Kids, Poverty and Mental Health: Anxiety a growing problem

Tyler Chabot offers a shy smile as he talks about the social anxiety disorder that took over his life.

“I feel like I lost three years of my life,” he says.

Three years is a long time when you’re only 18, an age when most teens are hanging with friends, developing social skills and deciding on their future. Instead, Tyler was trapped inside his house, paralyzed by the anxiety that was slowly creeping into his life.

It began in Grade 5 when he was transferred to the gifted program in another school. The pressure was overwhelming and he immediately asked to be moved back.

Once back, however, he became “the kid from gifted” who couldn’t cut it. That made him the perfect target for bullies, says Tyler, who remembers being “viciously bullied” and beaten on a regular basis.

“I needed help but I didn’t know how to ask for it,” he says.

The bullying continued on and off into Grade 8. He finally stopped going to school.

"I would pretend to go then I’d take the bus back home," says Tyler.

Pressures at school and home

On top of school pressures, he was worried about whether his mother, a single mom, could pay the bills. He began spending his days playing video games while his mother was at work, dropping into school once or twice a month so they didn’t call home.

“A lot of the days I just crawled into bed and stayed there,” he says.

Last year at the advice of a social worker, Tyler enrolled in the Hamilton-Wentworth District School Board’s System Alternative Education program located at the former Vincent Massey School on Macassa Avenue on the Mountain.

A lot of the days I just crawled into bed and stayed there.- Tyler Chabot

The school is also the location for an innovative treatment program for teens suffering from profound social anxiety. Chilled is a 10-week evidence-based program which uses cognitive behaviour therapy to reinforce positive changes in behaviour.

Anxiety disorders are the most common mental health problem among children and youth and affect approximately six per cent. Twenty-two percent of children will be affected by anxiety in their lifetime, with the most common being separation anxiety, panic disorders, phobias and post traumatic stress disorders. Those involved in treatment locally say they are seeing more and more cases of anxiety. They aren’t sure if that is more people seeking help, more access to services or just signs of a growing problem.

Regardless, all agree it’s important to address symptoms of anxiety early, as they can lead to more severe problems, as it did with Tyler. For kids living in poverty, that isn’t always easy.

Parental stress an issue

A McMaster University study by Dr.Ellen Lipman and Dr. Michael Boyle showed that children and youth who live in poverty are at three times higher risk of developing a mental health problem with anxiety being high on the list.

That’s largely due to the toxic stew of stressors surrounding them as well as problems accessing services. Children also pick up on the anxiety their parents are experiencing around such things as paying bills and they tend to model the behaviour they see in their parents.

“How you see your parent respond has a huge impact,” said Dr. Karen Francis, Clinical Director of Child and Youth Mental Health Ambulatory Services at Hamilton Health Sciences.

How you see your parent respond has a huge impact.- Dr. Karen Francis, Clinical Director of Child and Youth Mental Health Ambulatory Services at HHS

“If mom comes home and freaks out every time she opens a bill, ‘I don’t know know how we’re going to pay this month’s rent,’ being exposed to that is going to increase the child’s anxiety.”

The longer a family lives in poverty, the higher the chance of them having mental health disadvantages, according to the study, which also showed the neighbourhood where one lives can have an impact on a child’s mental health.

According to the study, lower income neighbourhoods tend to have less access to health care which means parents can face more challenges getting help for their child.

Mental health professionals in Hamilton rely on the Early Development Instrument (EDI), to help determine where services are most needed. The EDI is a school readiness measurement tool developed in Hamilton which has been used since 2002 to analyze information on more than 5,200 kindergarten students every few years. The EDI is now recognized internationally as the most effective tool for measuring the whole child and is used across Canada and around the world. 

The EDI measures a child’s abilities in such areas as social/emotional health, communication skills, general knowledge and language and cognitive development.

With the Chilled treatment program, most sessions are held in the classroom but students are also taken out into the real world to test what they’ve learned.

Randy Shiga, social worker with the System Alternative education program, who ran the Chilled group Tyler was in, said when the students are thrown into real life situations, it forces them to confront their fears. One of those situations involved Shiga sitting in a crowded mall food court with the students where he stood up and yelled to a pretend person across the room while waving his hand.

The students cringed in embarrassment but, said Shiga, “They lived through it and it helped them put into practice what they learned.”

“We say to them, ‘what’s the worst that can happen?’ They say they’ll throw up or faint or something but none of that happens. They get through it and they see that,” said Shiga.

For Tyler, the program was a godsend that turned his life around. He points to the two-minute impromptu speech he gave to a roomful of strangers, that was part of the program, as an example of how much he’s changed.

“I talked for seven minutes,” he says, smiling. “They had to tell me to stop.”

Shiga said they started running Chilled about four years ago and offered two programs last year. This year they are on track to run four so far but, said Shiga, the demand is there for many more. 

The need is always there. We’re finding that we could easily fill up the groups.- Randy Shiga, social worker, the System Alternative

The problem is funding is only available to cover a coordinator for three hours a week to oversee the program so any social workers who are part of Chilled have to squeeze it in with their regular workload.

Otherwise, Shiga said, if they were able to offer more programs, he is sure they would all be filled.

“The need is always there. We’re finding that we could easily fill up the groups,” said Shiga.

“I don’t know if the number of cases of anxiety are going up or if more kids are coming forward because the stigma around mental illness has lifted a little or if we’re just more aware of it. What I do know is that the cases are more complicated now.” Follow-up studies on students who took the Chilled program showed that 80 per cent had “significant” improvement. Tyler counts himself among those.

“I can’t believe what I missed in those three years. School is fun to go to. I have yet to miss one day.”

A similar anxiety program called Cool Kids is offered to elementary school students.

While secondary students most often struggle with social anxiety, for younger students it’s often about separation anxiety and not wanting to leave their parents. McMaster Children’s Hospital out-patient unit sees about 1,000 children and youth a year, approximately one-third of whom present with some type of anxiety problem.

More complex 

Francis said the kids they’re seeing these days have far more complex cases of anxiety.

More than half have an anxiety disorder combined with another disorder. “We’re seeing young children who are six, seven, eight-years old who are worried about getting into university,” said Francis, adding that more complex cases of anxiety may be related to higher demands that are placed on kids today.

“Even kids in kindergarten have more academic activity so it’s a lot of pressure.” 

There’s also the chronic exposure to information kids have through social media outlets.

Seventy per cent of adult mental illness begins in childhood which points to how many children are slipping through the cracks, said Francis. Without early treatment, children can miss school and fall behind and also miss out on developing valuable skills, including social skills.

As Francis, said, “It’s not just that it gets in the way of their life, it gets in the way of their ability to develop appropriately.”

The Early Development Instrument (EDI) was the first tool designed to measure a child’s overall health development and readiness for school. Because it is considered a legal document, CBC Hamilton had to receive special approval from all stakeholders for its use in this series.  CBC Hamilton is revealing Hamilton's EDI data for the first time.

The map shows the neighbour percentages for emotional vulnerablity, one of the five domains it measures. EDI data is used to help decide where social and mental health services are best located. 

The map below shows the  percentages for vulnerablity in any one of the five domains measured by EDI. This data is broken down by census tract. The data in the grey areas is "shielded" because the numbers of children studied is so small individuals might be able to be identified. This shows how localized the data can be and how it can be used to help determine where services are needed.