Some of the most vulnerable children in the province are going without adequate mental health care because the province shut down the one program that was serving them, advocates say.
Until last fall, the Syl Apps Youth Centre (SAYC) in Oakville was providing intensive mental health care for youth involved in the justice system through its secure custody and detention program.
But in September, the Ministry of Children, Community and Social Services (MCCSS) abruptly pulled the kids from its care as it launched a review of the program sparked by “serious concerns” about its operations.
What followed, according to youth advocates, was a string of bureaucratic errors that saw the Doug Ford government shut the secure custody and detention program down entirely in an unrelated cost-saving exercise, leaving nothing to take its place. At the same time, the Ministry of Health boosted investment in another arm of the Syl Apps centre and increased its base funding, praising its help of kids with complex mental health issues.
Irwin Elman, Ontario's former child advocate whose position was terminated by the Progressive Conservative government, said that his former office had received complaints about the programs at Syl Apps.
(Photo of Irwin Elman by Jim Rankin/Toronto Star)
"It's not a perfect place, it never was, I think the government can do many things better in terms of how it serves young people in custody for sure," said Elman. "But that doesn't mean close it, don't replace it with anything else or don't bother to try and improve it."
Now, Elman along with the province’s foremost children’s mental health advocates and organizations are calling the move to close the secure custody and detention program "short-sighted" and want to see it overturned.
The head of the organization that runs the Syl Apps program said she believes the decision to shut it down was rooted in a mistake civil servants made when calculating its utilization rate — and the government hasn't backed down in the face of evidence of the error.
"I’m shocked and I’m dismayed and I’m a strong believer in the value of the public service ... and I find it very distressing that decisions can be made and then the decision-makers get entrenched even when clearly they’ve made a mistake and that they’re not able to put the needs of kids in the youth justice system front and centre," Cathy Paul, president and CEO of Kinark Child and Family Services, told QP Briefing.
Paul said she was informed on March 1 that the secure custody and detention program at Syl Apps, which is operated by Kinark, would lose its funding of approximately $11 million in 60 days.
The program, aimed at youth who came into conflict with the law between the ages of 12 and 17, worked by "secondary referral," said Paul. Youth justice facilities that couldn't meet the severe mental health needs of youth in their care could refer them to Syl Apps. Up to about 90 per cent of youth in trouble with the law have some kind of mental health issue, but about 25 per cent have severe mental illness, said Paul, noting it was the latter group that Syl Apps was treating. Concurrent addictions and developmental issues are also common. About half of the youth sent to Syl Apps had attempted suicide and many who were referred were Indigenous, Black and racialized.
QP Briefing requested an interview with Minister of Children, Community and Social Services Todd Smith, but his office said they are "not able to accommodate an interview this week." In response to questions, MCCSS said a focus on "prevention and community-based programming" has led to an 81 per cent reduction since 2004–05 of youth in custody or detention, and that "this shift has led to a significant underutilization of facilities."
(Photo of Minister Todd Smith by Rick Madonik/Toronto Star)
But the ministry’s statement made no reference to the utilization of the Syl Apps program specifically. And, according to Paul and other advocates who are calling for the program to be restarted, it's on that issue that bureaucrats erred.
In a March 1 letter to Kinark, MCCSS said that as part of "modernizing youth justice services, the government is now taking action to have the right spaces in the right places to address the needs of youth and to improve operational efficiencies." This would mean the "discontinuation of bed space that is underutilized."
But Syl Apps’ program, according to Paul, almost always had a waitlist.
MCCSS funded 24 beds, but licensed 40, through Syl Apps' youth justice program. Paul said this was the root of the mistake — she thinks the civil service based their utilization calculation on the licensed, not the funded capacity.
A March 3 email from David Mitchell, assistant deputy minister of MCCSS's youth justice division, to Kinark said the SAYC "had a utilization rate of 53 per cent of its specific capacity."
Paul pushed back on this.
