When Moving on Mental Health was announced at our Children’s Mental Health Conference in November of 2012, then Assistant Deputy Minister Aryeh Gitterman pledged a sweeping transformation that would profoundly improve the way child and youth mental health services were delivered in this province. With the goals of creating and supporting pathways to care, defining core services, establishing community lead agencies, creating a new funding model and building a legislative framework to sustain the transformation, the hopes of the community-based children’s mental health treatment sector reverberated throughout the plenary.
A slide entitled “Looking Back from 2015” lauded a future state where children would receive responsive, seamless, equitable, evidence-informed services matched to their level of need. Sure – it would be difficult. But we were up to the task. We wanted change and were eager to lead it. Full implementation – it was promised – would take about 3 years. We couldn’t get started quickly enough.
Fast forward 5 years, 4 Ministers, 2 Deputies, 3 Assistant Deputies and a revolving door of policy staff (even the name of the team changed from System Transformation to System Transition and then back to System Transformation again) and what have we accomplished? Not nearly enough.
Interviews with more than 75 Senior Leaders from community-based children’s mental health treatment centres over the past 3 months reveal that no one is yet prepared to say that MOMH has succeeded in improving the experience of children and families in Ontario. Instead, system leaders describe a strategy that, while well-intended, has sadly missed the mark.
It’s not all bad of course. Lead agencies have been established in 31 of the 33 service areas. Communities are pioneering work to map available services and improve pathways to care via central access. The Ministry has developed requirements for service providers, including those related to core services and key processes, and has introduced 13 key performance indicators to begin measuring results (albeit subjective ones that are not well understood). But MOMH falls short. Not only is it painfully behind (the sector has yet to see a revised funding formula or a new regulatory framework) but with time it has become increasingly evident that the initial goals of MOMH did not actually address the problems that needed fixing to begin with.
Service providers instead speak to the many ways in which their capacity is eroding. With no base funding increase in nearly two decades, and with more than 12,000 kids on waitlists across the Province – some waiting up to 18 months for coveted long-term counselling and therapy, the system has quite simply not kept up with demand. The increasingly popular ‘walk-in’ approach, while fine for some clients, is masking the longer-term needs of so many more which go unfulfilled. These are the kids with more intensive, ongoing needs whose problems cannot be solved in 1-3 sessions. These are the kids who wind up in our emergency departments and in-patient units at increasingly alarming rates. (CIHI reports a 63% increase in emergency room visits and a 67% increase in in-patient admissions for youth with mental health issues in Ontario since 2006 – rates which are higher than the national average and at a time when hospital usage for this age group has declined for all other issues.)
Service providers tell us that what keeps them up at night are the kids on their wait lists - the ones who have severe issues who require more treatment than they are resourced to provide, the ones who require interdisciplinary intervention, intensive out-of-home treatment, and intensive wrap-around support together with their caregivers. They worry about the increasing level of complexity that they are seeing and their inability to meet needs with limited staffing resources. And they worry about the kids that don’t make it through their doors at all – the ones who die by suicides that could have been prevented had they been provided with timely and appropriate treatment.
Children’s mental health treatment providers are expert innovators who are committed to the children and families they serve and who desperately want to see system transformation that was promised 6 years ago. But until the inherent lack of capacity in the system is acknowledged and addressed, there will be limits to what they can accomplish.
Children’s Mental Health Ontario has a plan to address the lack of capacity at community-based children’s mental health centres. With an estimated investment of only $125 million per year, this plan would:
- Ensure no child waits more than 30 days for mental health treatment
- Expand specialized mental health services for children with the most intensive needs, in particular in Northern communities
- Ensure children’s mental health treatment providers can recruit and retain high-quality staff – including the right mix of interdisciplinary professionals – with specialized clinical expertise in child and youth mental health and addictions.
- Create provincial quality standards including those related to admissions, wait times, client experience and client outcomes.
This plan would begin to address the systemic challenges facing the children’s mental health sector as a result of chronic underfunding. It would also yield cost-savings for government of $175 million each year in reduced hospital visits alone.
Our sector is well-positioned to drive this change forward. We are ready, willing and able partners. With the right level of government investment, we can get kids off wait lists, out of emergency rooms, and into treatment – and that would truly be transformational.