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Framework for A Mental Health Strategy for Canada

Country: 
Canada
Partner Institute: 
Canadian Policy Research Networks (CPRN), Ottawa
Survey no: 
(13) 2009
Author(s): 
MacAdam, Margaret
Health Policy Issues: 
Quality Improvement, Access, Responsiveness
Reform formerly reported in: 
National Mental Health Strategy
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Abstract

The Mental Health Commission of Canada has released a draft framework for developing a comprehensive mental health system in Canada. The framework sets forth eight goals, among others recognition of the importance of the family in promoting recovery, equitable access to services, recognition of the diverse needs of Canadians, evidence-based actions, measurement and research, elimination of discrimination and stigma. Canadians are being asked to submit comments on the framework.

Recent developments

Canada is the only Group of Eight country without a national strategy on mental illness and mental health.  In 2007, we reported on the creation of the Mental Health Commission of Canada.  During its expected ten year life, the goals of the Commission are to develop an anti-stigma campaign to educate Canadians about mental health, promote the development of a national strategy, and create a knowledge exchange for mental health professionals, advocates and the Canadian public.  One of its first major activities is the publication of a draft framework for the eventual mental health strategy.  The plan for the national stategy is expected to be completed by 2011.

In January 2009, the Mental Health Commission invited Canadians to submit comments on its proposed framework for a national mental health strategy.  The draft framework contains eight goals:

  1. The hope of recovery is available to all;
  2. Action is taken to promote mental health and well-being and to prevent mental health problems and illnesses;
  3. The mental health system is culturally safe, and responds to the diverse needs of Canadians;
  4. The importance of families in promoting recovery and well-being is recognized and their needs are supported;
  5. People of all ages have equitable access to a system of appropriate and effective programs, services and supports that is seamlessly integrated around their needs;
  6. Actions are based on appropriate evidence, outcomes are measured and research is advanced;
  7. Discrimination against people living with mental health problems and illnesses is eliminated, and stigma is not tolerated; and
  8. A broadly-based social movement keeps mental health issues out of the shadows-forever. 

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Characteristics of this policy

Degree of Innovation traditional traditional innovative
Degree of Controversy consensual rather consensual highly controversial
Structural or Systemic Impact marginal neutral fundamental
Public Visibility very low low very high
Transferability strongly system-dependent strongly system-dependent system-neutral
current current   previous previous

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Initiators of idea/main actors

  • Government
  • Providers
  • Patients, Consumers
  • Opinion Leaders

Stakeholder positions

To date, six stakeholder consultations have been held in Vancouver, BC,  Regina,  Sask., Toronto, ON, Thunder Bay, ON, Ottawa, ON, Halifax, NS  and St John's, Newfoundland and Labrador.  Others are planned.  In addition to, or instead of attending one of the regional consultations, stakeholders are invited to complete an online workbook available on the website of the Commission (www.mentalhealthcommission.ca

Stakeholders indicated general support for the goals listed above but added additional issues to be considered such as the importance of performance measurement, addressing the unique access issues of those living in rural and remote areas of Canada, the importance of the social determinants of health and mental illness, the role of health promotion and prevention, the meaning of cultural safety and the need to address addictions as part of a mental health strategy.  In some cases rewording of some goals was proposed.

Actors and positions

Description of actors and their positions
Government
federal governmentvery supportivevery supportive strongly opposed
Providers
Canadian Alliance on Mental Illness and Mental Healthvery supportivevery supportive strongly opposed
Patients, Consumers
Canadian Mental Health Associationvery supportivevery supportive strongly opposed
patients with mental health problemsvery supportivevery supportive strongly opposed
Opinion Leaders
Canadian Psychiatric Associationvery supportivevery supportive strongly opposed
current current   previous previous

Influences in policy making and legislation

NA

Actors and influence

Description of actors and their influence

Government
federal governmentvery strongvery strong none
Providers
Canadian Alliance on Mental Illness and Mental Healthvery strongvery strong none
Patients, Consumers
Canadian Mental Health Associationvery strongstrong none
patients with mental health problemsvery strongstrong none
Opinion Leaders
Canadian Psychiatric Associationvery strongvery strong none
current current   previous previous
Canadian Mental Health Association, patients with mental health problemsfederal government, Canadian Alliance on Mental Illness and Mental Health, Canadian Psychiatric Association

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

NA

Monitoring and evaluation

NA

Expected outcome

The draft framework will be revised as a result of the stakeholder consultations.  There have been several statements by important advocates of mental health policy.  For example, the Canadian Mental Health Association (CMHA) has urged the Commission to take a number of steps in developing the eventual national strategy. They include:

  1. Weave the recovery vision throughout the components of the strategy; and
  2. Create a theorretical framwork for distinguishing formal services and approproaches that operate outside the (mental health) service system;

The CMHA sees a reformed system that is centered on the goal of mental health and recovery, with internal linkages that connect community action and formal services, and with external links to a broader health and social services system.   

The Canadian Alliance for Mental Illness and Mental Health suggested that a framework for action on mental health and mental illness focus on four priorities:

  1. Leadership: federal, provincial and territorial governments must demonstrate co-operative leadership to improve access and quality of mental health services and programs;
  2. Information: Canada must build a national data collection and reporting system;
  3. Research: Governments must strategically invest in new research; and
  4. Promotion: Effective mental health promotion initiatives must be undertaken.  

Another group which has taken a public position on improving the mental health system in Canada is The Globe and Mail, one of the country's most influential national newspapers.  After running a series of articles on aspects of mental health care, the paper published a set of 12 actions that could be taken: 

  1. Commit to a national mental-health plan-now
  2. Conduct public education campaigns to combat stigma;
  3. Create a $10-billion, national mental health fund;
  4. Set up community-treatment programs in every health district;
  5. Build tens of thousands of supportive housing units;
  6. Double the amount Canada spends on research;
  7. Establish mental health courts in every province;
  8. Set up advisory groups to represent afflicted families in every district;
  9. Implement early intervention programs in all schools;
  10. Push the business community to lead the way on workplace support;
  11. Radically reduce wait times for both emergency and therapeutic care;
  12. Invest in peer-support groups. 

These steps can be embeded in the national strategy but ultimately action on any strategy will be the responsibility of the provinces.  The extent to which the provinces will improve their care for those with mental illness may depend, in part, on new financial incentives being provided by the federal government.

Impact of this policy

Quality of Health Care Services marginal neutral fundamental
Level of Equity system less equitable system more equitable system more equitable
Cost Efficiency very low neutral very high
current current   previous previous

References

Sources of Information

"A 12-Step program for Canada". The Globe abd Mail. June 27, 2008. Available at www.globeandmail.com

Canadian Alliance on Mental Health and Mental Illness. Framework for Action on Mental Illness and Mental Health: Recommendations to health and Social Policy Leaders of Canada for a National Action Plan for Mental Illness and Mental Health. 2006.

Canadian Mental Health Association. 'Out of the Shadows' Redux. nd.  Available at www.cmha.ca

Mental Health Commission of Canada. Toward Recovery & Well-Being. 2009. Available at www.mentalhealthcommission.ca

Mental Health Commission of Canada. Stakeholder Meeting Reports. Available at www.mentalhealthcommission.ca

Reform formerly reported in

National Mental Health Strategy
Process Stages: Policy Paper

Author/s and/or contributors to this survey

MacAdam, Margaret

Senior Fellow, Canadian Policy Research Network

Suggested citation for this online article

MacAdam, Margaret. "Framework for A Mental Health Strategy for Canada". Health Policy Monitor, April 2009. Available at http://www.hpm.org/survey/ca/b13/4