Canada-British Columbia Home and Community Care and Mental Health and Addictions Services Funding Agreement

BETWEEN:

HER MAJESTY THE QUEEN IN RIGHT OF CANADA (hereinafter referred to as "Canada" or "Government of Canada") as represented by the Minister of Health (herein referred to as "the federal Minister")

- and -

HER MAJESTY THE QUEEN IN RIGHT OF THE PROVINCE OF BRITISH COLUMBIA (hereinafter referred to as "British Columbia" or "Government of British Columbia") as represented by the Minister of Health (herein referred to as "the provincial Minister")

REFERRED to collectively as the "Parties"

PREAMBLE

WHEREAS, on February 17, 2017 Canada and British Columbia agreed to targeted federal funding over 10 years, beginning in 2017-18, for investments in home and community care and mental health and addictions, in addition to the existing legislated commitments through the Canada Health Transfer;

WHEREAS, Canada and British Columbia agreed to a Common Statement of Principles on Shared Health Priorities (hereinafter referred to as the Common Statement, attached hereto as Annex 1) on August 21, 2017, which articulated their shared vision to improve access to home and community care as well as mental health and addictions services in Canada;

WHEREAS, Canada authorizes the federal Minister to enter into agreements with the provinces and territories, for the purpose of identifying activities provinces and territories will undertake in home and community care and mental health and addictions services, based on a menu of common areas of action and in keeping with the performance measurement and reporting commitments, consistent with the Common Statement;

WHEREAS Canada and British Columbia agree that data collection and public reporting of outcomes is key to reporting results to Canadians on these health system priorities, and that the performance measurement approach taken will recognize and seek to address differences in access to data and health information infrastructure;

WHEREAS, the Ministry of Health Act authorizes the provincial Minister to enter into agreements with the Government of Canada under which Canada undertakes to provide funding toward costs incurred by the Government of British Columbia for the provision of health services which includes home and community care and mental health and addictions initiatives;

WHEREAS, British Columbia makes ongoing investments in home and community care and mental health and addictions services, consistent with its broader responsibilities for delivering health care services to its residents;

AND WHEREAS the Government of Canada makes ongoing investments in home and community care and mental health and addictions services for Indigenous communities and other federal populations.

NOW THEREFORE, Canada and British Columbia agree as follows:

1.0 Objectives

1.1 Building on British Columbia's existing investments and initiatives, Canada and British Columbia commit to work together to improve access to home and community care and strengthen access to mental health and addictions services (listed in the Common Statement, attached as Annex 1).

2.0 Action Plan

2.1 British Columbia will invest federal funding provided through this Agreement in alignment with the selected action(s) from each menu of actions listed under home and community care and mental health and addictions in the Common Statement.

2.2 British Columbia's approach to achieving home and community care and mental health and addictions services objectives is set out in their five-year Action Plan (2017-18 to 2021-22), as set out in Annex 2.  

3.0 Term of Agreement

3.1 The term of this agreement is four years, from April 1, 2018 to March 31, 2022 (the Term).

3.2 Renewal of Bilateral Agreement

3.2.1 British Columbia's share of the federal funding for 2022-23 to 2026-27, based on the federal commitment in Budget 2017 of $11 billion over ten years, will be provided upon the renewal of bilateral agreements, subject to appropriation by Parliament, and British Columbia and Canada's agreement on a new five-year action plan.

3.2.2 The renewal will provide British Columbia and Canada the opportunity to review and course correct, if required, and realign new priorities in future bilateral agreements based on progress made to date.

4.0 Financial Provisions

4.1 The contributions made under this Agreement are in addition and not in lieu of those that Canada currently provides to British Columbia under the Canada Health Transfer to support delivering health care services within their jurisdiction.

4.2 Allocation to British Columbia

4.2.1 In this Agreement, "Fiscal Year" means the period commencing on April 1 of any calendar year and terminating on March 31 of the immediately following calendar year.

4.2.2 Canada has designated the following maximum amounts to be transferred in total to all provinces and territories under this initiative on a per capita basis for the Term starting on April 1, 2018 and ending on March 31, 2022.

Home and Community Care

  1. $600 million for the Fiscal Year beginning on April 1, 2018
  2. $650 million for the Fiscal Year beginning on April 1, 2019
  3. $650 million for the Fiscal Year beginning on April 1, 2020
  4. $900 million for the Fiscal Year beginning on April 1, 2021

Mental Health and Addictions Services

  1. $250 million for the Fiscal Year beginning on April 1, 2018
  2. $450 million for the Fiscal Year beginning on April 1, 2019
  3. $600 million for the Fiscal Year beginning on April 1, 2020
  4. $600 million for the Fiscal Year beginning on April 1, 2021

4.2.3 Annual funding will be allocated to provinces and territories on a per capita basis, for each fiscal year that an agreement is in place. The per capita funding amounts for home and community care and for mental health and addictions services, for each fiscal year, are calculated using the following formula: F x K/L, where:

  • F is the annual total funding amount available under this program (funding amount will change depending on fiscal year);
  • K is the total population of the particular province or territory, as determined using annual population estimates from Statistics Canada; and
  • L is the total population of Canada, as determined using annual population estimates from Statistics Canada.

4.2.4 For the purposes of the formula in section 4.2.3, the population of British Columbia for each fiscal year and the total population of all provinces and territories for that Fiscal Year are the respective populations as determined on the basis of the quarterly preliminary estimates of the respective populations on July 1 of that Fiscal Year. These estimates are released by Statistics Canada in September of each Fiscal Year.

4.2.5 Subject to annual adjustment based on the formula described in section 4.2.3, British Columbia's estimated share of the amounts will be:

Annual Funding for Home and Community Care and Mental Health and Addictions Services
Fiscal Year Home and community care
Estimated amount to be paid to British ColumbiaTable 1 Footnote * (subject to annual adjustment)
Mental health and addictions services
Estimated amount to be paid to British ColumbiaTable 1 Footnote * (subject to annual adjustment)
2018-2019 $78,740,000 $32,810,000
2019-2020 $85,300,000 $59,050,000
2020-2021 $85,300,000 $78,740,000
2021-2022 $118,110,000 $78,740,000
Footnote *

Amounts represent annual estimates based on StatCan 2017 population

Table 1 Return to footnote * referrer

4.3 Payment

4.3.1 Canada's contribution will be paid in approximately equal semi-annual installments as follows:

  1. The first installment will be paid on or about April 15 of each Fiscal Year. The second installment will be paid on or about November 15 of each Fiscal Year.
  2. The amount of the first installment will be equal to 50% of the notional amount set out in Article 4.2.5 as adjusted by Article 4.2.3.
  3. The amount of the second installment will be equal to the balance of Canada's contribution to British Columbia for the Fiscal Year as determined under sections 4.2.5 and 4.2.3.
  4. Canada will notify British Columbia at the beginning of the Fiscal Year of their notional amount.  The notional amount will be based on the Statistics Canada quarterly preliminary population estimates on July 1 of the preceding Fiscal Year.  Canada will notify British Columbia of the actual amount of the second installment in each Fiscal Year as determined under the formula set out in sections 4.2.5 and 4.2.3.
  5. Canada shall withhold payment of the second installment for the Fiscal Year if British Columbia has failed to provide its annual financial statement for the previous Fiscal Year or to provide data and information related to home and community care and mental health and addictions to CIHI for the previous Fiscal Year in accordance with section 5.1.2.
  6. The sum of both semi-annual installments constitutes a final payment and is not subject to any further adjustment once the second installment of that Fiscal Year has been paid.
  7. Payment of Canada's funding for each Fiscal Year of this Agreement is subject to an annual appropriation by Parliament of Canada for this purpose.

