Drummond report mostly ignores mental health despite the high cost of doing nothing

The McGuinty government says they are committed to implementing about half of the recommendations from the Drummond Commission on the Reform of Public Services.

The other half will be subject to study (read: likely to drift away into the ether).

In health care most of that should be relatively easy given a significant number of Drummond’s 105 recommendations are already in the McGuinty government’s plan, from the implementation of a new funding formula for hospitals (Health-Based Allocation Model) to his endorsement of the government’s sketchy mental health strategy.

Given the recommendations are intended to be implemented over the next four years, it may take some time to ultimately figure out what is really in and out.

Commission head Don Drummond recognizes the high cost of mental health to Ontario, noting the Ministry of Health’s estimates a cost of $39 billion annually, about three-quarters of that representing lost economic productivity.

Given this high cost, his recommendations are remarkably few and mostly cribbed from the province’s 2011 Open Minds, Health Minds mental health and addictions strategy.

Drummond does support the idea of a coordinating body for mental health similar to Cancer Care Ontario. The Commissioner recognizes in his report that mental health and addictions services are funded or provided by at least 10 different ministries.

Fiscally Drummond wants to cap nominal growth of health care spending to 2.5 per cent per year, but suggests that this increase should not be applied uniformly. Instead he recommends more be channeled into community care and mental health.

Keep in mind that 2.5 per cent is the present rate of inflation. Add in the costs of aging (0.8%) and population growth (1%) and its apparent the “growth” in funding actually represents a real cut. Addressing long-standing grievances in mental health funding will be very difficult in such an environment.

The unreality of Drummond’s report also includes a lengthy shopping list of items while under extreme restraint. In addition to spending more on mental health and community care, Drummond wants the province to upload public health costs from the municipalities, expand the LHINs, accelerate costly e-health initiatives, establish numerous coordinating bodies and create a long-serving commission to guide reforms. He also wants to expand the scope of Medicare coverage in Ontario, including “aspects” of mental health.

In other words, don’t hold your breath for a significant reinvestment in mental health services. Premier Dalton McGuinty tipped his hat in this direction during the provincial election, in which he stated new funding for adult mental health services would not come until after 2014, and at that, be limited to a paltry $40 million per year.

Even if Drummond recommends increases to mental health funding, it won’t necessarily translate to more mental health agencies providing front line care. The Commission complains that there are more than 2,500 funded health organizations in Ontario, making it difficult for the Local Health Integration Networks to broker relationships between them. Given many of these agencies are providing mental health services, it is likely there will be much more consolidation particularly within the community sector.

He is more specific in his recommendations for child and youth mental health services, calling for them to consolidate and integrate both within their own sector as well as within children’s services, health, education and youth justice.

Hospitals may once again come under pressure to cut loose mental health services they have developed in the community. This makes little sense given these services are run efficiently, respond to community need, are far more accountable than their private sector counterparts, and have a strong link with other hospital services. Drummond believes community-based hospital services, such as Lakeridge Health’s Pinewood Centre, should be instead delivered by the private sector.

“Hospitals should conduct affairs largely within hospitals,”* he writes.

It’s notable that while Drummond creates groupings of health care recommendations, there is no real mental health section in the report. This may suggest that both McGuinty and Drummond are seeing mental health as little more than a footnote in their plans.

Given the absence of mental health services is costing our economy $39 billion a year and impacting the lives of so many Ontarians, you would think that this would be a greater priority.

(*) Drummond contradicts this edict by lamenting the fact that hospitals have pulled back on public health functions such as diabetes counselling, suggesting there should be more coordination of public health functions between hospitals, community care providers and public health units.

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