"I said it’s not 53 per cent, it goes between 75 and 80 per cent, which is as pretty close to full utilization as is possible to have," she said, explaining that utilization was not 100 per cent because space was needed if kids had to be moved to a different unit if the air conditioning stopped working or if they needed to be isolated during the pandemic.
The Syl Apps program was one of 26 youth justice facilities the province decided to close. Paul said while the program lost funding this year, youth were transferred from the facility last fall when MCCSS launched a review of the program.
(Photo by Kinark Child and Family Services)
A Sept. 30 letter to Kinark stated the ministry was "initiating a full operational review of the secure custody program at Syl Apps Youth Centre (SAYC) as a result of serious concerns related to operational oversight" in a few areas.
These included "management of recurring serious incidents including self-harm/suicidal behaviour, contraband, youth supervision and serious occurrence reporting requirements," the "adequacy of search policies/procedures to safely manage a secure custody/detention facility and protect the well-being of youth and staff" and licensing and compliance related to standards under the Child, Youth and Family Services Act.
The ministry added in the letter that "there is no imminent risk to youth safety as a result of the concerns," but that youth would be transferred so that the service provider could focus on the review.
Paul said the "only reasonable reason" to remove the youth would be if there was a safety risk.
An MCCSS spokesperson said the youth were sent to other facilities "the same day the agency was notified of the operational review to prevent their programming from being further impacted. This was intended to support youth receiving the mental health supports and services they may need." The ministry said probation officers notified the youth and their families, but didn't say when.
"They created risk for them by moving them," said Paul, adding that attempts to get more details about the review and the outcome were challenging and that at one point ministry officials "just went dark."
Paul said a ministry official has told her "there were no concerns identified" in the review, but she's been unable to get anything in writing. She called the review a "red herring” because “there are a number of organizations funded by MCCSS that are being subject to these operational reviews … but there were no issues substantiated."
In his email to Kinark, Mitchell said the government's decision to "reduce capacity in the youth justice system was not a reflection on the quality of the service provided by our dedicated transfer payment partners including SAYC, but rather the result of an underutilized system which can no longer be sustained."
An MCCSS spokesperson said the review and the "modernization" initiative "are two separate, unrelated matters."
"This review has been completed, and the final report will be shared with the agency in the near future," the ministry said.
Sixteen youth from Syl Apps were transferred on Sept. 29.
"Within two hours, we had vans pulling up at the door and kids were being transferred," said Paul, noting that most of them returned to the facilities they arrived from and that had referred them to Syl Apps for treatment.
Kinark's board of directors was "outraged," said Paul, and wrote a letter to the government accusing it of breaching standards related to consulting, engaging and planning for youth transfers.
"If one of my clinicians transferred a youth in secure treatment in the way those youth justice kids were transferred, they would be subjected to discipline by their college," said Paul, referring to another treatment program run by Syl Apps and funded through the Ministry of Health.
"Because these kids were all involved in treatment plans, many of them had very serious medication requirements, some of them were medically fragile, and so to transfer these kids with no planning and no consultation was kind of unbelievable actually and the kids were very upset," said Paul.
Transfers between facilities are sometimes used to deal with "troublemakers," said Paul, "so the kids were all kind of going, 'well what did we do?' and 'we don’t want to go.' And so it was a pretty terrible scene and pretty shocking."
Some of the facilities receiving the youth called Syl Apps asking for help.
"In some cases, the kid needed a medication renewal and they didn’t have a psychiatrist coming in for three weeks and so we were shipping medication across the province," said Paul.
Elman, who has been a vocal critic of the Ford government since the child advocate’s office was shuttered and some of its functions were transferred to the provincial ombudsman, called the government's decision "short-sighted." He said that while he's not against finding "efficiencies," the focus should be on people's well-being and that in this case it's youth struggling with mental health challenges that "happened to find them or push them into conflict with the law."
"To not make a decision based on their well-being, but based on money ... it's ironic but it's kind of criminal in itself," said Elman, relating this to decisions the government has made in its handling of the pandemic.
