Mental health policy in Ontario has moved from an emphasis on institutionalization of people with mental illnesses and addictions to a system that depends on effective and accessible services delivered in the community. This redirection in policy is frequently referred to as mental health reform.
The following reports concerning mental health reform have been published in Ontario in the last 30 years. All reports have strongly endorsed the principle of moving mental health and addictions care from psychiatric hospitals into the community, where people with mental illnesses and addictions can receive the services they need when they need them.
1983 – Towards a Blueprint for Change: A Mental Health Policy and Program Perspective (Heseltine Report)
The primary goal of this report was to provide support for the development of a continuum of service delivery, while ensuring that people with mental illnesses can receive appropriate help in their own communities.
1987 – National Drug Strategy
Canada launched a five-year National Drug Strategy in order to address concerns with both supply and reduction of illegal drugs in Canada. This strategy noted that a balanced approach was necessary and six areas of focus were identified:
- Education and prevention
- Treatment and rehabilitation
- Enforcement and control
- Information and research
- International cooperation
- A national focus on demand reduction
The report followed a series of consultations and recommended that priority should be given to services for people with serious mental illnesses. The report proposed a plan for the development and implementation of a comprehensive community mental health system. [Copyright © Queen’s Printer for Ontario, 1988. Reproduced with permission.]
1992 – National Drug Strategy Phase Two
Canada launched a second phase of the National Drug Strategy by including the National Strategy to Reduce Impaired Driving. The initiative is named Canada’s Drug Strategy.
This report endorsed the Graham Report (1988) and proposed a 10-year plan for mental health reform in Ontario based on common vision and values. It also confirmed that priority should be given to services for people with serious mental illnesses and stated that the goal of the Ministry of Health and Long-Term Care should be to allocate 60 percent of the mental health funding envelope to community services and 40 percent for hospital care by 2003, reversing the actual funding allocations at that time. [Copyright © Queen’s Printer for Ontario, 1993. Reproduced with permission.]
1994 – Implementation Planning Guidelines for Mental Health Reform
This report set out clear expectations for District Health Councils and their role in mental health reform based on Putting People First (1993). (This document is copyrighted.)
1996 – District Health Council Recommendations
Based on Putting People First (1993) and following the 1994 commitments, District Health Councils recommended that community mental health services be coordinated through strategies such as joint networks, lead agencies, joint protocols, assessment tools, and tracking with a clear point of access into the system, that models of delivery be based on best practices and that a continuum of services are offered, including case management.
Canada’s federal drug control statue, the Controlled Drugs and Substances Act, was passed. The act established eight schedules of controlled substances and repealed the Narcotic Control Act.
This strategy provided a plan for Ontario to improve the coordination of human and justice services for individuals that come into conflict with the law. The strategy targets adults with mental illnesses and developmental disabilities that are involved with the criminal justice system and was developed by partnering ministries: Ministry of the Attorney General, Ministry of Health (now the Ministry of Health and Long-Term Care), Ministry of Community and Social Services, the Solicitor General and Correctional Services (now the Ministry of Community Safety and Correctional Services). This is the founding document for the various local, regional and provincial Human Services and Justice Coordinating Committees across Ontario that are still improving coordination between human and justice services across the province today.
This report was based on a consultation led by Dan Newman, MPP, who was at the time the Parliamentary Assistant to the Minister of Health and Long-Term Care. The principle of community-focused care set out in Putting People First (1993) was endorsed by the government, but the Newman report noted that at the five-year mark, funding had not yet been allocated to implement needed reform.
1999 – Building a Community Mental Health System in Ontario: Report of the Health Services Restructuring Commission no link
The provincial Health Services Restructuring Commission (HSRC) included in its recommendations to the Ministry of Health and Long-Term Care divesting Ontario’s nine provincial psychiatric hospitals to the public hospitals. It also recommended transitional funding so that services could be established before the beds were closed, and it estimated that $83 and $87 million would be needed for transitional investments until savings from the closed beds would be realized.
