Mental Health Report Halton Region - A profile of mental health and wellbeing in Halton Region - Halton.ca
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Halton Region Mental Health Report 2018 A profile of mental health and wellbeing in Halton Region
Reference:
Halton Region Health Department. (2018). Halton Region Mental Health Report. Oakville, Ontario.
Author:
Megan Brunner, Epidemiologist, Halton Region Health Department
Contributors:
Lorraine Gold, Public Health Nurse – Health Equity Advisor, Halton Region Health Department
Michelle Schwarz, Public Health Nurse – Health Equity Advisor, Halton Region Health Department
Acknowledgements:
Lisa Collimore, Chief Officer and MISA Leader, Halton Catholic District School Board
Jean Gresham, Manager, Halton Region Health Department
Kendra Habing, Epidemiologist, Halton Region Health Department
Lynne Hanna, Manager, Halton Region Health Department
Bonnie Hewitt, Manager, Halton Region Health Department
Dr. Daniela Kempkens, Associate Medical Officer of Health, Halton Region Health Department
Frank Nezavdal, Instructional Program Leader (K-12), Halton District School Board
Erika Norris, Public Health Nurse – Health Equity Advisor, Halton Region Health Department
Alison Rothwell, Epidemiologist, Halton Region Health Department
Emma Tucker, Manager and Senior Epidemiologist, Halton Region Health Department
Elisabeth Wells, Researcher and Knowledge Broker, Our Kids Network
Kristen Wheeler, Epidemiologist, Halton Region Health Department
Halton Region Mental Health Report 2018 2
Contents
Contents 3
Highlights 4
Data notes 6
Introduction 8
Social determinants of mental health 9
Overview of mental health in Halton 10
Child and youth mental health 15
Mental health in pregnancy and parenthood 22
Adult mental health 27
Older adult mental health 33
Conclusion 39
References 40
Appendix A: Data sources and limitations 42
Appendix B: Definitions 46
Appendix C: ICD-10-CA codes 49
Halton Region Mental Health Report 2018 3
Highlights
The Halton Region Mental Health Report dementia and Alzheimer’s disease, mental students. Elementary and secondary
provides a snapshot of the mental health of and behavioural disorders due to substance students who were born in Canada were
Halton residents across the lifespan. use, mood disorders, and various other most likely to have positive relationships
disorders of psychological development. with their peers, while newcomers (less
Data from the Canadian Community Health than five years in Canada) were least likely.
Survey show that 4 out of 5 Halton From 2006 to 2015, there was an increase Newcomer secondary students were less
residents (ages 12+) reported having very in ED visits and hospitalizations for mental likely than both Canadian-born students
good or excellent mental health, which was illness among Halton residents, although and those who immigrated five or more
higher than Ontario. Having a higher rates were consistently lower in Halton than years ago to have a positive sense of
income, a strong sense of community Ontario. Rates of ED visits for mental belonging. Living in a two-parent household
belonging, and being a post-secondary illness were highest among those aged 15 was also associated with positive mental
graduate were associated with better self- to 24. Rates of hospitalizations were health and social connectedness.
reported mental health. highest among 15 to 24 year olds, as well
as adults aged 85 and over. Rates of ED The rate of ED visits for mental illness has
Some Halton residents face mental health visits and hospitalizations for mental illness increased for 10-17 year olds in Halton and
challenges: 23% reported that most days were lower in high income neighbourhoods Ontario over the past 10 years (particularly
were quite a bit or extremely stressful, and compared to low income neighbourhoods. among females), with the greatest increase
9% reported ever having been diagnosed occurring between 2010 and 2013. The rate
with a mood and/or anxiety disorder. Children and youth of ED visits for mental illness was about 2.5
Data from the Tell Them From times higher among Halton females
This report also examined trends in Me/OurSCHOOL Survey show that compared to males aged 10-17 from 2013
emergency department (ED) visits and differences in mental health exist within to 2015. Hospitalizations also increased in
hospitalizations over time for mental illness. Halton’s student population. Grade 9 this age group during approximately the
For the purposes of this report, mental students had lower depression, and higher same time period.
illness includes a wide range of mental self esteem, sense of belonging and
illnesses including organic disorders like positive relationships compared to grade 12
Halton Region Mental Health Report 2018 4
Pregnancy and parenthood Like other age groups, there has been a rise
From 2013 to 2015, an average of 778 in ED visits and hospitalizations for mental
women per year in Halton (13.9% of women illness among Halton adults (18-64), but the
who gave birth) reported experiencing one rates have remained well below the
or more mental health concerns during provincial average.
pregnancy. Pregnant women in Halton were
less likely to have experienced one or more Older adults
mental health concerns during pregnancy In Halton, life satisfaction decreased as age
compared to Ontario. increased. However, older adults (65+)
reported being less stressed and having a
Halton parents who felt close to other stronger sense of community belonging than
parents, were able to take time for their own adults aged 18-64.
wellbeing, and felt supported in parenting
There was no significant trend in ED visits
were less likely to report feeling stressed.
for mental illness among adults aged 65+
Adults from 2006 to 2015, however rates of
Good physical health, having a job, and hospitalizations for mental illness in this age
higher household income was associated group increased during this time period.
with better self-reported mental health
among Halton adults. However, one in three
Halton adults reported being stressed most
days at work.
Halton Region Mental Health Report 2018 5
Data notes
Data sources
Five data sources are presented in this report. The table below provides a brief summary of each data source. For more information on data
sources including limitations, see Appendix A.
DATA SOURCE SECTION YEARS DESCRIPTION
Tell Them From Youth 2015-16 The Tell Them From Me/OurSCHOOL is a voluntary, online survey asked of elementary
Me/OurSCHOOL school year and high school students in the Halton District School Board and Halton Catholic District
Survey School Board. The survey explores topics such as student engagement, bullying,
emotional and physical wellbeing. For the 2015-16 school year, approximately 18,000
Grade 4-6 students and 17,500 grade 9-12 students completed the survey. Results
should not be compared between elementary and secondary school students, as they
completed different versions of the survey.
