Calgary Catholic School District — agree that because the new SLS grant combines and replaces a number of old grants, it can't be compared meaningfully with RCSD funding of the past. 

"The two programs are not comparable. The SLS grant encompasses funding for additional supports over and above what was provided through RCSD. Also, RCSD provided services for multiple school jurisdictions," said Andrea Holowka, CBE superintendent of school improvement.

The CBE's funding allocation for mental health and rehab from RCSD for the 2019-20 school year was just under $8.4 million. The SLS grant for 2021-22 totals just over $95.6 million.

The CCSD said this year, its SLS grant was $47.7 million. Its last RCSD funding was $4 million, but not all of it was received as direct funding by the boards.

Instead, both boards say the RCSD was a combination of funding and support provided by AHS and other providers.

Holowka said this meant AHS staff were working directly in Calgary schools.

"Under the new funding framework, some services are still being provided but by CBE staff, and other services are provided by AHS in the community," she said.

The change in funding model also came at the start of the first full school year impacted by the COVID-19 pandemic.

The CBE reported a 92 per cent increase in need for student mental health services in September 2021, compared to 2020. The school board had 131 referrals for psychological services in the first month of school in 2020, but in 2021, that number grew to 252.

"Certainly, our well-being has been a priority for the CBE for many years but during the time of COVID, we've seen an increase in needs for support and those requests coming forward," said Holowka.

But the school board has historically struggled to meet all of the mental health needs of its students. Back in 2017, the CBE had more than 80 full-time equivalent psychologists on its staff and reported then that it hadn't been able to keep up with demand.

Four years later, following budget cuts and and in the midst of a global pandemic, the largest school board in the province now has more students and less resources, with only 60 full-time psychologists. 

Holowka says schools are doing their best to make sure students who need help get it.

"A lot of the schools are triaging on their own and putting forth those that have the most need," she said.

"There has been an increase in need that's significant, but we are still managing to make sure that we're providing the services to the students who need them the most."

Limited counselling

Once students are seen, the support is usually short-term, and then they would be referred to services in the community.

"It is a limited amount of counselling sessions that they would provide. It's not meant to be an intensive years and years long relationship," said Holowka.

The CCSD says it has maintained the same number of psychologists since 2017. But the district said the need for mental health services has been growing.

Before the pandemic, the school board said requests for mental health services represented about 40 per cent of its diverse learning team's workload. Last school year, it took up 57 per cent.

"The pandemic has certainly increased awareness of mental health issues or mental health experiences. Some students and some staff have had a great increase in their anxiety or stress reaction," said Leanne Timko, director of learning services and diverse learning at CCSD.

She says the most notable increase has been for behavioural assessments of kindergarten and Grade 1 students.

"We're attributing a bit of that to the fact that … they might not have come to school for kindergarten or they were maybe not in preschool prior to."

Psychologist wait lists

Both school boards say that once a need is identified, it can take up to a few weeks — sometimes longer — for a student to see a psychologist.

"We're at about a two-week wait before a case manager can start to engage with our students and our families," said Timko. "But there might be a greater delay, depending on the complexity of that issue."

Wilkes, who also works as a professor at the University of Calgary's Cumming School of Medicine, says he thinks there is a solution to overwhelmed emergency rooms.

"We need more resources available, and I'm really going to strongly advise that we need to get our school mental health system back in place," he said.

"I think that was not a wise decision to remove that service, which provides timely counselling and advice on how to manage stress for these children who first showed their problems at school rather than at home."

Wilkes said it's not fair to expect school-based psychologists to take on this increasing load, arguing AHS partnerships need to be restored. 

"One of the major problems in mental health is been a siloed system. When you work with partners … in a place like a school or child welfare service, you have a lot of indirect education about how those services operate and you facilitate appropriate referrals in those settings," he said. 

"That's been a policy I've advocated over the years, is to collaborate, avoid having these pockets of isolated services and to try and build capacity, as well as provide direct service care…. The feedback hasn't gone very far at this point."

Alberta Education says boards should use funds strategically

Alberta Education says school authorities have the flexibility to make local decisions to best meet the needs of their students and staff, including decisions regarding mental health programming, staffing and resources. 

In budget 2021, Alberta Education says it allocated $556 million to the SLS grant, which supports access to mental health professionals and behavioural consultants, among other things.

"Alberta Education expects school authorities to continue to use resources strategically as they navigate changes to the new funding model, ensuring resources are responsive to their current local context and identified needs," said press secretary Nicole Sparrow.

"Alberta Education will continue to examine the funding under the Specialized Learning Support grant in order to ensure that our most vulnerable students and children are supported."

If you would like to share your experiences with Calgary's youth mental health system please email: calgarynewstips@cbc.ca

If you or someone you love is struggling, AHS recommends the following resources:

• Call the Distress Centre at 403-266-HELP (4357)
• Call ConnecTeen at 403-264-TEEN or text 587-333-2724
• Call the Kids Help Phone at 1-800-668-6868 or text CONNECT to 686868.
• Bullying Helpline at 1-888-456-2323
• Call the Mental Health Helpline at 1-877-303-2642 or the addiction line at 1-866-332-2322.
• Visit the Help in Tough Times website for more resources.
• If in crisis call 911 or visit the closest emergency department.