This report outlines the Ministry’s strategy “to increase the capacity of the system for comprehensive and integrated treatment, rehabilitative and support services while focusing on community alternatives wherever possible.” It was also intended to guide strategic investments over the next three years and committed to protecting mental health funding. With this report, the government committed to investing in community mental health care prior to the divestment of provincial psychiatric hospitals, so that appropriate services would be available for individuals when they left hospital. It also made a commitment to continued investments/reinvestments in mental health services to “support mental health reform and increase the overall capacity of the system.” The report also stated that in 2002 there would be a review of the plan to “revise implementation strategies and program funding priorities as necessary.”
1999 – National Drug Strategy Renewed
Canada reaffirms its commitment to the National Drug Strategy and takes on the four pillars approach to drugs, which includes: Education and Prevention; Treatments and rehabilitation; Harm reduction; Enforcement and control. This is renewed until 2003.
This is a short report on the consultation process on legislative changes to the Mental Health Act and the Health Care Consent Act. The report states that the proposed legislative changes will “ensure people with serious mental illnesses get the care and treatment they need in a community-based mental health system.”
This report elaborates on the issue of employment supports, providing additional recommendations on issues not adequately addressed in the initial ten-year plan set out in Putting People First (1993). The goal was to develop a coordinated response at both the federal and provincial levels to income and employment supports and the business sector.
2000 – Drug Treatment Courts Open
Drug treatment courts open in Ontario, with the first being in partnership with the Centre for Addiction and Mental Health in Toronto. The objective of Drug Treatment Courts is to divert individuals who are addicted to drugs into rehabilitation programs rather than jail.
This document is a companion to Making It Happen: Implementation Plan for Mental Health Reform (1999). It established a framework to reform the mental health system. The report commits to including a continuum of services for persons with mental illnesses: first line, specialized and intensive. Again, the government re-affirmed its commitment to investment in community mental health care to alleviate pressure resulting from the divestment of psychiatric hospitals.
2001 –Controlled Drugs and Substances Act Amended
Amendment made to the Controlled Drugs and Substances Act that would allow for the legalization of cannabis for medical purposes.
2002/2003 – Mental Health Implementation Task Force Reports
The Mental Health Implementation Task Forces were convened in 1999 to provide recommendations and advice to the Ministry of Health and Long-Term Care regarding the implementation of a reformed mental health system in Ontario. Over a three-year period, these regional task forces consulted with thousands of people in the field of mental health. Based on these consultations, the task forces submitted nine region-specific reports for implementation of mental health reform. The final report of the Provincial Forum of Mental Health Task Force Chairs identified the following themes for reform in their report, The Time is Now:
- Adopting a recovery philosophy, with the consumer at the centre of the system
- Creating partnerships with other supporting services in the health, social and justice sectors
- Implementing regional decision-making, to improve local delivery systems
- Building peer support into the mental health system
- Increasing support to families of people living with mental illnesses
- Providing safe and affordable housing
- More emphasis on early intervention and treatment
- Enhancing employment support
- Ensuring adequate income support
- Developing greater system accountability, performance standards and information systems
- Appointing a provincial team to keep mental health reform on the provincial agenda
2003 – Insite Opens
Canada opens Insite, the first safe injection site in North America in the downtown east side in Vancouver. The site provides drug users with a clean place to inject drugs and connect to health care services.
This report was released by the Canadian Centre for Substance Abuse, which was developed collaboratively with multi-sector partnerships.
In October 2004, the Standing Senate Committee on Social Affairs, Science and Technology was authorized to examine the Canadian health care system, in particular, issues concerning mental health and mental illnesses. This report looks at the current state of mental health and mental illnesses across the country. Experiences of individuals, families and health care providers informed the report and investigated specific issues relating to mental health including patient rights, service organization and delivery, children and youth related issues, workplace and employment mental health, First Nations and Inuit-specific challenges, and provides the foundation towards the first national Mental Health Strategy. This document was the basis for creating the Mental Health Commission of Canada in the spring of 2007.
