Ministerial Advisory Council on Mental Health (MACMH) Summary of Discussion for October 21, 2018

Office of the Minister of Health - In attendance

• The Honourable Ginette Petitpas Taylor, Minister of Health
• Kate Moussouni, Policy Advisor, Office of Minister of Health

Ministerial Advisory Council on Mental Health Members (MACMH)

In attendance

Ex-Officio Members - In attendance

• Helen McElroy (Ex-Officio), Health Canada
• Anna Romano (Ex-Officio), Public Health Agency of Canada

Ministerial Advisory Council on Mental Health Secretariat - In attendance

• Marie-Anik Gagné, Manager, Mental Health Unit, Health Canada
• Susan Phillips, Senior Policy Analyst, Mental Health Unit, Health Canada

1. Welcome and Introductions

• Helen McElroy welcomed members and asked Council members to provide brief introductions.

2. Ongoing Business

• Approval of Agenda:
  • The agenda was approved and no additions were made.

• Discussion regarding co-chairs:
  • Judith Bartlett and Manon Charbonneau were introduced as the Council’s co-chairs, appointed by the Minister of Health.
• Summary of Discussion June 14-15, 2018:
  • The Summary of Discussion was approved without amendments.

3. Recapitulation of June MACMH Meeting and Discussion

• The Co-chairs provided a recapitulation of the June MACMH meeting, and included a synopsis of what was discussed in the following areas:
  1. Mental health human resources planning
  2. Accreditation of mental health programs
  3. Integrating mental health services for children and youth
  4. Framework for psychotherapy for the uninsured
• The Co-Chairs invited members to identify two or three projects that the Council could collaborate to lead.
• It is worth noting that the discussion was more fluid than this summary indicates and that the following is a summary of all points raised and does not represent a consensus.

1. Mental health human resources planning
   • Focus first on competencies, then evaluate gaps (e.g., do we need more peer support, system navigation, health literacy?) and then determine which health professionals are required.
   • Include pharmacists as part of the solution. For example, the Bloom Program in Nova Scotia, the pharmacy is part of the community integrated mental health care approach.
2. Integrating mental health services for children and youth
   • Improve mental health delivery by working with guidance counsellors, social workers, and health care providers as a team.
   • Build integrated mental health programs in schools (e.g., New Brunswick, Nova Scotia).
3. Accreditation of mental health programs
   • Focus on improving the quality of the services currently available. Push providers to adhere to the fidelity of models and practice standards. Develop indicators to measure the quality of the care.
   • Offer guidance for self-care initiatives Orient people in need to self-identify needs and appropriate tools.
   • Guide individuals to understand which mental health “APP” is of good quality. There is a lack of accreditation regarding the use of applications (i.e., “Apps”). There are some really dangerous apps out there.  We need to develop better apps for mental health (i.e. e-mental health). Disseminate through the Mental Health Commission of Canada’s portal.
4. Framework for psychotherapy for the uninsured
   • Attend to the cost of mental wellness, getting well is expensive. Working poor are falling through the cracks.
   • Eliminate gate keepers; self-referrals should be all that is needed.
   • Respect that the path to recovery differs for everyone. There is not one solution for all. Such a framework needs to be inclusive of all approaches (e.g., acupuncture naturopaths, diet, and coaching).
   • Include pharmacists as part of the framework; they are a part of the solution. The community pharmacy is a good anchor point.  Pharmacists can triage individuals and connect them to appropriate mental health services in the community. They can support individuals to understand what they can expect as they move through the system. The pharmacy should be considered a “health centre” in the community, not just a dispensary.

4. Global Actions on Mental Health

• Sarah Lawley, Office of International Affairs for the Health Portfolio (PHAC) presented on global mental health landscape and the Minister’s efforts to advance mental health internationally.

Comments for Office of International Affairs

• Build capacity for low-middle income countries and use it as a model in Canada.
• Integrate mental health in general medical settings.
• Acknowledge that Canada is behind in data collection.  Canada cannot compare itself to other countries internationally.
• Promote the need for more data to make global advancements.
• Promote initiatives that Canada is leading, for example, the University of Toronto’s work in Ethiopia with Dr. Clare Paine and the increase of psychiatrists 11 to 70 within 15 year span.

