Long-awaited mental health strategy missing cash or timelines

It was almost three years in the making. It totals 28 pages, including pictures, cover, a few case studies and a couple of blank pages.

Open Minds, Healthy Minds is the long awaited provincial mental health strategy. Whether it ever gets implemented will depend on a fall election and a government’s willingness to expand services in a new era of fiscal austerity.

Ambitious in scope, it comes up short on specifics or even on timelines for implementation of many of the strategies. This was supposed to be a 10-year blueprint. Beyond $257 million over three years for mental health initiatives aimed at children and youth, there is no costing or financial commitment for the rest. In fact, new reporting requirements without administrative support will likely mean some mental health providers will have to divert resources to keep everyone posted on the progress of their unfunded quality improvement plans. OPSEU’s child treatment sector reports “we are already drowning in ‘justifying’ our work with limited support staff.”

Specific and funded commitments include expanding mental health supports in the school system, increased funding for community-based agencies to reduce wait times for children, expansion of telepsychiatry (video counselling) to remote and underserviced areas, and more mental health workers in aboriginal communities, the courts and post-secondary education.

The government also promises to develop performance measures for public reporting of wait times, client experiences and health outcomes – all new administrative work without any matching resources.

The government claims these initiatives will mean more than 50,000 kids and their families will immediately benefit from this strategy even though the funding is supposed to roll out over the next three years. (Curiously when they factor how many children will be supported by each initiative, it only adds up to 47,000.)

Nowhere in the report does it even mention the role of tertiary care mental health facilities, leading one to question why these facilities issued their own press release praising a plan that doesn’t include them. Given these institutions take up 60 per cent of current mental health funding, it is a notable absence.

The question of funding is central to the ambitions in the plan, especially when both the Tories and Liberals have committed to reducing health care spending increases to three per cent per year despite a growing and aging population.

The document makes note of the fact that mental health disability claims have overtaken cardiovascular disease as the fastest growing category of disability costs in Canada. The plan says workplaces should be key partners in the mental wellness strategy – adopting policies and programs that help employees enhance their mental health.

The report gleefully states: “Happier workers, higher productivity and less absenteeism – we all gain from improvements in mental health.” It is interesting the plan suggests the government work with communities and the private sector to deliver education and awareness programs and to develop best practices. Whatever happened to the public sector in this scenario?

It is not clear under a Hudak government how “happy” public sector workers will be as he tries to scale back their incomes, cut the size of the public sector by two per cent per year, make workers insecure in their employment through competitions for their jobs, or interfere in the arbitration process. This flies in the face of the plan’s recommendation to create “attractive career choices and pathways for people who work in mental health and addictions.”

As part of their effort to “create healthy, resilient, inclusive communities,” the plan calls for harmonizing policies to improve housing and employment supports, but nowhere does it actually call for an increase to supportive housing for mental health clients. It does suggest that Ontario “develop policy, guidelines and tools to match health, housing and employment resources to the needs of people with mental health and addictions problems.”

While OPSEU’s own mental health survey indicated a widespread need for workplace training in mental health both for employee wellness and to help respond to clients with mental illness, there is very little beyond a call for training to support family health care providers, teachers and first responders, including police who will receive “sensitivity training.”

The government has also put mental health workers on notice that it intends to develop a competency-based mental health and addictions workforce with standardized roles and responsibilities and scope of practice. There is no detail as to how this would function or affect existing workers in the system, including whether the government intends to provide workplace training.

No McGuinty-era health care report would be complete without the usual tools of accountability agreements, wait time targets, targeted funding increases (unspecified) and integration between providers.

There is no question that transition between providers has been lacking in the mental health system. The report speaks to the need for a client-centered approach, one that “engages the person with mental health addiction needs and includes health services, housing, employment and education, social services and the justice system, if needed.”

Let’s not forget the fragmentation that does exist is largely due to the rush to get services out of hospitals where many of the supports had already been integrated.

The plan does call for a “directory of services” to help families navigate the system as well as a plan to “identify core institutional, residential and community services at the regional and local level.” The government and Children’s Mental Health Ontario just completed a lengthy provincial mapping exercise, raising the question of whether the plan is intended to repeat this work.

In the section “building on our progress” the government admits it has only provided two base funding increases to child and youth mental health in over a decade to “support and expand core services.” Any service that gets only two funding increases in a decade is not expanding core services – it is losing ground.

In terms of leading the strategy, the government clearly sees no role for workers who toil on the front lines of mental health service delivery. Workers are not invited to sit on the Mental Health and Addictions Advisory Council.

While the report puts all the emphasis on community-based care, they acknowledge that St. Joseph’s Health Centre, a West-end Toronto hospital, has been so successful in reducing wait times for mental health visits that it now has the second highest volume of mental health visits in the city. There is no mention in the report as to whether the government is funding these additional volumes, or whether quality is being affected. At the same time, the report sets an objective of reducing “unnecessary use” of emergency departments.

The World Health Organization says governments should aim to spend 8 cents per health-care dollar on mental health. New Zealand spends 10 cents. Britain spends 8 cents. Ontario manages just 5.4 cents. While the $257 million is welcome towards addressing a long standing shortfall in children’s mental health, the money is being spread around to the extent that it may limit its overall effectiveness on any particular agency. Let’s not forget that over the three years the funding starts at $76 million and will rise in year three to $93 million. On a $47 billion health budget, this is not exactly a game changer.

For those looking for supports for the adult population coping with mental illness, Open Minds, Healthy Minds is absent of any actionable items within the next three years. Given the length of time it has taken to come up with this document, it is a bitter pill for adults seeking better to have to wait that much longer.