2007 – National Anti-Drug Strategy
The National Drug Strategy was changed to the National Anti-Drug Strategy and harm reduction was removed as one of the key pillars. This Strategy was carried out by 12 federal departments and agencies, and led by the Department of Justice Canada. Goals of the strategy included:
- decreasing the prevalence of harmful drug use;
- decreasing the number of young Canadians who experiment with drugs;
- decreasing the incidence of communicable diseases related to substance abuse;
- increasing the use of alternative justice measures such as drug treatment courts;
- decreasing the illicit drug supply and addressing new and emerging drug trends; and
- decreasing avoidable health, social and economic costs.
In 2004, the Ministry of Health and Long-Term Care increased funding to the community mental health and addictions system by 52%. The Systems Enhancement Evaluation Initiative was a project created in 2005 set out to review the impacts that this significant investment had on the community mental health system within Ontario over a four-year period. The project was coordinated by the Health Systems Research and Consulting Unit at the Centre for Addiction and Mental Health. There were nine research studies conducted through this initiative and the report outlines the key findings of each of the projects. Research studies were conducted on a provincial, regional and program level basis and covered such areas of community mental health as: Assertive Community Treatment, crisis services, court programs, discharge planning and early intervention programs. This report was created in partnership with key stakeholders within the mental health and addictions system in Ontario including: the Centre for Addictions and Mental Health, the Ontario Government, the Ontario Mental Health Foundation, the Canadian Mental Health Association Ontario Division, and the Ontario Federation of Community Mental Health and Addictions Programs (now Addictions and Mental Health Ontario).
2009 – Every Door is the Right Door
This is a discussion paper developed by the Minister’s Advisory Group on Mental Health and Addictions for public consultation as part of the development of a new 10-year provincial strategy for mental health and addictions in Ontario.
Produced by the Mental Health Commission of Canada, this document provides a mental health framework for Canada and was informed by consultations with thousands of stakeholders across the country. The framework outlines the goals to create a transformed mental health system that, if fulfilled, would create a system capable of improving mental health care for Canadians. This was the initial phase of the Mental Health of Canada Commission’s development of the first national mental health strategy that would be released in 2012.
This report provides a summary of major issues identified through the public hearings the committee convened throughout the province and submissions received by the committee during 2009/10.
This report summarizes the results of the committee’s investigations into the mental health and addictions needs of Ontario’s population and outlining their recommendations to improve the mental health and addictions system.
In June 2011, Ontario released this report, outlining the plan to support mental health and to provide the integrated services and supports that Ontarians need if they experience a mental illness or addictions.
This was Canada’s first mental health strategy led by the Mental Health Commission of Canada as part of their mandate when it was created in 2007. Building on the national framework titled, Towards Recovery & Well-Being: A Framework for Mental Health Strategy for Canada, this 2012 strategy outlines recommendations for action to create the mental health system envisioned by the framework produced in 2009. Areas of recommended action include: the promotion of mental health across the lifespan and various environments, improving access to treatments and supports, reducing disparities in risk factors and access to mental health services, addressing First Nations, Inuit and Métis mental health needs, and the need to take a whole-of-government approach to transforming the mental health system across Canada.
Open Minds, Healthy Minds: Ontario’s Comprehensive Mental Health and Addictions Strategy was created in 2011 and outlined that the first three years of Ontario’s mental health strategy would focus on child- and youth- centered priorities. The Ministries of Children and Youth Services, Education, Health and Long-Term Care, and Training, Colleges and Universities created this strategy, Moving on Mental Health, which outlined a plan for action for Ontario to take in order to ensure that children and youth will have improved access to mental health services. Specific goals of this strategy included: defining a core set of children and youth mental health services that will be available in all communities across Ontario, establishing community lead agencies that would be responsible for providing the core services in specific regions across the province, and building a regulatory framework for the lead agencies so that all would be providing the same level of care to children, youth and families of Ontario.
