With Dr. Stacey Bélanger, pediatrician at CHU Sainte-Justine Hospital in Montréal and Mental Health Task Force member at the Canadian Pediatric Society. Young people in Canada aged 12 to 17 say their mental health has declined since 2015, and the decline is more pronounced amongst young women. On top of that, children and youth who are recent immigrants or refugees, racialized, or in rural and remote communities are less likely to get appropriate mental health care.

Think social media pressures, hyper-sexualization, stereotyping, toxic masculinity, bullying, fear of rising abuse and harassment, climate anxiety, and generally feeling left behind. The list of what girls and gender-diverse young people face today is intense. Their mental health and well-being, as well as their sense of connection, belonging, and confidence have been shaken. Their healthy relationship skill development opportunities have taken a hit, too.

How can caring adults in the lives of girls and young people smooth the transition back to school? How can we support improved youth mental health, confidence, and healthy relationships?

Dr. Stacey Bélanger, pediatrician with specialized training in pediatric neurology and a doctorate degree in neurological sciences, joins us. At CHU Sainte-Justine Hospital in Montréal, her focus is on patients with neurodevelopmental and mental health conditions. Dr. Bélanger is also Associate Professor of Medicine at Université de Montréal where she teaches about mental health and mental illness. She authored a book on mental health and has written in peer-reviewed journals on mental health disorders in children and youth. Amongst other roles, she sits on the Mental Health Task Force and Digital Health Task Force at the Canadian Pediatric Society.


00:00:02 Stacey 

And we know that without intervention, the prognosis is poor and there’s a lifelong impact of not treating mental health issues. 

00:00:12 Andrea 

What’s going on for girls and gender-diverse youth in this back-to-school season? And how can we support their well-being and mental health?  

I’m Andrea Gunraj from the Canadian Women’s Foundation. 

00:00:27 Andrea 

Welcome to Alright, Now What? a podcast from the Canadian Women’s Foundation. We put an intersectional feminist lens on stories that make you wonder, “why is this still happening?” We explore systemic routes and strategies for change that will move us closer to the goal of gender justice.  

The work of the Canadian Women’s Foundation and our partners takes place on traditional First Nations, Métis and Inuit territories. We are grateful for the opportunity to meet and work on this land. However, we recognize that land acknowledgements are not enough. We need to pursue truth, reconciliation, decolonization, and allyship in an ongoing effort to make right with all our relations. 

00:01:10 Andrea 

In Canada, 20 to 25% of young people deal with at least one mental health disorder. Young people aged 12 to 17 said their mental health has declined since 2015 and the decline has been more pronounced amongst young women. On top of that, children and youth who are recent immigrants or refugees, racialized or in rural and remote communities, are less likely to receive appropriate mental healthcare. 

Think social media pressures, hyper sexualization, stereotyping, toxic masculinity, bullying, fear of rising abuse and harassment, climate anxiety, and generally feeling left behind. The list of what girls and gender diverse young people face today is intense. 

As of late, young people have had a lot of interruptions at a sensitive developmental age, especially girls and gender-diverse young people with fewer resources. Their mental health and well-being, as well as their sense of connection, belonging, and confidence have been shaken. Their healthy relationship skill development opportunities have taken a hit too. 

How can caring adults in the lives of girls and young people smooth the transition back to school, whether they be a parent, guardian, teacher, coach, auntie, uncle or neighbour? How can we support improved youth mental health, confidence and healthy relationships? 

I’m joined by Doctor Stacey Bélanger, a paediatrician with specialized training in paediatric neurology and a doctorate degree in neurological sciences. She practices at CHU St Justine Hospital in Montreal. Her focus is on patients with neurodevelopmental and mental health conditions. Dr. Bélanger is also associate professor of medicine at Université de Montréal, where she teaches about mental health and mental illness. She authored a book on mental health and has written in peer reviewed journals on mental health disorders in children and youth. Amongst other roles, she sits on the Mental Health Task Force and Digital Health Task Force at the Canadian Paediatric Society. 

