Use technology to foster collaboration, increase access to services, and engage

3.1

A transformed mental health system should primarily be based in the commu-nity, because obtaining services, treat-ments and support in communities improves quality of life and leads to spending less time in hospital.^{130, 131} De-institutionalization—when Canada, along with many other countries, moved away from a long tradition of warehousing people with mental illness in institutions (or ‘asylums’)—was the right policy. Our failure was in not replacing institutional care with sufficient services and supports in the community.

This failure has contributed significantly to the proportion of people living with mental illness among the homeless population and in our jails and prisons, turning them into the ‘asylums’ of the 21^st century. Lack of access in the community to crisis

support, mental health and primary care services also drives people to emergency rooms for help, increasing waits and stretching resources.¹³² Many community services do not even keep waiting lists, because it might give false hope to people in need that eventually their turn will come.

Not only is it essential to do a better job of measuring waits for community-based services, but standards should also be set for wait times, similar to those that exist for several physical illnesses.^{133, 134}

Community services—when they are working well—are responsive, focused on individual needs, and in tune with local realities. Among other benefits, commu-nity mental health teams have produced good results in ensuring engagement and satisfaction with services, as well as in continuity of care.¹³⁵ All services (mental

Increase the availability and coordination of mental health services in the community for people of all ages.

PRIORITY 3.2

Reducing Wait Times for Mental Health and Addictions Services, Saskatchewan

As part of a broader provincial initiative, mental health and addictions services in Regional Health Authorities (RHAs) across Saskatchewan have been using the ‘Lean’ approach to reduce wait times.

Lean is an approach to evaluating service delivery in a workplace, which focuses on services users in order to make processes and procedures more efficient and more responsive.¹³⁶ One larger RHA has reduced wait times for adult mental health services from eight months to one month, and is meeting 80 per cent of urgent requests within seven days. A smaller RHA now has no waiting list for child

health, addictions, health, social services, education, justice and other sectors) need to be better coordinated, including across the lifespan. People who are using such services need support in navigating their way through the system. One way to make this happen is to enable people living with mental health problems and illnesses to work with service providers on individual-ized plans that can help to ensure that all services, treatments and supports are better tailored to their individual recovery and well-being.

My life has been hard and long but I am now a mentor for others living with mental health issues. I work in the system, and I understand what my clients are going through. I believe I’m a better person for it. But it should not have taken as long, it should not have been as hard, and services should be more available. When I tell someone I’m sorry I don’t know where to send them for help, I know only too well how it feels.

— Social worker with lived experience

Children, youth, and seniors face particular challenges in gaining timely access to the right combination of services, treatments and supports.¹³⁷ In addition to addressing critical gaps in services, human resour-ces, and research, mental health services across service systems which are specific to each stage of life—including day care and child welfare for children, and home care and long-term care for seniors—must be better coordinated.

Other services for which we know people are waiting too long, if they can get it at all, are psychotherapies and clinical counsel-ling. There is strong evidence that these services, when provided by those who are qualified to deliver approaches that are based on the best available evidence, are cost effective and improve outcomes for many people living with mental health problems and illnesses.^{138, 139} Publicly funded systems in countries such as Australia and the United Kingdom have made expanding access to these services a priority.

There are some publicly funded psychotherapies and clinical counselling in Canada in hospitals and mental health centres, but the waiting lists are very long and the criteria to access these services can be very restrictive. There are therapists and counsellors in private practice, but many people cannot afford them, and not enough is being done to fund and support innovative, team-based approaches to providing these services in com-munity mental health and primary health care networks.

Given the potential benefits across the lifespan, it is especially urgent for governments to address the problem of ‘two-tier’ access to psychotherapies and clinical counselling in the area of child and youth mental health. It is not acceptable that young people whose families cannot afford to pay for privately delivered services should be made to wait for up to a year for publicly funded services. Governments must ensure that there are no financial barriers for children and youth who need timely access to psychotherapies or clinical counselling.

MHCC Evergreen: A Child and Youth Mental Health Framework for Canada. ¹⁴⁰ The MHCC Child and Youth Advisory Committee developed this framework to be a resource for those involved in, affected by and responsible for child and youth mental health policy, plans, programs and services. Evergreen presents a set of values and strategic directions to guide child and youth mental health initiatives across Canada. It was developed through an innovative approach to gathering evidence and build-ing consensus among national and international experts.

RECOMMENDATIONS FOR ACTION

3.2.1 Increase resources and capacity for a range of