4.4 Carry Over

4.4.1 At the request of British Columbia, British Columbia may retain and carry forward to the next Fiscal Year the amount of up to 10 percent of the contribution paid to British Columbia for a Fiscal Year under subsection 4.2.5 that is in excess of the amount of the eligible expenditures actually incurred by British Columbia in that Fiscal Year, and use the amount carried forward for expenditures on eligible areas of investment incurred in that Fiscal Year.  Any request by British Columbia to retain and carry forward an amount exceeding 10 percent will be subject to discussion and mutual agreement in writing by the Parties via an exchange of letters.

4.4.2 For greater certainty, any amount carried forward from one Fiscal Year to the next under this subsection is supplementary to the maximum amount payable to British Columbia under subsection 4.2.5 of this Agreement in the next Fiscal Year.

4.4.3 In the event this bilateral agreement is renewed in accordance with the terms of section 3.2.1, and at the request of British Columbia, British Columbia may retain and carry forward up to 10 percent of funding provided in the last Fiscal Year of this Agreement for eligible areas of investment in the renewed 5-year agreement (2022-23 to 2026-27), subject to the terms and conditions of that renewed agreement. The new Action Plan (2022-23 to 2026-27) will provide details on how any retained funds carried forward will be expended. Any request by British Columbia to retain and carry forward an amount exceeding 10 percent will be subject to discussion and mutual agreement in writing by the Parties via an exchange of letters.

4.5 Repayment of overpayment

4.5.1 In the event payments made to British Columbia exceed the amount to which British Columbia is entitled under this Agreement, the amount of the excess is a debt due to Canada and, unless otherwise agreed to in writing by the Parties, British Columbia shall repay the amount within sixty (60) calendar days of written notice from Canada.  

4.6 Use of Funds

4.6.1 Canada and British Columbia agree that funds provided under this Agreement will only be used by British Columbia in accordance with the areas of action outlined in Annex 2.

4.7 Eligible Expenditures

4.7.1 Eligible expenditures for funds provided under this Agreement are the following:

  • capital and operating funding;
  • salaries and benefits;
  • training, professional development;
  • information and communications material related to programs;
  • data development and collection to support reporting; and,
  • information technology and infrastructure.

5.0 Performance Measurement and Reporting to Canadians

5.1 Funding conditions and reporting

5.1.1 As a condition of receiving annual federal funding, British Columbia agrees to participate in a Federal-Provincial-Territorial process, including working with stakeholders and experts, through the Canadian Institute for Health Information (CIHI), to develop common indicators and to share relevant data in order to permit CIHI to produce annual public reports that will measure pan-Canadian progress on home and community care and mental health and addictions services.

  1. British Columbia will designate an official or official(s), for the duration of this agreement, to work with CIHI and represent the interests of British Columbia related to performance measurement and reporting for home and community care, as well as mental health and addictions services. 

5.1.2 As a condition of receiving annual federal funding, by no later than October 1 of each Fiscal Year during the Term of this Agreement, British Columbia agrees to: 

  1. Provide data and information (based on existing and new indicators) for the prior fiscal year related to home and community care and mental health and addictions services to the Canadian Institute for Health Information annually. This will support the Canadian Institute for Health Information to measure progress on the shared commitments outlined in the Common Statement and report to the public.
  2. Provide to Canada an annual financial statement, with attestation from the province's Ministry of Health's Executive Financial Officer, of funding received from Canada under this Agreement during the Fiscal Year compared against the action plan, and noting any variances, between actual expenditures and British Columbia's Action Plan (Annex 2):
    1. The revenue section of the statement shall show the amount received from Canada under this Agreement during the Fiscal Year;
    2. The total amount of funding used for home and community care and mental health and addictions programs and services;
    3. If applicable, the amount of any amount carried forward by British Columbia under section 4.4; and
    4. If applicable, the amount of any surplus funds that is to be repaid to Canada under section 4.5.

5.2 Audit

5.2.1 British Columbia will ensure that expenditure information presented in the annual financial statement is, in accordance with British Columbia's standard accounting practices, complete and accurate.

5.3 Evaluation

5.3.1 Responsibility for evaluation of programs rests with British Columbia in accordance with its own evaluation policies and practices. 

6.0 Communications

6.1 Canada and British Columbia agree on the importance of communicating with citizens about the objectives of this Agreement in an open, transparent, effective and proactive manner through appropriate public information activities.

6.2 Each Party will receive the appropriate credit and visibility when investments financed through funds granted under this Agreement are announced to the public.

6.3 In the spirit of transparency and open government, Canada will make this Agreement, including any amendments, publicly available on a Government of Canada website.

6.4 Canada, with prior notice to British Columbia, may incorporate all or any part or parts of the data and information in 5.1.2, or any parts of evaluation and audit reports made public by British Columbia into any report that Canada may prepare for its own purposes, including any reports to the Parliament of Canada or reports that may be made public.

6.5 Canada reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and bilateral agreements. Canada agrees to give British Columbia 10 days advance notice and advance copies of public communications related to the Common Statement, bilateral agreements, and results of the investments of this Agreement.

6.6 British Columbia reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and bilateral agreements. British Columbia agrees to give Canada 10 days advance notice and advance copies of public communications related to the Common Statement, bilateral agreements, and results of the investments of this Agreement.

7.0 Dispute Resolution

7.1 Canada and British Columbia are committed to working together and avoiding disputes through government-to-government information exchange, advance notice, early consultation, and discussion, clarification, and resolution of issues, as they arise.

7.2 If at any time either Canada or British Columbia is of the opinion that the other Party has failed to comply with any of its obligations or undertakings under this Agreement or is in breach of any term or condition of the Agreement, Canada or British Columbia, as the case may be, may notify the other party in writing of the failure or breach. Upon such notice, Canada and British Columbia will endeavour to resolve the issue in dispute bilaterally through their designated officials, at the Assistant Deputy Minister level (hereinafter the "Designated Officials").

7.3 If a dispute cannot be resolved by Designated Officials, then the dispute will be referred to the Deputy Ministers of Canada and British Columbia responsible for health, and if it cannot be resolved by them, then the respective Ministers of Canada and British Columbia most responsible for Health shall endeavour to resolve the dispute.

8.0 Amendments to the Agreement

8.1 The main text of this Agreement (not including attached annexes) may be amended at any time by mutual consent of the Parties. To be valid, any amendments shall be in writing and signed, in the case of Canada, by Canada's Minister of Health, and in the case of British Columbia, by British Columbia's Minister of Health.

8.2 Annex 2 may be amended at any time by mutual consent of the Parties. To be valid, any amendments to Annex 2 shall be in writing and signed, in the case of Canada, by their Designated Official, and in the case of British Columbia, by their Designated Official. 

9.0 Equality of Treatment

9.1 During the term of this Agreement, if another province or territory, except the province of Quebec, negotiates and enters into a Home and Community Care and Mental Health and Addictions Services Agreement with Canada, or negotiates and enters into an amendment to such an agreement and if, in the reasonable opinion of British Columbia, any provision of that agreement or amended agreement is more favourable to that province or territory than the terms set forth in this Agreement, Canada agrees to amend this Agreement in order to afford similar treatment to British Columbia, if requested by British Columbia. This includes any provision of the bilateral agreement except for the Financial Provisions set out under section 4.0. This amendment shall be retroactive to the date on which the Home and Community Care and Mental Health and Addictions Services Agreement or the amendment to such an agreement with the other province or territory, as the case may be, comes into force.   