Better Outcomes Parents and 2013-15 BORN includes data on pregnancy and birth (including home births) in Ontario from
Registry and pregnancy hospitals, labs, midwifery practice groups, and clinical programs.
Network (BORN)
Halton Parents and 2015 The KPS is a voluntary online survey by the Our Kids Network, which is distributed to
Kindergarten pregnancy parents of kindergarten children in the Halton District School Board and Halton Catholic
Parent Survey District School Board. The KPS explores topics related to the health and wellbeing of
(KPS) kindergarten children and their parents. In 2015, 2,257 parents completed the KPS.
Canadian Adults, Older 2009-14 The CCHS is a voluntary survey conducted in-person or by phone by Statistics Canada.
Community Health adults CCHS collects data related to health status, healthcare, and health determinants across
Survey (CCHS) Canada. About 600 Halton residents complete the CCHS each year.
National Youth, Adults, 2006-15 NACRS contains data for all hospital-based and community-based ambulatory care in
Ambulatory Care Older adults Ontario hospitals. This report includes NACRS data on emergency department visits and
Reporting System hospital admissions where the patient’s main problem or diagnosis as determined by the
(NACRS) emergency department was a mental illness (ICD-10-CA: F00-F99, G30, O993).
Halton Region Mental Health Report 2018 6
Years of data presented with an asterisk (*) and should be was the Most Responsible Diagnosis – the
The years of data presented throughout interpreted with caution due to high one diagnosis or condition most
this report vary, as the years of data variability. responsible for a patient’s stay in a facility.
available differ depending on the data Note that ED visits and hospital admissions
source. Where counts were small, multiple Definitions for self-harm are not included in this report,
years of data were combined to account for A complete list of definitions of indicators but can be found in the Halton Self-Harm
unstable rates in the population which can and key terms presented in this report can and Suicide Report. See Appendix C for a
occur when examining a single year of data. be found in Appendix B. complete list of ICD-10-CA codes and
groupings included in this report.
Statistical significance Survey data
Differences between groups were tested The indicators “anxiety” and “depression” It is important to keep in mind throughout
for statistical significance by calculating from the Tell Them from Me/OurSCHOOL this report that the ED and hospital
95% confidence intervals for rates. If the survey are based on a series of self- admission data are not intended to reflect
confidence intervals between groups did reported survey questions and should not the true burden of mental illness in the
not overlap, differences were considered be interpreted as rates of clinically population, but rather to identify trends in
statistically significant. Trends over time diagnosed anxiety and depression. mental health service use for mental illness
were tested for significance using linear in the population. This report does not
regression and adjusting for auto- ED and hospital admission data capture those who sought help for mental
correlation. If a trend is referred to as For this report the term “mental illness” illness from other sources such as family
“increasing” or “decreasing” throughout the refers to codes F00-F99, G30, O993 from doctors, walk-in clinics, counselors, or
report, the trend described is statistically the Canadian version of the International psychologists.
significant. Differences between groups Statistical Classification of Diseases (ICD-
described in the report are also statistically 10-CA).1 This includes a wide range of Data tables
significant, unless otherwise stated. mental illnesses including organic Please note that data tables to accompany
disorders like dementia and Alzheimer’s the graphs, figures and key findings
Coefficient of variation disease, mental and behavioural disorders presented in this report are available upon
The coefficient of variation refers to the due to substance use, mood disorders, and request.
precision of an estimate. With survey data, various other disorders of psychological
where the coefficient of variation was development. The report presents ED visits
between 16.6-33.3, estimates are marked and hospitalizations where a mental illness
Halton Region Mental Health Report 2018 7
Introduction
The Halton Region Mental Health Report diagnosed mental illness to experience poor community service providers, educators,
provides a snapshot of the mental health of mental health.6 and health care providers in the community.
children and youth, parents, adults, and
older adults living in Halton Region. The Mental health is important at every stage of The purpose of the Halton Region Mental
United Nations defines mental health as: life, from birth and early childhood to Health Report is to provide data on trends,
adolescence and throughout adulthood. emerging issues, and the current status of
“a state of wellbeing in which every Mental health is also dynamic. It changes mental health in Halton to inform mental
individual realizes his or her own potential, over time depending on various factors health programs, services and policies in
can cope with the normal stresses of life, such as life experiences, levels of stress, our community. The report also seeks to
can work productively and fruitfully, and is health and lifestyle behaviours, and identify populations within Halton’s
able to make a contribution to her or his genetics.3 community who may be disproportionately
community.”2 affected by poor mental health.
Evidence shows that creating supportive
While the terms “mental health” and “mental environments, increasing resiliency, This report is divided into four major
illness” are often used interchangeably, the improving mental health literacy, and sections focusing on mental health during
two terms have different meanings.3 reducing stigma around mental illness can various ages and stages in life, including
Everyone has mental health, just like help improve mental health at all ages and mental health among children and youth,
everyone has physical health.3,4 Mental stages of life.7 parents and pregnancy, adults, and older
health is the ability to feel, think and act in adults. While it is recognized that the
ways that help people to enjoy life and deal Promoting positive mental health in the foundation for good mental health begins
with any challenges they may face.4 Mental community is an important goal of Halton early in life,9 the early years are not
illness, on the other hand, refers to mental Region’s 2015-2018 Strategic Action Plan.8 included as an area of focus in this report
health problems that are diagnosed and The Halton Region Health Department due to data limitations.
treated by mental health professionals.5 A works towards this goal by providing
This report also includes stories that
person can have a mental illness and still information, programs and resources on a
illustrate the impact of mental health on the
experience mental wellbeing.6 It is also variety of mental health topics to teens,
lives of Halton residents.
