Status: At First Reading as of September 11, 2017

Background

Ontario introduced legislation titled “An Act to establish the Ministry of Mental Health and Addictions” on September 11, 2017. The new ministry will be sold as a single entity wholly focused on building and maintaining mental health and addictions infrastructure.

The proposed bill establishes thirteen duties and functions for the minister, and while all of them impact First Nations, there is little directly relating to First Nation peoples. Highlights of the Minister’s tasks from this Bill that will impact First Nations include:

  • Leading the “transformation” of mental health so that necessary supports are offered when needed and within communities,
  • Managing, develop, and coordinate the mental health and addictions system
  • Implementing recommendations from the Select Committee on Mental Health and Addictions (2010) that remain outstanding,
  • Develop a “core basket of co-ordinated mental health and addictions services” that would enable regional variation and cultural sensitivity,
  • Make all funding decisions in mental health and addictions, and
  • Improve responses to public health emergencies.

The minister will also be responsible to deliver timely, coordinated, and high-quality mental health services, eliminate the stigma of mental illness, promote “values that define Canadian health care,” and collaborate with other ministries and governments.

Ontario is in a unique position because British Columbia has very recently established a new Ministry of Mental Health and Addictions. This was part of the NDP platform, and has received mixed reviews. We can learn from their experience.

Impact

There is an existing infrastructure for mental health and addictions, and it is not completely clear how the new ministry will impact it, especially the services for First Nations. We have developed an overview of existing mental health and addictions initiatives, which is a useful backgrounder on the context of mental health and addictions.. For more information on these initiatives, click here.

The new legislation does not clarify how those funds and programs will be impacted.

This new Ministry might present an opportunity to improve mental health and addiction services to First Nations. The Ontario Mental Health and Addictions Leadership Group made several helpful recommendations in its 2016 Annual Report. They are:

  • Increase access to community-based, Indigenous designed, developed and delivered services.
  • Ensure mainstream system transformation results in an improved, culturally safe service experience for Indigenous people and communities and that local service planning gives a greater role to First Nations, Inuit and Métis partners.
  • Actively create and integrate Indigenous approaches to mental wellness and well-being that are holistic, inclusive of the whole family and address needs across the life span from a social determinants of health perspective.

These goals might be achieved through the new Ministry of Mental Health and Addictions. We can use this transition phase to ensure that these goals are met.

Analysis

An open question related to this proposed ministry is whether more bureaucracy is the best way to address mental health and addictions. Perry Kedall, the Provincial Health Officer in BC, expressed concerns that it could create funding, staffing, and information-sharing challenges. He wondered if this new Ministry would become the “poor cousin” of the Ministry of Health. Conversely, Canadian Mental Health Association CEO Bev Gutray has supported the new ministry in BC in creating a system of care “that values mental health and addictions care as equal to physical health care.”

Whether or not a new bureaucracy is taken as a positive or negative, there are no government reports or recommendations that explicitly put the idea of an entirely new ministry forward. The Select Committee on Mental Health and Addictions (2010) recommended establishing an umbrella organization on mental health within MOHLTC instead. In 2011 the Canadian Mental health Association recommended serious consideration of such a ministry, but that was from an external agency, and the recommendation was one of several policy options presented.

Another concern is that the new Minister will be responsible to implement “outstanding” recommendations from the Select Committee on Mental Health and Addictions, but it is not clear what recommendations are included in that definition. This means it is not clear precisely what the new Ministry will do.

Several recommendations from the Select Committee on Mental Health and Addictions, which may be part of this new ministry, impact First Nations directly.

  • Recommendation 10: Directs “interdisciplinary primary care models” to include a mental health and addiction treatment component. This care model includes Aboriginal Health Access Centres. The implications are unclear.
  • Recommendation 20: Extends the “core basket” of mental health services to incarcerated populations, but it remains unclear whether this includes Indigenous mental health services.
  • Recommendation 22: Proposes that a task force investigate and propose changes to the Personal health Information Protection Act, 2004 so family members and caregivers living or caring for individuals with mental illness have the information necessary to provide support. Neither the recommendation nor the description of the problem include any consideration of how this would align with principles of OCAP.

Conclusion

While this Act, if passed, would create a new ministry, the impact of that ministry is still very much unclear. The basic purpose of the new ministry – to support mental health and addictions – is a good one. How that plays out in implementation is something that Chiefs of Ontario will be tracking, specifically making sure that existing services for First Nations are protected, and that culturally appropriate, community-driven mental health and addictions services are developed.

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