TOWARDS A MENTAL HEALTH STRATEGY FOR CANADA Presentation to Making Gains 2009 Howard Chodos Director, Mental Health Strategy Mental Health Commission of Canada November 2, 2009 Toronto, Ontario

PRESENTATION OUTLINE  A Framework for a Mental Health Strategy  Context, Uses  The Goals  Where to from here?  The HOW phase

MENTAL HEALTH COMMISSION MANDATE  Non-profit, at arm’s length from all levels of government, funding from Health Canada.  Five strategic initiatives:  Mental health strategy for Canada  Anti-stigma/discrimination initiative  Knowledge exchange  Homeless research demonstration projects  Partners for Mental Health  MHCC as “catalyst” for mental health system transformation  Not involved in service delivery or monitoring

CONSTITUTIONAL CONTEXT  Health care and social services are largely a provincial/territorial responsibility  Key reason there is no “national” strategy  Challenge: develop a mental health strategy for the whole country without having the authority to implement it

GUIDING PRINCIPLES FOR STRATEGY DEVELOPMENT  Practical  “Just inside the outer edge of political feasibility”  Adaptable  To different regions, jurisdictions, etc.  Inclusive  Cast a wide net, across sectors, stakeholders  Comprehensive  Promotion, prevention, early intervention, recovery, treatment, services and supports  Collaborative  MHCC will seek advice, support, input, work together  Don’t reinvent the wheel

TWO-PHASE PROCESS  The transformation of the mental health system is a complex, multi-faceted undertaking  Two-Phase Approach 1.Framework: Build support for the vision, WHAT we are trying to achieve.  a framework ensures a coherent, consistent approach across the many topic areas that will need to be addressed  helps build consensus on broad goals needed before tackling HOW to achieve them 2.Next phase is HOW to achieve the vision  potentially more difficult  need to make choices, set priorities, realize change.

HOW THE FRAMEWORK CAME TO BE  Over a year in the making  Review of Canadian and international mental health policies  Public consultations (February – April, 2009)  15 stakeholder meetings (approx. 450 participants)  online public (1700) and stakeholder (350+)  Internal consultations with MHCC Board, Advisory Committees, Consumer Council  Other consultations  key provincial, territorial, and federal officials  conferences such as Mental Health Promotion Think Tank, Clifford Beers conference, etc.

. Timbrés et affranchis, 2005 Mireille Bourque Collection permanente Vincent et moi Photographie Simon Lecomte TOWARD RECOVERY AND WELL-BEING: a Framework for a Mental Health Strategy

PURPOSE OF THE FRAMEWORK: 1.To Guide the second phase of mental health strategy development which will focus on HOW to achieve the goals; and 2.To Introduce the public, providers, policy-makers and the research community to the MHCC’s vision for a transformed mental health system in Canada.

Overview  Introduction sets out the approach to mental health and mental illness  The seven goals describe the elements required to build a comprehensive mental health system  Each goal represents one key dimension of a comprehensive system, but they are each linked to the others and progress will be required towards achieving all of them

VISION  All people in Canada have the opportunity to achieve the best possible mental health and well-being.  Inclusive of people of all ages living in Canada, regardless of whether or not they have a mental illness.  Mental health is understood positively, as more than the absence of mental illness  People can have varying degrees of mental health, regardless of whether they have a mental illness  At the core, when it comes to mental health and well-being, we are all the same - there is no ‘us’ and ‘them.’  Some people will need specialized services to help them achieve the best possible mental health.

GOAL ONE: RECOVERY AND WELL-BEING People of all ages living with mental health problems and illnesses are actively engaged and supported in their journey of recovery and well-being.  Recovery principles apply universally, but adapted across the lifespan  Hope, choice, responsibility, self-determination, dignity and respect.  Emphasis on both recovery and well-being  People living with mental health problems and illnesses, service providers, family caregivers, peers and others are partners in the healing journey.