possible for a person who does not have a parents, adults, older adults, caregivers,
Halton Region Mental Health Report 2018 8
Social determinants of mental health
Like physical health, mental health is positive mental health.11 Belonging to a Interwoven throughout this
influenced by the social and economic strong social support network can act as a
factors in the environments where people buffer against stress, promote positive
report are stories of individuals
live, learn, work and play. These factors, health, and help people to feel cared for and in our community and their
such as income, education, social support valued.12 Social connectedness leads to experiences with the social
networks and housing are often referred to stronger and more resilient communities.12 determinants of mental health.*
as the social determinants of health.10
Sometimes these factors limit access to the Discrimination and violence can lead to
opportunities and resources needed to be poor mental health. Discrimination refers to
Some of the differences in mental health
healthy, and this can lead to avoidable actions taken to exclude or treat others
between groups described in this report are
differences in health. differently due to factors such as their race,
related to individual factors such as biology.
ethnicity, gender, sexual orientation and/or
disability.11 Communities that value However, some differences are related to
Three important social determinants of
diversity, promote physical security, and the social determinants of mental health. By
mental health include:
• social inclusion, empower individuals with the opportunity to taking action to address the social
• freedom from discrimination and take control over their lives provide greater determinants of mental health, the
violence, and opportunities for positive mental health.11 conditions of everyday life can be improved
• access to economic resources.11 and avoidable barriers to good health can
Access to economic resources, such as be reduced or eliminated.13 This means that
Social inclusion refers to the degree to work, education, money and adequate everyone has a fair and just opportunity to
which individuals feel connected to their housing, is another important social be as healthy as possible both physically
communities, and includes concepts such determinant of mental health. Participation and mentally.
as supportive relationships, participation in in the economy not only provides access to
community and group activities, and civic adequate income, but it also can improve
engagement.11 Social connectedness and social connectedness and increase
inclusion is an important protective factor for opportunities for control over one’s life.11
*note that the stories presented in this report are works of fiction to help illustrate the important connection between mental health and the social determinants of health.
Halton Region Mental Health Report 2018 9
Overview of mental
health in Halton
This section of the report provides a high level overview of indicators of the
mental health of Halton residents aged 12 and over using data from the
Canadian Community Health Survey. Also included is an overview of trends
in emergency department visits and hospitalizations for mental illness for all
ages.
Halton Region Mental Health Report 2018 10Background Mental health
Mental illness is one of the most common In order to promote positive mental health promotion in Halton
causes of disability in Canada.14 It is and work towards improving the lives of Mental health promotion refers to initiatives
estimated that in a given year, one in five those living with mental illness in Halton, that aim to create living conditions and
Canadians will experience a mental it is important to gain a better environments that support mental health and
illness or addiction.15 In Ontario, the understanding of the picture of mental allow people to adopt and maintain healthy
burden of mental illness is one and a half health in Halton across the lifespan. lifestyles.18 By working to enhance factors that
times higher than all cancers put Indicators of mental health (such as self- promote mental wellness (such as sense of
together, and more than seven times that reported mental health and life belonging and good physical health) and
of all infectious diseases.16 satisfaction), mental illness (such as self- reduce risk factors for poor mental health
reported diagnosis with a mood or anxiety (such as discrimination, isolation, and stress) it
Mental illness places a substantial burden disorder), and health service utilization is possible to increase the proportion of the
on the healthcare system, on employers, (such as emergency department visits population experiencing good mental health.19
and individuals affected by mental and hospitalizations) can be used to help
illness.14 It is estimated that the economic identify issues, set priorities, and monitor A recent review of the literature conducted by
the Halton Region Health Department found
burden of mental illness in Canada is $51 progress in improving the mental health
four areas of opportunity to improve the mental
billion dollars per year, which includes of the population.17
health of Halton residents:
costs associated with healthcare, lost
productivity, and reduced health-related • promoting opportunities to foster social
quality of life.14 connectedness;
• creating supportive, healthy, safe and
inclusive environments where Halton
residents live, learn, work and play;
• increasing resiliency of Halton residents
(i.e. ability to bounce back after major
challenges) by promoting individual
protective factors for mental wellness; and
• Improving awareness and understanding of
mental illness and reducing stigma.7
Halton Region Mental Health Report 2018 11The social determinants of mental
General mental health and wellbeing health impact people differently,
and this can lead to differences in
Positive mental health is about both feeling good and functioning well. In Halton from mental health in the population.
2009-2014:
In Halton from 2009-2014,
7 out of 10 Halton residents • Life satisfaction decreased with age, while the
94% reported a very or somewhat middle age group (18-64) reported higher stress
strong sense of community and a lower sense of community belonging than
4 out of 5 Halton of Halton residents
belonging
residents reported that reported that they youth (12-17) and older adults (65+)
their mental health was were satisfied with • Females were more likely than males to report
very good or excellent life
consulting a mental health professional, and
having been diagnosed with a mood and/or
anxiety disorder
81% of Halton residents Compared to Ontario, Halton • As income increased, life satisfaction and self-
reported that they were residents were more likely to reported mental health increased, while reported
happy every day or rate their mental health as diagnosis with a mood and/or anxiety disorder
almost every day this very good or excellent, and decreased
past month (2011-12 only) to indicate that they were
satisfied with life. • Self-reported mental health was higher among
post-secondary graduates compared to non-
post-secondary graduates
Some Halton residents also experience mental health challenges. From 2009-2014, • Halton residents with a strong sense of
community belonging also had higher self-
reported mental health and life satisfaction, and
23% 9% 12% lower reported life stress and diagnosis with a
mood or anxiety disorder
• There were no significant differences by
of Halton residents of Halton residents of Halton residents reported immigrant status.
reported that most days reported ever having been consulting a health
of their life were quite a diagnosed with a mood professional about their
bit or extremely stressful and/or anxiety disorder mental health in the last year
Data source: CCHS [2009-2014], Statistics Canada, Share File, Ontario MOHLTC
Halton Region Mental Health Report 2018 12Emergency department visits for Trends over time
mental illness Over the past ten years, there has been a significant increase in the rate of ED
visits for mental illness in Halton and Ontario. Rates of ED visits were consistently
lower in Halton compared to Ontario.
