need them.
We have made, and continue to make, progress in dealing with mental health problems and illnesses in Canada. Still, fragmented and underfunded mental health systems across the country are far from able to meet the mental health needs of Canadians. The emergence of mental health as a growing public priority offers a real opportunity to transform our approach to mental health and mental illness and improve access to the full range of services, treatments and supports that are needed to foster recovery and well-being.
People living with mental health problems and illnesses—whatever their age and however severe their mental health problem or illness—and their families should be able to count on timely access to the full range of options for mental health services, treatments and supports, just as they would expect if they were confronting heart disease or cancer.
For those needing assistance, the current system can feel like a maze, as it can to the thousands of dedicated people who provide the services, treatments and supports that people need. Unfortunately, there is no simple formula for creating a system that is truly integrated around people’s needs and draws fully on their strengths.115
Mental health-related services, treatments and supports are delivered in many locations by a wide variety of mental health professionals, health professionals, other service providers and volunteers. Each individual’s journey to recovery and well-being is unique, and the right combination of services, treatments and supports will depend on what people want and need, as well as the nature of their condition. Each community has particular resources to draw upon and specific challenges to meet.
While there will never be a ‘one-size-fits-all’ solution, it is important to reduce fragmentation and achieve better integration of services. In order to identify the areas requiring the most attention, it is helpful to think in terms of different ‘levels’ or ‘tiers’ to the system. Such an approach allows us to focus both on the settings where services are located and on the level of intensity of service. It provides a way of thinking about how to improve the flow and efficiency of mental health-related services, so that people are able to access the most appropriate and least intensive services, treatments or supports required to meet their needs.116, 117
In her home community, my mother has access to a community mental health worker, crisis services, and a social group. However, this fragmentation of service has not facilitated her recovery, and her functioning remains the same as it was 15 years ago.
is on providing less intensive and less expensive services to large numbers of people. Services and supports at this level should be available in most communities, and can include population-wide mental health promo- tion and prevention initiatives. They may also include low-intensity supports in the community for people with mental health problems and illnesses, as well as school-based prevention programs and primary health care screening for depression.
In the upper tiers, the degree of intensity and level of specialization increase—along with the cost of delivery— but fewer people need to make use of these services. These more intensive and specialized services include psychiatric units in general and psychiatric hospitals as well as some community mental health services and crisis services. The top tier focuses on providing the most intensive and expensive services to address the most severe and complex needs, such as treatment for people with developmental delays and mental illness who may also be involved with the criminal justice system. While there is variation across the country, services at the upper tiers will often be available on a regional basis and can involve longer term, facility-based services.
People do not ‘reside’ in any specific tier. They need to be able to access services from multiple tiers at the same time. For example, a person with severe symptoms may need intensive services in the upper tiers, but will still need access to primary health care. We need a balanced approach so that people have ready access to intensive services, treatments and support when they need them, and are able to move easily among dif- ferent levels of care as their needs change. Our goal should be to have a system in which every door is the right door to meeting people’s mental health needs in the least intensive, most appropriate, and cost effective manner possible.
A more integrated mental health system must also be linked to, rather than isolated from, all parts of the com- munity and other service systems. Family doctors, teachers, police personnel, and long-term care workers are among those who should work with each other and with mental health service providers to address people’s mental health needs. A more coordinated and integrated system will make available multiple resources to help facilitate recovery: timely access to medications and to adequate and affordable housing; professional counselling, as well as readily available peer support; and help in setting and meeting educational and employ- ment goals.
This Strategic Direction proposes five priority areas that will move us closer to achieving such a system for people of all ages.
Community-Based Discharge Planning Program, Sarnia, Ontario
This service, based in the Sarnia Lambton Canadian Mental Health Association, facilitates seamless access to community services for anyone over the age of 16 who is hospitalized at the Bluewater Health Mental Health Unit. The service works with people, their families, and others involved in providing support to develop a discharge plan while the person is still in