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Daphne Penrose, the Manitoba Advocate for Children and Youth, is seen in a March 12, 2019, file photo.

JOHN WOODS/The Canadian Press

A review by Manitoba’s children’s advocate who looked into the suicides of 22 girls found consistent gaps and barriers that made it difficult for young people to get help.

“Children deserve better and the government must begin responding in meaningful ways that demonstrates its understanding of the short- and long-term costs of inaction,” Daphne Penrose wrote in her report, which was released Thursday.

Suicide is the leading manner of death for young people 10 to 17 years old in Manitoba. In the past five years, 79 youths have killed themselves, an average of nearly 16 each year.

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“That means we are losing on average more than one child or youth each and every month to suicide,” Ms. Penrose said, adding that the province’s mental-health programs are not child friendly.

She said they have long wait lists and put the onus on children and their families to hold it together before getting help. There are not enough programs to intervene early when it’s clear children have experienced trauma such as family violence.

Ms. Penrose said it’s clear “the adult system currently has the eye of the government” and funding for youth is being used elsewhere.

Her review looked at the risk factors of the 22 girls, most of whom were Indigenous and lived large portions of their lives in rural or isolated communities.

“The fact is that the quality and effectiveness of health services depends on where a child lives in Manitoba,” Ms. Penrose said.

The girls’ real names were withheld for privacy reasons. More than 90 per cent of them had parents or caregivers who abuse drugs or alcohol, 86 per cent had a history of suicidal ideation, 82 per cent were in unstable housing and 77 per cent experienced violence at home. Sixty-eight per cent had also been bullied.

While most of the girls had long histories with child-welfare agencies, they received little substantive support or effective intervention.

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One girl, called Gabriella in the report, died at 17. Her life was spent in and out of child welfare as her parents struggled with addictions. There was also physical abuse in the home.

The report says she was a good student who enjoyed extracurricular activities.

Gabriella became a permanent ward at 13. That’s when she began to hurt herself and was referred to a therapist. Later, she would disclose she’d been sexually abused.

As time went on, Gabriella attempted suicide multiple times and had short stays in hospital. She was always discharged with a plan, but the responsibility to follow through was on her. Her final discharge plan included crisis numbers and instructions to reach out. Gabriella took her own life the next day.

A girl called Andrea died by suicide when she was just 11 and after she had finished Grade 6. She was exposed to a number of risk factors for suicide, but received no documented support despite evidence of mental-health challenges as early as age 7.

“With the government’s lack of action on early trauma, some children in our province continue to carry immense pain from one day to their next with little or no support, intervention, engagement, or healing,” Ms. Penrose said.

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The report has seven recommendations, including ensuring equitable access to services and mandating early childhood trauma education for service providers.

Health Minister Cameron Friesen said in a statement that the province will consider the recommendations. He pointed to government funding for mental-health services for youth and children.

“We are committed to working together with organizations, communities and families to help improve the lives of our children and youths,” Mr. Friesen said.

Bernadette Smith, the provincial NDP’s mental-health critic, said in a statement that it’s “no surprise that the most vulnerable and disadvantaged kids – young people in the North – are unable to access much-needed supports and services.

“The government’s patchwork approach to programs and one-time funding model doesn’t benefit kids, youth, and families in the long term.”

The Manitoba Liberals said it’s been clear for a long time that the province has a weak mental-health system and more needs to be done.

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