CMHA, Ontario submission to the Ministry of Children and Youth Services supporting development of their Mental Health Policy Framework for children and youth. The Framework should describe a continuum of services and include in its principles the need for intersectoral collaboration and cross-ministerial coordination. (October, 2005)
The Canadian Mental Health Association, Ontario (CMHA, Ontario) welcomes the opportunity to provide comments on the proposed Child and Youth Mental Health Policy Framework Background Document.
CMHA, Ontario is a provincial association, committed to improving services and support for individuals with mental illness and their families, and to the promotion of mental health in Ontario. We have 33 branches providing community mental health services throughout Ontario. A number of our branches provide services to children and youth. The Ministry of Children and Youth Services funds several of these programs. Many of our branches provide services to transitional age youth, from 16-18 years of age, through counselling, case management, suicide prevention and early psychoses intervention.
We support the Ministry of Children and Youth Services’ plan to develop a children and youth mental health framework. It is essential to create a vision for this policy framework that goes beyond the Ministry’s generic mission statement. In Ontario, there is presently no legislation, mandate or policy framework to specifically address children and youth mental health. Services are currently provided by a myriad of service providers and sectors with no overall vision or mechanism for integrated planning and coordination.
The vision should describe a future state where the Ministry of Children and Youth Services provides leadership in ‘intersectoral collaboration to support a continuum of services that support the mental health of children and youth in Ontario’. The vision statement should be a rallying call for coordinated action.
The proposed guiding principles in the Background Document identify many tenets and assumptions to guide the planning of future directions and services. The list is long and prescriptive. There is some repetition. It is suggested that the final list be pared down and revised, based on feedback received during the Ministry’s consultation process on the policy framework.
We especially appreciate the last proposed principle, to balance the need to respond to those with the greatest need, while investing in prevention and early identification. Following on this point, it is recommended that another principle be added that recognizes the impact of the broad determinants of health, such as income security, education and housing, on mental health and consequently the need for intersectoral solutions to prevention. The Ministry of Children and Youth Services is already developing cross-ministerial initiatives, and recognizing this approach in the principles enshrines the value of these activities in the framework.
Particular attention must be paid to cross-ministerial communication with the Ministry of Health and Long-Term Care. This Ministry is undertaking broad reform of the health care sector which should be taken into account as the children and youth mental health framework is developed. The regionalization of health care planning through the introduction of Local Health Integration Networks will necessarily impact services delivered specifically for children and youth and close collaboration must be a priority. Some mechanism for coordination between these regional bodies and the Ministry of Children and Youth Services is necessary. As children and youth move into the adult mental health system, transition and referral systems must be in place to ensure that young people do not slip through gaps between the two systems.
There is a need for a continuum of services. The policy framework identifies a range of services. It is recommended that education and reducing stigma are conceptually at an earlier stage of the continuum than prevention. The former focuses on public awareness and attitudes while the latter focuses on interventions that can reduce the incidence of mental health problems. These approaches should be separated out and profiled sequentially along the continuum.
There should be no core services defined to the exclusion of others. The last principle in the proposed framework identifies the need to strive for balance in responding to children in need while at the same time investing in prevention. While the framework should set out a continuum of services, actual needs may differ between communities. Population-based planning should be used to establish the right balance of services for a community.
Both system performance indicators and health status monitoring should be used to assess results. There will be greater readiness to assume accountability if there is agreement on the vision and key strategic objectives necessary to achieve these results. The policy framework should be expanded to reference the need to monitor population-based data and service outcomes to determine if programs are leading to expected results.