00:03:14 Stacey 

So, the Canadian Paediatric Society, as I said, is the national association of paediatricians, and child and youth mental health is a priority. I have to say that I have no financial or industry relationships to disclose. Well, my first interest and hobby, of course, is looking after children, caring for children. But I’m also interested in architecture-related hobbies: sketching and photographing the city and buildings has always been – and interior design – have always been a passion of mine. And as a result, I also am a collector of coffee table books. So, I collect chic coffee table books and still rather flip through bound volumes than scroll through Instagram and look at these books. I’m thinking of actually launching my own collection based on the photos that I’ve taken and my travels over the years. So they’re great also if you have limited wall space because they’re easy to sort of stack and accumulate. But I have to say because of them I’ve accumulated a lot of tables over – living room tables – over time because I’ve had to have more and more room for my coffee table books, so I’ve had to get bigger and bigger tables. 

00:04:21 Andrea 

Now a lot of people are talking about worsening mental health for girls and young people, but can you help us understand the basics of mental health for young people? 

Why is it important? What does it mean? And how about young people who might be at higher risk? 

00:04:35 Stacey 

It’s very important to talk about mental health, because children’s and youth’s mental health is sort of the foundation on which they build their future lives. It’s really up to us as parents, as caregivers, as educators in schools, in daycares, and also up to policymakers who can help influence the outcome and to ensure that youth have every opportunity to achieve the mental health status that will enable them to become successful members of society, contributing members to their families and their communities and to their nation.  

We know for a fact that one in five Canadian children and youth, and that’s about 1.2 million, will experience a significant emotional, behavioral and/or mental health issue. Only one in three of these children or adolescents will receive the services they need.  

We also know that the consequences of untreated mental health illness are profound. We have school failure, we have increased risk for substance abuse, we have unstable employment as a young adult, suicide, and very, sometimes, poor medical outcomes. 

And we know that when a child or a teenager has mental health issues that we cannot, we do not have a lot of time to wait, because if we wait, they will get worse and they will end up in an emergency department. They may be hospitalized in paediatrics or they may be hospitalized in some cases in psychiatry. And we know that without intervention, the prognosis is poor and there’s a lifelong impact of not treating mental health issues. 

Especially, we know that the majority of mental health conditions or diseases reported in young adults actually start in childhood and during adolescence. Having accessible evidence-based treatment can help mitigate some of these long-term disabilities, support academic and occupational success. Now, in general, children and youth across Canada have struggled unfortunately, to access quality, affordable and accessible paediatric mental health services for decades. 

It’s true that during the pandemic there was an increased demand for mental health services and we saw a decline in youth’s mental health – increased eating disorders, stress, anxiety, depression, suicide attempts. It’s multi-factorial but it was mainly associated with the lack of supportive activities.  

We know that it wasn’t just during the pandemic, we see these difficulties that are persisting in time. And actually Canada, once ranked tenth among affluent countries, has fallen to 30th place for protecting the well-being of children, according to UNICEF. Unfortunately, we are going in the wrong direction. Raising Canada is an annual series of reports that track the top 10 threats to children and adolescents. Poor mental health is amongst the 10 threats, as are bullying, child abuse, limited physical activity and play, climate change, etc.  

Equity-deserving children and youth are facing the greatest impacts from the pandemic – young First Nations, Métis, Inuit children, youth from racialized communities, gender-diverse youth and also young people with disabilities. Those living in rural or remote communities are even less likely than their peers to receive appropriate mental healthcare and are more likely to use services like emergency rooms when there’s a crisis. 

Girls, definitely during the pandemic, were more negatively impacted than boys. But even before the pandemic, depression, anxiety, stress, eating disorders were at least twice as common in girls than in boys. Gender differences that begin after puberty and continue into adulthood… and there’s many sort of hypotheses as for the possible reasons for the higher mental health burden in girls compared to boys – greater exposure to adversity, violence, assault, more loneliness, lower self-esteem and acknowledge also the difficulty of acknowledging emotional distress or talking about it. 

With all the barriers, there are also significant financial costs associated with accessing mental healthcare in Canada that further exacerbates the inequities in access, particularly for families with no or inadequate private insurance coverage. So those that have private insurance coverage can access quickly, mental health services and evaluations, for example, from psychologists or have support from psycho educators. 

So the current paediatric mental healthcare system, it’s complex, it’s costly, it’s fragmented, and there’s inadequate government funding in general. We just had the federal mental health transfer that was cancelled for paediatrics. As a result, there’s a lack of access in general to what we call multidisciplinary teams because mental health involves many professionals, not only physicians. There are longer, long waiting lists, very long waiting lists. And as mentioned, disparities in the access along rural, Indigenous, racialized and economic divides. 