10.0 Termination

10.1 Canada may terminate this Agreement at any time if the terms of this Agreement are not respected by British Columbia by giving at least 12 months written notice of its intention to terminate. British Columbia may terminate this Agreement at any time if the terms of this Agreement are not respected by Canada by giving at least 12 months written notice of its intention to terminate.

10.2 As of the effective date of termination of this Agreement under section 10.1, Canada shall have no obligation to make any further payments to British Columbia after the date of effective termination.

11.0 Notice

11.1 Any notice, information, or document provided for under this Agreement will be effectively given if delivered or sent by letter or email, postage or other charges prepaid. Except in periods of postal disruption, any notice mailed by post will be deemed to have been received eight calendar days after being mailed.

The address for notice or communication to Canada shall be:

Health Canada
70 Colombine Driveway
Brooke Claxton Building
Ottawa, Ontario
K1A 0K9

Email: marcel.saulnier@canada.ca

The address for notice or communication to British Columbia shall be:

Ministry of Health
Legislation, Intergovernmental Relations & Knowledge Management
PO Box 9637 STN PROV GOVT
Victoria, BC
V8W 9P1

Email: Kevin.Samra@gov.bc.ca

12.0 General

12.1 This Agreement, including Annexes 1 and 2, comprise the entire agreement entered into by the Parties with respect to the subject matter hereof.

12.2 This Agreement is based on the Common Statement of Principles on Shared Health Priorities, Annex 1, finalized on August 21, 2017.

12.3 This Agreement shall be governed by and interpreted in accordance with the laws of Canada and British Columbia.

12.4 No member of the House of Commons or of the Senate of Canada or of the Legislature of British Columbia shall be admitted to any share or part of this Agreement, or to any benefit arising therefrom.

12.5 If for any reason a provision of this Agreement that is not a fundamental term is found by a court of competent jurisdiction to be or to have become invalid or unenforceable, in whole or in part, it will be deemed to be severable and will be deleted from this Agreement, but all the other provisions of this Agreement will continue to be valid and enforceable.

SIGNED on behalf of Canada by the Minister of Health this 21st day of August, 2018.

The Honourable Ginette Petitpas Taylor, Minister of Health

SIGNED on behalf of British Columbia by the Minister of Health this 21st day of August, 2018.

The Honourable Adrian Dix, Minister of Health 

Annex 1 to the Agreement

Common statement of principles on shared health priorities

Annex 2 to the Agreement

British Columbia Action Plan on Home and Community Care and Mental Health and Addictions Services

Introduction

The Government of British Columbia has a strategic vision for an integrated system of care that helps people maintain their health, recover from illness and surgery, improve their quality of life, stay independent longer and avoid unnecessary hospital visits. This health system is person-centered, coordinated, seamless and easy to understand for clients, family members and care providers.

The foundation of the integrated system of care is the delivery of effective primary care services. Doctors' offices will be transformed and linked into Primary Care Networks of team-based primary care practices, called Patient Medical Homes, serving the primary care health needs of a local community. Linked to the Primary Care Networks will be Specialized Community Services Programs, which includes existing home and community care services, designed to provide care planning and service delivery wrapped around the individual needs of clients in the following categories: adults with complex medical conditions and/or frailty; mental health and addictions; cancer care; and scheduled surgical care.

An integrated system of care, hinged on the delivery of effective primary care services, also serves as a foundation for the improved delivery of mental health and addictions services. With the launch of the Ministry of Mental Health and Addictions, the Government of British Columbia is planning and designing systems of care so that British Columbians can ask once, and get help fast, for mental health and addictions problems. The mental health and addictions initiatives described in this action plan focus on strengthening and expanding evidence-based services and supports designed to prevent and intervene early with some of the most common mental health and addiction problems across the lifespan. The initiatives include services and supports in key settings that are critical to ensuring people get the right care at the right time, including schools, community, and in the home. The initiatives also serve to strengthen the response of primary care services to mental health and addictions problems by directing people to first line of defence interventions for mild to moderate problems, while increasing capacity for primary care to respond to people with more acute symptoms. The initiatives have been selected and linked to accelerate progress in advance of the launch of a new provincial mental health and addictions strategy in spring 2019.

The Ministry of Health and Ministry of Mental Health and Addictions have worked together to develop this action plan, focused on two priority areas – home and community care and mental health and addictions services – where federal funding will be provided to BC to enhance, expand or accelerate the progress the province is making towards achieving its vision for an integrated system of care. The initiatives outlined in this plan focus on two of the client populations identified above: adults with complex medical conditions and/or frailty, and mental health and addictions. This plan aligns with both the BC strategic vision and the objectives of the Common Statement of Principles on Shared Health Priorities.

Home and Community Care

Context

In 2016, 18% of BC's population was 65 years old or older. By 2036, it is estimated that more than a quarter of British Columbians will be over 65Footnote 1. Aging brings a growing incidence of chronic disease, with nearly 20% of patients in BC living with two or more chronic conditions. With longer lifespans, the need for care of patients towards the end of their lives is increasingly complicated; cancer and dementia are key health issues, as is the need for both in-home and out-of-home long-term care. There is increasing demand for home health services in the community, including personal care, professional services, as well as other supports such as light housekeeping, transportation and meal preparation. Adding additional complexity to care and service delivery is the broad range of rural, urban and remote communities and the inconsistent access to the range of community-based care options required by complex populations.

BC's home and community care system consists of a range of services including residential care services, assisted living services, community nursing, community rehabilitation, adult day services, and home support services. In 2016/17, there were approximately 41,082 clients receiving publicly subsidized residential care services; 6,068 clients receiving publicly subsidized assisted living services; and 34,760 clients receiving publicly subsidized home support servicesFootnote 2.

Residential care facilities offer seniors 24-hour professional supervision and care in a safe and secure environment. Publicly subsidized residential care services are provided to approximately 5% of the total BC 65+ populationFootnote 3. The majority of people moving into residential care are over the age of 75, are frail, and have complex care needs. As of March 31, 2017, the total capacity of publicly subsidized residential care beds in BC was 27,885Footnote 4.

Assisted living is a housing option that provides seniors with enhanced supports to maintain their independence. In BC, as of October 2017, there were a total of 4,418 publicly subsidized registered assisted living unitsFootnote 5.

BC has a range of comprehensive home health or community care services that are managed or contracted by health authorities, including: community nursing, community rehabilitation, adult day programs, home support for assistance with activities of daily living, hospice and at-home end-of-life and palliative care. These services support adults with disabilities and/or chronic conditions to manage their health care needs and remain in the community as long as possible. Informal family/friend caregivers, volunteers and community-based/non-governmental organization (NGO) services are also relied upon to provide other supports outside of the health system.

Palliative and end-of-life care services are provided within each of the above service areas. The Ministry of Health and health authorities provide a range of palliative and end-of-life care services to support people in the care settings that best meet their needs, including at home, in hospital, in long-term care facilities, and in free-standing hospice residences. In 2015/16, there were 26,082 BC residents receiving some type of palliative care. Of those, 47% were users of the Pharma Care BC Palliative Care Drug Plan (Plan P) Footnote 6, and 62% accessed home care servicesFootnote 7.

