Meagan Coote thought she was coming down with something when she began feeling sick at school one day. She had just started grade nine and was feeling overwhelmed and a little nauseous but brushed it off as back-to-school jitters. 

KIDS, POVERTY AND MENTAL HEALTH: About this series
A child who lives in poverty is three times more likely to have a mental health problem. Reporter Denise Davy investigates why this happens and what’s being done. Davy’s research was supported with a journalism
fellowship from the Canadian Institutes of Health Research.

PART ONE - Why kids in poverty are at higher risk to developing mental health problems

PART TWO - How Hamilton schools are helping students in lower income neighbourhoods

PART THREE - Anxiety: Why so many children in poverty struggle with anxiety

PART FOUR - Children of war: Healing immigrant and refugee children

PART FIVE - Hamilton’s poor children could be a better place to raise a child poverty

After all, starting high school was a big step for her, since she’d been used to small classes to accommodate her learning disability. Now her classes were twice the size.

As the days passed, she felt more and more overwhelmed until one morning she woke up and couldn’t get out of bed. The crushing feeling she’d been experiencing had crashed down on her.

Her mother tried to coax her out by throwing open the curtains. Maybe some sunshine will help, she said. Meagan implored her to close them. Even the bright lights were too much.

The more she tried getting out of bed, the more overwhelmed she felt.

Anxiety disorder

“I was actually scared to leave my room,” says Meaghan, 16. Her mother took time off work and did crafts with her in her bed.  After several weeks, she called the school who sent a social worker over. Meagan was diagnosed as having a profound social anxiety disorder. “When I thought back, I realized I’d experienced anxiety before,” recalls Meagan.

“I could never speak in public and I was always nervous about going into a classroom with other students because they would pick on us because I was a little slow.”

With the help of her social worker, Meagan began the slow recovery back.

"She started with small things, like having me open the curtains rather than sitting in the dark all day. After that, she got me to go out on the porch,” says Meagan.

Transition help

After about a month, Meagan was able to leave her house. To help her transition back to school, her social worker enrolled her in a school-based anxiety treatment program called Chilled, run by the Hamilton-Wentworth District School Board.

Both the public school board and the Hamilton-Wentworth Catholic District School Board have programs to help students who are experiencing mental health problems,because they recognize that missing schooling for extended periods can set students on a slippery slope.

David Hoy

David Hoy, Manager of social work services for the Hamilton- Wentworth District School Board (Denise Davy)

They also recognize that a higher proportion of students with some type of mental health problem come from lower income neighbourhoods, a statistic confirmed by a 2008 McMaster University study which showed that children and youth who live in poverty have three times the rate of mental health problems than those from non-poor areas.

Much of that is related to poverty-related stressors as well as problems around accessing services. As David Hoy, manager of social work services for the Hamilton- Wentworth School Board, said, “I think the type of (mental health) concerns are similar (as in non-poor areas) but the volume is higher and not just around mental health but around area of needs.”

Indeed, a report by the Hamilton-Wentworth catholic board recognized that children surrounded by poverty-related stressors, like unstable housing, can be more prone to anxiety and depression because they internalize the stress around them.

That’s why many mental health school programs are located in areas where students live. School boards use data from the Early Development Instrument (EDI), a made-in-Hamilton tool that has been measuring school readiness in kindergarten students since 2002. 

EDI data has consistently shown that children in lower income neighbourhoods are at higher risk to falling behind in school. That datareleased to CBC Hamilton for the first time for this series— has played a critical role in the decision-making of school boards, the city of Hamilton and agencies on locating of services in inner city and lower income neighbourhoods.

A prime example of that is the compendium of services located at Sir John A. Macdonald Secondary School, where close to 40 per cent of students come from low income homes.

