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Opening Doors in Primary Health Care

March 1, 2010

Recommendations from CMHA Ontario and OFCMHAP on 11 core strategies to strengthen primary health care responsiveness to the needs of individuals with mental health and addiction conditions in Ontario.


Let us recognize that there can be no health without mental health.[1]

It’s time to clear the air – addiction is a disease, and those who suffer with it need medical assistance just as those who suffer from heart disease or cancer.[2]

Despite these widely held beliefs, we have, historically, structured our health care system, and delivered services as if mental health and addiction problems were separate and distinct from other health conditions, and as if they could be treated effectively in isolation.

The result?

For too many years, people with mental illnesses or addictions have been marginalized and stigmatized. Mental health and addiction services have been the distant cousins of the health care system: planned and managed separately from other health services.[3]

The new 10-year Mental Health and Addiction Strategy that is currently under development signals the intention of the Ministry of Health and Long-Term Care to move away from the siloed approach that created that “distant cousin” relationship. With the publication of Every Door Is the Right Door, the MOHLTC has committed to an approach that:

…aims to integrate people with mental health and addictions into their communities, and to integrate mental health and addiction services with the rest of the health care system – to make every door the right door.[4]

Our organizations applaud the MOHLTC for that bold commitment. At the same time, we believe that there are a number of issues that must be addressed before linkages with the rest of the health care system, and specifically with primary health care (PHC) providers, can be improved. Further, we wish to suggest strategies which, we believe, are essential to the realization of the future envisioned for Ontario — one in which:

  • Prevention and early identification are priorities
  • Care is proactive and ongoing
  • Providers and programs work collaboratively
  • Services are integrated and coordinated
  • Individuals are supported to lead their own recovery and to provide peer support for others.[5]

There is ample evidence to suggest that enhancing collaboration among the sectors can result in “…better health, improved access to services, more efficient use of resources, and better satisfaction for both patients and providers”.[6] It can facilitate delivery of the ‘right services’ by the ‘right people’ at the ‘right time’, and thus reduce the risks and impacts of the many other health conditions associated with addiction and mental illness.

Achieving those objectives will require bold action and unwavering commitment. Government must be prepared to promote, support, and, if necessary, mandate, fundamental changes in the operation of this province’s mental health, addiction, and primary health care systems. The time is right for this endeavour.

This province has set a path which is consistent with the directions defined at the national level by both the Mental Health Commission of Canada7 and the National Treatment Strategy Working Group8 as well as many other planning, policy, and research bodies both here and abroad. The challenges, issues and strategies at the interface between PHC and mental health/addiction services are consistent across Canadian and international jurisdictions.

Those issues and strategies, the lessons learned through recent projects, studies and reports and advice from experts and key stakeholder groups, have informed the content of this document and the recommendations we present. Together, our organizations believe that we can help the government of Ontario achieve the goals to which it is committed, that is:

  • Identify mental illnesses and addictions early and intervene appropriately.
  • Provide high quality, effective, integrated, culturally competent, person-directed services and supports for Ontarians with mild to complex mental illnesses and/or addictions.[9]

We present this report in support of that commitment.


  1. U.N. Secretary General Ban Ki-Moon, October 10, 2008
  2. Online posting, Dr Brian Day, Canadian Medical Association. The Toronto Star, 8 June 2008., cited in Stepping Forward – Improving Addiction Care in British Columbia
  3. Every Door is the Right Door, Ministry of Health and Long-Term Care, 2009 (Discussion Paper) p 9
  4. Every Door is the Right Door, Ministry of Health and Long-Term Care, 2009 (Discussion Paper) p 9
  5. Peer support may take a variety of forms. It can be provided by paid peer support workers or by consumer/client volunteers; in support groups or through mutual aid/self-help programs.
  6. Primary Health Care Reform in About Primary Health Care, Health Canada accessed January 20/10 at:
  7. Toward Recovery and Well Being: A Framework for a Mental Health Strategy for Canada. Mental health Commission of Canada. November 2009. Accessed January 20/10 at:
  8. National Treatment Strategy Working Group. A Systems Approach to Substance Abuse in Canada – Recommendations for a National Treatment Strategy. Ottawa: National Framework to Reduce the Harms Associated with Alcohol and Other Drugs and Substances in Canada. 2008
  9. Every Door is the Right Door, Ministry of Health and Long-Term Care, 2009 (Discussion Paper), p. 9.

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