BC has a number of ways in which it monitors the strengths and gaps in its home and community care program. This includes bi-annual reports produced by the Ministry for monitoring expenditures and client and service volumes, as well as reviewing reports and surveys produced by BC's Office of the Seniors Advocate (OSA), such as the annual monitoring report: Monitoring Seniors' Services 2017Footnote 8. This OSA report identified that while seniors' attachment to a general practitioner (GP) or GP office has remained constant over the past three years, the average number of home support hours delivered per client has decreased. Another OSA report focussed on caregivers: Caregivers in Distress: A Growing ProblemFootnote 9, which identified that caregiver distress increased by 7% between the September 2015 and August 2017 reporting periods and that access to adult day programs had decreased by 5%. A further document produced by the OSA, Listening to your Voice: Home Support Survey ResultsFootnote 10, which was a home support survey of almost 10,000 seniors and their family members, identified concerns regarding continuity of care, the lack of skills and training, awareness of medication and the need to consider additional supports, such as light housekeeping and meal preparation.

Currently within the community care sector of the health care system, there are gaps in care planning.  The presence of a comprehensive, interdisciplinary care plan to facilitate organized and coordinated care for complex clients is inconsistent as multiple health care professionals and unregulated care providers operate relatively independently of each other when delivering client care.

As client complexity has increased over the past years and the regulated scope of professionals has evolved, some role confusion and overlap has occurred. To further complicate the issue, the scopes of practice of some professions are not currently optimized, so clarification and improvement to increase the functionality and effectiveness of team based care is required. Investment in increasing the number of professionals, as well as education, training and orientation for these people, will assist in the clarification of roles and expectations in client care to ensure that each care provider is working to a full range of competency, and that their roles are clear within interdisciplinary teams to optimize care delivery and functionality.

Additionally, there is a lack of a consistent approach to developing strong linkages between the formal health system in primary and community care to the community-based organizations and NGOs that offer services to adults with complex conditions (including seniors).  To date, community-based services are not always considered an essential element within the system of care, tend to be based upon local relationships, and are not consistently positioned within the system. There are also discrepancies in access to the full range of home and community care services available in rural, remote and on reserve communities. Meal programs, exercise programs and client/caregiver check-in programs are just a few examples of services that are offered in various forms in many communities.  By investing in the community-based/NGO sector and supporting more services and supports for clients and their families, BC plans to establish formal linkages in the creation of a 'system of care' that will enable clients to remain in their homes as long as possible. 

BC's Plan for Home and Community Care

In addition to the federal funding being made available to provinces, BC's Budget 2018 has committed $548 million over three years, 2018/19 – 2020/21, in order to support BC's home and community care system priorities in six key areas. These two sources of funding will be used to support initiatives in these areas, with federal funding targeted in specific areas in order to complement BC’s broader strategy. The six key areas for the broader strategy are:

  1. Home Support Services
  2. Community Based Professional Services
  3. Community Based Care Giver Supports
  4. Community Based NGO Services (e.g. seniors centres)
  5. Assisted Living Staffing
  6. Residential Care Staffing

With an emphasis on shifting care to the community and away from hospital and facility care where possible, BC is investing to meet the present and future demand for home and community care through the development and redesign of the full suite of community care and community-based services, including residential care. Redesigned services will be integrated into a single program in each of BC's Local Health Areas (LHAs) to meet the needs of seniors and other adults with complex medical conditions and/or frailty, to be known as Specialized Community Services Programs for Adults with Complex Medical Conditions and/or Frailty (Specialized Community Services Programs).

Provincially, there are 89 LHAs serving 218 community health service areas. The five regional health authorities are expected to establish and develop, at minimum, one Specialized Community Services Program in each LHA within their region, based on population health needs and geography. These Specialized Community Services Programs will be established and linked to Primary Care Networks that enable team-based care which provides effective interdisciplinary care planning, as well as comprehensive and coordinated service delivery to meet the needs of clients within a local community area.

To enable the development of these Primary Care Networks, the BC Ministry of Health has also invested $150 million over three years (2018/19 - 2020/21) in team‐based primary care that will link to Specialized Community Services Programs. This will allow progress to be made in expanding the coverage of primary care providers through team-based care and support clients not being well-served in the community. Shifts in the system will improve increased attachment to primary care for British Columbians that present in emergency departments and prevent unnecessary hospital admissions. This approach, coupled with the Specialized Community Services Programs, will provide supports needed to assist complex clients to remain as independent as possible in community.   

A range of services that are currently provided to permanent occupants of residential care facilities such as meals, bathing and foot care, will be made available to clients with complex care needs that are currently residing in the community. By making the services available to those who do not live in residential care facilities, more people will be supported to continue to live in their own homes for as long as possible.

Overnight facility-based respite care for adults living in the community is essential to support care providers and reduce burden and burnout associated with being the main caregiver to a complex client.  Investment in respite care will improve availability and flexibility to enable clients to remain in their communities as long as possible.

In assisted living, a focus will be adapting to the changes resulting from the recent revisions to the Community Care and Assisted Living Act, which will allow clients to remain in assisted living who have increased complexity and require more services than is permitted under the current model – for example, this could include provision of palliative care. This includes development of new policy and guidelines to support revised staffing levels and skills mix, as well as different service delivery models to best meet the needs of clients.

Palliative care will be an important component of BC's strategy, linked with specialized services for people with complex medical conditions and/or frailty. A focus will be on improving the capacity to provide quality palliative and end-of-life care at home, in assisted living, in residential care, and other housing and care settings. Earlier provision of palliative care is linked with better client outcomes, as well as better alignment of a person's treatment choices with their personal goals of care.

The Ministry works with the First Nations Health Authority (FNHA) on mutual accountabilities in planning, administration, service delivery and monitoring of health programs for First Nations people in BC, in partnership with First Nations communities in BC. In order to facilitate coordination and integration of First Nations' health programs and services at the regional level, regional partnership accords have been signed between each of the regional health authorities, the FNHA and the regional caucus of the First Nations Health Council (political leadership). The accords commit the partners to work collaboratively within a shared agenda to improve the health of First Nations and Indigenous people in their region.  The FNHA has regional directors that work closely with the regional health authority Aboriginal Health directors to support the work in the region and the partnership accord tables.

Strengthening the provincial system of integrated primary and community care services, delivered by inter-professional teams and functions, is a priority for the Ministry of Health. Meaningful engagement with First Nations and Indigenous organizations, as they relate to geographical boundaries and demographics, is an important criterion for the development of Primary Care Networks and the delivery of Specialized Community Services Programs.

British Columbia's commitment to fully adopt and implement the United Nations Declaration on the Rights of Indigenous Peoples, the Truth and Reconciliation Report's Calls to Action, and the Métis Nation Relationship Accord II will be foundational to achieving culturally safer, culturally relevant, and trauma-informed services, including in home and community care.   

Priority Areas for Investment

Over the next five years, BC will be strengthening its home and community care services, including enhancing supports that will allow British Columbians with increasing care needs to stay in their homes as long as possible. In addition to new provincial funding, the federal investment provides the BC health care system additional resources that can be targeted toward the home and community care system transformation and enable more flexibility in the provision of care across rural and remote communities and the incorporation of virtual delivery of care where appropriate. The priority federal investment areas for British Columbia are:

  1. Community Care Services: Within the overall plan for home and community care integration and improvement, the federal investment will be specifically targeted at advancing key elements of the province's strategic priority of integrating Specialized Community Services Programs with Primary Care Networks. The focus is on care being provided in the community and hospital/emergency department avoidance.
  2. Palliative and End-of-Life Care: While palliative care services are embedded within the general services provided in home and community care, BC will invest in a range of activities to improve access, responsiveness and quality of community-based palliative services to support complex clients to access the care they need within their home environment. Staff providing care will have adequate training and education to provide evidence-based care and services based upon the needs and wishes of the clients.  

