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Sarah Cannon

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Child and Youth Mental Health - A Ministry Hot Potatoe?

There has been much talk lately about where the needs of our children and youth dealing with mental illness are best served - The Ministry of Health and Long-Term Care, or the Ministry of Child and Youth Services. Some of this discussion comes from the number 1 recommendation of the Select Committee on Mental Health and Addiction's Report: Navigating the Journey to Wellness: The Comprehensive Mental Health and Addictions Action Plan for Ontarians. The first recommendation is that a new umbrella organization "Mental Health and Addictions Ontario should be created to ensure that a single body is responsible for designing, managing, and coordinating the mental health and addictions system, and that programs and services are delivered consistently and comprehensively across Ontario AND ALL mental health and addictions programs and services - for all regions of the Province and for ALL ages, including children and youth - should be consolidated in the Ministry of Health and Long Term Care. Also MPP David Caplan has recently presented a Private Members Bill addressing this same issue. Child and Youth Mental Health Care becoming a Ministry Hot Potatoe? Once upon a time, child and youth mental health services were indeed coordinated through the Ministry of Health and Long Term Care, and at that time was felt it would be more appropriately addressed in the Mninistry of Child and Youth Services. Now we face the same discussion a few decades later - familiar course? It seems to me (and please this blog is written with the intention of being provocative and to create conversation) it seems to me that when the Ministry coordination was switched years ago - we were trying to address the ongoing concern and building crisis. Here we are many years later, still with ongoing concern and an even bigger crisis, and now we re-visit the conversation of what Ministry would serve our children, youth and their families better. So....the question may not be as simple as which Ministry is better or which Ministry will be best equipped to deal with our issues, the issue may just be why have these issues not been addressed in either Ministry?
So, I think it is time that WE, those most directly affected by the "issues" weigh in and have an opportunity to have our expert thoughts and opinions considered. Is this a "political" maneuver? Will it benefit our children and youth? Will it make a real difference? Is it just more rhetoric to make us all believe someone somewhere is addressing this crisis because we keep talking about it and there seems to be apparent "action" - or is this "action" static?
Here is my other thought - is the Ministry of Child and Youth Services truly being given what THEY require to truly address the crisis and growing concerns, or are they themselves being "bullied" and underresourced by the larger more powerful Ministries? And if so, what is OUR role in ensuring that OUR Ministry, the Ministry designed for OUR Children and Youth, do indeed get the support required so that they can proactively support our children?
The recent legislative debate, limited public discussion, and media about this issue has indeed kept the issue of children and youth mental health in the legislature, BUT, does the conversation and the debate about which Ministry we "live" in address our issues? Does it create opportunity for true action to be implemented that will have a positive impact on outcomes for our children or youth - OR - does it keep us from addressing the crisis and from spending time and money where it is most needed? I don't have the answer - I hope this blog and the discussion that happens from it will help to provide us the information that we as public, parents, and those directly affected need to make an informed decision, so we do know which side of the fence we want our feet, and our children and youth's future to land. I of course have an opinion - but this blog is designed in the hope that we will hear many opinions, we will begin a dialogue that will not only inform us, but will have an impact on and inform the ultimate discussion and decision process. So.....Child and Youth Mental Health a Ministry Hot Potatote?


Add comment 2010-10-24 Sarah

To me, the issues are multi-jurisdictional - not just Ministry of Child & Youth Services and Ministry of Health & Long Term Care, but also Ministry of Education. I believe that through reform in the Education system, there may be better outcomes and less use of service(perhaps) regardless of the Ministry charged with the provision of services! How can we possibly know what Ministry is best suited to serve our children's needs? The recommendation by the Select committee is presumably the only research into this question that has been done, so does PCMH support the recommendations? Regardless of where the decision is made to co-ordinate services, the children that they are charged to serve are languishing with the current status quo. I feel that giving families the funding to support their children in whatever way they feel would be most effective should be considered first & foremost. This would be a very effective way (I think) of parents having a vote as to what services they feel are most effective for their children. The needs are vastly different from case to case, so this in my mind is the way to show the government what is most useful to help these families. Make no mistake, the families are well aware of the fact that NOTHING is getting done, we don't need more research, we need ACTION! Liz

