Mental health live blog

  • Welcome

    My name is Haydn Watters and I'm with the CBC's provincial elections team. Today, we're talking mental health and the provincial election. It's something the major parties have pledged billions to on the campaign trail.
     
    Joining me today (and taking your questions) are mental health advocate Alicia Raimundo and Steve Lurie, executive director of the Canadian Mental Health Association's Toronto branch. 
     
    Alicia ... Steve ... would you mind introducing yourself?
  • I've worked for CMHA since 1975 and have been the executive director of cmha toronto. i have been active on mh policy and funding, having worked with the ONtario ministry of health on the grahm report and subsequenet mh reports since 1987, and assisted Senator Michael kirby with his 2006 report on the mental health system in Canada and chaired the mhcc service systems advisory committee from 2007-2012. I teach health and mental health policy at  UofT FISW where i am an adjunct professor
  • Hello Everyone! My name is Alicia Raimundo. I work to empower young people to overcome mental health stigma and to create treatments that are accessible and fun. Inspired by my own struggles with mental illness, I have worked in mental health for over 8 years. I helped create BeanBagChat.Ca At Stella’s Place which supports young adults to the support they need.  I am the co-chair of the ACCESS Open Minds Youth a Council.  I have shared my story on numerous stages including at the United Nations, the Federal Standing Committee on the Status of Women, TEDXWaterloo and One Young World. I have also written and book aimed at schools to educate young people on Suicide and was recently featured along Cher in Vanity fair.
  • First, let's talk politics.

    All the major parties have talked about mental health and made some specific pledges. 

    The Liberals are committing $2.1 billion over four years to "rebuild" the mental health care system, including hiring more mental health care workers in secondary schools and increasing access to publicly funded psychotherapy.

    The PCs are promising $1.9 billion over 10 years, pledging to cut waiting times for youth who need mental health treatment.

    Meanwhile, the NDP has marked $2.4 billion over four years for mental health and addictions funding. Their promises include starting a new ministry of mental health and addictions and hiring 2,200 new mental health care workers.

    The Greens have the most substantial promise financially, pledging $4.1 billion over four years and hoping to bring mental health services under OHIP+.

    What do you think of these promises? Is there a particular party or promise that stands out?

  • For me, I am very happy that mental health has become an election issue. As someone who waited over 7 years for treatment after attempting to end her own life, I know that we need more supports and options out there for people to access. I am sad to not see Peer Support mentioned in any of the promises so far, as access to peer support saved my life. I am pretty excited by the NDP creating a ministry for mental health, as that has been really interesting to watch develop in BC. I also helped our current government created the structured psychotherapy program that is part of their promises, so it would be awesome to see that develop as well. There isn't much information available on the PC promises, but I am a bit wary given what they have been saying about health generally.
  • it is great to see that all parties pledging to do more to improve access to mental health services and supports. The McMcmaster Health forum estimates that there is an annual shortfall of 1.5 billion each year related to population needs. All parties are moving toward fixing this over the long term. However based on funding commitments, the Liberals, Greens and NDP have committed the most funding over the short term. The PCs will add 3.8 billion over 10 years. All parties have promised more  money for supportive housing, with the NDP committing to implement the recommendations that the province fund 30,000 supportive housing units over 10 years. The waitlist in Toronto currently stands at 14,100 and grows by 400 every 3 months
  • Question here from Corrine.
     