Most common mental illness ED visits
From 2013-15, there were an average of 2,800 ED Figure 2: Age-
standardized rate of ED
visits per year among males and 2,929 ED visits per visits for mental illness,
year among females in Halton for mental illness. The Halton Region and
most common mental illnesses were: Ontario, 2006-2015.
1. Substance disorders (915 ED visits per year)
2. Anxiety (515 ED visits per year)
3. Depression (426 ED visits per year)
1. Anxiety (730 ED visits per year)
2. Depression (621 ED visits per year)
3. Substance disorders (575 ED visits per year)
Differences by age and sex
From 2013-15, the rate of ED visits for mental illness was highest among 15-19
year-olds for females. Rates generally decreased with age after this peak until
Differences by neighbourhood income
older adulthood, when the rates then began to increase with age. Among Halton
In Halton from 2013-15, the rate of ED visits for
males, rates were highest in the 20-24 year old age group, and then followed the
mental illness decreased as neighbourhood income
same general pattern with age as females.
group increased. See Appendix B for income group
definition.
Figure 3: Age-specific
rate of ED visits for
mental illness, by sex,
Halton Region, 2013-
2015 combined.
Figure 1: Age-standardized rate of ED visits for mental illness, Halton
Region, by neighbourhood income group, 2013-2015 combined.
Data source: National Ambulatory Care Reporting System [2006-2015], Ontario MOHLTC: IntelliHEALTH Ontario, extracted June 2017
Population Estimates [2006-2015], Ontario MOHLTC: IntelliHEALTH Ontario, extracted August 2016
Halton Region Mental Health Report 2018 13Hospitalizations for mental illness Trends over time
Over the past ten years, there has been a significant increase in the rate of
hospitalizations for mental illness in Halton and Ontario. Rates of hospitalizations
Most common mental illness hospitalizations were consistently lower in Halton compared to Ontario.
From 2013-15 there were an average of 785
hospitalizations among males and 816 Figure 5: Age-
hospitalizations among females for mental illness in standardized rate of
Halton per year. The most common mental health hospitalizations for
mental illness, Halton
illnesses resulting in hospitalization were:
Region and Ontario,
2006-2015.
1. Schizophrenic and psychotic disorders
(212 hospitalizations per year)
2. Depression (172 hospitalizations per year)
3. Substance-related disorders (212 hospitalizations
per year)
1. Depression (265 hospitalizations per year)
2. Schizophrenic and psychotic disorders
(140 hospitalizations per year)
3. Organic disorders† (91 hospitalizations per year) Differences by age and sex
†See
From 2013-15, for Halton females the rate of hospitalizations for mental illness
Appendix C for definition of organic disorders and other mental illness
categories was highest among the 15-19 year-old age group. Rates then decreased with age
until older adulthood, when rates began to increase. Among males, rates
increased with age until ages 20-24, and then generally decreased with age until
Differences by neighbourhood income
older adulthood, where rates peaked in the 85 and older age group.
In Halton from 2013-15, the rate of hospitalizations
for mental illness decreased as neighbourhood
income group increased. Figure 6: Age-
standardized rate of
hospitalizations for
mental illness, by sex,
Halton Region and
Ontario, 2006-2015.
Figure 4: Age-standardized rate of hospitalizations for mental illness,
Halton Region, by neighbourhood income group, 2013-2015 combined. Data source: National Ambulatory Care Reporting System [2006-2015], Ontario MOHLTC: IntelliHEALTH Ontario, extracted June 2017
Population Estimates [2006-2015], Ontario MOHLTC: IntelliHEALTH Ontario, extracted August 2016
Halton Region Mental Health Report 2018 14Child and youth mental
health
This section of the report provides an overview of indicators of the mental
health and wellbeing of Halton students in grades 4-6 and 9-12 based on
data from the Tell Them From Me/OurSCHOOL survey. Also included is an
overview of trends in emergency department visits and hospitalizations for
mental illness among Halton youth aged 10-17.
This section starts with Zara’s story. Her story illustrates how social and
economic factors can negatively impact mental health, and how access to
community resources and other social supports can improve mental health.
Halton Region Mental Health Report 2018 15Zara is a grade 12 student who attends committee of students, staff, and parents
The facts
high school in Oakville. She came to to explore strategies to help all students ► Most Halton high school students report
Canada a year ago with her mother and feel a sense of belonging and connection. having a positive sense of belonging (68%)
younger brother, and together they live in In order to ensure all students had the and having positive relationships with their
a small apartment a few kilometers from opportunity to participate the committee peers (77%).
school. Zara recently began a part-time organized meetings over the lunch hour, ► However, high school students who were
job working three nights per week to help which gave Zara a chance to join. newcomers were less likely to report having
her mother with expenses. a positive sense of belonging compared to
students born in Canada and students who
At the meetings, Zara was able to make
immigrated five or more years ago.
Although Zara feels comfortable in her new friends, and shared some of her
new school, she hasn’t made many friends experiences trying to adjust to her new life ► Students from single-parent households or
other family arrangements were less likely
and often spends time alone at lunch and in Canada. The school also invited a local
to report having a positive sense of
between classes. She has been unable to settlement worker to join the committee, belonging and having positive relationships
join any clubs or teams because of the which was a great connection for Zara and compared to students from two-parent
hours of her job, and the fact that she her family as well as other newcomer households.
cares for her little brother after school. families in the school.
