Abstract
Background
Mental disorders affect 14% of children, cause significant long-term disability and are arguably the leading health problems that Canadian children face after infancy. Treatment services alone cannot meet children’s mental health needs. In addition to treatment, prevention programs hold potential to reduce the number of children with disorders in the population. Effective programs exist for preventing conduct, anxiety and depressive disorders, three of the most prevalent disorders in children. Therefore, we investigated the state of Canadian programs in comparison with prevention programs described in the literature for these three disorders.
Methods
We identified children’s mental health and early child development (ECD) programs across Canada with national or provincial/territorial scope and significance and with potential relevance to mental health. We then interviewed policy-makers to determine which programs included goals related to mental health, and incorporated key features from programs known to be effective for preventing the three disorders of interest.
Results
No prevention programs specific to children’s mental health were identified. However, 17 ECD programs incorporated generic goals related to mental health and incorporated key features seen in effective prevention programs. Only Ontario’s Better Beginnings, Better Futures (BBBF) explicitly included mental health within its major program goals, incorporated multiple features seen in effective (conduct disorder) prevention programs and demonstrated positive child mental health outcomes.
Discussion
The lack of Canadian prevention programs specific to children’s mental health is concerning. ECD programs have the potential to improve child mental health outcomes within their wider mandates. BBBF is an exemplar for such programs. However, new investments in implementing (and evaluating) programs that specifically aim to prevent mental disorders are required to improve the mental health of children in the population. Preventing children’s mental disorders must be a Canadian public health priority.
MeSH terms: Primary prevention, mental disorders, public health, health policy, infant, child
Résumé
Contexte
Les troubles mentaux touchent 14 % des enfants, ils sont la cause d’importantes limitations fonctionnelles de longue durée, et l’on peut soutenir qu’ils sont les principaux problèmes de santé auxquels les enfants canadiens sont confrontés après la première enfance. Les services de traitement à eux seuls ne peuvent répondre aux besoins de santé mentale des enfants. Il faut y ajouter des programmes de prévention, qui offrent la possibilité de réduire le nombre d’enfants présentant des troubles dans la population. Il existe des programmes efficaces pour prévenir le trouble des conduites, l’anxiété et la dépression, trois des troubles les plus courants chez les enfants. C’est pourquoi nous avons examiné la situation des programmes canadiens, que nous avons comparés aux programmes de prévention décrits dans les articles de recherche sur ces trois troubles.
Méthode
Nous avons répertorié les programmes de santé mentale et de développement du jeune enfant (DJE) disponibles au Canada; ces programmes devaient être d’envergure et d’importance nationale ou provinciale-territoriale, et susceptibles d’exercer une influence sur la santé mentale. Nous avons ensuite interviewé des décideurs afin de déterminer lesquels de ces programmes comportaient des objectifs liés à la santé mentale et lesquels intégraient des éléments clés des programmes prouvés comme étant efficaces pour prévenir les trois troubles qui nous intéressent.
Résultats
Nous n’avons trouvé aucun programme de prévention portant spécifiquement sur la santé mentale des enfants. Toutefois, 17 programmes de DJE comportaient des objectifs généraux liés à la santé mentale et intégraient des éléments clés présents dans les programmes de prévention efficaces. Seul le programme ontarien « Partir d’un bon pas pour un avenir meilleur » incluait explicitement la santé mentale dans ses grands objectifs, intégrait de nombreux éléments que l’on retrouve dans les programmes de prévention efficaces (contre le trouble des conduites) et avait manifestement donné des résultats positifs sur le plan de la santé mentale des enfants.
Discussion
L’absence de programmes de prévention canadiens portant spécifiquement sur la santé mentale des enfants est préoccupante. Les programmes de DJE, dont le mandat est plus vaste, pourraient améliorer la santé mentale des enfants. Le programme « Bon pas » en est un exemple. Cependant, si l’on veut améliorer la santé mentale des enfants dans la population, il faut investir de l’argent frais dans la mise en oeuvre (et l’évaluation) de programmes visant spécifiquement à prévenir les troubles mentaux. La prévention des troubles mentaux chez les enfants doit être considérée comme un besoin prioritaire en santé publique au Canada.
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