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The Gold Standard: Family Planning

Network, Fall 2006

Families are often an essential support and system navigator for loved ones with a mental illness. The Canadian Mental Health Association’s A Framework for Support recognizes families as one of the pillars of support for persons with a mental illness. Similarly, the vision for recovery asserts that the formal service system does not hold the key to assuring consumers live a satisfying and hopeful life. Consumers do. Recovery can be facilitated through consumers’ natural supports and this includes their families. There is currently a call to establish standards for a recovery-oriented mental health system and this includes having families involved in collaborating, planning and monitoring the formal service system.

Given the important role and needs of families of persons with a mental illness, one might presuppose that Local Health Integration Networks (LHINs) would include these key stakeholders in planning for an integrated and effective mental health system. However, there is in fact wide variation in the practices of the 14 LHINs to specifically engage families.

Ontario is moving ahead with LHINs, a ‘made-in-Ontario’ solution that devolves the planning, funding, and monitoring of health services to the regional level. While each LHIN is governed by a community board and managed by a small professional staff, a key strategy for LHINs to achieve their objectives – to enhance system integration and promote efficiencies to sustain Ontario’s publicly funded health system – is through community engagement. Delegating these activities to the local level is intended to enable those who live and work in a community, and who know it best, to be ‘engaged’ in the process. Families are among those who need to be at the planning table in every LHIN.

The new Local Health System Integration Act, 2006, provides minimal direction as to the scope and methods of community engagement. Consequently, each of the 14 LHINs in Ontario has developed its own community engagement framework. Most of these frameworks broadly define the community as the public, users, health service providers, interest groups and funders. Who to engage, and how, will be determined by the needs of each LHIN in order to carry out its work. LHINs have recently completed their first round of ‘relationship building’ with communities of interest and are now focused on completing their integrated health services plans (IHSPs). Mental health services should figure prominently in the IHSPs.

Australia is considered an early adopter in setting policy directions for consumer and family involvement. In 1992, their national mental health strategy directed that national, provincial and local levels involve consumers and families in planning to promote an effective mental health system. A review of the implementation of this policy found that while there were increasing opportunities for consumer involvement, caregiver involvement has been less significant. As a result, Australia’s new National Mental Health Plan 2003-2008 gives more specific direction to decision-makers in the health system for involving families in meaningful participation. These directions include defining the need for formal structures to support family participation, providing support and training to families to strengthen their capacity to participate, placing the onus on decision-makers to demonstrate that meaningful participation has occurred, and evidencing outcomes arising from enhanced participation.

The province of Manitoba has recently developed a ‘Family Member and Natural Support Participation in Mental Health Service Planning, Implementation and Evaluation’ policy, which directs regional health authorities to create detailed plans on how they will engage families in planning and evaluating the mental health system. This is not about generic community engagement. Specific directions include involving family members in creating the family participation policy itself, specifying the communication strategies that will be utilized to inform family members of participation opportunities, identifying resources to be provided to enable effective family participation, and creating and publicizing a formal complaints mechanism to deal with problems with the experience or opportunities for participation itself.

Ontario LHINs must develop policies for meaningful family, as well as consumer, involvement in planning and monitoring the mental health system. It appears the LHINs should be open to this discussion, as evaluation of their community engagement activities has been promised. The dialogue should be about moving the LHINs from principles of community engagement to standards for meaningful consumer and family involvement.

Family members need to take action. I encourage families to locate their LHIN, familiarize themselves with the role of LHINs, and identify opportunities to influence the health system. Ask that the discussion move beyond utilizing generic public participation models to a recovery-oriented approach to mental health reform.

In a previous column, I wrote about key elements for meaningful engagement of mental health consumers and families by LHINs, and that article may offer useful approaches to bring to the table. There will also soon be a new report on the role, needs and opportunities to involve families in the mental health and addiction sector, which should provide useful information to bring to the discussion. CMHA Ontario is a partner in preparing this report and it will be available on our website.

To contact your LHIN, go to or call the Ministry of Health and Long-Term Care information line at 1-800-268-1154.

Michelle Gold, MSW, MSc, is senior director of policy and programs at CMHA Ontario.

1. Trainor, J., Pomeroy, E., and Pape, B. (2004). A Framework for Support. Third Edition. Canadian Mental Health

2. Anthony, W.A. (2000). A Recovery-Oriented Service System: Setting Some System Level Standards. Psychiatric Rehabilitation Journal. 24(2): 159-168.

3. Lammers, J., and Happell, B. (2004). Mental Health Reforms and Their Impact on Consumer and Carer Participation: A Perspective from Victoria, Australia. Issues in Mental Health Nursing. 25(3): 261-276.

4. Australian Health Ministers. National Mental Health Plan 2003-2008. Canberra: Australian Government, 2003.

5. Manitoba Health. (2005). Family Member and Natural Support Participation in Mental Health Service Planning, Implementation and Evaluation. Policy HCS-210.3.

6. Canadian Mental Health Association. (2005). Rules of Engagement.Network 21(2): 20-22.

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