Child care is too expensive for her family
to afford. Although Zara feels grateful for The school social worker was also able to
her new life in Canada, she often feels that share some important community
she doesn’t really belong in her resources with Zara’s mother, including
neighbourhood or at her school. childcare and housing subsidy supports.
These resources have helped relieve
Zara’s
At Zara’s school, staff understand that some of the financial stress Zara and her story
feeling connected to school is an important family have experienced, and given them
factor in school success and positive more opportunities to get involved in
mental health. Together with a Public school and community life, and for the first
Health Nurse from the Halton Region time since they came to Canada, Zara
Health Department, the school created a feels a sense of belonging and connection.
Halton Region Mental Health Report 2018 16Background
Adolescence is an important time of change. mental illness among Canadian children and Schools and mental health
Youth face many challenges during the youth, a reduction in stigma resulting in Schools are important avenues for
transition to adulthood, including pressures more youth seeking help, and/or greater promoting positive mental health among
to succeed at home, at school and in social reliance on hospital care in the face of children and youth. Schools are an optimal
groups.20 The onset of many mental limited access to community services.22 setting to:
illnesses also occur during this period.21 • identify students in need;
In addition to increased rates of ED visits and • build pathways to care;
In recent years, there has been an increase hospitalizations for mental illness, there has • develop student social-emotional skills
in rates of emergency department visits been a parallel increase in the rate of and resilience;
(ED) and inpatient hospitalizations among hospitalizations for intentional self-harm • prevent mental health problems in high
children and youth across Canada for among Canadian youth, particularly among risk groups;
mental illness.22 Between 2006-07 and females.23 From 2009-10 to 2013-14, the • promote positive mental health and
2013-14, the rate of ED visits for mental rate of hospitalizations for self-harm wellbeing for all students; and
illness among Canadian children and youth increased by 110% for Canadian females • reduce stigma.24
increased by 45%, while the rate of aged 10-17.23 As with mental illness, the
hospitalizations increased by 37%.22 The reasons behind the increase in The Halton Region Health Department
greatest increase in rates during this time hospitalizations for self-harm are complex works together with the local school boards
period occurred among youth aged 10 to and not well understood. For more and community partners to help build
17.22 Several possible explanations for this information on self-harm, see the Halton healthy school communities and promote
trend include increases in the prevalence of Sefl-Harm and Suicide Report. positive mental health among Halton’s
children and youth.
Halton Region Mental Health Report 2018 17General mental health and wellbeing in children and youth
The Tell Them From Me/OurSCHOOL survey asks elementary and secondary students a series of questions related to friendships, sense of
belonging, and experiences with self-esteem, anxiety and depression. See Appendix B for a description of each measure.
Elementary school students Secondary school students
Overall findings for students in grades 4-6 Overall findings for students in grades 9-12
had a positive had positive had a positive had positive had positive self-
sense of relationships with sense of relationships with their esteem
belonging their peers at school belonging peers at school
reported being had moderate to reported being had moderate to had moderate to
bullied at all in the high levels of bullied at least high levels of high levels of
past four weeks anxiety† once per week in anxiety† depression†
the past four weeks
Notes
The bullying measure includes students who report being the victim of any one or more of the following types of bullying: physical, social, verbal, or cyber bullying.
† Foranxiety and depression, the criteria used are NOT equivalent to those used in clinical diagnoses. The Tell Them From Me/OurSCHOOL survey assigns students to the
categories of moderate and severe anxiety or depression based on their self-reported responses to a series of questions related to sadness and worry. High rates of anxiety
and depression as rated by these items should not be confused with high rates of clinical anxiety and depression in the students.
Data source: Tell Them From Me/OurSCHOOL Survey [2015-16], The Learning Bar
Halton Region Mental Health Report 2018 18Differences in mental health and wellness among Halton students
Analysis of the Tell Them From Me/Our School data also showed that differences in indicators of mental health and wellness exist in Halton’s
student population.
Among students in grades 4-6,
• Bullying decreased as grade increased.
Secondary school
students • Males had a higher sense of belonging and less anxiety than females, while females reported higher positive
relationships and less bullying than males.
• Having positive relationships was highest among Canadian-born students followed by students who immigrated
five or more years ago. Newcomers who immigrated less than five years ago were the least likely to report
having positive relationships.
• Students from two-parent households had less anxiety and bullying, and a greater sense of belonging and
Elementary school positive relationships compared to those from single parent or other arrangement households.
students
Among students in grades 9-12,
• Grade 9 students had higher self-esteem, sense of belonging and positive relationships, and lower depression
compared to grade 12 students.
• Males had lower anxiety and depression compared to females, and higher self-esteem and sense of belonging.
Females, however, reported higher positive relationships.
• Having positive relationships was highest among Canadian-born students followed by students who immigrated
five or more years ago. Newcomers who immigrated less than five years ago were the least likely to report
having positive relationships. Sense of belonging was similar between students born in Canada and those who
immigrated five or more years ago, but lower among newcomers.
• Anxiety, depression and bullying were lower among students from two-parent households, while sense of
Secondary school belonging, self-esteem and positive relationships were higher.
students
Data source: Tell Them From Me/OurSCHOOL Survey [2015-16], The Learning Bar
Halton Region Mental Health Report 2018 19Emergency department visits for mental Trends over time
illness in children and youth The rate of ED visits for mental health illness among Halton females aged 10-17
increased significantly over the last 10 years, from 1,083 per 100,000 females
aged 10-17 in 2006 to 1,801 per 100,000 in 2015, with the greatest increase
Differences by sex occurring between 2010 and 2013. Ontario females experienced a similar increase
From 2013-15, females aged 10-17 in Halton had during this time period. The rate of ED visits for mental illness has generally been
nearly double the rate of ED visits for mental illness lower among Halton females aged 10-17 compared to Ontario.
compared to males.
