*Lily’s name has been changed to protect her identity.
Content warning: This piece contains mental illness and self-harm.
Jennifer McGowan was sitting in her spacious, sun-streamed office in 2014 when a young girl and her four friends visited. McGowan, a popular school counsellor, often had students popping by for a chat.
“They stopped by all the time. They’d ask to go to the bathroom and they’d stop by and it’s like, ‘Get your butt back to class,’” said McGowan.
Lily* approached McGowan and took off her black Adidas track jacket, which lifted her flowy sleeve adorned with colourful flowers.
Peering at Lily’s arm, McGowan asked the other students to give her and Lily some time to talk.
The door to McGowan’s office remained open, but once they were alone, McGowan asked if she could see Lily’s arm.
“’Oh honey, can I look at that?’” said McGowan, recalling the meeting during an interview in January. “’I just need to see if it needs to be cleaned,’”
The seventh-grade student sat on the brown couch facing McGowan and raised her sleeves, revealing razor marks trailing both arms.
Lily, playing with the tongue ring between her teeth, downplayed the cuts and begged McGowan not to tell her mom.
“The response of a caring adult can actually cause more harm than good,” said McGowan.
Panicking in response to a student’s mental health issue or even rushing to get them outside help like therapy can negatively reinforce a student’s behaviour, she said.
She knew Lily wasn’t ready to stop self-harming, but McGowan compromised with her.
“’I think that as long as you let me see your arms every now and then, so I can see if things are getting worse, we can just keep meeting and talking,’” McGowan remembered telling Lily.
She acknowledged only Lily had the power to decide when she would stop cutting.
“That really opened the door for just putting it all back on her plate.”
McGowan now works as the support services director for Seven Oaks School Division.
Teachers often approach her with similar cases, but even with good intentions they can feel personally harmed by a student’s struggle.
“(Teachers) want to fix it for them,” said McGowan. “They want them to go to therapy.”
“When you go in with a fixing mentality, kids don’t feel heard. They feel dismissed. They feel like there’s something wrong with them and that doesn’t help.”
Approaching mental health with a “fixing mentality” can be considered “medicalizing” the issue, which means treating the mental health challenge as a problem that can be solved.
“Caring’s different than saving,” said McGowan.
A caregiver’s support can alleviate the weight of a child’s mental health challenges, but without knowing the imperative role they can play in their child’s recovery, families can be stuck in a cycle of medicalized treatment and endless waitlists.
Manitoba’s mental health system struggles because it has a reactive response to crises instead of a proactive system that fosters familial support.
Changing these fundamental aspects could encourage positive mental health throughout a child’s life.
A cry for change
Statistics Canada states that Manitoba has the highest major depressive disorder cases and the third-highest generalized anxiety disorder cases in Canada.
A study by the Manitoba Centre for Health Policy says one in seven Manitobans between six and 19 years old was diagnosed with a mental disorder between 2009 and 2013.
These rates are even higher for Indigenous people, where 50 per cent of adults were diagnosed with depression or anxiety and 71.4 per cent of youth reported being bullied through social media.
In 2018, the Manitoba government employed a team of consultants to analyze the province’s overwhelmed and insufficient mental health, substance use, and addiction resources.
A third of the province’s mental health service providers expressed concern about the quality of options in Manitoba.
Research showed an obvious need to start addressing mental health challenges in early childhood.
Youth treatment can help prevent substance use, addictions, and mental health problems in later years, the report states. Treatment can also prevent stress on the health care and justice systems and avoid reliance on social assistance.
The province currently spends an average of 5.1 per cent of its yearly health budget on mental health services, according to Virgo Planning and Evaluation Consultants Inc. This amounts to less than half of Canada’s benchmark of 7.2 per cent, which still falls short of other high-income countries.
In 2017, the federal government declared mental health a national priority and promised to disperse $5 billion across all provincial and territorial governments over the following ten years. Manitoba receives around $18 million annually to prioritize mental health and addiction services.
The Virgo report calls on all levels of government, community resources, and service providers to work together to offer co-ordinated, streamlined services.
One step forward, two steps back
A child’s journey to receive mental health support in Manitoba is similar to a game of snakes and ladders.
When a family gets closer to accessing resources, it’s like they’re climbing a ladder towards their goal. But when the family hits an obstacle, a snake slithers them back to where they started.