    This is something that the Greens have promised to do if they are elected. Is it doable? 
  • That's a great question, and to be honest I am not really sure. I wish it was covered under OHIP, as it would make getting services a lot easier. Part of me is a bit worried though, as we need to have space for a variety of mental health professionals to be covered. Community mental health services like social workers, peer supporters, and occupational therapists and others were really helpful to me but aren't traditional doctors. I would want all these services to be covered as well as the traditional psychiatrists and doctors. Whatever we do, I really hope it makes mental health services more accessible for people so they don't have to wait like I did. Having been to over 14 funerals due to suicide, I know that waitlists are really deadly. Anyone brave enough to ask for help should get it.
  • Alicia, I have a follow up question for you. What are you wary of in particular for the PCs when it comes it health? You mentioned it in your earlier answer.
  • Mental health services provided by physicians  and psychiatrists are covered by OHIP. Also the government funds multidsciplinary teams in community health centres, family health teams and community mental  health and addiction programs. Recently access to psychotherapy will increase through a new program called Bounceback and specialty hospitals like camh and ontario shores will be fielding psychotherapists.
  • In particular, I am worried about there not being a lot of information on where the money would go over time. I also have heard a lot of quotes coming from the PCs about cutting healthcare costs, and in the past that has meant cutting mental health first. We already have so little, so even less would make waitlists and getting services even harder.
  •  
    Here is a question from Knittybun on Twitter. Perhaps the both of you can respond to this from your perspectives and how politicians could go about doing this?
  • Every region of the province is different. in the North cmha has been providing comprehensive services for many years through our branches , eg Timmins, Sudbury, Dryden, ThunderBay. Services need to be planned with the community and other service providers in the area, based on unique needs and evidence based practice.
  • As someone who lived in a small community, the ways I was able to access mental health services was through the internet and telephone. While I know that these types of support are not for everyone, it was really helpful to meet me where I was at, and didn't expose me to stigma that accessing the limited services in my community would have. I hope that having internet based services and telephone services can help bring some more amazing services to remote and rural places in Ontario - while the in person services work on expanding their services. Having both is ideal.
  • We need more harm reduction based programs and housing provided by peers... ie people with lived experience with mental health or substance use issues

    -Debbie Jones
     
    Here's a thought from Debbie Jones, one of our commenters on the blog. What do you think? Is this the step forward? Is it reflected in the party promises?
  • As I said earlier, I am sad to not see Peer Support more explicitly mentioned in the party promises. As someone who has benefited from Peer Support and now delivers Peer Support online through www.beanbagchat.ca, I wish that the parties had expressed more support of peer support. It's something that can really reach through to folks who have had negative experiences with the system or feel like traditional mental health professionals don't get them.  I would love to hear more support for peer support in all of the party mental health promises.
  • There are examples of this in Ontario and around the world that need to be scaled and spread. None of the parties has been specific with regard to program models, although the PCs have promised to work with the sector to develop evidence based programs. There is a huge need including a continuum of wet damp dry housing. Also Ottawa recently launched a managed opioid housing program in addition to the managed alcohol program they have, thanks to the work of Dr. Jeff Turnbull and Inner City health
  • I've got a question now.

    What's the biggest challenge facing the province when it comes to mental health at the moment?
  • There are a number of big challenges- access to psychotherapy, access to supportive housing and clinical services that will keep people out of hospital as well as more peer support for services users and families. Also hospitals are seeing a spike in alcohol poisoning as well as opioid users in emerg
  • For me the biggest challenge facing the province when it comes to mental health is the lack of resources. For me it took so long to work up the courage to ask for help, to be told I would have to wait over 3 years for any one to listen to me, and when those three years passed to be told I was being bounced on to yet another waitlist was really discouraging. It made it feel like no one cared about the suffering I was going through and that only made me feel more suicidal. I also hope that as we increase resources in the province, we are also making space for innovative new programs like Peer Support, giving support through apps or the internet, and therapies beyond just CBT. Not everyone recovers from mental health issues the same way, so having choices for people living in Ontario is really important to me.
    A thought from Sophie. We're getting a lot of comments about mental health and OHIP. Alicia and Steve, why is this on the top of so many people's minds? What is the relationship between mental health and OHIP?
    While we are waiting to hear from Steve and Alicia, you can take part in the conversation too. Sign on in just above here to post your questions or you can ask them here on Twitter.
  • I think people are connecting OHIP and Mental Health because it's where most of our other health services are funded. However, a lot of mental health services that people want to access are not delivered by medical professionals so getting them covered by OHIP has been a struggle. I really hope we can create an Ontario where people can access the evidence based mental health services that work for them and not have to pay out of pocket. As someone how has seen how deadly the barriers to receiving mental health systems can be, I really hope we can remove them and allow supports for any person who needs them.
  • Drs Goldbloom and Kurdyak have done studies showing that many psychatrists are doing long term psychotherapy with small numbers of patients. This needs to change. The shared care model between primary care and family doctors in hamilton that covers 80% of the population needs to be scaled across the province. Most people go to their family doctors when they experience a mh or addiction problem, so it makes sense to up the game in primary care. The Bounceback progam I mentioned earlier is increasing access to psychotherapy across the province.