Males aged 10-17 in Halton and Ontario also experienced a significant increase in
the rate of ED visits for mental illness over the past 10 years, although this
increase was not as large as it was for females. The rate of ED visits for mental
1,037 1,916 illness in Halton and Ontario for males aged 10-17 were fairly similar in past years,
ED visits per ED visits per
but in more recent years (2013-15) Halton’s rate has been significantly lower than
100,000 males 100,000 females
aged 10-17 aged 10-17 Ontario for males.
Most common mental health illness ED visits
From 2013-15 there were an average of 303 ED visits
per year among males and 537 ED visits per year
among females aged 10-17 in Halton for mental illness.
The most common mental illnesses resulting in ED
visits were:
1. Depression (66 ED visits per year)
2. Substance disorders (60 ED visits per year)
3. Anxiety (56 ED visits per year)
1. Depression (265 ED visits per year)
2. Anxiety (112 ED visits per year) Figure 7: Age-specific rate of ED visits for mental illness, ages 10-17, by sex, Halton Region and
Ontario, 2006-2015.
3. Substance disorders (69 ED visits per year)
Data source: National Ambulatory Care Reporting System [2006-2015], Ontario MOHLTC: IntelliHEALTH Ontario, extracted June 2017
Population Estimates [2006-2015], Ontario MOHLTC: IntelliHEALTH Ontario, extracted August 2016
Halton Region Mental Health Report 2018 20Hospitalizations for mental illness in Trends over time
children and youth The rate of hospitalizations for mental health illness among Halton females aged
10-17 nearly tripled over the last 10 years, from 188 per 100,000 females aged 10-
17 in 2006 to 529 per 100,000 in 2015, with the greatest increase occurring
Differences by sex between 2011 and 2014. Ontario females experienced a similar increase during
From 2013-15, females aged 10-17 in Halton had 2.5 this time period. In general, the rate of hospitalizations for mental illness has been
times the rate of hospitalizations for mental illness higher among Halton females compared to Ontario females, however these
compared to males. differences were not statistically significant.
Males in Ontario aged 10-17 also experienced an increase in the rate of
hospitalizations for mental illness from 2006 to 2015. There were no significant
224 550 trends among Halton males aged 10-17 during this time period. In 2008, 2009 and
hospitalizations Hospitalizations
per 100,000 females
2012, Halton males aged 10-17 had a significantly higher rate of hospitalizations
per 100,000 males
aged 10-17 aged 10-17 compared to Ontario males.
Most common mental illness hospitalizations
Each year in Halton from 2013-15 there were an
average of 66 hospitalizations for mental illness among
males and 154 hospitalizations for mental illness
among females aged 10-17. The most common mental
illnesses resulting in hospitalization were:
1. Depression (22 hospitalizations per year)
2. Schizophrenic and psychotic disorders
(9 hospitalizations per year)
3. Acute stress (8 hospitalizations per year)
1. Depression (73 hospitalizations per year)
2. Anxiety (55 hospitalizations per year) Figure 8: Age-specific rate of hospitalizations for mental illness, ages 10-17, by sex, Halton Region
3. Eating disorders (14 hospitalizations per year) and Ontario, 2006-2015.
Data source: National Ambulatory Care Reporting System [2006-2015], Ontario MOHLTC: IntelliHEALTH Ontario, extracted June 2017
Population Estimates [2006-2015], Ontario MOHLTC: IntelliHEALTH Ontario, extracted August 2016
Halton Region Mental Health Report 2018 21Mental health in pregnancy
and parenthood
This section of the report summarizes the incidence of mental health concerns
during pregnancy using data from the Better Outcomes Registry and Network
(BORN) Information System. Also presented in this section of the report are
several indicators of the mental wellbeing of Halton parents using data from
Halton’s Kindergarten Parent Survey (KPS).
This section starts with Candace’s story. Her story illustrates the impact of
social isolation on mental health, and how building a strong social support
network can reduce stress and improve mental health.
Halton Region Mental Health Report 2018 22Candace is a new parent of a three month community resources available to support
The facts
old girl. Candace and her partner live in a new parents. Candace reached out and ► 13.9% of women who give birth in
small bungalow in Halton Hills around the joined a parenting group and was able to Halton experience one or more mental
corner from her parents. Although meet other new parents. She found that health concerns during pregnancy
Candace’s family has always lived in Halton spending time with other parents helped her ► Among women who give birth in Halton
Hills, her parents recently retired and now to feel less isolated, and helped to reduce each year,
spend six months per year in Florida. Her her stress. A health care professional at the ► 8.6% have anxiety during
parents were around for the birth of their group also helped to answer her parenting pregnancy
granddaughter, but left for Florida two questions, and this support helped Candace ► 6.6% have depression during
months ago once the winter weather arrived. to relax and enjoy her time with her baby pregnancy
much more. She found that her baby was
► 3.0% have a history of post-
Candace noticed that since her parents left less fussy and that the interactions between partum depression (among those
town, she has felt more stressed being at them were more positive. Candace made who have previously given birth)
home with the baby. Candace’s partner arrangements with some of the other
commutes to Toronto for work and spends mothers in the group to get together once
long hours away from home on weekdays. per week for coffee, and they plan to start
The winter weather has made it difficult to walking together once the weather improves.
walk in the neighbourhood like she was able
to do in the first couple months of her Maternal mental health has a direct impact
maternity leave. Candace realized that since on the social-emotional development of
Candace’s
her parents left, she spends a great deal of children. Having a strong social support story
time alone with the baby, and doesn’t feel network is essential to reducing parenting
like she has any one to talk to. She was the stress. By reaching out and connecting with
first of her friends to start a family, and feels other parents, Candace was able to start
that she has lost some connection with them building a network of other parents and
since the baby was born. professionals to support her with her
parenting journey.