5. Promoting Health Equity: Mental Health of Black Canadians

• Gerry Gallagher, Centre for Chronic Disease Prevention and Health Equity (PHAC) presented on the Mental Health of Black Canadians Fund.

Comments for Centre for Chronic Disease Prevention and Health Equity

• Acknowledge the role of socio-economic status, stigma, racism, and a person’s background on mental illness.

6. Welcome by the Minister and Roundtable

• The Minister joined the Council at 6:30 p.m. She welcomed everyone, asked the Council members to introduce themselves to the group, and provided a summary of the work she has been involved with nationally and internationally.

7. Discussion of Proposed Priority Areas

• The Co-chair summarized the discussion that took place earlier in the day and the floor was opened to discussion.
• A number of key points were raised that have been grouped into guiding principles that the Council may wish to review and agree upon to guide their work.

Key guiding principles:

• Focus on the spectrum of wellness, including prevention and promotion.
  • Recognize that people move along the spectrum at different times in their lives.
• Focus on the entire Life Span with a focus on transition points.
• Be extremely cautious of unintended consequences (e.g., accreditation program could negatively impact community-based organizations; there is a harmful side to technology)
• Develop quality indicators to measure impact of any new initiative.
• Collect good data to plan services and measure impact.
• Focus on what is best for people, people are waiting for services.
• Focus on early intervention.
• Recognize that there is not one solution for all.
  • Include traditional and non-traditional care and providers.
  • Ensure individual self-determination of needed services.
• Be fully aware of the context before making recommendations for action, that is:
  • The federal and provincial role in mental health. 
  • Activities which are underway. Build on existing work and do not start from zero given how much work has already taken place in these areas.
  • Do not commence work which will unduly pressure provinces. Acknowledge that provinces prefer to follow their own path.
  • Role of MHCC, Pan-Canadian Health Organizations (PCHO).
• Do not offload onto community services without additional funds.
• Expand existing services.
• Build on what exists.
• Develop initiatives for those that suffer from the greatest inequalities:
  • Identify where the mental health inequalities are in each community. Target programs for the most vulnerable (e.g., low socio-economic status, young mothers).
  • Invest in the early years. Health providers can identify the families at risk. 
• The work of the Council should be guided by an overarching framework.

Develop a national association for those with lived experience - For and by the people - this association could:

• Provide support for those with mental illness. This would include contact based education and provide peer support.
• Include people at both extremes, those that believe in psychiatry and medications, and those opposed to the formal mental health system.
• Train people with lived experience to become board members and participate in policy development.
• Act as the “rights watchmen”.
• Offer Mental Health First Aid families.
• Train youth that want to be engaged.

Implement a step-care model:

• Focus stepped care on early years; include pre-birth programs, self-care, and defining the role of health literacy in stepped care.
• Include promotion and prevention, pharmacies, peer support into the stepped care approach.
• Develop national quality indicators for stepped care.

Other potential initiatives:

• Develop emotional development milestones for children for family physicians to support early intervention.
• Fund tiered initiative for international fellowship (e.g., early career) to travel and study best practices abroad.
• Establish innovative fund similar to the Primary Health Care Transition Fund established 20 years ago. This Fund has had a lasting impact.
• Change insurance standards so that people with lived experience are not discriminated against when seeking home, health, disability insurance (e.g., in Europe people are forgiven for a suicide attempts).
• Change the need to declare any previous mental health issues on job applications.
• Introduce legislation to change the size of acetaminophen packages in Canada. Reducing the packing size could reduce up to 500 deaths based on the UK experience.
• Develop e-mental health applications which would assist youth to access mental health services online.
• Develop program to address the increased incidence of social anxiety in youth due to increased exposure to screen time.

Council members requested clarity on the types of projects that would be appropriate for the Council to recommend and to undertake. Members were reminded of the electoral cycle. Although, no funds were earmarked for these initiatives, if there is Ministerial support, some funds could be earmarked. Therefore, the members should not limit themselves to recommending initiatives with zero resource implications.

• It was noted that there was no consensus as to which recommendations should be pursued.

8. Summary and Next Steps

The Minister thanked Council members for their input and rich discussion. 

• Next steps: At the request of the Co-Chairs, teleconference calls will be scheduled to discuss a way forward to identify key initiatives that the Council could develop and establish a few working groups.

The meeting was adjourned at 8:30 p.m.