Posted: Sunday October 24, 2010 03:10 PM

Thank you for your comments Liz - PCMH as a whole, with input from its membership, needs to evaluate where our support etc will have the most benefit/effect for families. I personally like the idea of an overseeing body BUT this body would have to have some "teeth" in my opinion to be effective. Creating just another buracratic layer that has really no authority to make any definitive changes I can't see being beneficial, so my personal belief is that if PCMH were to support the recommendation of the Select Committe in this regard, we would have to first have a complete understanding of what the function and authority of this new governing body may look like and actually have the power and resources to implement. I agree with you that we do not need more "static conversation" we need action - What you suggest about the funding going to families - is similar to what the Autism Families were able to accomplish with their active advocacy in making a difference. I am hopeful that when our "experts" weigh in on this conversation perhaps some of them may be able to address how this change has "looked and played out" for those families. Great points, thanks for contributing! Sarah

Posted: Sunday October 24, 2010 04:10 PM

It seems that there is already too much beauracracy. It would be nice to streamline programs into an umbrella Ministry but it probably won't happen that way considering the Ontario gov't's track record. I believe that no matter how or who the programs for mental health consumers is set up I am only concerned that the care, consideration, and services that these groups need are addressed appropriately at all times; enough with false promises and questionable funding levels; do the right thing politicians and listen to your constituants. We pay enourmous taxes in this province and the disgusting waste (including the ridiculous benefits these politicans receive for the miniscule amount of work they actually do) that is ongoing limits the level of consideration and service these groups at risk receive. Our dollars need to be channeled to people who are struggling just to survive, recover, exist. Just look at OW and ODSP as an example; these folks are facing incredible odds just to survive. Cildren with mental health concerns should never be put on any back-burner and if we have any amount of integrity and decency we should never let groups at risk wallow in the shadow of the well-to-do simply because the wealthy need to be given breaks so they "might" create jobs. For now, I suppose, all we can do is pray is that whoever pulls the strings in power makes the right choices - for a change.

Posted: Monday October 25, 2010 08:10 AM

A Ministry Hot way! Once upon a time some people thought that children and youth mental health would be better served under a different ministry so it was moved to MCYS. Has it worked? Are our children well served? NO!! So its time to go back to the way it was. We as mental health advocates say that we want mental health illness to be treated, and thought of, in the same way that physical health is treated. In my opinion that means they need to be treated in the same system. The other problem with childrens mental health being under MCYS is that adult mental health is under the Ministry of Health. It is no wonder that transition for youth to the adult system is so difficult. I agree with Liz we dont need any more research we need action. The Select Committee did an amazingly thorough job. They produced a very well thought out report. Does every person agree with every part of it? No. The committee members talked about the challenges they had in getting consensus. There will never be a report that everyone agrees with 100%. I believe it is time for us as parents to stand up and support the Select Committees Report and demand that the government implement it A.S.A.P. Donna

Posted: Monday October 25, 2010 09:10 AM

I worry that if they create yet another new body it'll take so long for them to get political clout and really get up to speed on the issues and by then - ten years and a few more million dollars will have gone to what? Nadda.

Posted: Monday October 25, 2010 11:10 AM

I worry that if they create yet another new body it'll take so long for them to get political clout and really get up to speed on the issues and by then - ten years and a few more million dollars will have gone to what? Nadda.

Posted: Monday October 25, 2010 02:10 PM

I think it's a mistake to create any kind of "oversight body" for kids mental health. I also think it's a mistake to "coordinate" services intentionally. I think this will lead to more bureaucracy, more politics and more inertia. I believe the needs of families are far too diverse for this type of approach. The services we need cannot be centrally planned. I prefer an approach that: * Removes the geography from service delivery. Get rid of the LHINs. Stop restricting the Kinarks and Newpaths of the world to specific geoegraphic areas. * Makes the service providers compete with one another. If one of them can't get the job done, I want to have recourse to someone else. * Removes funding from service providers and gives it to families instead (with strings). I expect this will reorient service providers' attention away from the province (where the currently get their funding) to their users (which is where they should be getting their "funding" from. * Reform the education system. There's a ton of things to do here. Top of my list would be to revisit the list of "exceptionalities" that entitle a student to special education resources. The exceptionality called "behaviour" has to be discarded immediately. In fact, I'd rather see the entire list replaced with specific biological, cognitive and emotional characteristics that can impact learning. To sum up: I think we should immediately drop the idea that we need to "choose" a ministry to deliver/oversee mental health services to children. Several ministries need to be involved, the ministries themselves may need to be restructured anyway and not all of families needs will necessarily be met by government.

