INCLUDE

Among Canadians aged 15 or older who report that they need mental health care, one-third say the health care system does not meet their needs.⁴

In Ontario, mental illness accounts for about 11 to 15 per cent of the burden of disease but receives just 7 per cent of health care dollars.⁵,⁶ This underfunding affects our health care system's ability to offer timely intervention and adequate support for mental illness.

CAMH experiences the immediate effects of this gap. In the last five years, the number of patients visiting our emergency department has increased by 68 per cent. Through services such as the CAMH Gender Identity and New Beginnings Clinics, we know that our hospital and the overall health system must do better to meet the diverse needs of the communities we serve.

Our work is ongoing to address this unmet and growing demand. For example, the CAMH Bridging Clinic provides more appropriate care to people entering our emergency department with less acute needs. Following on the development of a culturally adapted form of cognitive- behavioural therapy for people of Caribbean origin, CAMH is leading a similar project for Canadians of South Asian origin.

One CAMH focuses our efforts on areas where we see the biggest opportunities for meaningful change. With our partners, we remain committed to ensuring timely, easy access and to growing and changing our services and processes to meet the needs of patients and families.

Our commitments to “Connected Systems of Care” (within Impact) and to “Digital Health and Innovation @CAMH” and “Fair and Just CAMH” (within Include) help to advance this important work.

MILESTONES

2020–2021

• Consolidate our crisis care capacity and improve patient experience as we co-locate services to the Crisis and Critical Care Building.
• Work with partners and the community to improve the cultural appropriateness of services. Enhance services for transition-aged youth that respond to their self-identified needs.

2021-2022

• In alignment with “Connected Systems of Care” commitments, launch an enhanced referral management system through improvements to Access CAMH.
• To help scale and spread virtual care services across CAMH and the broader system, evaluate these services in connection with “Digital Health Innovation @CAMH.”

2022–2023

• Leverage data, analytics and community partnerships to innovate, address gaps and ensure timely, easy access to care.

Footnotes

At CAMH, leading-edge information technology plays an integral role in supporting the best possible care. We have a highly coordinated, paperless electronic health record and are leaders in analytics and big data. These are transforming how patients, families and communities experience care.

The CAMH response to COVID-19 reshaped how we deliver care. Dramatic expansion of our virtual offerings saw us adopt new ways of caring for patients and integrate technology like never before.

At the same time, the acceleration of virtual care has meant that patients who do not have the technology to participate have greater challenges accessing care. We are committed to addressing this emerging barrier to belonging.

Digital Health Innovation @CAMH continues to reimagine the patient journey and scale technologies (e.g., mobile apps, wearables) to support recovery in places that work for patients (e.g., homes, communities, CAMH).

Our next step, a robust innovation ecosystem and its pipeline, is necessary to improve patient and population health outcomes now and into the future.

This priority action links closely to “Responsive Access to Care” (within Include) and to “Caring and Accountable CAMH” (within Impact). Through these interconnected initiatives, we embrace patient and family co-design, partnerships and a culture of inclusive innovation that moves us together from ideas to reality.

MILESTONES

2020–2021

• Launch “Digital Health Innovation @CAMH,” a road map grounded in early wins and long-term changes.
• Continue our virtual care expansion and roll out internet-based cognitive-behavioural therapy.

2021-2022

• Build on successes from the CAMH Innovation Expo to launch an innovation pipeline and demonstration units that will accelerate identification and adoption of technology solutions.
• Formalize strategic partnerships within the start-up, research and technology communities to deliver digital services and tools.

2022–2023

• Continue our move toward a virtual hospital, where care follows the patient and is accessible online.

Movements such as #MeToo and #BlackLivesMatter opened conversations about long-standing patterns of power, privilege and oppression, which can result in poor outcomes for patients and negative experiences for CAMH people.

Many CAMH initiatives aim to increase health equity and promote belonging. To coordinate and amplify our work, we launched the Fair and Just CAMH initiative in 2019. In collaboration with groups such as the CAMH Horizontal Violence, Anti-Racism and Anti-Oppression Working Group, the initiative helps to advance multi-year milestones in areas that include data-sharing, health outcomes, training and other support for CAMH people.

Fair and Just CAMH represents our commitment to do more. It weaves through all our work and aligns with other priority actions, such as “Individual and Team Health” (within Inspire), “Shkaabe Makwa” (within Impact) and “Responsive Access to Care” (within Include). Together, we walk an intentional path toward greater diversity, equity and inclusion.

MILESTONES

2020–2021

• Conduct a survey and continue to host inclusivity events to inform actions that address horizontal violence, racism and oppression at CAMH.
• Informed by results of a quality improvement project for Interpreter Services, implement initiatives to improve service use at CAMH and beyond.
• Build on our extensive internal and external health equity training experience to pilot targeted training in the CAMH forensics program, then expand to additional areas.

2021-2022

• For CAMH recruitment, retention and training, drive improvements that support survey findings and that are integrated with initiatives under “Individual and Team Health.”

2022–2023

• Monitor impact, make necessary adjustments and continue working toward a more diverse, equitable and inclusive CAMH.

Patients and families must be central to our work. Our three-year Patient and Family Engagement Road Map activates this principle. It outlines steps toward a future where we include patients and families in all aspects of our organizational, clinical, research and education initiatives. It aims to achieve care of the highest quality.

We have already begun to evolve our structures and culture to ensure that CAMH people, patients and families can collaborate meaningfully and respectfully. Through One CAMH, we commit to further changes and to establishing mechanisms for monitoring the outcomes of patient and family engagement. We know that peers play important roles, and our work will include efforts to amplify their participation.

The “Collaboration and Co-Design” priority action (within Include) outlines additional plans to elevate partnerships. Patient, family and partner engagement also features in numerous other sections of One CAMH, which illustrates the centrality of engagement to our vision of redefining health with our communities.

MILESTONES

2020-2021

• Launch the Patient Advisory Committee to ensure CAMH embeds patients and families in decision making.
• Launch patient and family research advisory groups, which support researchers in engaging and co-designing with patients and families across the research spectrum.
• Establish the Patient and Family Partners Program.

2021-2022

• For quality improvement initiatives, co-create research and measures driven by experiences and outcomes that are important to patients and families.
• Increase access to peer education, advocacy and support.

2022-2023

• Evaluate and optimize patient and family engagement outcomes.

The One CAMH engagement journey surfaced important questions, including what it means to develop and implement change together; how to build a shared understanding of collaboration, co-design and co-production; and how to know when we are using the right approach.

CAMH has expertise in these ways of working. For example, the Krembil Centre for Neuroinformatics calls upon its scientists to ensure collaboration in 80 per cent of research undertakings. The Discovery Fund builds convergence platforms to support researchers from different fields of expertise to work with one another and with patients and families in new ways.

The CAMH recovery college pilot program brings to life service user–identified strengths and values (e.g., self-determination, empowerment, equity). It does this by co-developing and co-delivering courses that help people achieve their self-defined recovery goals. The program is committed to building community partnerships and to putting decision-making power in the hands of people with lived experience. This will ensure the direction of the program remains in the hands of many.

When we work together in ways that disrupt traditional structures, opportunities for deeper inclusion and transformative change increase. We see this informing One CAMH implementation broadly and our "Connected Systems of Care" priority action (within Impact) particularly.

MILESTONES

2020–2021

• Evolve the recovery college to meet student needs through virtual delivery, expanded course offerings and innovative partnerships.
• Enter new, non-traditional partnerships in priority areas aligned with our vision of health redefined. These areas include housing, income support, education and food security.

2021-2022

• In the recovery college, establish community-based partnerships and expand virtual offerings that increase program reach and accessibility in the Greater Toronto Area and beyond.

2022–2023

• Use co-created evaluation to measure the effects of the recovery college, while implementing a co-developed, recovery-oriented research program.