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The Windows of Opportunity for Mental Health Reform in Ontario

March 1, 2010

As part of the response to the Ministry of Health and Long-Term Care discussion paper, “Every Door is the Right Door,” the Canadian Mental Health Association (CMHA) Ontario has prepared a review of recent strategies for mental health reform. (March, 2010)

Executive Summary

As part of the response to the Ministry of Health and Long-Term Care discussion paper, “Every Door is the Right Door,” the Canadian Mental Health Association (CMHA) Ontario has prepared a review of recent strategies for mental health reform released by:

  • The government of Australia: Fourth National Mental Health Plan: An agenda for collaborative government action in mental health 2009- 2014 (November 2009)
  • The state of Victoria, Australia: Because Mental Health Matters: Victorian Mental Health Reform Strategy 2009- 2019 (February 2009)
  • The government of England: New Horizons: A Shared vision for mental health (December 2009)
  • The Future Vision Coalition of the National Health Service, England: A Future Vision for Mental Health (July 2009)
  • Judge McKee’s report to the province of New Brunswick: Together into the Future: A transformed mental health system for New Brunswick (February 2009)
  • The government of Scotland: Towards a Mentally Flourishing Scotland: Policy and Action Plan 2009 – 2011 (April 2009)

These strategies have been compared using the framework presented by the Mental Health Commission of Canada (MHCC), in their document “Towards Recovery & Well-Being” under the goals: Recovery and Well-Being; Promotion and Prevention; Diversity; Families and Carers; Effective, Seamless, User-determined Services; Research and Outcome Measures; and Stigma and Discrimination. In addition, this report has included sections comparing Vision, Governance and Workforce Issues.

This review will show that there are many similarities in core elements amongst the reviewed strategies, however the actual approach to system and service change varied widely depending on local factors such as the current state of mental health reform, cultural differences and the preparedness for change.

The vision contained in all the strategies stressed the necessity for system reform that is predicated on a recovery-based or person-centred approach. Believing that the best outcomes for those with mental illness are contingent on a partnership between providers and consumers, all jurisdictions addressed the barriers and opportunities for shifting control from the system into the hands of people with lived experience.

Social determinants have long been seen as primary factors in physical well-being. Reform strategies have recognized that these determinants are equally beneficial, or detrimental, to mental well-being and as such, are recommending action to coordinate cross-sectoral portfolios. Public health, child and family services, education, housing and employment are examples of departments that are now being considered as part of a “whole of government” approach.

The reviewed strategies were also in agreement that the social, economic and moral impacts of mental illness are so substantive that money spent on mental health promotion and the prevention of mental illness (the upstream costs) pose significant cost-benefits when compared to the downstream costs of illness. As a result, reforms in the reviewed reports detailed a variety of actions that cultivate healthy families, good starts in early childhood, mentally health workplaces and the reduction of risk factors. Early identification and early intervention were also seen as clinically effective and cost-beneficial in mitigating the effects of mental illness.

The challenges related to increasingly diverse communities were also addressed in this review. Diversity takes many forms. The damaging effects of social isolation resulting from linguistic and cultural differences, gender, living with a co-occurring disability and life in rural or remote communities are discussed.

In the past, the main focal point for mental health reform was on the consumer and the delivery system. Attention has now broadened to include the informal networks that surround a person with lived experience, such as family and other carers. Strategies now recognize the vital role that these individuals play in recovery and have developed recommendations to “support the supporters.”

The importance of community was also recognized as another essential element to mental well-being. Vibrant, inclusive communities that build mental resilience were seen as absolutely pivotal in the development of population mental health. In that same context, the provision of mental health services within the community to facilitate early identification, early intervention and treatment when mental illness does arise was consistently seen as vital to efficiency, effectiveness and a recovery orientation. Resource considerations to expand community services were evident throughout all strategies.

Enhanced resources were also recommended for research. Whereas investigations have primarily been related to drug interventions in the past, governments are encouraging research that will bring more science to the field and drive evidence-based practice. The development of performance indicators and the inclusion of consumer experience measures were also part of the trend to monitor the effectiveness of system and service changes.

Strategies to combat stigma and discrimination were addressed by all jurisdictions. The discrimination that exists towards people with mental illness, their families and carers, and that which is both levied and experienced by the mental health workforce itself, were topics of discussion.

Finally, reformation of many aspects of the mental health workforce was seen as a prerequisite to successful system change. The challenges relating to service culture, shortages, moral, education, ongoing professional development and career opportunity were recognized and plans to remedy these issues were reviewed.

The Canadian Mental Health Association (CMHA), Ontario has prepared this review to offer insights into strategies and action plans of other jurisdictions’ activities in mental health reform. The similarities in core elements reflect the growing recognition of factors that influence mental health and support the journey of recovery. The differences in implementation reflect the variations that arise from local context. Nonetheless, the degree of consensus in the need and direction of reform is illuminating.

CMHA, Ontario congratulates the Ministry of Health and Long Term Care (MOHLTC) on its discussion paper, “Every Door is the Right Door.” We hope this review will further inform your deliberations and ultimately lead to mental health reforms that nurture mentally healthy people in a healthy society.

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