Posted: Tuesday October 26, 2010 09:10 AM

Some really good discussion and view points. I think one of the overlying themes that is developing is that our needs are complex - when dealing with a child or youth with mental illness it impacts and reaches so many aspects of our lives - their treatment, their education, social services impact etc etc. This is something that we do need to keep in mind when we talk about reform or transformation of the "system". Great conversation, lets keep the ideas flowing, and can't wait to see how the experts may weigh in here. Sarah

Posted: Tuesday October 26, 2010 12:10 PM

Unfortunatly my education on this topic is one of personal experience. I believe it would be a waste of TIME, ENERGY, and the MONEY we desperatly need to change system. If our current system was given adiquate funding to do it's job, as well as NEW funding to create and impliment new programs for our children and youth, success could be achieved. Passing the buck, once again, decades later, DOESN'T solve anything. It just delays, and costs LIVES!!!!! In reality, it's a BIG puff of smoke, so we all look in that direction, diverting the attention. Politics!!!??? It comes down to NEEDS vs WANTS. Lets ask those politicians to brown bag their lunches for a year and put the money allocated for their "work lunches" into new programs. Sonia, Niagara.

Posted: Wednesday October 27, 2010 10:10 PM

I think Sonia may be onto something. We could potentially begin a campaign directed at all of our MPPs asking them to do this, asking them to in essence give something up - and the money saved allocated to CYMH. Even if we get no money in the system, it is sure to generate some press, and talk among politicians. I think it is a very easy "campaign" to implement? Good thoughts too - I like the puff of smoke analogy. Sarah

Posted: Friday October 29, 2010 10:10 AM

Bureaucracy is something that we all hate in principle. We feel like it is money that is spent on items that do not affect our children. We equate bureaucracy to waste. But bureaucracy means to govern or organize. In my opinion we need this new umbrella organization. What we have is a patch work of services that are not consistent across the province. The funding formula is ancient and no longer fair. Our children are either not being served or not being served adequately. We need a fresh start!!!!! This new organization and the money that will come with it will, in my opinion, breath fresh life into our currently ineffective system. I am sure that they will not throw away the good programs but rather use them as models. We need this!! If we go to politicians now, and say give us more money for children's mental health care, they will probably say no, because changes are under discussion. No money will come. So I say let's get started with this new system NOW so the money starts to flow and change and improvements happen. If we continue to fight the small stuff no change will happen. We need to support the Select Committee members and their recommendations!!!!! They worked hard and did a good job. Let's get on with implementing their recommendations NOW! Our children are waiting. Donna

Posted: Monday November 01, 2010 10:11 AM

Donna - you make some good poins for sure. I guess one of my concerns would be changing the Ministries PRIOR to the implementation of the new organizational body - I think it will likely take a couple of years to establish this organization, and I am not sure if moving Ministries right now is the best move for us without a body that will ensure that our children, youth and family needs are being met. Remember, we were once upon a time a part of the Health System and one of the reasons for the lobby to move Ministries was because we "came last" so to speak and all the money was spent by the time children's mental health issues needed to be addressed. That said, I also HOPE that with new organization would come new funding, not just in the establishment of the new organization. I also think that for this new organization to have benefit to us it has to be granted some TEETH, and AUTHORITY, not just another group making recommendations. The best example of this to compare I think of the Mental Health Commission - of which I am a strong supporter - however, they have no authority, or "power" in implementation - so to have another body that makes recommendations, does research/evaluation etc without the authority to implement in my mind would be another layer that would not move us forward. Again, just my thoughts, and somewhat designed to be provocative to provoke discussion. I am not sure any of us at this point have the "right" answer, what I hope is that through this discussion and insight from our "experts", we will have informed opinions upon whch we can act. Thanks again everyone for the great comments! Sarah

Posted: Monday November 01, 2010 09:11 PM

Knowing that the transition from youth mental health services to adult I feel the Ministry of Health and Long-Care should be the umbrella ministry to oversee this. However, to create another group under that umbrella is redundant given the excellent investigative approach the Mental Health Commission of Canada has accomplished. I feel the MHCC would be ideal in overseeing, directing and navigating this way to an effective progressive agency under the Ministry of H & LT Care. The KISS principal...keep it simple silly! Karyn MAYDAY FOR MENTAL HEALTH

Posted: Monday November 01, 2010 10:11 PM thoughts....I meant to say that the transition from youth to adult care is one of the "gaps" and difficulties I would like to see all mental health agencies under the Ministry of Health and Long-term Care.....K

Posted: Monday November 01, 2010 10:11 PM

I Like your thinking Karyn - the only pitfall really is that the MHCC is Canadian, and we are governed Province by Province - so I think that what the Select Cte proposes is something to address our Provincial Specific needs regarding funding, policy, etc.

