Can Canada’s first mental health strategy really find buy-in from the provinces?

At the very end of the launch of Canada’s first ever mental health strategy, a reporter asked Federal Health Minister Leona Aglukkaq if the government intended to seek uniform mental health services across the provinces.

Senator Michael Kirby jumped in, saying there never has been uniformity. The level of access to services presently varies between provinces. Some will need to do more than others. The gaps were different.

Dr. David Goldbloom, the new Chair of the Mental Health Commission of Canada, said the recommendations were meant to be at a high enough level that they could be shaped by the individual provinces.

The presenters had begun the presentation by describing the strategy in historic terms; the reality became clear by the end that there was a considerable job ahead to sell the provinces on one guiding path forward.

Canada is the last of the G7 nations to adopt a national mental health strategy. Is it really possible to have a national strategy in a policy area that is the jurisdiction of the provinces?

If there was an opportunity to adopt a truly national approach, it was back in January when the provinces were set to negotiate a new health accord with the Federal government. Instead of doing for mental health what the Martin Accord had done for wait times, the Harper government instead told the provinces how much they would receive in health transfers and showed no interest in how the money was going to be spent.

In the absence of any talk of funding the strategy, Aglukkaq instead spoke of the Federal government funding research projects that would run parallel to the work of the Mental Health Commission.

Noticeably absent from the launch of the strategy was any representative of the provinces to suggest there would be buy-in on this plan. That may be because there isn’t buy-in at a level that counts.

Kirby himself has already jumped ship from the Commission, launching “Partners for Mental Health,” an advocacy group separate from the Commission (but none-the-less on their website) intended to provide a “strong marketing effort” to get the strategy implemented.

The report itself speaks about an “unstoppable movement,” but as we have seen in Ontario, it’s more of a stop and start movement.

Our own provincial 10 year strategy was much hyped, took three years to develop, and in the end represented a modest $70 million a year initiative over three years to improve mental health for children and youth. To put that in perspective, that’s about a quarter of what it would take to run one medium-sized regional hospital.

We know Canada is way behind other developed countries in our commitment to mental health funding. In Britain, between 9 and 12 per cent of health budgets are allocated for mental health services, of which the Royal College of Psychiatrists says is not nearly enough.

The World Health Organization estimates the “burden of disease” for mental health and addictions is closer to 14 per cent.

Goldbloom himself noted that mental health will affect more people in Canada than cancer and heart disease combined.

Yet the strategy only seeks to increase funding from 7 per cent of present health budgets to 9 per cent within 10 years. Canada spends about $200 billion a year on health care, but only 70 per cent of that is public. That means the Commission is seeking an increase in public funding of $2.8 billion (in 2012 dollars) over 10 years. Just compare that to the new fleet of F-35 fighter jets which are expected to cost the Federal government $25 billion.

To be fair, the Commission is also asking for a two per cent increase in the proportion of mental health funding that comes from social services – an amount nobody seems to even have a handle on.

Instead the emphasis is on using resources better – haven’t we heard this before? And during the launch, there was repeated reference to the role the private sector is expected to play.

In fact, the Commission explicitly states that they intend to “engage the private and philanthropic sectors in contributing resources to mental health.”

While tepid on the financial ask, there are many good recommendations in the report.

It will be a huge loss to see this report gather dust after five years in development. Kirby wouldn’t be out to market the ideas in the report if he already had buy-in. The question is, can he really succeed?

More on this in the coming days.

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