Vulnerable populations, you know, children that are said to be neurodiverse or children that are gender-diverse or transgender, in general, despite the fact there have been sort of an increased in the rights and visibility of these minority groups, thanks to the endurance of generations before them. In spite of this, they still face higher rates of negative mental health outcomes, depression, anxiety, suicidal ideation, eating disorders, self-harm behaviors… Just the fact of being different or being a minority group often leads to stigma and we know that over time the stress and stigma get internalized and often lead to a feeling of inferiority, invalidation, feeling unsafe and of course this has long term health deficits and morbidity also. 

00:11:10 Andrea 

What can we do to help girls and young people improve their mental health? 

00:11:13 Stacey 

There are many things that we can do as families, that educators can do, that professionals like physicians can do, and other types of professionals, to promote protective and resiliency factors. It takes a team to promote mental health. Schools are very important. So school-based mental health programs that have multidisciplinary teams are sort of a thing of the past – we don’t see it because of budget cuts in education, we don’t see that anymore. It’s very important to have these teams because we know teenagers feel more comfortable and are more likely to seek behavioral and emotional health support when its school-based services are available. When you provide the mental health support to youth in the schools, it increases academic performance, there’s increased engagement in academic activities, an increase in improved school attendance and in general, better mental health.  

Parents need to be involved. Families need to be involved. We need to open the discussion about mental health. We need to know what our children and our teenagers are doing so that we can support them in any way we can. And of course, there’s paediatricians and family doctors. They are actually critical in the management of mental health conditions and in the screening of mental health difficulties and emotional difficulties, because we are sort of in the front line and we recognize mental health concerns in children and in youth because we see them, we see them more often. We also have a role in building relationships with mental health specialists, including school-based providers, to identify and to provide emergency care to youth who are at risk and to minimize the morbidity that comes with mental health, mental health problems. 

Community involvement and support groups in the community for families who are vulnerable. Because when we have children who are vulnerable for mental health conditions, we know that a lot of these mental health conditions are very complex, and there’s often an interaction between genetic factors and environmental factors. So a lot of them also have caregivers who are also suffering from mental health difficulties and may not be in a position to help their children or their youth, if they themselves are in need of help. 

00:13:40 Andrea 

Can you share some more concrete and everyday mental health improvement tips for young people? 

00:13:45 Stacey 

We talk about lifestyle interventions. We talk about having good nutrition. We talk about physical activity, exercising. We talk about having good sleep hygiene. So, these are sort of the basics that we shouldn’t forget.  

And then there’s more specific sort of targeted treatments that we can access. Psycho-education – understanding the factors that may relate to a specific mental health condition, the diagnosis, and what is the anticipated course of treatment. So we have to work together with the families and with youth as teams to sort of set the building blocks that are essential for promoting good mental health.  

I would say that another area that parents need to get involved is looking a little bit about their children and their use of screens and social media. The US Surgeon General and the American Psychological Association and many other groups, including the Canadian Paediatric Society, sounded the alarm about the risks of social media. Permanence, a 24/7 availability of social media – these are huge risk factors for mental health. 95% of teenagers report using some form of social media and about 1/3 say they use it all the time constantly. Studies, long term studies, have shown that it will lead to unhealthy behaviors, it will lead to mood changes, and it will lead to eventual mental health difficulties. 

Self-esteem can be affected if the child or a teenager sees what friends are doing in real time and they’re being excluded. There’s also the risk for obviously for cyber bullying and sexual exploitation, and there are other risks. Social media also is linked to sleep disruption. It has been linked to negative body images and increased risk for anxiety and depression in youth, and especially in teenage girls. So teenage girls, in particular, the negative self-images can be brought on by sort of the weight loss ads that we can see, pictures of influencers with often edited and filtered figures, and even cyber bullying can trigger restrictive eating habits and significant health risks. 