A high-level summary of actions and anticipated outcomes under each of these action areas is provided below. The actions are consistent with the actions outlined in the Common Statement of Principles on Shared Health Priorities.

1. Community Care Services

BC is working to align services with community need to ensure British Columbians are able to receive the appropriate level of care and support and remain in their homes and communities for as long as possible.

The Specialized Community Services Programs encompass the full suite of services provided in home and community care to provide direct client care and family caregiver supports through a range of services provided by nurses, health care assistants, and allied health staff in the community, managed or contracted by health authorities and linked to primary care homes, as well as local community-based/NGO seniors' services. The multiple related services required by this population will be integrated into a single program structure to provide coordinated, seamless, interdisciplinary team-based care that is easy to access in order to meet the client's physical and psychosocial needs. Clients will experience an integrated system of care, organized by a single care manager, based upon their individual needs. 

Services include access to specialist medical care, home support, adult day programs, respite care services, palliative and end-of-life care, assisted living as well as both long-term and short-term/transitional residential care. Services currently only available within residential and assisted living facilities will become accessible to adults with complex medical conditions living in the community, e.g., meal programs, social activities, bathing, laundry and personal care.  

The services are provided to adults with complex conditions including palliative care and dementia through a client-centred, needs-based model by a range of professional and unregulated staff with general skill sets but with clear and timely access to subject matter experts to assist with problem solving in complex situations (e.g. palliative pain management and complex dementia behaviours). For all services, efficient and effective access and coordination of care and services will be based upon assessed needs and delivered incorporating the principles of consistency and continuity of care providers.  Creative virtual care strategies will enable service delivery and monitoring remotely, where practical. 

The redesign of home and community care services, with the focus on services provided in the community to avoid and reduce emergency department, hospital and residential care utilization, will bridge gaps within the existing system and provide more care for complex clients, lead to improved client outcomes and improved client/caregiver satisfaction. For example, a report produced by the OSAFootnote 11 identified that the average number of home support hours and number of clients receiving home support has declined since the previous report.  Investment into training, recruiting and retaining health care assistants will support and sustain this vital workforce. Another example is a report that examined caregiver distressFootnote 12 (mentioned above) and identified that 29% of unpaid caregivers experienced symptoms of distress. Investment into increased adult day program and overnight respite care services will contribute to providing the needed supports for unpaid care providers to continue to provide care for their loved ones in their homes, avoiding hospital and residential care admissions where possible.

Within the overall plan for community care services, the additional federal funding, combined with new provincial funding, will be used specifically to accelerate progress in the following five areas over the life of the agreement:

  1. Home support
  2. Community-based professional services
  3. Community-based caregiver supports
  4. NGOs, including seniors' centres
  5. Technology and infrastructure

The allocation of federal funding will primarily be focussed on home support, palliative and end of life care, and technology and infrastructure.

a) Home support

Federal funding will be used to increase access to in-home assistance with activities of daily living care and in-home respite for clients based upon need, through:

  • Increased service hours for existing and new clients at risk of requiring long term care over the coming year. 
  • Increased short term service hours immediately after hospital discharge.

Improved delivery of home support will be achieved by: 

  • Establishing formal linkages with Primary Care Networks to support rapid assessment and support for clients requiring home support to prevent hospital admissions and emergency department visits.  
  • Ensuring Health Care Assistants are providing home support services with assigned client caseloads using cluster care or geographic assignment and through fixed shift scheduling.  
  • Enabling Health Care Assistants to work across all services within a specialized community services program (residential, assisted living and all home health services, etc.) to optimize continuity of care, productivity, and job satisfaction. On the job skill development and training will be clearly planned for as part of a broader recruitment and retention strategy.
  • Ensuring home support schedules permit sufficient time for client focused care and are flexible to meet unscheduled or urgent care needs of clients. 
  • Increasing capacity to provide both responsive in-home services including short term, episodic ‘overnight care’ and unscheduled in home respite care to prevent or reduce hospital admissions/readmissions. 

Health Care Assistants are included in the “team-based care” model and considered valuable members of the interdisciplinary team, and that professional staff (RN, Allied Health) are available to assist health care assistants with problem solving or consultation during all working hours that they are providing care in client’s homes.

This aligns with the Common Statement of Principles on Shared Health Priorities by:

  • Spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care.
  • Increasing support for caregivers.

b) Community-based professional services

Funding will be used to increase access to professional services and improve the quality and timeliness of care for adults with complex medical conditions through the following activities:

  • Enabling all professional staff (Nursing and Allied) to work to a full range of competency when providing direct client care, with ‘case management’ considered only one of a range of services offered by each professional. 
  • Ensuring professional staff within the specialized community services program are working as a multidisciplinary team to support complex clients living in the community, within which a “most responsible clinician’ is assigned to each complex client. 
  • Allied Health resources such as occupational therapists, physio therapists and social workers are working across all services across the specialized community services program (residential, assisted living and all home health services, etc.) and not segregated by sector.
  • Clinical educators and consultative resources, such as wound care and palliative care consultation are working across all specialized community services program services (residential, assisted living and all home and community health).
  • Supporting early intervention, post hospital discharge care, and to prevent readmission by:
    • Linking with Primary Care networks to enable proactive case monitoring for clients that do not require specialized community services program services but are at substantial risk of health decline. Processes for at-risk clients are developed collaboratively between PCNs and the specialized community services programs. The tools (RAI Contact Assessment) used for this ‘upstream screening’ is standardized and electronic to enable appropriate data collection. 
    • Implementing re-ablement programs across the health authority to support seniors’ successful transition back to community post-acute care discharge and to prevent readmission. Programs are provided by a range of health professionals and unregulated care providers and include assertive activities to support the optimization of functioning (i.e. strengthening, balance and exercise supports) to prevent hospital readmission and decline.

This aligns with the Common Statement of Principles on Shared Health Priorities by:

  • Spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care.

c) Community-based caregiver supports

Funding will be used to assist informal family/friend care providers to continue to support complex clients in their homes, where possible, by improving access to both unscheduled and scheduled health authority services that reduce caregiver burden, including:

  • Expanding hours of operation for evenings and weekends, and/or increased Adult Day Program spaces, Overnight Respite Facility Care and In-home respite services for both pre-planned and urgent care.
  • Reducing care giver burden by embedding care and service delivery activities offered by the specialized community services program, including care giver support programs and risk/screening tools to identify and reduce caregiver burden.

This aligns with the Common Statement of Principles on Shared Health Priorities by:

  • Increasing support for caregivers.

d) NGOs, including seniors' centres

Funding will be used for actions that strengthen the relationship and linkages between health authorities and community-based/NGO services to create the system of care needed to appropriately support seniors living in the community with complex and chronic health challenges and/or who are at risk of frailty. There will be a focus on six core areas: nutritional supports; health and wellness; physical activity; cultural, educational and recreational programs; information, referral, and advocacy; transportation. Actions include:

  • Examining currently provided local community-based/NGO programs and identifying new programs, or expanding existing programs, that bridge gaps in service by providing non-medical supports to assist adults with complex conditions to remain in their homes as long as possible by developing contracts or funding programs that meet the needs of the community and formally link to the health system.
    • For example, Better at Home is a community development-based model that provides seniors with access to simple, non-medical home support services aimed at helping them remain in their homes longer (e.g. transportation, grocery shopping, friendly visiting, light housekeeping and yard work).
  • Providing new funding for contracts and/or resources to enable health authorities to increase investments to formal local linkages with community-based services linked to primary care with clear and uncomplicated referral patterns.
    • An example could include collaboratively developing a program to be delivered by a local seniors' centre that provides a "morning check-in" service that calls seniors in their homes each morning, as a way of monitoring those not currently accessing health authority services but who could benefit from daily interaction. Another example would be funding a local "meals on wheels" program that provides warm and nutritious meals for clients with identified nutritional risk.
  • Developing educational materials and methods for sharing information to ensure the public and all stakeholders are aware of local community-based services and how to access them.  An example may include creating a printed directory of community-based services for public distribution through physician offices.

