“No coherent system” – All party committee recommends changes to mental health care

An all-party committee of Ontario MPPs has released its report on mental health after 18 months of deliberations. With all party support, will the recommendations contained within be incorporated into a larger mental health plan for the province?

Entitled “Navigating the Journey to Wellness: The Comprehensive Mental Health and Addictions Action Plan for Ontarians,” the surprisingly compact report (it’s only 21-pages plus appendices) recommends a number of significant changes.

Looking at the Cancer Care Ontario model, the report recommends a similar coordinating agency be established: Mental Health and Addictions Ontario (MHAO). The new agency would be responsible for designing, managing, and coordinating the mental health and addictions system, with responsibility for ensuring programs and services are delivered consistently and comprehensively across Ontario.

Given the unequal geographic distribution of mental health services, the committee recommends MHAO should conduct an assessment of the need for acute care psychiatric beds for both children and adults by region.

This might start by placing a moratorium on any further bed cuts. Ontario is already below its divestment target of 35 beds per 100,0000 residents, yet we are continuing to see further bed cuts proceed under the misguided illusion that we don’t need beds at all.

The Select Committee on Mental Health and Addictions paints a disturbing picture of Ontario’s shortcomings in providing care:

“In general, Ontarians wait too long for treatment. Youth are caught in the gap between programs for children and adults, repeating their case histories to a series of unconnected service providers. First Nations people struggle with above-average rates of mental illness, addictions, and youth suicide owing in part to a history of poverty and consequences of residential schooling. Francophones are misdiagnosed because they are not treated in their first language. Linguistic and cultural barriers may also affect newcomers and refugees. Seniors unnecessarily languish with depression, often undiagnosed, while society as a whole must face what has been called the coming tsunami of Alzheimer disease.”

The report suggests that about one in ten people suffer from highly treatable, yet overlooked, conditions such as anxiety disorders.

The committee also recognizes something OPSEU has been saying for years: “community support” often means that an individual is cared for by a stressed, over-burdened family struggling along without assistance.

This was a theme raised in the committee’s interim report. If Ontario was to maintain a divestment target of 35 beds per 100,000 residents, 60 per cent of mental health funding would have to be community-based.

According to a 2008 Ontario auditor report, the province only spent $39 on community-based services for every $61 spent on institutionalized care – a statistical indictment of the province’s rational behind ongoing bed cuts.

Further, the report acknowledges that the community-based care that does exist is uncoordinated.

“One of the main problems in Ontario’s mental health and addictions system is that there is, in fact, no coherent system,” the committee acknowledges.

Mental health and addictions services are delivered by 440 children’s mental health agencies, 330 community mental health agencies, 150 substance abuse treatment agencies and 50 problem gambling centres.

“Many people simply fall through the cracks, or give up in frustration because of the complexity of the system,” the committee writes.

The health minister may want to think long and hard about this given the rest of the health system is also being pushed into a similar fragmented environment.

The report calls for the new MHAO to ensure that a basket of core institutional, residential and community services is available in every region of the province for clients of all ages, identify gaps, and eliminate duplication.

What’s missing in the report is any estimate on what it would cost to implement its recommendations. Given the government’s penchant for tax cuts over new health care spending, it will be interesting to see if this report gathers dust or whether we are likely to see a long overdue investment in mental health care.

 More on this to come in the next few days.

One response to ““No coherent system” – All party committee recommends changes to mental health care

  1. Let’s hope our Minister of Health, Deb Matthews listens, comprehends and initiates a game plan to enhance services for community mental health. She should ensure that an immediate moratorium is in fact implemented to stop mental health bed closures. We need to investigate and identify what services are effective and contributing to societies most vulnerable members, supporting their individual needs. We need a realistic and attainable game plan to be initiated in the forseeable future.

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