GOAL TWO: PROMOTION AND PREVENTION Mental health is promoted, and mental health problems and illnesses are prevented wherever possible.  Efforts are directed at the population as a whole, at people and communities at risk, at those with emerging problems, and at people living with mental health problems and illnesses  Emphasis on cross-sectoral collaboration to address the social determinants of health  Importance of mental health promotion and mental illness prevention to the sustainability of the system

GOAL THREE: DIVERSITY The mental health system responds to the diverse needs of all people in Canada.  Incorporates both cultural safety and cultural competence.  Emphasizes the importance of addressing disparities and power imbalances.  Recognizes that we are all multi-faceted individuals with many different types of experiences and sources of identity.

GOAL FOUR: FAMILIES The role of families in promoting well-being and providing care is recognized, and their needs are supported.  Inclusive definition of ‘family’ as ‘circle of support’  Recognize families’ need for support and information.  Points to the importance of acknowledging the needs of families while always respecting the rights of people living with mental health problems and illnesses.

GOAL FIVE: ACCESS AND INTEGRATION People have equitable and timely access to appropriate and effective programs, treatments, services and supports, that are seamlessly integrated around their needs.  People’s multiple needs – no matter how complex – should be met in a seamless fashion.  Coordination between mental health and general health services, housing, justice, social services, education and the workplace.  Special emphasis on underserviced areas such as the North.

GOAL SIX: KNOWLEDGE AND RESEARCH Actions are informed by the best evidence based on multiple sources of knowledge, outcomes are measured, and research is advanced.  Need to rely on many kinds of research, employing diverse sources of knowledge in order to enhance our understanding of mental health and mental illness  Scientific research, lived experience, policy experience, traditional and customary knowledge, etc.  Importance of acquiring the data needed to monitor mental health status, and system performance.  Faster and more effective knowledge transfer.

GOAL SEVEN: SOCIAL INCLUSION People living with mental health problems and illnesses are fully included as valued members of Canadian society.  Having a mental health problem or illness is no longer a source of shame or stigma for people and their families, and discrimination toward them is eliminated.  People of all ages living with mental health problems and illnesses are accorded the same respect, rights and entitlements, and have the same opportunities as people dealing with physical illnesses and as other people living in Canada.

A CALL TO ACTION: BUILDING A SOCIAL MOVEMENT  Closing element in framework.  Grass roots social movement to keep mental health issues on the policy agenda and to advocate for change.  Build on the achievements of existing mental health organizations, but work together to take everything to the next level.

THE HOW PHASE  Key questions:  How to achieve the goals for each topic area (constituency group/setting) and cross cutting theme?  Where are we at now in each topic area?  Where do we want to get to?  What are possible actions and priorities to get there?  Where are the strategic opportunities?  Key role for Advisory Committee Projects and Advice  Other Initiatives to be decided.

Mental Health Commission: Service Systems Advisory Committee Role and Activities Steve Lurie November 2009

Service Systems Advisory Committee  Advisory Committee Role  Provide input to Commission priorities- i.e. anti-stigma campaign, knowledge transfer  Help the Commission write the “how to” elements of the service system components of the mental health strategy  Committee process needs to be focused, but transparent and open to stakeholder input

Context  Senate Committee report details numerous service delivery system issues including but not limited to:  Areas of federal jurisdiction: immigrants and refugees, corrections, Aboriginal and Inuit funding and service delivery  Provincial systems issues: supportive housing, basket of services, funding, concurrent disorders, peer support, integration, to name a few

Context  Framework from Crossing the Quality Chasm/Improving Quality of Health Care for MH and Substance Abuse (Institute of Medicine) should anchor our work  Recommendations/ strategies should focus on one or more of the following issues:  Patient/consumer centred care> care coordination> improve quality and evidence base> improve informatics>strategic mental health workforce planning> funding