    Another thought from Twitter

     
    This is in response to what's lacking when it comes to mental health resources? Alicia ... Steve ... what do you think as individuals who have worked, lived and studied mental health for so long?
  • Everything- we need more multidsciplinary teams, supportive housing, peer and family support. There is a good evidence base to build on including supportive employment.
    To go further Steve, what's holding it back? Is it entirely a money issue?
  • That's easy, everything. We don't have enough of anything to ensure that people get the support they want and need while struggling with mental health concerns. For me specifically, I think we are lacking support Peer Support, ways of accessing mental health services remotely (from home or from behind your phone screen) and a mental health system that is easy to navigate. People need to see people like them thriving with mental health issues, achieving their dreams, and have a way to ask for help that makes sense to them. We also need to co-design any new resources with people who have experienced mental health issues and their families to make sure the resources make sense and are easy to access. Lastly, we live in a country that's know for it's pilot projects and no sustainability when it comes to mental health. If something shows it works, we should keep funding those things to do their awesome work.
  • Funding hasn't kept pace with population needs. in fact mh funding as a share of health spending has declined from 11.3% in 1979 to 6.5% today. Governments have invested more in other areas of health care historically. The election commitments and the federal funding of $5 Billion over 10 years is beginning to address this. But we need to ensure the mh spend is at least 9% of health spending.
  •  
    Tina had to wait six months for mental health resources to become available to her. Let's talk now about wait times and wait lists.
     
    How long have you heard about people waiting? How do we fix it? Is there a quick solution?
  • Targeted investments in areas of high need with  a multi year plan for this is impt. there are also examples that can be built on. Scarborough has a flexible support model that enables services to be flexed up and down based on client need. This reduces time on the wait list, increases capacity and saves $ in tersm of reduced hospiialization
  • So there is definitely a lot of waitlists for any kind of mental health services in Ontario. I find that community mental health resources can sometimes have shorter waitlists but even there it was 4-6 months of waiting. Doctors and Psychiatrists tend have even longer waits. I waited about 7 years after attempting suicide before I found a mental health resource that worked for me, and I have heard of people waiting just as long if not longer. I hope drop in services like the ones offered at Stella's Place will at least offer people something to access while they are waiting, and might help reduce some of the waitlists. Peer Supporters can also be a really awesome resource to help support people who are waiting for doctors or counselling, and often times can help people just as well as counselling.  
     
    For me, this was also an navigation issue. I spent a lot of time waiting for resources that didn't fit me because health care professionals supporting me didn't have fully understand what resource was what. 
  • Mental health and seniors

     
  • There has been a program called Behavioral Supports Ontario that works with nursing homes and LTC homes to better care for people with dementia and and manage their behavior. If someone does commit and assault court support programs are available to triage the senior to appropriate supports if possible and there can be a referral into the forensic mh system through the courts.
  • What's changed? 

    You've both been talking about mental health for quite sometime now. What are some of the biggest changes that have happened when it comes to talking about mental health, resources and funding?
    And while we are waiting to hear from Steve and Alicia, here's yet another comment about OHIP and mental health.
     
  • The biggest changes we have had in mental health recently (at least from my perspective) is that we have so many people talking about mental health now. We have managed to reduce mental health stigma to the point where so many more people are okay asking for support and help. However, we did this without creating more mental health resources to meet the need, so we have created even longer waitlists and an even more overloaded mental health system. I hope that innovations in e-mental health, peer support and counselling will help people be seen faster and more effectively. My favourite change is how much our conversations have shifted towards recovery! When I was first sick as a 13 year old, everyone would talk to me like my life was over and my dreams weren't possible. But now, we are shifting the conversations to say that people can and do recover and that their dreams are all possible. For me, I am living a life that is much cooler then I could have dreamed of as a kid. I mean, I got to meet Cher and be in Vanity fair - that was pretty awesome.
  • Just out of curiosity, what were you in Vanity Fair for? You can't just drop that without letting us know!
  • There is an acknowledgement of stigma. More people are willing to share their stories of recovery. There is growing acceptance that recovery and wellbeing are possible. Funding for community mental  health and addictions has grown from $5million in 1979 to over $1.2billion now, but hasn't pace with population need or been scaled based on the evidence that currently exists. Hopefully this will change for the better with the addition of federal and provincial funding in the years ahead. there is no health without mental health and non mental health without housing!
  • I was in Vanity Fair as one of the speakers at One Young World 2016 where I spoke about mental health, my story and the work I have done in mental health. Cher is really awesome, if you were wondering! It's awesome to see mental health be given platforms like this, when even 5 years ago, it didn't seem possible.