"Perhaps criminal is a very strong word and I don't think I mean it literally that they've broken a law, but people get hurt when you make decisions based purely on economics and not on the well-being of the individual."
NDP critic for mental health and addictions Monique Taylor echoed Elman's concerns.
"We see such a lack of availability for services in all of our communities, so to see any mental health facility for youth being closed down is horrifying," said Taylor, adding that her hope of the government reconsidering its decision "dwindles as each day passes."
She joins a long list of organizations and individuals — CEO of the Wellesley Institute Dr. Kwame McKenzie, former deputy minister and family court judge George Thomson, former deputy minister of corrections John Rabeau and hospital representatives — who have written to the government recently expressing their concern over the decision and urging that the program be funded again, but under the health ministry. Independent Senator Tony Dean wrote in a recent column for QP Briefing that this "would be an important step toward a more joined-up and integrated youth mental health system."
(Photo of Dr. Kwame McKenzie by Lucas Oleniuk/Toronto Star)
Dr. Catherine Zahn, president and CEO of the Centre for Addiction and Mental Health, wrote in an April 19 letter to the government that the program cut means some youth "will no longer have access to treatment that is matched to their level of need. It is inevitable that they be in crisis when they finally (do) get care."
In his correspondence with Kinark, Mitchell, the assistant deputy minister, said he is "confident in the current and expanding range of mental health supports available" to support youth in the justice system including individual plans for youth and access to professionals such as social workers, psychiatrists and psychologists.
Mitchell also noted a program called the Tele-Mental Health Service, which is run by CHEO, SickKids and the Child and Parent Resource Institute. He said it provides "specialist mental health services via video conferencing and other technologies" and that youth can access professionals through a range of services.
But in an April 14 letter to Health Minister Christine Elliott, Associate Minister of Mental Health and Addictions Michael Tibollo and Minister Smith, the presidents of CHEO and SickKids said the program doesn't provide treatment but aims to "build competence and confidence with local, on-site primary care providers via a suite of direct, indirect, and professional development services."
"The program cannot be considered a replacement for the mental health treatment needs or the milieus that is often critical for such high-risk youth," wrote Dr. Ronald Cohn and Alex Munter, adding that youth in the justice system should have the same access to mental health treatment as other youth.
"When they fail to get the help they need, they are at very high risk of landing in hospitals – including at SickKids and CHEO – in crisis," they said. "Longer-term, these untreated or undertreated mental health and addiction issues will have a lifelong impact on the health outcomes of these youth."
MCCSS insisted that all those in youth justice facilities "continue to have access to mental health and addictions supports based on their individual needs." A spokesperson said facilities can access funding for specialized services beyond funding agreements to support youth with complex mental health needs, and noted that it spent $2.5 million on this last year.
In February, just days before it notified Syl Apps of the funding cut for its youth justice program, the government announced funding for more beds in its secure treatment program for youth at risk of harming themselves or others, but who aren't in the youth justice system.
Paul said she believes this was a case of one ministry not knowing what the other was doing, along with the underlying assumption that kids in the youth justice system are “second-class citizens.”
"But if the kids are in the youth justice system in many cases because of their mental illness, isn’t that a huge opportunity for us to change their life trajectory and why is that not something that this government wants to do?" said Paul.
"Youth charged under the Youth Criminal Justice Act continue to have access to secure treatment programs, should they have identified needs and a court order or administrator approval for placement," said the MCCSS.
But Paul said while it is possible for youth who have been found guilty of an offence and are in secure custody to be “given a reintegration leave to access secure treatment, it almost never happens because the process is exceptionally cumbersome and lengthy.”
The Ontario ombudsman's office announced in March that it was investigating complaints related to the closure of two youth justice facilities in Thunder Bay and Kenora, but wouldn't confirm whether it had also received complaints about the closure of the Syl Apps program.
"The Office of the Ombudsman, including our Children and Youth Unit, is in close contact with the Ministry of Children, Community and Social Services about issues involving youth centres, and we are aware of some issues around recent closures," wrote a spokesperson in an email.
With files from Jessica Smith Cross