A lot of these behaviors are involved in the frontal lobe, in the prefrontal cortex, so those are very important parts of our brain that are responsible for emotional regulation, what we call risk versus reward, type of behavior, and for controlling impulses. And this part of the brain is not fully developed until late adolescence, I would say even in the early 20s, so teenagers are particularly vulnerable. You have to have conversations openly with your teenagers about these risks, just like you would have conversations about drugs, alcohol, other unhealthy behaviors with your teenagers, you can talk with them about social media. So these discussions have been shown actually to be very helpful in reducing these type of behaviors and the stigma around asking for help when it comes to drugs and alcohol use. And the same type of tactics have actually, can be applied to the use of social media.  

We also tell parents to sort of be informed. Check in on how the teenager is feeling when he’s on social media. What is the impact that it’s having on them. And you can have sort of a routine like a family dinner routine where everyone, including the parents or the caregivers will share one positive and one negative thing or experience that they actually experienced through social media that day.  

And it’s very important to set rules. Parents set rules about other types of behaviors. We can set rules and limits around social media for the whole family actually and the Canadian Paediatric Society and the Digital Health Task Force have, on their Caring for Kids website, information for families on how to develop what’s called a Family Media Plan – having rules that involve a routine that are modeled by all members of the family about when, where and why screens are used, including social media. 

00:18:04 Andrea 

Some members of the Canadian Women’s Foundations community sent us questions about the fact that girls self-confidence tends to plummet around age 9. They want to know how we can help stop that self-confidence drop or at least help girls deal with it. 

00:18:18 Stacey 

One sort of challenging part of this journey is building your self-confidence and developing sort of a healthy self esteem. So self-esteem is: How much do you like yourself? How much do you respect yourself? It’s all about appreciating who you are and your importance in this world and also taking responsibility for who you are, your decisions, your actions and showing respect and care for others. If you have good self-esteem, it helps you believe in your values, it helps you make healthier choices, manage your stress and your interactions with others.  

When teenagers or teenage girls suffer from low self-esteem, it’s not always obvious for families, the signs can be different depending on the individual. So sometimes it can include having negative thoughts or self-talk, feeling sort of deprived, having a low opinion of oneself, avoiding social situations, having negative emotions like feeling sad, having difficulties concentrating on school work, on academic work, fear of failure, fear of judgment from others… What we usually tell caregivers and some of the ways to improve, help your teenagers improve their self-confidence and self-esteem, first of all, basic things: Show them lots of love and acceptance. It does start from home, because children are not born with self-esteem, they develop it. Praise their achievements. Providing structure, providing routine. It’s key and it’s critical. It’s where teenagers will feel secure. They have to feel safe. They have to feel nurtured and it’s where they have the chance to rest, to play and to sleep. So providing a healthy home environment will help them develop also a healthy self-esteem.  

We also tell teenagers when we speak with teenagers to take care of themselves. To prioritize self-care, right? By ensuring that, again, I go back to the basics, they get enough sleep, they engage in regular physical activity, and they have good eating habits. Another thing we can tell our teens is to find something that they’re good at, focus on their strengths rather than comparing oneself to others because we’re all different, we’re all very unique. Embrace your uniqueness, accept and also understand that there’s some things that you will do that you will be very good at and there will be things that you will do that you’re not as good as others are. And that’s completely normal. And practicing positive self-talk: when you have these negative thoughts, try replacing them with positive thoughts. Be kind to yourself and practice self-compassion, that will be true for everybody. 

And also surround yourself with friends with people that love and support you. Make sure that your friends are people that make you feel good about yourself. And again, participate in activities, whether alone or with social activities that bring you happiness, joy ,and that build your self-confidence. 

00:21:20 Andrea 

Alright, now what? I encourage you to give to the Canadian Women’s Foundation this fall as we are raising funds for girls and gender diverse youth across Canada. Your gift will go directly to programs that bolster mental health, emotional well-being, and confidence, teach young people about healthy relationships and consent, provide cultural and community connection, offer mentorship, give participants opportunities to safely explore science and tech and math, sports and physical activity, media literacy and community leadership, and provide positive inclusive spaces where girls and gender diverse youth can thrive. 

Go to canadianwomen.org to give now. 

00:22:00 Andrea 

Please listen, subscribe, rate and review this podcast. If you appreciate this content, please consider becoming a monthly donor to the Canadian Women’s Foundation. People like you will make the goal of gender justice a reality. Visit canadianwomen.org to give today. 

And thank you for your tireless support.