What happened to Ontario’s mental health strategy?

TheStar.com – Opinion
Published On Wed Mar 31 2010.   By Carol Goar, Editorial Board

More than 1,000 people poured into the Toronto Convention Centre on a bright Monday last July for the release of the province’s direction-setting paper on mental health.

The mood was expectant. David Caplan, who was then health minister, had promised to make mental illness – normally an afterthought in government – a personal priority.

He did not disappoint the crowd. His discussion document, Every Door is the Right Door, was a breath of fresh air for the millions of Ontarians struggling to find help in the province’s confusing, fragmented mental health system. It acknowledged they were badly served. It set sensible goals. Every page stressed that the government needed and valued the views of people’s real-life knowledge.

Caplan’s tone was right, too. He spoke of the toll that psychiatric problems had taken on his own family. He promised to lead the fight against the stigma attached to depression, bipolar disorder, schizophrenia and other mental illnesses. He highlighted the staggering dollar cost of mental illness ($39 billion a year in Ontario) but stressed that the real, immeasurable cost was borne by those struggling to manage their diseases and their families. And he pledged to deliver a 10-year mental health strategy – designed for users, not bureaucrats – by the end of the year.

Steve Lurie, who heads the Toronto branch of the Canadian Mental Health Association, was there. He felt the optimism in the room. He shared it.

Nine months later: Silence.

Caplan is no longer health minister. He resigned last October, taking the fall for a spending scandal left by his predecessor, George Smitherman.

His Dec. 31 deadline came and went.

His replacement, Deb Matthews, hasn’t said a word – at least not publicly – about a mental health strategy.

According to a ministry official, it is still on track. The policy will be out by the end of this year. “It remains a top priority,” said David Jensen.

It is true that behind-the-scenes activity has continued. The health ministry has wrapped up its consultations with selected groups. Other government departments – children’s services, justice, housing, education, labour – are meeting to determine their role in the mental health strategy. And Caplan’s advisory panel of medical experts and providers of overstretched services is still in place, fleshing out the bare-bones plan he released last summer.

But none of this is visible. People with mental illness don’t know what’s going on.

Meanwhile, concerns are rising that the government will offer a collection of fine-sounding objectives with no funding to back them up.

Money has been a problem from the outset. Caplan acknowledged that. But since his departure, Ontario’s deficit has ballooned and Premier Dalton McGuinty has channelled an additional $300 million into post-secondary education.

There was no mention of mental health in last week’s budget. But the government did set a direction for overall health spending. Growth will be capped at 3 per cent, despite rising demand, rising costs for drugs and medical technology and an aging population. That doesn’t leave much room for mental health.

No doubt, existing resources can be used more effectively. But redeploying $2.5 billion – no matter how skilfully it is done – won’t meet the overwhelming need for basic services.

The World Health Organization says governments should aim to spend 8 cents per health-care dollar on mental health. New Zealand spends 10 cents. Britain spends 8 cents. Ontario manages just 5.4 cents.

“Everyone wants an ambitious strategy, but the bottom line is you can’t do it without more money,” Lurie said.

He is optimistic Matthews will come through. She has sent positive signals internally, he points out.

Those struggling with mental disorders are less confident. They liked having a health minister who spoke to – and for – them.

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