One family’s experience may look like this:
If a family is looking for help outside of their school division, anywhere in Manitoba, they can reach out to Centralized Intake Service (CIS), which boosts them onto a ladder.
CIS then refers the family to specific programs with the Manitoba Adolescent Treatment Centre (MATC), the Health Sciences Centre (HSC), or recommends community resources, which guide them up another ladder.
From there, MATC or HSC works with the family to decide what will help the child in need. Some programs might recommend families get a formal mental health diagnosis.
Receiving a diagnosis can also be an intrusive and upsetting process, which could send the family cascading down a snake, but the label can help families narrow down their treatment options or access medication, which could lift them onto another ladder.
The most common snake in this game that can discourage a family from pushing for help is waiting between each turn.
“It’s tough when you’re told that you (have) to wait an extended period of time, especially when you’re dealing with any kind of youth because these are formative years,” said Jay Greenfeld, a clinical psychologist with Mind Matters Clinic.
“Oddly enough, adults can sometimes make do. But as kids are growing up, they’re formulating their own identity, and if they’re struggling, it’s tough.”
Mind Matters specializes in child psychology, but even at the private practice, the average wait time is just over a month.
“You’d think that ‘Well, because they’re paying for it, they should get it way faster,’ right?” said Greenfeld.
“And they do. When you compare it to the hospital system or other sort of agencies like that they might have like a year-long wait, but it’s still a decent waiting period (for treatment).”
Jaye Miles said she’s noticed the stress on services at MATC, where she serves as the psychology director.
“The needs are growing for a whole bunch of reasons,” said Miles.
“It’s evident in schools. It’s evident in mental health services … Child and adolescent services are not resourced in the ways that they need to be.”
Miles said the waitlist differs depending on the program but declined to clarify how many families are waiting and for how long.
In 2019, MATC had contact with over 40,000 families.
A community effort
Inspire Community Outreach focuses on a holistic model of care when approaching children with mental health issues. The Winnipeg centre specializes in helping families and adults with neurological differences such as autism and ADHD, but chief operating officer Lisa van den Hoven said they try to help as many people as they can.
“A lot of folks that are coming to us are sort of at that breaking point,” said van den Hoven. “They’ve been bouncing around the system for years and years and years, very frustrated and very tired.”
But even Inspire has a waitlist and can only offer short-term programs for around six to eight weeks.
“We really want families to experience being welcomed and feeling like they came to the right place because a lot of families don’t get that experience with the mental health system,” she said. “There’s a lot of shuffling around that happens, and that just contributes to stress and destabilization.”
The barriers families face can narrow their options in finding treatment that works for their children. Inability to access services, the recommendation to secure a formal diagnosis, and the high cost of private services can deter families from getting the care they need.
Van den Hoven said a lot of Inspire’s staff have used mental health resources and understand clients’ issues navigating the difficult system.
Inspire also creates programs to fill gaps in mental health resources, said van den Hoven. The organization reaches out to clientele through social media and “keeps an eye on what people are struggling with” to offer updated resources.
In 2020, they created superhero art with middle school students.
“There’s a lot in the theme of superheroes that you can use to sort of understand things like trauma and, you know, ‘What’s your kryptonite?’” said van den Hoven.
The superhero art program helped make complex issues like triggers (kryptonite), trauma, and coping mechanisms approachable for kids.
“It’s really about being nimble and responsive. Because we’re a very small organization and have a very limited budget and we want to make sure that when we’re developing programs it’s something that people would really respond to.”
Van den Hoven said some community organizations reach out to each other to see if another place can offer a program that would benefit their patients.
“If we co-ordinate, so that we’re not duplicating services, we won’t be fighting over the same grants.”
“What we’ve learned in terms of being really efficient with the funding we receive is that if you can affect the way that a caregiver is interacting with a child… you can make so much more impact.”
Van den Hoven said she hopes more caregivers and adults will work with their children to learn how to support them long-term.
“Any really effective engagement that makes a difference for children and youth, I think, has to start from a community and a family.”
Family Dynamics does just that by focusing on working with care givers and children through school, counselling, and group activities.
“No matter what you focus on, what they use on a child in therapy, it’s the parents that need to support whatever resources or solutions you kind of arrived at,” said Kim Barber, a counsellor with Family Dynamics.