    We're starting to wrap up now ... 

    ... you've still got time to get your questions here in the chat or via Twitter. 
     
    Let's bring politics back into it: if you had a chance to talk to the party leaders about mental health and had a message for them, what would it be?
  • I would want the politicians to know that our mental health system the way it is, is not working. No other young person should have to go to 14 funerals from suicide, or have years where they went to more funerals then birthday parties. We need to support mental health services that work and make them easy to access so we can reduce the number of people dying from suicide. Recovery is possible and happens every day, I just want more people to have that chance.
  • Fix the deficit in mental health care. Ensure that we spend at least 9% of our health budget on mental health and addictions. Increase access to community based care and early intervention. Close treatment gaps and set targets to do so with a multi year plan that is sustained. Focus on quality and building the evidence base as we go.
    Yesterday, we told you the story of Maria Estrada, a 22-year-old who first attempted suicide at age 12 and had to advocate for herself as she waded through the province's mental health system.
     

    'There is such a gap for resources': Mental health advocates say system is broken

     
    There are many stories like Estrada's. Under the current mental health system, what groups are the most vulnerable at being left behind? How do we solve this?
  • I hear stories like this story from young adults every day. I think our mental health system basically leaves everyone who can't afford to pay for services out of pocket behind, but young people in particular have it really hard. People don't listen to us as we advocate for our mental health needs, assuming we don't know what we are talking about or that we will just grow out of it. Neither of things are true. It really sucks that we are asking our young people to be impossibly resilient and advocate for themselves while also dealing with illnesses that steals away your motivation and self confidence. It's awesome that some young people are this strong, but so many of us aren't and that's why we have the youth suicide rate that we have. We shouldn't have to be as strong as super heroes to finally get someone to listen to us.
  • Young people are vulnerable, and it can take 18 months to be assessed and linked to services. see the CMHO website for more details. This is especially impt given that 70% of mi shows in adolescence and young people are at high risk of suicide. However adults with serious mental illness and addiction issues should not have to wait while we fix access for children and youth. We need to plan and fund appropriate mental  health services across the life span.
  • Final thoughts

    Steve and Alicia, thank you so much for taking part in this. Let's wrap up.
     
    Where is the mental health system currently? And where would you like to see it go? What is the province's role in this?
  • we need to keep the pressure up to ensure mental health gets its fair share of funding. Talk to candidates about this, use social media. Raise the issue at meetings. CMHA Ontario has a website called www.erasethediffrerence.ca  that calls for mental health services to have the same priority as physical health care. Visit the website and join the over 10000 people who have signed the petition. Together we can make sure that there is no health with out improving access to mental health services and supports
  • I think our mental health care system is broken right now and I hope that we can create a mental health system that works. A system that gives people choice to choose the recovery path that works for them, and that believes in their ability to recover the way they want too. The provinces role in this is to make sure that the funding is there to make a mental health system that works, especially for new and innovative options like peer support and online services. I hope the province can keep mental health organizations feet to the fire, making sure they are doing recovery oriented mental health services that work. Also, I hope Ontario creates space to co-design mental health services with the people who use them, to make sure we are investing in services that are relevant for people in Ontario who need to use them. 
     
    When I speak in person, I usually close my speeches out by asking people to do this:
    Think about the worst time you have had in your life so far
    Think about the person you needed during that time
    If you go forward being the person you needed when you were younger, I think we will all have a hand in creating a mental health system that works. 
  • Thank you for taking part

    Incredibly insightful responses from both Alicia and Steve, with some practical solutions for the leaders. Thank you for taking part and for sharing what you do.
     
    We'll be having more of these live blog discussions on various election topics shortly. You can follow along with our Ontario Votes page. Have a good afternoon.
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