Where to go for help:

Contact Hamilton - 905-570-8888

COAST (Crisis Outreach and Support Team) — 905-972-8338

Schizophrenia Society of Ontario (family support) — 905-777-9921

Alternatives for Youth (substance abuse issues) — 905-527-4469

Canadian Mental Health Association (Hamilton) — 905-521-0090

The York Boulevard school has become the hub for several health and social programs where a health clinic office in the school acts like a one-stop shopping centre. Students can see a nurse practitioner, public health nurse or social worker as well as an addiction counselor from Alternatives for Youth and a trauma counsellor (for new immigrant students). 

'Instead of having the student go to services, we have the services where the students are.'- David Hoy, HWDSB manager of social work services

Social workers do consultations, make referrals to other agencies, help with short term interventions and assist with accessibility problems.

Basing those services in the school has proven to be effective because it’s the place children and youth spend most of their time.

“Instead of having the student go to services, we have the services where the students are," said Hoy.

“Kids can walk through the door with any issue, mental or physical, and get connected to the most appropriate services. If it’s a newcomer suffering from PTSD (post traumatic stress syndrome) there’s a program for that, and if it’s a student needing addiction services, someone can connect them to it.”

EDI MAPS:

CBC Hamilton is revealing Hamilton's EDI data for the first time. This 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

Hamilton Census Maps

The public school board also began offering a cognitive behaviour-based program for the most aggressive and disruptive children who are at-risk for subsequent substance use and delinquency.

Coping Power is being piloted in select schools and delivered to the whole class in some schools and in small groups with selected students at other schools.

“We target kids who need the program,” said Hoy, adding that some are located in schools in lower income neighbourhoods.

“Poverty makes anything a bit of a challenge.”

Three years ago, the province allocated $220 million to mental health initiatives, with a heavy emphasis to placing those services in the schools. Each school board is hiring a mental health lead to help direct staff to effective evidence-based programs.

'We’ve embraced a view of mental health which is to understand that mental health is a state of balance.'-Michele Bates, mental health lead for HWDSB

Michele Bates, was hired as mental health lead for the HWDSB last year. He said helping students is also about offering preventive programs that encourage resiliency.

“We’ve embraced a view of mental health which is to understand that mental health is a state of balance,” said Bates.

“So while some of our social workers are focusing on kids who are experiencing mental health problems, there are other efforts and energies within the school board trying to help them get healthy and stay healthy.”

Positive Action is an example of that type of program. It teaches positive social and emotional skills to students and was implemented last year in certain Hamilton schools and will be taught in every school by next year.

Bates said social/emotional learning programs like Positive Action are evidence-based and not only proven to promote good mental health in schools but have also shown to help with academic achievement.

Improving performance

One study of more than 200 schools showed that programs which nurtured a student’s social and emotional skills improved student academic performance by 11 per cent.

“So teachers who are using social-emotional learning programs are providing caring classrooms that are emotionally and physically safe. Where students are treated with respect, they get a better sense of belonging,” said Bates.

Jackie Bajus, Superintendent at HWCSB, said they received their share of the provincial funding for mental health programs last June so they’re still deciding which programs to roll out.

Their longstanding program for students with mental health problems is Wilma’s Place, an alternate learning environment that recently relocated from Main Street East to St. Columbia Elementary School.

The school is home to around 130 students, who also include teen moms, homeless youth and those struggling with addiction. Students work on a variety of skills, including cooking.

Bajus said they used EDI data to identify 12 high risk schools where students showed higher vulnerability rates. The majority were located below the Mountain and in the downtown core.

Smaller classes

The board recognizes that many of the students in those areas face challenges because of poverty and have set up various programs to buffer the negative impacts of poverty, including offering free bus tickets and breakfast programs.

They also created smaller class sizes for children who were having difficulty in traditional-sized classes. The results have been positive, especially at At St. Agnes Catholic Elementary School, which is located near Barton and Centennial streets, where they saw EQAO test scores go up.

 Both boards admit they’re not able to meet the needs of all students who need help. As Bates said, that’s simply not possible with a total of 29.1 social workers and 114 schools.

 “It’s not very many when you consider there are 51,000 students and when you think of one in five kids having a mental health problem, that’s over 10,000 students at any one time who are in need of help,” said Bates.