This aligns with the Common Statement of Principles on Shared Health Priorities by:

  • Spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care.

e) Technology and infrastructure

Federal funding will be used for leveraging technology and infrastructure to increase home and community care service provision to clients; to improve communication with clients; and improve communication between interdisciplinary team members in order to increase capacity and access to care and services. This includes:

  • Increasing the use of technology to improve access to care, e.g. investment in FTEs and equipment to expand the provincial Home Health Monitoring Program to support chronic disease management monitoring for complex populations as an alternate method to care delivery.
  • Increasing the use of technology to improve interdisciplinary teams' communications, e.g. the investment in software and handheld devices that can provide real-time information about the needs of clients and schedule changes for care providers to access while in the client's home.
  • Increasing the availability of mobility equipment to reduce barriers to hospital discharge, e.g. to enable equipment rental, or purchase for clients with limited income, to reduce barriers in transition from hospital back to the community.

This aligns with the Common Statement of Principles on Shared Health Priorities by:

  • Enhancing home care infrastructure, such as digital connectivity, remote monitoring technology and facilities for community-based service delivery.

Expected Outcomes – Community care services

  • Increase in home support hours
  • Increase in adult day services (spaces and/or hours)
  • Increase in respite services (beds and/or hours)
  • Number of FTEs hired by discipline

2. Enhancing Palliative and End-of-life Care

Palliative care is an important component of the Ministry's vision to develop Primary Care Networks, linked with specialized services for people with complex medical conditions and/or frailty. Early access to palliative care is linked with better client outcomes, as well as better alignment of a person's treatment with their personal goals of careFootnote 13.

BC has been a leader in promoting integration of a palliative approach to care, and a number of initiatives have been implemented in BC to improve the quality and accessibility of palliative and end-of-life care. For example:

  • Specialized training modules for general practitioners aimed at improving identification of those in their last year of life, and to integrate the palliative approach to care.
  • The After-Hours Palliative Nursing Service provides palliative nursing support via telephone to palliative clients living at home. This helps clients to remain in their homes by providing informal caregivers with an accessible clinical resource for consultation during nighttime hours.
  • The BC Centre for Palliative Care, established in 2013, is a provincial hub advancing best practices in palliative and end-of-life care, based on evidence, education, and innovation.
  • Adding 56 new community hospice beds to date since 2014, with planning underway to complete an additional 70 beds by 2020.  This will increase the number of community hospice beds in the province by 44% from 2013.

Additional federal funding will be used to accelerate progress in the area of community-based palliative care services.

Community-Based Palliative Care Services

With the focus of shifting care to the community and reducing Emergency Department and hospital utilization by complex clients, the federal funding will allow BC to invest in a range of activities to improve access, responsiveness, and quality of community-based palliative services. Federal funding will support these provincial initiatives, which are targeted to:

  • Improving and expanding client access to 24/7 palliative and end-of-life services by increasing clinical care coverage (primary care nurse and physician resources), consultation, and information to meet their needs in the community.  Additional resources will be added to the workforce to ensure that when palliative care is required, the appropriately trained clinicians and health care assistants are available to provide the necessary services.
  • Increasing generalist clinicians’ access to 24/7 pain and symptom management and clinical consultation, to support clients to remain in the community at the end of their lives (including private homes, community hospices and assisted living settings). This will be achieved by creating processes to support expedited access to an increased number of resources with higher levels of knowledge specific to palliative and end-of-life care that are accessible to clinicians at the time they require consultation.
  • Ensuring clients with complex conditions returning to the community post-hospitalization have the supports necessary to support them to return home as quickly as possible and with optimal functioning.
  • Increasing education/orientation/training for all care providers.

This investment aligns with the Common Statement of Principles on Shared Health Priorities by:

  • Enhancing access to palliative and end-of-life care.

Expected outcomes – Palliative and end-of-life care

  • Number of staff trained using standardized palliative care training.
  • Number of new clinical consultative resources hired.

Funding Allocation

In order to support BC's home and community care system transformation, BC's Budget 2018 has committed $548 million over three years, 2018/19 – 2020/21, for seniors. Together with the federal funding of $249.34 million over the same time period, this amounts to a net new investment of $797.34 million above the Health Authority estimated Community and Residential Care sector annual budgets of $3.15 billion.

Federal funding in the table below is allocated into the two main streams of Home and Community Care Services and Palliative and End-of-Life Care. In BC, regional health authorities are responsible for delivering health services that meet the needs of their specific populations. Accordingly, each health authority will be expected to create detailed plans for Ministry approval, which allocate funding within the Home and Community Care Services stream in order to meet the needs of their population. Health authorities will meet with the Ministry of Health for further discussion and clarification about the expectations for documentation and reporting on their use of federal funds. 

Home and Community Care Funding Allocation
Federal Funding Allocation for Early Action Initiatives
($ millions)
2017-18Table 2 Footnote * 2018-19Table 2 Footnote ** 2019-20Table 2 Footnote ** 2020-21Table 2 Footnote ** 2021-22Table 2 Footnote ** TotalTable 2 Footnote **
Home and Community Care Services $21.26 $66.93 $72.50 $72.50 $100.40 $333.59
Palliative and End-of-Life Care $4.93 $11.81 $12.80 $12.80 $17.71 $60.05
Total Federal Funding $26.19 $78.74 $85.30 $85.30 $118.11 $393.64
Table 2 Footnote *

Funding already provided through legislation

Return to table 2 footnote * referrer

Table 2 Footnote **

Allocations are notional. Funding allocations are subject to annual adjustment based on the formula described in section 4.2.3 of the Agreement.

Return to table 2 footnote ** referrer

Mental Health and Addictions

Context

In any given year, one in five in British Columbians experience a mental health or addiction problem or disorder which can have significant implications for education, work, family, and community life. Many mental health and addiction disorders in adulthood show their first signs in childhood, and if left untreated, can develop into serious conditions which need ongoing care, support and treatment. An estimated 12.6% of children aged 4–17 years are experiencing mental disorders at any given time with just over a third able to access specialized treatmentFootnote 14. BC is grappling with an opioid overdose public health emergency, which resulted in the loss of over 1,400 people in 2017Footnote 15. In 2015, over 600 British Columbians died by suicide, which continues to be the second leading cause of death among young people aged 15-24 yearsFootnote 16.

Similar to other provinces and territories across Canada, BC invests in a mix of mental health and addiction services that includes:

  • Long-stay facilities/specialist services;
  • Psychiatric services in general hospitals;
  • Formal community mental health and addiction services (e.g. psychosocial rehabilitation programs);
  • Mental health and addiction services through primary health care;
  • Informal community mental health and addiction services (e.g. community non-profit peer support programs);
  • Self-management services and supports.