Candace subscribed to the HaltonParents
emails and found information about
Halton Region Mental Health Report 2018 23Background
Pregnancy and parenthood can be an Fathers can also experience stress and
exciting time in one’s life. However, the other mental health concerns. Research
transition to parenthood and coping with suggests that as many as 5-10% of
the demands of raising a family can be fathers experience depression in the year
stressful at times. While parenting can be after their baby is born.27
both rewarding and challenging for
anyone, it can pose particular challenges Promoting positive mental health is
for those with a mental health condition. important for both parents and their
children. When parents look after
Maternal mental health concerns are themselves and feel supported, they are
common, with as many as one in five better able to accept and manage
women developing a mental health issue difficulties, be responsive to their
while pregnant or during the first year after children’s needs, and make good
childbirth.25 Maternal mental health is an decisions for their children.28
important public health issue, as it can
impact the health of both a mother and her Through HaltonParents, Halton Region
baby, including an increased risk for offers a variety of free parenting programs
pregnancy complications and difficulty and resources that promote positive
caring for herself and her baby.25,26 For mental health, help people manage the
more information on mental health during transition to parenthood, build confidence
pregnancy, see The Reproductive Health to parent their child in a positive way, and
in Halton Report. support the healthy growth and
development of their children.
Halton Region Mental Health Report 2018 24Mental health concerns during
pregnancy
From 2013-15, an average of 778 women
per year (13.9% of women who gave birth)
in Halton reported experiencing one or
more mental health concerns during
pregnancy.
For 2013-15 (combined), Halton women
were slightly less likely than Ontario
women to report experiencing one or more
mental health concerns during pregnancy,
experiencing depression during
pregnancy, or having a history of post-
partum depression. However, Halton
women were slightly more likely than
Ontario women to have experienced Figure 9: Percentage of females who gave birth who experienced any mental health concern, depression, anxiety
anxiety during pregnancy (Figure 9). during pregnancy, or who had a history of post-partum depression, Halton and Ontario, 2013-15 (combined).
Data source: BORN Information System [2013-2015], extracted January 2017 (history of post-partum depression data) and October 2016 (all other
maternal mental health data)
Halton Region Mental Health Report 2018 25Mental health and parenting
Figure 10: Reported level
Halton’s Kindergarten Parent Survey asked of stress within the last
two weeks, parents of
parents of kindergarten children a series of kindergarten students,
questions related to parenting stress, as well Halton Region, 2015
as factors associated with positive mental
health like social connectedness.
In 2015, 15% of parents of kindergarten
students in Halton reported feeling very or
extremely stressed out in the last two weeks
(Figure 10). Mothers were more likely to
report feeling stressed compared to fathers,
and parents who were born in Canada were
more likely to report feeling stressed
compared to parents who were immigrants.
There were no significant differences in
reported stress by education or household
income.
The majority of Halton parents of
kindergarten parents reported feeling close to
other parents (82%), taking time for their own
wellbeing (73%), and feeling supported in
parenting by the people in their life (93%) .
of parents agreed or strongly of parents agreed or of parents agreed or
Halton parents who felt close to other agreed that they felt close to strongly agreed that they strongly agreed that they
parents, took time for their own other parents with children take time to care for their feel supported in parenting
wellbeing, and felt supported in the same age own health and wellbeing by the people in their life
parenting were less likely to report
feeling very or extremely stressed.
Data source: Kindergarten Parent Survey, Our Kids Network, 2015.
Halton Region Mental Health Report 2018 26Adult mental health
This section of the report provides a high level overview of several
indicators of the mental health of Halton residents aged 18-64 using data
from the Canadian Community Health Survey. Also included is an
overview of trends in emergency department visits and hospitalizations
for mental illness for adults aged 18-64.
This section starts with Dimitri’s story. His story illustrates how social and
economic factors influence the ability to manage mental illness and how
access to quality and timely health care, social supports, and good
working conditions can improve mental health.
Halton Region Mental Health Report 2018 27Dimitri is a 23 year old man who lives in Within a few weeks of being discharged
The facts
Milton. Dimitri was diagnosed with anxiety from the hospital, Dimitri was successful in ► 9% of Halton adults (18-64) report
and depression a few years ago, but getting a new job. His new employer having been diagnosed with a mood
usually manages his symptoms well with offered a benefits program which helped and/or anxiety disorder
the support of his doctor, family, and other Dimitri to afford his new medication. His ► 13% of Halton adults (18-64) reported
community resources. After losing his job new employer also understood the benefits consulting with a professional about
recently, Dimitri experienced significant of promoting positive mental health for all their mental health in the past year
stress and anxiety about his living employees in the workplace, and offered a ► Having a higher income and being
expenses. His family doctor prescribed a variety of health and wellness activities. employed is associated with more
new medication to help with his symptoms, This positive workplace environment helped positive self-reported mental health
but Dimitri was unable to fill the prescription Dimitri to feel comfortable, connected, and ► Each year an average of 4,178 Halton
as it was too expensive. Too embarrassed well supported. adults (18-64) visit the emergency
to go back to his doctor, Dimitri tried to department for a mental illness, and an
manage without the medication. Although access to timely, quality mental average of 1,101 are hospitalized
health care had a significant positive impact
After several days of not seeing Dimitri on Dimitri’s mental health, many of the
leave his apartment, a concerned factors that influence mental wellbeing fall
neighbour checked in, realized he needed outside of the health care system. Living
some help, and called an ambulance. with limited income can be a significant risk
Dimitri was transported to the local hospital factor for poor physical and mental health.
emergency department. He was briefly In order to influence health and mental
hospitalized in order to stabilize his mental health in a meaningful way at an individual Dimitri’s
health condition. While in the hospital, a and community level, investments need to
discharge planner met with Dimitri to talk strengthen social supports like story
about plans for going home. She referred employment, affordable housing and
Dimitri to an employment program in the education. Additionally, mental wellbeing is
community, designed to support residents influenced by environments that offer
experiencing barriers to finding and keeping opportunities for social connectedness.
a job.