“It’s the parents that support that in everyday life.”
One program called Family and Schools Together (F&ST) connects caregivers and children by getting them to cook a meal together and to work through different activities.
“It’s not a therapy group,” said Barber. “The skills that are being taught is like how do you learn to spend intentional time with your child.”
“Because of the F&ST program, the kids and I had deeper conversations about things that we haven’t talked about before,” wrote one family in a review. “The quality time every week made it easier for us to talk about difficult topics.”
After families work collaboratively, children and parents have separate opportunities to talk as a group, led by a counsellor.
The program, which was piloted in the summer of 2020, runs four times a year for eight weeks with around eight to twelve families and is offered for free through some school divisions.
“We’ve seen huge, huge success,” said Barber.
However, more accessible or free services need to be available, she said.
Family Dynamics can only offer short-term services between 12 to 20 sessions and has a waitlist of around three months.
In 2019, the organization connected with 2,000 people while employing only 12 staff members.
Barber said one of the reasons they started the F&ST program was to assist overwhelmed school divisions and offer support outside of the classroom.
“Schools can only do so much,” she said. “They can’t see kids on a regular basis.”
Most Winnipeg public schools employ at least one trained counsellor who may have several responsibilities like teaching, substituting, or assisting other classes.
Each of Winnipeg’s school divisions also usually have an arsenal of psychologists, clinicians, therapists, and other resources a school can use if students need more support.
Every staff member in the Winnipeg School Division (WSD) has received mandatory mental health literacy training to understand how to promote positive mental health in school, said WSD Inclusive Support Services director, Jón Olafson.
“It’s really great to get the support started with staff, so staff know how to have those conversations,” said Olafson.
WSD focuses on a preventative model that encourages teaching young people about positive coping strategies, facilitating group discussions on mental health, and being open about their feelings he said.
Seven Oaks has similar structures in place, but McGowan said she faces each case as a human being first and a support services director second.
“Our staff doesn’t necessarily provide therapy,” said McGowan.
“We don’t have very many people with their master’s in counselling who might be able to provide therapy. And even if they could, it’s a time thing.”
McGowan said she’s unsure whether mental health services are overwhelmed in Manitoba or if the province lacks services. But she said she thinks there should be a proactive strategy and emotional pain should be normalized.
“When we start to connect everything just to a policy… we remove humanness from it,” said McGowan
“We also have to work at building the capacity to sit with people in their discomfort.”
There’s a stress on adults pushing kids towards different treatments without consulting them to see what they think would work best for them, McGowan added.
Sometimes it could be therapy, she said. Sometimes it could be sitting and listening.
“I understand that as a common response we are saying there’s not enough supports out there, but maybe the answer is there’s no one out there to fix this emotionally upset child,” said McGowan.
The first step
After about a month of their lunchtime meetings in McGowan’s tidy office, she and Lily decided to approach her mom about her self-harming.
“For this little peanut, I’d say her supports outside of school would have been inconsistent. So, lots of people that I’m sure loved her a lot, but just in terms of consistent kind of support… she just didn’t have that outside of school.”
“We (worked) on a script beforehand,” said McGowan. “In this case, I knew the mom would be nervous coming in.”
McGowan said she always keeps snacks like veggie trays and sweets in her office for students to munch on while they talk.
For the meeting with Lily’s mom, McGowan took extra care to pick up a 10-cup from Tim Hortons and placed assorted mugs and powdered doughnuts on the coffee table between her office chair and the couch.
With the door closed, the conversation started with talking about how amazing Lily was.
“Parents, I find, often would feel responsible if their child was hurting themselves,” said McGowan.
She wanted to acknowledge Lily’s self-harm wasn’t the mother’s fault.
Nestled into the two-seater couch flanked by brown and blue accent pillows, Lily turned to her mom and explained how she was struggling.
After 30 minutes, McGowan left the room to let Lily and her mom talk alone.
“It was a really powerful meeting, and that mom was lovely,” she said. “(But) it was a hard situation because Mom was also dealing with quite a bit of stuff.”
McGowan offered to follow up with the family in a week to see how things were going and was pleasantly surprised when the mom returned.
“Her mom came back two or three times to talk about things, but it wasn’t immediate,” said McGowan.
Lily is now married and works for a child welfare agency in her home community. She still reaches out to McGowan a few times a year.