New systems of accountability that encompass home care, primary and community care, and hospital services are unfolding as the Ontario government reimagines a coordinated healthcare system responsive to the needs of patients and their caregivers.
I’m gratified to see a repeated articulation of better physical and mental health as aspirational goals for Ontario. Yet, I believe it’s time to abandon the false dichotomy of this language. Mental health is health, and like all conditions of ill health, it’s brought about by a combination of biological and psychosocial factors. Mental health care has been historically separated from the rest of the healthcare system, to the detriment of individuals and populations. This time of extraordinary change is an opportunity to place mental health where it belongs, at the centre of healthcare. Integrated structures and processes that are co-created with service users, along with systematic measurement of results, will be pivotal to creating a system of care that can improve health outcomes for Ontario citizens.
Here’s how it could happen.
First, primary care providers need a system that provides the tools to promote mental wellness, to identify those at risk, to provide treatment for mild to moderate forms of mental illness, to seamlessly tap into community and social support systems, and to have immediate access to specialists through defined referral pathways. This means algorithms for first line medication use and an unimpeded corridor to structured psychotherapy and other therapeutic modalities delivered by a range of qualified professionals. Imagine the potential to reduce wait times and hallway medicine if patients received timely care for depression or an anxiety disorder – just as they would for high blood pressure – rather than experiencing first contact with the healthcare system in crisis at an emergency department.
We can build this capacity through guidelines for common conditions – linked to data collection and analysis for outcomes – that supports a healthcare system that learns and improves. The technology to disseminate and embed evidence informed practice exists, even for rural and remote communities. Opportunities to scale and spread the tools and processes to primary care providers over digital platforms are endless. At CAMH, Project ECHO (Extension for Community Health Outcomes) helps build communities of practice and provides support from specialists. Models like ECHO Ontario Mental Health provide long distance education, specialty support, and coaching to health professionals across the province. Local teams welcome the interaction and patients receive care in their home community.
Next, specialty care must be re-imagined for patients with complex mental illnesses like schizophrenia, bipolar disorder, severe depression, and disorders complicated by co-occurring substance use. Such individuals need support over months and years, and may develop lifelong disability. They should have access to the same quality of care that we would all expect if we required chemotherapy for cancer, care for congestive heart failure, or an organ transplant.
The cost and the health risks for individuals, their loved ones and for society are immeasurable. People with complex mental illness are at greater risk for cancer, heart attack, stroke, chronic lung diseases – and suicide. Their life expectancy is 10-20 years shorter than the general population. Early diagnosis and comprehensive care delivered by all components of the healthcare system can change their life trajectory to the benefit of us all.
Finally, to drive better clinical and functional outcomes for those who live with mental illness, provincial oversight through a public and transparent structure should be created. We should expect public scrutiny of wait times and health outcomes to include mental healthcare. This function exists to improve access to and effectiveness of care for other complex conditions, and mental illness should be no different. A provincial oversight function can monitor for quality of care and it can direct public investment. Implementation of care pathways and integrated care processes can then drive quality of care in all of its domains through standardization, measurement, improvement and accountability.
This government can create conditions that enable those of us in the mental healthcare sector to fully activate our skills and expertise. I look forward to working with system partners to improve care and supports for our patients, today and tomorrow, in our local communities and across the province.
Because, at the end of the day, #MentalHealthIsHealth.