This report is published by the Canadian Centre for Substance Abuse as a response to the growing opioid problem in Canada and subsequent addiction and substance misuse. The report presents 58 sort and long term recommendations.
In November 2014, the second phase of Ontario’s Comprehensive Mental Health and Addictions Strategy was released, outlining the government’s plan to continue to invest and transform mental health and addictions supports throughout the province. Five strategic pillars were introduced as priorities for the province to improve mental health and addictions within the province of Ontario. The priorities outlined in this strategy include: promoting mental health and well-being; ensuring early identification and intervention; expanding housing, employment support and diversion and transitions from the justice system; providing the right care, at the right time, in the right place; and funding reform based on need and quality. This report also highlighted the progress of the first three years of the Strategy which lead to many improvements for the child and youth mental health system including: the launch of Ontario’s youth suicide prevention plan, increased psychiatric consultations for children and youth through expanded and enhanced Tele-Mental Health services, and over 50,000 additional children and youth receiving mental health supports.
Formed in 2014, the Mental Health and Addictions Leadership Advisory Council is a group of individuals from across Ontario who are working to support the implementation of Ontario’s Comprehensive Mental Health and Addictions Strategy. Part of the Council’s task is to report annually on the progress of the Strategy and create recommendations to government on ways to improve the mental health and addictions system. This initial report from the Council focused on their priorities for the years ahead including: prevention, promotion and early intervention; youth addictions; supportive housing; system alignment and capacity; and community mental health and addictions funding reform. The Council also outlined some key recommendations that require urgent attention from government to address unmet needs for Ontario including the recommendation to move on key First Nations, Métis, Inuit and Urban Aboriginal mental health and addictions issues, and also to prioritize investments in supportive housing, youth addictions and promote a culture of quality like in other parts of the health care system.
December 2015 we saw the first report from Health Quality Ontario (the government agency responsible for reporting on system performance of the provincial health care system) on mental health and addictions within the province. The document was produced in partnership with the Institute for Clinical Evaluative Sciences (ICES). System performance indicators are used to tell the story of the current state of mental health and addictions in Ontario including: financial implications of mental illnesses and addictions for Ontario, perceived effectiveness of community mental health and addictions services, prevalence of mental illnesses and addictions based on sex and age, wait times, and follow up and emergency department visits for individuals with mental health and addictions needs. The report also identifies gaps in information that are preventing the province from understanding issues related to access and quality within the mental health and addictions system.
2016 – Ontario’s Opiod Strategy
The Ontario Opioid Strategy is announced to address the high rates of addiction, substance misuse and overdose deaths. The strategy looks to modernize prescribing and monitoring, improve the treatment of pain, and enhance addiction supports and harm reduction.
In this report, Ontario’s Mental Health and Addictions Leadership Advisory Council focused on three strategic considerations: to promote, prevent, and intervene early; to close critical service gaps; and to build foundations for system transformation. These considerations led to the Council making three key recommendations to the Ministry of Health and Long-Term Care:
- To work collaboratively with other ministries and stakeholders to promote, prevent and intervene early across the lifespan. Such investments are known to have the highest returns on mental health spending in terms of cost savings in education, justice and health care sectors.
- To address the chronic service gaps in youth addictions, psychotherapy and supportive housing. The Council highlights that current gaps in service capacity for youth addictions, in addition to establishing service standards and referral pathways for psychotherapy services, must be addressed urgently. Additionally, to close the gap in existing supportive housing, the Council recommends creating at least 30,000 units of supportive housing over 10 years.
- To undertake steps toward large-scale system transformation by leveraging and building on the work of the Ministry of Children and Youth Services to achieve a seamless transition for children and youth to the adult system.