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Children’s and youth mental health is a growing concern in Canada as the Mental Health Commission of Canada (MHCC), building on the work of the Kirby Commission (Kirby & Keon, 2006), continues to raise awareness of its importance to national well-being. Similarly, Reaching for the Top (Leitch, 2007), a national report by the advisor to the federal Minster of Health on healthy children and youth highlights mental health as one of three national health priorities in this population. Internationally, the World Health Organization has called for national address of child and youth mental health concerns, including publishing a monograph on Child and Adolescent Mental Health Policies and Plans (WHO, 2005), supporting the integration of mental health into primary care (WHO, 2008) and identifying a number of specific child and youth mental disorders in the Mental Health GAP project (WHO, 2008b).
Currently, Canada does not have a child and youth mental health strategy. While the responsibility for health care implementation and governance rests almost exclusively within the sphere of the provinces and territories, many important issues relevant to health care continue to be addressed nationally. Concern has been expressed that the existence of only four dedicated child and youth mental health policies at the provincial/territorial level may contribute to discrepancy between the need for child and youth mental health care and the availability of appropriate child and youth mental health services (Kutcher, Hampton & Wilson, 2009).
In light of these and other pertinent issues, a proposal was submitted to the MHCC by the Child and Youth Advisory Committee (CYAC) of the Mental Health Commission of Canada to establish a mental health framework specific to child and youth. The proposed framework, entitled Evergreen, will complement and may provide child and youth context to the Mental Health Strategy for Canada currently being developed by the MHCC. Evergreen can also be made available to responsible policy makers and planners within provinces and territories and other jurisdictions as a tool to inform and guide the creation, development and/or adaptation of child and youth mental health policies and plans. The MHCC has provided support and the majority of funding for this project. Additional funding and support has been provided by the IWK Children’s Health Centre.
Since Evergreen is national framework rather than a national policy it will serve a supportive rather than a prescriptive role. There are a number of domains in which a national child and youth mental health framework can be useful:
Evergreen will be created using an online interactive collaborative process that includes over 100 nationally and internationally recognized experts from a variety of child health and mental health domains and the public at large. At the core of these committees are youth and parents who are interested in, or who have lived experience with mental illness. Evergreen’s committee structure is organized into the Drafting Committee (DC), National Advisory Committee (NAC), and International Advisory Committee (IAC). Furthermore, an online consultation process with the general public will be used to elicit input from all who are interested and wish to contribute. The Evergreen project is chaired by Dr. Stan Kutcher and supported by Alan McLuckie, both of Dalhousie University/IWK Health Centre.
First, using Socialtext, an advanced web 2.0 technology that facilitates online collaborations and networking, the Evergreen draft documents will be written collectively by the DC, a group of about thirty nationally recognized experts including youth and parents with lived experience. This will be accomplished using a wiki format that will be open to all members of the other committees for review and comment. Furthermore, the drafts will be open for public comment from all those interested - using an online consultation process. A concerted national public awareness process, using conventional media (e.g., radio, newspaper) and unconventional media (e.g., Facebook) will be engaged, with the intent of eliciting input from the widest range of Canadians possible. Evergreen’s public awareness and engagement process will particularly target engaging those whose voices are seldom heard in policy development.
Evergreen will receive ongoing input and feedback from the NAC and IAC, which have respective committee memberships of 70 and 30 professionals, youth and parents. Each committee member will have access to the Evergreen draft documents and will have the opportunity to provide critical input to the drafting committee either individually or in collaboration with other committee members. All committee members will also have access to all public input to assist them in their deliberations.
We expect that the Evergreen document will undergo at least three major revisions based on this model. The first posting will reflect the values and principles that form the nucleus from which Evergreen will grow. This values and principles document is expected to be available within the month of June of this year to launch the beginning of the public and committee processes. We encourage all who are interested in child and youth mental health to access these public forums and contribute to the creation of Evergreen.
Once the drafting committee has finalized Evergreen, it will be sent to the CYAC for review and final editing. Following this consultation, the Evergreen framework documents will be sent to the MHCC for their acceptance, utilization and dissemination. We anticipate that this will occur sometime in the late winter or early spring of 2010.
To date the membership of the DC, NAC and IAC is nearing the final stage of recruitment, a first draft of values and principles is being gathered, and a resource library is being created, which includes seminal articles on children’s health and mental health, as well as examples of mental health frameworks. All going according to plan, we hope that public commentary on the first draft of the values and principles posting will be open for input by June 2009.
We have called the project Evergreen to evoke the image of an ever-evolving framework that can be updated to remain relevant to the changing needs of Canadians. We hope that Evergreen’s process will be self-sustaining and that within 3 to 5 years of completion, the framework will be reengaged by interested parties, this time to incorporate new research, new evidence and new perspectives on child and youth mental health. We hope that this process will then continue in 3 to 5 year cycles into the foreseeable future. Thus this process will be “evergreen”.
Evergreen’s development process differs from the top-down approach commonly used in health policy, which is drafted by a small number of commonly linked committee members, interest groups and established stakeholders. Instead, Evergreen provides a novel and unique approach that cuts across ideological boundaries and encourages the creation of a transformative model free from usual constraints and interest group pressures. Will this actually happen? We are not sure, but the process is potentially liberating. The product will be the answer. In the words of one youth with lived mental health experience, who participated in a focus group regarding the framework development process, “Evergreen offers an opportunity to contribute to the future of Canada’s mental health landscape”.