British Columbia uses a tiered model of care to align its investments from health promotion to tertiary care treatment. This model of care supports individuals to access services and receive care at any point in the system.  Once accessed, services are clinically aligned to the intensity of services that meets the person's current needs. However, BC also is challenged with the issues related to transitions in care from youth to adult services, from GPs to specialists, and across service settings. In addition, the inability to access timely services can mean that people's symptoms often worsen, leading to increased demand for more specialized and expensive forms of care. However, the integration of mental health and addictions into primary care has significant potential to increase access for people with mild to moderate mental health and substance use challenges.

A recent internal government analysis of mental health and addictions services in BC points to insufficient access to community-based mental health and addiction services for children and youth, particularly integrated youth services with interdisciplinary professionals that includes primary care. Service access varies across population groups and geographic location and is impacted by stigma, discrimination, and a lack of culturally safer and trauma informed services.

It is well documented that Indigenous populations in BC, including First Nations, Inuit, and Métis peoples, experience significant disparities in mental health and wellbeing outcomes, due to the ongoing effects of colonization and experiences of intergenerational trauma.

The Province currently supports the First Nations Health Authority for the planning, management, service delivery and funding of health programs, in partnership with First Nations communities in BC. British Columbia's commitment to fully adopt and implement the United Nations Declaration on the Rights of Indigenous Peoples, the Truth and Reconciliation Report's Calls to Action, and the Métis Nation Relationship Accord II will be foundational to achieving culturally safer, culturally relevant, and trauma informed services.

BC's Plan for Mental Health and Addictions

Over the next five years, the Province will guide the transformation of British Columbia's mental health and addictions system through the development and implementation of a new mental health and addictions strategy and a comprehensive plan for child and youth mental health and addictions services. Focus areas include improving access to services, investing in prevention and early intervention, and improving the mental health and wellbeing of key populations experiencing significant disparity in outcomes. In addition, the Ministry of Mental Health and Addictions is actively responding to the overdose public health emergency through targeted investments and improvements to services.

Looking forward over the next five years, the Province plans to strengthen supports and services that address social determinants within the context of universal access to mental health and addiction services and care. This includes attending to the structural conditions that create power imbalances and unfair health outcomes between population groups. This will be achieved by increasing cultural safety where all people benefit from an environment that is physically, spiritually, socially and emotionally safe, and applying a health equity lens to services. The Province will be asking British Columbians across population groups, including Indigenous people and particularly vulnerable populations such as the LGBTQ2 population, about the most effective way to deliver services and improve the service experience.

The vision is for a seamless system of care where people "ask for help once and get the help they need fast," and where "every door is the right door." The Ministry of Mental Health and Addictions will undertake this work in partnership with other ministries, service delivery partners, researchers, other levels of government, families, people with lived experience, and Indigenous peoples. It will also be informed by consultation with internal and external stakeholders to determine the most effective way to deliver quality mental health and addiction services. As noted earlier, the Province contemplates that the new strategy will integrate a focus on the social determinants of mental health and wellbeing.

Priority Areas for Federal Investment

While the broader strategy is developed, the targeted federal funding for mental health and addictions will support the ministry to implement a series of early actions designed to accelerate progress to respond to some of the most pressing gaps in the province's mental health and addictions system. The Early Actions are designed to respond to a series of priorities (see below) that will pave the way for the Province's new mental health and addictions strategy.

Within the priorities described below, and consistent with the actions outlined in the Common Statement of Principles on Shared Health Priorities, the federal investment in mental health and addictions will support BC to focus on a series of strategic early actions in 2018/19 immediately prior to the release of a provincial strategy.

Presently, the Province is conducting a targeted consultation with British Columbians to inform the design of the new provincial mental health and addictions strategy. The Province anticipates the public release of the strategy in spring 2019. Each of the strategic early actions outlined in this proposal are designed to achieve gains in mental health and wellbeing outcomes across targeted populations that will be built upon with the new strategy.

The Province anticipates that many of the initiatives in this proposal will require sustained funding, so out year funding amounts have been identified. Upon approval of the strategy, uses of the federal funding for 2019/20 to 2021/22 will be reviewed to ensure they are targeted to support aspects of the strategy. This review will help ensure that targeted federal funds are leveraging the strategic directions and actions identified in the new provincial strategy to the fullest extent possible. 

The following five priority action areas have been identified for the federal investment:

  1. Strengthen the capacity of primary care to respond to mental health and addictions, with a focus on prevention/early intervention and children/youth;
  2. Expand access to culturally safer and trauma-informed mental health and addictions services for Indigenous communities across BC;
  3. Improve seamlessness across systems of care so that people can ask once and get help fast;
  4. Increase access for students to mental health and addictions prevention and early intervention services; and
  5. Expand access to evidence-based treatment and recovery options for vulnerable populations.

A high-level summary of actions and anticipated outcomes under each of these action areas is provided below. The actions are consistent with the actions outlined in the Common Statement of Principles on Shared Health Priorities.

1. Strengthen Primary Care Capacity to Respond to Mental Health and Addictions, With a Focus on Prevention/Early Intervention and Children / Youth

Research has shown that many primary care practitioners want to successfully identify and treat mental health and substance use problems, but report they often do not have the specialized knowledge or supports in placeFootnote 17. Indeed primary care practitioners identify mental health diagnosis, treatment, and care planning, including connections to resources, as a top priorityFootnote 18. With increasing demands on the primary care setting, the following initiatives are designed to increase capacity and ensure the availability of effective supports for mild to moderate mental health and substance use problems.

Federal funding in this area will be used to resource a range of evidence-based interventions designed to offer primary care professionals referral tools to help prevent and intervene early with common and debilitating mental disorders. The availability of these interventions will be integral to the mandate of the province's developing Primary Care Networks and their response to people experiencing mild to moderate problems and disorders.

Federal funding will be used to resource the following actions:

  1. Support evidence-based virtual care interventions designed to prevent and intervene early with behavioural and anxiety problems/disorders in childhood and depression and anxiety problems/disorders in adults.

    BC has invested in developing a robust provincial infrastructure that delivers evidence-based interventions through a range of telehealth methods. For example, the Province currently funds two services through a provincial organization to deliver both cognitive-behavioural therapy coaching ($2.5M/year) and positive parent training ($1.49M) online and via the telephone, reaching thousands of British Columbians each year.

    Federal funds will sustain and expand the gains made through these provincial services, preventing the worsening and intervening early with common mental disorders like depression, anxiety, and childhood behavioural problems. In addition, the federal funds will create the opportunity to launch a new and integrated telehealth service focused on preventing and intervening early with childhood anxiety.  

  2. Strengthen the capacity of primary care providers to embed the latest research in adverse childhood experiences into practice and improve pathways of care in the child and youth mental health and substance use system.

    Between 2013 and 2017, the Province implemented a systemic quality-improvement initiative focused on the child and youth mental health and substance use system, using the Breakthrough Series Collaborative model.Footnote 19 This initiative identified a number of priority strategic areas for continued improvement, including the integration of best practice in adverse childhood experiences into primary care and the strengthening of pathways of care.

    Federal funds will launch new focused work designed to activate and integrate screening, assessment, and interventions focused on adverse childhood experiences into BC's primary care context. Further, by leveraging the gains made by the previous systemic quality improvement work, the federal funds will create the opportunity to define and strengthen pathways of care through the child and youth system, in turn improving access, coordination, and experience for children, youth, and families.

  3. Resource the initial integration of mental health and addiction programming into the province's new primary care networks.