Context  Committee has been strategic in selecting issues, also has considered issues that were raised during the roundtable discussions across the country and the “advice” the Commission received from stakeholders.  Our Year 1 priority projects on diversity, supportive housing and peer support reflect advice heard during the recent national consultations

How we work  Our membership reflects a range of stakeholders and members have content expertise on some of the areas the committee could be looking at, e.g. peer support, diversity, telemedicine, collaborative care, chronic disease management  Project work is done by task group/ subcommittee drawn from sectors which are the focus of the project

How we will work  Suggested approach is a variation on “Plan, Do, Study, Act” (National Primary Care Development Team 2003)  Review Issue> Study> Propose Action>Get feedback> Recommend action strategies to the Board  Allows for strategic selection of time limited projects and stakeholder participation

Proposed Year 1 Priority Projects  Review of Peer Support across Canada- RFP  As improving the lives of people living with mental illness, is central to the Commission, this project will examine the range of supports and services that that are directed and provided by people who live with mental illness  will identify range of services, promising practices and cost effectiveness- aligns with choice, community support pillars, will contribute to KEC and mental health strategy

Peer Support Review  Project Committee led by consumer leaders from across the country  coordinated with CSI Builder project in Ontario  Consultants selected and work began in Feb  Completion by Jan 2010

Proposed Year 1 Projects: Diversity  Diversity: Towards an understanding of issues, best practice and options for service development to meet the needs of ethno-cultural groups, immigrants, refugees and racialized groups - review progress or lack of it on meeting the mental health needs of immigrants and refugees and racialized groups since the publication of After the Door Has Been Opened (1988) and the mental health implications of the 2006 census. Aligns with Commission pillars of choice and community support systems and will also contribute to KEC, anti stigma, and will provide a foundation for the national strategy and Commission work in a number of areas.  Project now complete

Year 1 Priority Project Proposals  Supportive Housing readiness survey- survey the readiness of regional and local systems across the country to develop supportive housing units over the next years.  Review includes an assessment of housing options required, financing options, services and supports that need to be available- Aligns with Commission pillars: Choice, Community Support Systems, will also contribute to KEC and anti stigma campaign. We believe this project is a critical issue for the National Mental Health Strategy.

Other Projects- years 2-3  Primary health care and mental health: prevention, shared care and chronic disease management.  Aligns with Commission pillar of integration- will contribute to KEC

Primary Health Care and Mental Health: Some facts  40 % prevalence of mental health problems in primary care settings  40% of people living with mental illness only receive care from a GP  72% of people with a psychiatric disorder receive no treatment in the course of a year; 81% of these individuals will visit a family physician  Collaborative primary and mental health care is evolving- in Hamilton 68% of the population is covered under a family health team scheme involving 80 physician practices

Primary Health Care and Mental Health  The Canadian Collaborative Mental Health Initiative, funded through the Primary Care Transition Fund has developed tool kits, policy documents, a charter and research which are available to the Commission, as well as a website  CCMHI is now doing provincial consultations and finding high degrees of interest from RHAs, provincial governments, and other stakeholders and is willing to collaborate with the Commission  This is a strategic issue for the national mental health strategy

Other issues for the National Mental Health Strategy  Issues that need work for the national strategy:  Concurrent Disorders: The Commission needs to ensure that work is done on concurrent disorders as part of the national strategy, given the large numbers of people with concurrent disorders who are ill served by both the mental health and addictions systems due to the lack of integrated treatment and community supports. People with concurrent disorders are also over represented in correctional services and do not get adequate treatment.

Other Strategic Issues  health human resource planning ( training, recruitment, retention),  mental health system quality assurance  FAS (work with First Nations, Inuit and Metis Committee and NADD  Supported employment  How to achieve integration- what actually works  Work over the next two years will be influenced by results of current projects, and issues MHC selects to build the how to for the national mental health strategy  A number of issues will require collaboration with other Commission advisory committees i.e. dual diagnosis, supported employment, workforce planning, diversity, MH and corrections.