By Adrienne Spafford
The need for reform in mental health and addiction in Ontario was identified more than adecade ago. Since then there has been some (albeit slow) progress—not the least of which is a greater willingness to acknowledge and talk about the issues.
We are now, hopefully, on the verge of a new era of understanding and action. The newly created Mental Health and Addiction Centre of Excellencewithin Ontario Health will serve as the foundation from which this systemic change will happen. The Centre will be the central, provincial body that will enable and drive effective implementation of the Roadmap to Wellness, the provincial government’s plan to build a connected and comprehensive mental health and addiction system to support Ontarians across their lifespan.
A new driving force
As the CEO of Addictions and Mental Health Ontario (AMHO), I am very supportive of a centralized planning organization for the mental health and addiction sector. We have been waiting years for this type of action. My hope is that the Centre of Excellence can be the driving force behind the changes needed, similar to how Cancer Care Ontario worked to improve cancer outcomes through system redesign.
It was way back in 2010 that an Ontario Legislature all-party select committee report first signalled the need for reform in mental health and addiction. In the ensuing years, we have seen a growing recognition of the importance of more evidenced– based services that connect people to the care they need quickly, with dignity and ease.
Ontario can no longer afford to overlook the urgent need for system redesign.
Time for transparency
There are pockets of excellence and good alignment in some communities and some effective infrastructure in different parts of the system. However, as a whole, Ontario lacks capacity, coordination and transparency. Currently, for instance, we don’t know if the types of services that are available in downtown Toronto are also available in Sarnia, Yarker, Thunder Bay or anywhere else in the province. Making matters more complicated, there is no consistency in the definitions describing services or the standard against which to measure their quality or delivery. We also have no way to understand whether people are waiting longer than research suggests to access services to both improve their health or, at times, save their lives.
People with a mental illness die, on average, 10 to 20 years sooner.
Current statistics paint a worrying picture. Research tells us that people with a mental illness die, on average, 10 to 20 years sooner than people without a mental illness. According to Public Health Ontario, hospital emergency rooms (ER) are seeing a rising number of overdoses. More families and communities are grieving the death of loved ones every day. There were more than 7,000 ER visits related to opioid overdoses in 2017, a 72 per cent increase from the year before. ER visits continued to increase in 2018 and 2019 and were exacerbated by the COVID-19 pandemic. At the same time, 24 per cent of hospital long-term stay beds are currently filled by patients with mental health conditions who would be better served in community care.
The average wait time to access residential treatment for addiction support—treatment that isn’t even funded as a provincial resource— is 50 days across the province before the COVID-19 pandemic. That is 50days that someone who is worried they will die from their drug or alcohol use and ready for treatment is waiting for care. Worse still, for children and youth the wait time is up to over two years.
Obviously, challenges in the mental health and addiction sector are very real. But they aren’t insurmountable. A model for positive change The Mental Health and Addictions Centre of Excellence has the potential to be a driving force behind reform, in the same way Cancer Care Ontario improved cancer outcomes by equipping health care professionals, organizations and policy-makers with the most up-to-date cancer knowledge and tools to prevent cancer and deliver high-quality care in every corner of the province. Today, fewer people are dying because of a cancer diagnosis. This outcome was not by accident or a coincidence. Lives have been saved because of system redesign. Consider the possibilities of this approach for mental health and addiction here in Ontario.
Ontario Health Teams:
The steps the government is taking with Ontario Health Teams (OHT) to better integrate services around clients’ needs is critically important. But as we continue to move ahead with health transformation, we need to ensure the foundations are there to best support OHTs to be able to locally deliver on the promise I know we all want: that no matter where you live in this province, if you have a mental illness or addiction, you will get access to the best quality care.
Central nervous system:
With the Centre of Excellence as a central nervous system for the sector, front-line agencies can be better supported to excel in the OHT model. They can also be better supported to improve transitions and connections between themselves and other parts of the health care system: primary care, hospitals, specialists like psychiatrists, and addiction medicine.
With a stepped care model, we will be able to do a much better job of matching treatment to individual need and context in terms of income, housing, family status and concurrent medical conditions. We will be able to coordinate what services are being provided by what part of the system—so that the majority of care is delivered locally in communities and is sustainable for future generations.
2 year wait time for residential treatment for youngsters and 50 days for adults.
Building on success
While we look to improve and better coordinate the quality of care, let us keep our focus on what is working.
1. Client and caregiver input: People who use drugs and people with mental health challenges have often had the doors shut on multiple requests for help before a door was finally opened. As we develop and continually refine quality standards, we need to take into account both empirical evidence and the knowledge that people with lived and living experience bring to the table. Nowhere is client and caregiver co-design more important than in the area of mental health, addiction and substance use.
2. Unique needs: It is also important to make sure that evidence and standards consider the unique needs of individual communities along with intersectionality; particularly Indigenous and racialized communities, women, LGBTQTwo- Spirited communities, people experiencing homelessness, people who use drugs and other diverse populations that would suffer if an equity lens is not applied to the work of the Centre of Excellence.
3. Fundamental differences: While undertaking its work, the Centre must also understand that there are fundamental differences between mental health and addiction, along with other parts of the health system (like cancer care).
4. Evolving process: We must not let the perfect be the enemy of the good—i.e., we don’t need to perfect the system before we can invest confidently. This is an iterative, evolving process, and we must take action based on the best information we have, adapting and adjusting as we move forward. People are dying, right now, because of a lack of access to services and supports for mental health, addiction and substance use.
Ontario’s historic commitment to invest $3.8 billion over 10 years has the potential to have a positive and transformative impact on the lives of families across the province.
AMHO has repeatedly urged the government to support investments both in services proven to be effective and in building capacity in the community so that acute care settings can be maintained for those with more complex and chronic conditions. Particularly, we need to quickly ramp-up investments in child and youth services—there is no sounder investment than recovery for a young person.
We can have confidence in the positive impact of those investments today while together we build a stronger system for tomorrow, from the Centre of Excellence to every community in the province.
Adrienne Spafford is the CEO, Addictions and Mental Health Ontario. She is a valuesdriven leader with 15 years of experience in public policy, advocacy, communications, and stakeholder relations.