Reflection of a Children’s Mental Health Clinician - On Accessibility and Stigma

Boy Crying

by Emma Silver, MSW, RSW

I will never forget my first session as a children’s mental health clinician. I was meeting with the mother of a 6-year-old boy who had recently attempted to end his own life. This in itself was enough to paralyze me. Was this a result of an impulsive nature? Was it a cry for help? Could a 6-year-old have the capacity to understand the effect of his actions? There were so many questions racing through my head. The realization that mental health issues could affect individuals even at their earliest stages of life was a turning point for me in my professional life.

This was the first encounter of many with this mother and her young child. Soon, I would become a familiar face to them. In time, our therapy sessions - where I spoke with a mother stricken by fear and shame, and a son who tried to understand his actions - would become a safe space for them to share their story. In time, fear and shame would be replaced by hope and change.

Throughout my short time working in this field, I have witnessed a range of mental health challenges affecting the lives of children and youth. Sadly, it is not uncommon for these individuals to face many obstacles before accessing supportive services. Currently, in the children’s mental health system of Ontario, the average wait time for a child to receive ongoing government-funded counseling is approximately six to twelve months. This may vary, depending on the region and funding available. Further delays might be caused by a mental health system that is multi-faceted and difficult to navigate. Despite these difficulties, I am encouraged by the professionals who are dedicating their lives to breaking down barriers and questioning government policies that have made it too difficult for those in need to access the services that they require.

I have witnessed firsthand the positive impact that being a part of a multidisciplinary team can have in ensuring that children and youth receive the support they need to help them reach their full potential. I have experienced the immense gratitude when a child’s mental health concerns are validated and a family’s crisis is normalized, so they can begin to develop hope for a better future.

Life is not fair. There is no question that some people have to face obstacles that might seem insurmountable. These can be related to finances, illness, loss, or fate. In spite of this, many will succeed and prosper. The interaction between our biology, psychology, and environment is constantly influencing our social, emotional, and psychological well being. Children and youth, our most vulnerable population, face many obstacles when it comes to receiving the mental health support that they need. This is due both to accessibility of services and to the stigma that exists when it comes to dealing with mental illness. This stigma is reflected in the voices of children confiding in their therapists and sharing their isolation. They feel ignored in their homes and are often bullied by their peers. There are cultural, religious, and gender barriers that reinforce their sense of isolation.

Despite these barriers, there are many avenues to seeking mental health support. There are walk-in clinics operating across different regions that provide opportunities for children and youth to gain immediate and brief counseling support. The importance of privacy is essential when considering the possibility of sharing a personal struggle, and it is a legal obligation for helping professionals to keep personal information confidential. The only exceptions to this where I practice, are situations in which there is the suspicion of child abuse or disclosures of imminent harm to one’s self or to others. In these situations, there is a legal duty on the part of the therapist to protect the individual and others who might be in harm’s way. This may vary in different locations based on the laws that govern areas of practice. There are also anonymous help lines that operate 24/7, which provide opportunities for individuals to gain immediate counseling support over the telephone. Crisis workers will even set up mobile visits to meet individuals at various locations within their respective communities. There are also educational workshops, groups, and seminars hosted at various community centers. These resources are not only available for individuals who are personally experiencing mental health concerns, but for their trusted confidantes who are desperate to learn the steps to take in supporting them. There is still work to be done to ensure that all those in need are aware of the various resources that are available to them.

I have been lucky enough to witness great success in a broken system, but there is so much more room for growth. I am optimistic that I will one day witness a time when mental health support is at the forefront of political forums, when mental education is as relevant as physical education in our school systems, and when societal barriers do not marginalize individuals who desperately need to access mental health services.

Until we recognize that there is this stigma associated with mental illness, we cannot fix it. Regardless of race, culture, ethnicity, or gender, mental health issues can affect us all. There is no vaccine to protect u,s and we are all at risk. When we talk about mental health challenges, we are advocating for those who often cannot voice their concerns for themselves.

In my case, I am advocating for my 6-year-old client who didn’t have the emotional vocabulary to tell me his story. It is my job to advocate for those who do not have their own voice and to teach them how to speak for themselves. We must join forces in eliminating a stigma that surrounds mental illness. This requires going further than just talking. We must listen, hear, and act to help instill positive change in the lives of vulnerable individuals.

Emma Silver

Emma Silver received her Master of Social Work degree from the University of Toronto in 2015. She is a practicing child and family clinician at a mental health agency in Ontario, Canada. In her role, she provides counseling support to children, youth, and families experiencing a range of social, emotional, and behavioral difficulties.

For more on children's mental health, see SAMHSA's Children's Mental Health Awareness Day 2016 page.

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Children's pain is real

Before I began the MSSW program I'm in, I was an elementary school teacher. In those several years I taught, I encountered three seven year olds who confided in me that they wanted to end their lives. The first time, just like you, I was stunned and I was heartbroken. This scenario wasn't addressed in my teacher preparation program. I was able to calmly respond to these childrens' pain with empathy and compassion, as I awaited the arrival of our school social worker. Thank goodness for school social workers! They, along with teachers, are often the first ones to identify a mental health need that isn't being met and advocate for children to receive services. Two of my students were able to receive the help they needed. One did not, because of her parents' denial and suspected lay their own mental health issues. I still wonder about her today.

I completely agree with your assessment of the stigma associated with mental illness and the challenges to accessing care. The same is the case in the U.S., particularly for families of color in lower-income communities like the one I taught in. In addition to the stigma surrounding mental illness, there is a misconception that children don't have problems, or that they have no reason to suffer from depression or anxiety. Many adults still believe childhood is a carefree period in life, and that children should be seen and not heard. As you mentioned, that's not at all the case. In addition to better access to services, My hope is that more families are educated about the existence and significance of childhood mental illness. Thank you for sharing your reflections and for advocating for our most vulnerable.

Nicole W more than 6 years ago