Ontario moved another step closer to its much talked-about 10-year mental health strategy when the Minister of Health’s advisory group released its report just prior to Christmas.
The road to Ontario’s 10-year mental health strategy has been a lengthy one. In October 2008 then Health Minister David Caplan established the advisory group to recommend how the province could improve mental health and addiction services. It released a discussion paper, Every Door is the Right Door, in July 2009. An all-party select committee of MPPs also worked on its own recommendations, released in August 2010 as Navigating the Journey to Wellness: The Comprehensive Mental Health and Addictions Action Plan for Ontarians.
December 20 the final recommendations of the original advisory group were released in a slim 45-page report: Respect, Recovery, Resilience: Recommendations for Ontario’s Mental Health and Addictions Strategy. The government’s final plan is expected in the spring of 2011 – two and a half years to establish a 10-year strategy.
Work on the 10-year strategy was also contracted to a private consultancy firm and subject to comment last fall by the office of the Auditor General of Ontario. The auditor noted the first two phases were contracted without competition. The third phase was put out to competition and awarded to the same company despite the fact that it was the highest bidder at $819,000. The scope of the work was reduced to bring the bid price to $495,000, still well above the budget of $375,000.
How much of the advisory group’s recommendations will be used in the final plan is an open question given it differs substantially from the MPPs recommendations.
The slim 45-page document gives little detail despite some very significant recommendations.
Unlike the MPPs report, which calls for a centralized administrative model similar to Cancer Care Ontario, the Minister’s working group is recommending the creation of a much more limited Mental Health and Addictions Council which would have “clear authority and resources” to set the pace of implementation, develop guidelines and standards that reflect all “human services,” and promote quality improvement. This Council would report to the Ministry of Health and Long Term Care. It would include representation from a broad base of sectors, including children’s and youth services, justice, municipalities, school boards, Local Health Integration Networks (LHINs), hospitals, physicians, and community mental health and addiction services.
The Advisory Group is also silent on many of the recommendations made by the MPPs, from the need for system navigators to increasing the number of mobile intervention teams. Whereas the MPPs recommended the need to do an assessment on the need for acute care psychiatric beds for both children and adults by region, the Advisory Group totally ignores any question of beds or tertiary care hospitals. In its diagram of how the new system will work, there is no specific reference to tertiary care hospitals.
The report is also silent on the issue of moving children’s and youth mental health to the Ministry of Health and Long Term Care.
What is striking about the report is the lack of evidence to support the changes they are recommending, or any indication that other options were examined.
Given the low key release at a time of year usually used to bury embarrassing details – such as the Ombudsman’s mini-report on long-term care – it is possible the government may be working on a different track altogether.
The advisory group does make a number of recommendations around human resources planning, including a review of current remuneration levels with the sector along with an implementation strategy to address inequities. While the report doesn’t indicate what those inequities are, there is no question that many small non-union agencies have difficulty attracting and retaining skilled workers at low levels of pay.
They also are calling for a more culturally diverse workforce, hiring more peers support workers, and for an increase in training aimed at existing workers, particularly around early identification and intervention and concurrent disorders.
The one profession it specifically calls for more of is mental health youth court workers.
The report acknowledges that Ontario spends less than “most other G8 nations.” Given the present period of restraint, the group suggests we may not be spending what we have “in the right way.” While it makes many sweeping and expensive recommendations – such as increased OHIP compensations for family doctors, widespread anti-stigma programs covering everyone from front-line health care workers to employers and landlords – it never addresses what any of this will cost.
The working group also recommends a new Assistant Deputy Minister (MOHLTC) who is dedicated to implementation of the 10-year strategy.
There is clear emphasis on fulfilling the promise of funding community-based mental health services, a promise that has met much scepticism given the recent track record in Ontario. Recommendations include extending the hours of community-based agency work from 7 am to 11 pm.
The report calls for more standardization, particularly around intake and assessment, more measuring of outcomes, and the establishment of wait-time targets for mental health services.
The report puts considerable emphasis on this being an all-government initiative. There is strong buy-in on social determinants, which would touch on such issues as poverty, housing, and education.
To view the full report, go to: