Provincial health strategy needed, but doubts remain amongst front line workers in Lanark County

Mental Health Help. Anne Moloney, community services consultant with the Ontario Ministry of Children and Youth Services gets her notes ready to speak at the Municipal Drug Strategy committee’s networking day at the Brunton Community Hall in Blacks Corners, Beckwith Township, on Friday, Oct. 26. Desmond Devoy

When it comes to Ontario’s new 10-year mental health strategy, David North doesn’t know whether to shout hallelujah or get on his knees to pray.

Last week, Nicki Collins, executive director of Open Doors for Lanark Children and Youth, praised the initiative, remembering when the story was leaked to the press.

“That strategy was a hallelujah,” said Collins with her trademark smile. “We had been waiting so long for a strategy on child mental health.”

North, executive director of TriCAS (Tri County Addiction Services), would have liked to have shouted out a hallelujah, but couldn’t quite bring himself to do so.

“I’m not as keen on aspects of the 10-year program as I would like (to be),” said North. “We think it is healthy to be skeptical.”

“Open Minds, Healthy Minds,” which is billed as “Ontario’s comprehensive mental health and addictions strategy, has just ended its second year of implementation, and is headed into its third. The first three years, according to Anne Moloney, community services consultant with the Ontario Ministry of Children and Youth Services, are dedicated to children and families, before opening out province-wide thereafter to improve mental health for all Ontarians, partly by identifying problems early on.

Funding for the program is expected to grow to $93 million by 2013-14.

“When we look at the numbers in terms of the economic situation, I think that is an encouraging aspect of this,” said Moloney during her overview of the program at the Municipal Drug Strategy committee’s networking day at the Brunton Community Hall in Blacks Corners, Beckwith Township, on Friday, Oct. 26.

She stressed that the program was a multi-ministry collaborative approach, incorporating not only her ministry but also the ministries of training, colleges and universities and health and long-term care.

“It creates this culture of shared responsibilities,” said Moloney, with, for example, a community mental health project linked with an educational component, which places mental health workers in schools.

“All of our boards, all of our schools, were quite accommodating,” said Moloney. It is hoped that the program will cover a multitude of problems, such as reducing mental health wait times, identifying and intervening with children earlier, closing service gaps, and transitioning kids back into the education system.

However, increased awareness can be sometimes too successful, said Moloney, because “increased awareness leads to increased demand,” which then requires increased time, money and coordination.

She added that tele-psychiatry “is coming. It’s not here yet.”

But Moloney conceded that there was still a long way to go with the program. She quoted America’s president from 1901 to 1909, Teddy Roosevelt, who said “Do what you can, with what you have, where you are.”

“That sums up what we need to do,” said Moloney. “(Let’s) take advantage of the increased attention towards mental health and addictions (and) reduce and do away with the stigmas attached to it.”

While grateful to Moloney for her talk and her time, North served as a one-man loyal opposition and wasted no time in pointing out what he saw as the flaws and deficiencies in the program.

“What is the actual impact of the policy which was developed at a high level?” said North. “What does this really mean for the people we are trying to serve?”

The policy was being developed at a time before the 2011 provincial election and the Drummond Report, and therefore things looked very different even a few short years ago. He noted that there are now proposals either afoot, or which have already been implemented, to privatize parts of legalized gambling.

“When you move over to the private sector, there is less control,” said North.

As for the Drummond Report, there is ongoing discussion about constrictions with public sector pay, from doctors to teachers, police officers to politicians.

“You have problems with retention of staff,” said North, affecting the ability of health services to deliver their programs, and challenges in recruiting.

“Right now, there is nothing hitting the ground in terms of funding,” said North. “Our costs relative to compensation are very problematic,” but there is nothing in the policy to deal with that.

With pay freezes already in place, wage discrepancies and differing mandates could also impact the delivery of the program. With the much-vaunted three-ministry, multi-agency approach, some agencies could be partnering with other agencies that do similar work, and “when they are making $5,000 more or $5,000 less, there is an implicit tension.”

Sara Hammel, TriCAS’s health promoter, agreed with her boss that, in the addictions field, there were competing visions about what even an addiction is, ranging from:

• lifestyle choice

• moral failing

• chronic medical condition

• mental health issue

• treatable medical condition

• averse social conditions.

“Addictions seem to be appended on to mental health,” said Hammel. “When we change how we look at addictions it changes how we choose to address it.”

She added that there were even inconsistencies within the Drummond Report, which noted that addictions and mental health are “cost drivers. Addictions and mental health have a lot of costs associated with them.”

At the same time, however, the report by the respected Toronto Dominion Bank economist, also recommended aggressively pursuing the expansion of Liquor Control Board of Ontario (LCBO) outlets across the province, as well as expanding points of sale for lotteries, expanding the availability of addictive substances and games.

“Gambling costs people a lot more…but at the same time we see that we need to raise funds by harming Ontario’s citizens,” said Hammel.

The provincial government recently announced $500,000 for pregnant and parenting women who abuse opiates.

“We sure could use $500,000 for addictions, that makes sense in our local area,” said Hammel. There was also money for early mental health problem identification, but not money for follow-up care.

“If we have nurses identifying, but no money for follow-up, it just adds to waiting lists,” said Hammel. “The government has been doing a lot of things that are counter-intuitive.”

She conceded that the provincial government has increased monies for addiction programs by 48 per cent since 2003, with an 80 per cent increase in mental health programs in the same nine year period.

Hammel advocated charging more for alcohol, a limit on LCBO and Beer Store hours, as well as entrance fees to casinos, restricting the sale of energy drinks to young people, and a nickel-a-drink tax that would be plowed back in to addiction programs.

Hammel, a recent graduate from Carleton University, said she too has been able to deal with her own addiction – she hasn’t lifted a coffee cup in two weeks.

Increased demand

“The referrals have been coming in hot and heavy these past few weeks,” said Collins of demand in the area for mental health resources, with a 19 per cent increase in referrals, with a high-water mark of 91 referrals in February alone. Collins commended the mental-health-worker-in-the-school aspect of the program.

“They feel that it is their child and health worker,” she said. “She (the nurse) becomes a face in the community. That’s increasing our referrals.”

Marcia Gibson, regional manger, east region, for the Centre for Addiction and Mental Health in Ottawa, praised the program for seeking to bring multiple ministries and agencies together, to have “systems improvement through service collaborations,” and to “focus on families with complex or highly complex needs,” which usually means that a family is accessing more than one agencies help.

A family could be accessing social services, have a member who has a mental health issue, and another who might have had run-ins with the law. Gibson hoped that the multi-agency approach “is seamless so that I don’t have to jump through hoops, so that I don’t go to doors that are closed to me.”

But she also admitted that people are used to doing things a certain way, and one agencies way may not jive with another agencies perspective. Also, people are busy and sometimes people “bleed away,” and nothing gets done.

“We have to jump in, have a leap of faith, and learn from our mistakes, without impacting children or families,” said Gibson.

“I’m grateful for the critical what works, what doesn’t work (comments),” said Moloney at the end of the morning.