Where Mental Health is Going

Interview with Bruce Maclaurin

Bruce MacLaurin says it’s time to stop catching people who are falling off the bridge.  We need to shift our efforts upstream through early intervention to understand and prevent their falls rather than only services to reduce trauma and injury after they have fallen.

 It’s a favourite analogy in the field of social work that speaks to the problem of gaps in mental health services.

Assistant Professor at the University of Calgary’s Faculty of Social Work, MacLaurin is also Senior Researcher at Wood’s Homes. Over the past three decades, he has significantly contributed to work and research in the field of mental health treatment services for young people. He regularly presents to various levels of government, and is currently working on two major projects on youth homelessness and a five-year update on child abuse in Alberta.

Earlier treatment intervention is a key to greater success, says MacLaurin, who readily points out that getting attention sooner can never be over emphasized.  A more concentrated effort at exploring root causes and pre-existing conditions and signs would also greatly contribute to better outcomes.

Fourteen per cent of all children and youth are experiencing clinically significant mental health concerns in this country (more than 800,000 young people) however less than 25% will actually receive meaningful services required to address these concerns.

“Earlier intervention would be an investment,” admits MacLaurin, “but it would pay huge dividends over the near future.” We could begin today, begin by early assessment of children, families and communities at risk.  But that would require a period of higher costs over the immediate years ahead as we continue supporting those who are currently in treatment.

MacLaurin’s interest in mental health began while volunteering during his studies at the University of Guelph. He spent a couple of days a week helping out at a drug rehabilitation community farm for addicted youth, and that “caught a fire in me.”

It was late in 1981 and he had applied to Wood’s Homes which at the time was about to open the Adolescent Care Centre on its Parkdale campus. He arrived in December and helped shape the program for the next three months, prior to program startups. He’s been back and forth to Ontario over the years, continuing to work in the field, but remains in Calgary, home of the Canadian Mental Health Commission’s head office.

Canada has a relatively short formal history of working with vulnerable children and/or their mental health challenges. But records show that back in the late 1800s, it was a former Toronto newspaper reporter and social crusader who first decided that society needed to start taking better care of its children as he witnessed them scrounging for survival on the streets in that city.  John Joseph Kelso had immigrated to Canada from Ireland with his family in 1874 when he was 10 years old. They suffered hardships of hunger and cold in their early years in Toronto and throughout his life, this motivated his compassion toward the poor and unfortunate – especially children.  He founded the Children’s Aid Society (Canada) in 1891.

Much of course has changed since those early days – orphanages (including Wood’s Christian Home ) closed in favour of foster care and community group homes.  And several advancements in psychiatry, psychology and social work were being made in the actual treatment of mental illness in children – therapy, counseling, medication, etc. 

“We are making great strides but there is so much more that can be done,” says MacLaurin, admitting that poverty – relative to pre-existing conditions – is the elephant in the room and a major predictor. Poor economic conditions can lead to mental health issues resulting from abandonment, neglect and trauma. We need to pay closer attention here, he admits.

Schools continue to be leading referrals of children who are not developing ‘normally’. We need to do more to help teachers recognize early signs and symptoms he says, “there are lost opportunities here.”

MacLaurin wishes that mental health enjoyed a broader spectrum in the field of public health, adding that we need to continue the work in blending mental health with other jurisdictions.

“It should really be all one system in many ways.”

He also wishes that children – all children, including those in the Northwest Territories, the northern Saskatchewan and Manitoba reserves – become top priority in this country.

Society always tells us they want less government in our lives, but at the same time government is there to help.

“We will never reach a final end point of success,” but good work continues.  

When asked for 3 wishes relative to the future of mental  health treatment, MacLaurin says:

  1. We need to recognize all children as the same children – no matter where they live.
  2. Budgets rarely increase, but our workload never decreases. We need to lessen the gaps in resources.
  3. Earlier intervention with a focus on pre-existing conditions will help pave the way for a brighter and more promising future in this work.

Signs of Safety

The Alberta government introduced on August 18, 2014, a province-wide program developed in the 1990s in Western Australia, that will change the way it deals with children at risk.

Wood’s Homes is developing practice in this area in our Outcomes-Based Service Delivery programs (Family Support Network located in Calgary’s Forest Lawn and Family Connections which is located in Lethbridge.)

Earlier in 2014, the province acknowledged the deaths of more than 750 children who had some involvement with the province's child welfare system between 1999 and 2003. Now, officials say they hope the new model — called Signs of Safety — will reduce the risk to children in government care in the future.

"I feel [it] has revolutionized child intervention practice," says Human Services Minister Manmeet Bhullar.  "It works with the family and other supports the family has in place to say, 'How are we going to build safety plans? How are we going to ensure this child is safe’?”

The method is now in use in North America, Europe and Australasia — focuses on safety planning and uses a risk assessment framework designed to be used together with families and support workers. This new approach has won two Australian social service awards for innovative practice and is slowly being recognized around the world (including Calgary).

Wood’s Homes hosted a week-long training session in October, 2013, and hosted (in concert with the ministry) close to 60 senior leaders from across the province and British Columbia.  Dr. Andrew Turnell, an internationally recognized child protection consultant and co-creator of Signs of Safety led the sessions.

According to the site’s website, the inspiration for the method came from the founder’s 16 years of experience working as a frontline child protection practitioner. Steve Edwards spent half that time working with Australia’s Aboriginal communities and became dissatisfied with the way workers dealt with the children.  He decided to seek out a better way to do child protection work along with Turnell, a therapist doing brief therapy for families with problem teens. (Brief therapy is one approach to psychotherapy, focusing on finding a solution to a specific problem and quickly implementing a solution.)

The August announcement marks the largest international system-wide implementation of the model. Wood’s Homes believes this work shows great promise for the future!

To watch the video on Signs of Safety, visit this link:

http://www.youtube.com/watch?v=x6WYm4F9mik

(With files from CBC News)