Posted: Tuesday November 02, 2010 09:11 PM

I like the comments about systems working more effectively for our kids. Lots of people inside systems now know that we have to "wrap" supports around children and youth that struggle but they keep discussing things that don't make this which Ministry should have "power" over it. How about we look to what EVERY independent report has recommended over the past forty years and have a Cabinet level coordinating body that forces mental health, education, health, health promotion, etc. to make their policies, outcomes and funding work together. (This has been done in other provinces and other countries with good results.) Who cares if it's with MCYS or Health? They don't coordinate internally and definitely wouldn't work more effectively with education if it remains in their Ministry silo. There's a real opportunity to do what other places have done because of all the "extra" space in schools. If the government decided to get practical and ensured that all child and youth Ministries looked at kids as whole people that deserve service right where they live and work and put the services there, we would end the artificial debate about which Ministry and move to a solution that actually focuses on kids and takes advantage of an opportunity (space in schools) instead of squandering it (selling them!). Imogen

Posted: Wednesday November 03, 2010 02:11 PM

MCYS would best serve children, youth & their families by adequately addressing child & youth poverty. Perhaps second by working with these families to help them realize & fulfill their social responsibilities. The idea of placing all of health under one authority should and could place all health concerns and all age groups on an equal playing field. To date, all ministries involved in health care have failed to recognize mental health as the core to all well-being. Bigger is not better. Making the MOHLTC will create more silos and less coordinated action. Funding should be disseminated to funding agencies that would be responsible for ensuring providers are funded equitably so children & youth can receive service as close to home as possible. Area care providers have the collective knowledge and know-how to create their own planning councils and could link across the province to provide a seamless service delivery model. Remember, all mental health consumers are a disenfranchised population. As long as the government has control of the purse strings, committee recommentations consultations, study results and the like will never be fully implemented. Any government action historically to implement recommendations such as those by the Select Committee have not come to fruition. They seem to be driven by political posturing & gaming and amount to smoke and mirrors. Consumers and their families have paid the price for this inaction and inadequate governance. The best predictor of future behaviour is past behaviour. Not all DHC'S were ineffective from a planning or resource utilization perspective, yet the government saw fit to shut them down. Their idea was to replace them with another kind of health authority (The LHINS)All of the knowledge transfer from the effective DHC'S was lost and the LHINS had to start from scratch with their "Community Consultations". The LHINS have not been given full control over administering and funding local health initiatives and their purse strings are held by a higher authority. Funding models should be based on a client assessment of needs. Based on those needs, each consumer should heve their own funding envelope that would be administered by their local health authority. This funding would be tapped by the provider deemed most appropriate to address those needs. We need to also advocate for the end of our existing two-tiered health system and to ensure adequate, equitable and sustainable funding for all providers. To be inclusive, fee for service and salary funding models should be eliminated and a new hybrid model based on quality of care, resource utilization and performance be instituted. I could go on but hope this stimulates dialogue... Ken

Posted: Wednesday November 10, 2010 10:11 PM

sorry, finger problems and my post flew away too early...however, i am not expecting any quick fixes to the services, no matter which Ministry it belongs to. however, i would just love to be wrong!!!! another donna

Posted: Sunday November 21, 2010 12:11 PM

I think investing in the current system would be a good start. It has been ignored for too long. A new /renewed start in another ministry will NOT mean more money, if anything it is a cost cutting measure I think. If we go into the Ministry of Health and Long term care....where will be our voice! It's not like hospitals are rolling in cash and not being asked to make cuts.... and where are those cuts going to come from. Maybe it'll be our children's mental health dollars. CMH agencies have been dwindling and competing with each other for program money. Mashing them together might decrease costs but will the services and the quality still be there!

Posted: Friday November 26, 2010 11:11 AM

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