Halton Region Mental Health Report 2018 28Background Workplace
Promoting positive mental health throughout The Halton Region Health Department is mental health
the lifespan is important as throughout our involved in many initiatives that seek to
lives we encounter challenges, stress and improve the conditions of every day life and Workplaces can play an important role
periods of transition which can have an support the mental health of Halton adults in promoting positive mental health, as
impact on mental health. The loss of a loved and residents of all ages, including: they can provide opportunities for
individuals to feel productive and
one, unemployment, illness, struggles with
• Halton’s Community Safety and Well- engaged. However, workplaces can
finances, unstable housing conditions, also be stressful environments, which
isolation from the community and Being Plan – an initiative led by Halton
at times can negatively impact both
experiencing bullying or discrimination are Region and the Halton Regional Police physical and mental health.31
just a few examples of challenging life Services that aims to identify and
circumstances that can negatively impact address emerging issues and trends that The Halton Region Health Department
mental health.29 impact safety and wellbeing together with offers a variety of resources to both
a wide range of community partners. employers and employees on reducing
stress and promoting positive mental
In contrast, factors such as healthy family health in the workplace at
• Supporting workplaces to promote the
relationships, good working conditions, halton.ca.
physical and mental health of employees
positive educational experience,
and their families
involvement in the community, healthy and Mental health promotion in the
active lifestyles, safe and well-maintained workplace benefits both employees
• Reducing social isolation of individuals
housing, and access to supportive services and employers. Psychologically safe,
and families by connecting them with
supportive and healthy environments
like counselling can help improve mental community groups (e.g. Early Years help to promote productivity,
health.29 Program Neighbourhood Groups) performance, job satisfaction, and
reduce employee turnover.32 It can
Actions to improve the conditions of every • Conducting health equity impact also help to support employees with a
day life and foster resiliency when dealing assessments to identify and address mental illness on their journey towards
with life’s challenges can help increase the potential unintended impacts of Health recovery.32
proportion of the population experiencing Department programs, initiatives, and
positive mental health.29,30 activities on different population groups
(e.g. newcomers, low income families).
Halton Region Mental Health Report 2018 29General mental health and wellbeing in adults Being employed and having a higher household income is
associated with better self-rated mental health in Halton.
Among Halton adults aged 18-64 for 2009-2014 combined,
reported their mental reported that most For 2009-14, For 2009-14, self-reported
81% health as very good 26% days are quite a bit or Halton adults mental health increased as
or excellent extremely stressful aged 18-64 household income
who had a job increased among Halton
adults aged 18-64.
reported a somewhat/ reported having been in the last week had higher
65% very strong sense of 9% diagnosed with a mood self-reported mental health
community belonging and/or anxiety disorder than those who did not have
a job or were permanently
reported being reported consulting a unable to work.
95% satisfied or very 13% professional about mental
satisfied with life health in the past year
Some Halton adults find work to be stressful
Mental health and physical health are often linked
For 2009-14 combined, Halton adults (18-64) who rated their physical For 2009-14 combined,
health as very good/excellent were more likely to experience favourable
mental health than those who rated their physical health as good/fair/poor. There were no
1 in 3 Halton adults aged statistically significant
18-64 reported that differences by sex or
most days at work education in workplace
were quite a bit or stress among Halton
extremely stressful. adults aged 18-64.
Halton adults (18-64) in the middle
and high income groups were more
likely than those in the low income
group to report that most days at work
were quite a bit or extremely stressful.
Figure 11: Indicators of mental health, adults aged 18-64, Halton Region, 2009-14 (combined)
Data source: CCHS [2009-2014], Statistics Canada, Share File, Ontario MOHLTC
Halton Region Mental Health Report 2018 30Emergency department visits for Trends over time
mental illness in adults The rate of ED visits for mental illness among Halton males aged 18-64 increased
over the past 10 years, from 987 per 100,000 males aged 18-64 in 2006 to 1,328
per 100,000 in 2015. The rate of ED visits for mental illness increased for Ontario
Differences by sex males from 2007 to 2015. Over the past 10 years, Halton males aged 18-64 have
From 2013-15, Halton males aged 18-64 had a consistently had a lower rate of ED visits for mental illness compared to Ontario
slightly higher rate of ED visits for mental illness than males.
females.
The rate of ED visits for mental illness among Halton females increased slightly
over the last several years, from 1,034 per 100,000 females aged 18-64 in 2010 to
1,120 per 100,000 in 2015. Among Ontario females, the rate has been increasing
1,289 1,122 since 2009. Halton females aged 18-64 have consistently had a lower rate of ED
ED visits per ED visits per
visits for mental illness compared to Ontario.
100,000 males 100,000 females
aged 18-64 aged 18-64
Most common mental illness ED visits
From 2013-15 there were an average of 2,203 ED visits
per year among males and 1,975 ED visits per year
among females aged 18-64 in Halton for mental illness.
The most common mental illnesses resulting in ED
visits were:
1. Substance disorders (788 ED visits per year)
2. Anxiety (422 ED visits per year)
3. Depression (332 ED visits per year)
1. Anxiety(494 ED visits per year)
2. Substance disorders (472 ED visits per year) Figure 12: Age-specific rate of ED visits for mental illness, ages 18-64, by sex, Halton Region and
Ontario, 2006-2015.
3. Depression (404 ED visits per year)
Data source: National Ambulatory Care Reporting System [2006-2015], Ontario MOHLTC: IntelliHEALTH Ontario, extracted June 2017
Population Estimates [2006-2015], Ontario MOHLTC: IntelliHEALTH Ontario, extracted August 2016
Halton Region Mental Health Report 2018 31You can also read