    The Province is embarking on a significant process of transformation of the delivery of primary care, with implications for the delivery of mental health and substance use services. Federal funds will be targeted toward the integration of mental health and addiction programming into the newly developed primary care networks. These networks will provide coordinated capacity for the screening, assessment, and management of mild to moderate mental health and substance use problems. For people living with complex yet stable disorders, the networks will also provide rapid access to specialized services when needed. In keeping with a tiered system of service intensity, the networks will also provide accelerated access to less and more intense tiers of service for this population.

  4. Undertake an evaluation of the potential of in-person group low-intensity cognitive behavioural sessions across the province.

    The Province would like to complete the necessary work to evaluate the feasibility of a fuller continuum of publicly funded psychotherapy. The federal funds will be targeted to develop a robust and tiered clinical framework, focused on more prevalent mental disorders among youth and adults, like major depressive disorder. Linked to this framework, the federal funds will also support the implementation of lower-intensity, in-person cognitive behavioural therapy groups in 20 communities across the Province.

    Each of these four actions are designed to account for the diversity of British Columbians, and the real issue that many people in the province experience disparities in access to quality mental health and addiction services. Each of the above actions is designed to improve access in rural and remote communities and the interventions embedded in actions #1, #2, and #4 have undergone extensive development to provide culturally safer options for Indigenous people in the province.

    These investments support a range of interventions based on a robust evidence base, and have the potential to increase primary care's ability to respond to common mental disorders through increased capacity and referral of mild to moderate concerns to evidence-based interventions. The proposed investments will be able to support people via telephone and other virtual means, thereby improving access, especially for those living in more remote areas of BC. All of the proposed investments can be implemented quickly by building on existing infrastructure, or by implementing in areas of the province that have demonstrated readiness.

Expected Outcomes

  • Increase in the number of children, youth and families receiving low-barrier mental health and substance use supports in primary care settings, and through referral by primary care physicians.
  • Increase the capacity of primary care to respond to mild to moderate mental health challenges through referral to appropriate and accessible services.

Investment in this priority area aligns with the Common Statement of Principles on Shared Health Priorities by:

  • Expanding access to community-based mental health and addiction services for children and youth (age 10–25), recognizing the effectiveness of early interventions to treat mild to moderate mental health disorders.

2. Expand Access to Culturally Safer and Trauma Informed Mental Health and Addictions Services for Indigenous Communities

The ongoing effects of colonization and intergenerational trauma have contributed to disproportionately high rates of overdose deaths, suicide, and adverse health outcomesFootnote 20. Compounding this need, Indigenous people consistently report reduced access to mental health and addiction treatmentFootnote 21.

The Province has committed to reconciliation and to fully adopting and implementing the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), the Truth and Reconciliation Commission (TRC) Calls to Action, and the Métis Nation Relationship Accord II. Linking to the Province's strategy development, in partnership with Indigenous people and organizations, an Indigenous-focused Mental Health and Addictions Strategy will be co-designed to improve mental wellness and access to culturally-safer and effective mental health and addictions services.

An allocation of the federal investment will support the initiative outlined below, providing a building block for the longer-term strategy to address the mental health and substance use needs of Indigenous peoples, which are disproportionate due to the ongoing effects of colonization and intergenerational trauma. Federal funds will leverage existing provincial investments to provide and increase access to culturally safer, trauma-informed and culturally appropriate healing and treatment services and mental health and substance use care in dedicated locations across British Columbia.

Federal funding will be used to fund program specific activities that take a holistic approach to individual and family healing, and would include, but not be restricted to:

  • Culturally-based assessment and programming
  • Trauma-specific services
  • Case management
  • Treatment services
  • Appropriate follow up / referrals, aftercare, and ongoing monitoring.

$1.5M over three years was announced in Budget 2017 to launch culturally safer and trauma-informed mental health and addiction services for a limited number of Indigenous communities across the Province. These provincial commitments have included a focused approach to suicide and crisis intervention and response and land-based healing opportunities. The land-based approaches have included traditional healing opportunities on the land, such as food gathering, hunting, trapping, fishing, and gardening. Current implementation has focused on two communities in BC – Ahousat and Kackaamin. The federal funds will expand upon this initial funding, expanding the reach of these services to up to five additional communities in year one. The number of communities and individuals served would increase proportionally during subsequent years. This targeted funding will resource efforts led by First Nations Health Authority.

Targeted investments in this priority area are justified due to an ongoing scarcity of cultural and group/family services, as opposed to solely bio-medical and individual-oriented services, available for Indigenous people. BC First Nations have articulated this need to the provincial government.

Expected Outcomes

  • Improved health outcomes of Indigenous populations through better-quality services and supports rooted in cultural safety and humility.
  • Increase in the number of cultural family-based and group-based treatment and healing services available.

This investment aligns with the Common Statement of Principles on Shared Health Priorities by:

  • Spreading evidence-based models of community mental health care and culturally appropriate interventions that are integrated with primary health services.

3. Improve Seamlessness Across Systems of Care so That People Can Ask Once and Get Help Fast

People with mental health or substance use issues in BC, especially young people, experience challenges accessing services quicklyFootnote 22. Federal funding will help the Province to build upon successful initiatives that ensure mental health and addictions services are accessible in a timely manner.

Federal funding will be used to resource the following actions:

  • Incrementally expand access to integrated youth services centres across the Province.
  • Start to build a virtual workforce designed to provide mental health and addictions care through virtual clinic access points.

The Province has invested in the development of up to 11 integrated youth services centres across the province by providing approximately $500,000 in launch money to each host community. The federal funds allow for the continued expansion of this model by one site per year, helping to ensure more equitable access to young people across the province. This is an expansion of the existing physical Foundry sites across the Province, which has benefited from philanthropic funding from the Boeckh Foundation.   

The targeted federal funds would also seed the development of a virtual workforce designed to provide access through a virtual clinic access point through eFoundry. This aligns with the Province's efforts to strengthen and coordinate the provisioning of e-mental health and substance use services.

The goal of the Province's integrated youth services centres is to improve mental health, substance use and primary care access and care for youth and young adults in communities across BC. By combining traditional integrated services through youth-friendly regional storefronts, as well as through integrated e-services, such as a web-based virtual clinic, and a phone help line, these centres can ease transition points for youth and their families, increase access and improve mental health and wellness throughout British Columbia. Each integrated youth services centre is expected to serve approximately 300-500 youth annually. 

These centres increase timely access for youth and young adults to integrated services by providing youth-friendly services that are easily accessible in person or virtually. The virtual clinic will be able to provide youth and young adults, familiar with online mediums and web-based services, an opportunity to receive MHSU care in a discreet and low-barrier point of engagement. Vulnerable youth including Indigenous youth, those with low income, and those with disabilities, particularly benefit as the services are designed to increase access to services in a youth-friendly way.

  • Improve seamlessness in access to the provincial crisis line network.

The provincial crisis line network serves as a key access point to the mental health and addictions system for thousands of British Columbians each year. In BC, there are five regional crisis lines aligned with the health authorities, including Indigenous specific crisis line services. Crisis lines provide a critical service in assessing and preventing suicides when people call in acute distress. Having received steady state funding for a number of years, the federal investment will afford the opportunity to improve technology and quality of service, streamline access, and strengthen the response to people in distress. Specifically, the funds will be targeted to the implementation of a single-number access point, utilizing the existing regional infrastructure, ensuring that callers can link into community mental health and substance use services.

Each of the initiatives described in this section have developed resources and responses in partnership with Indigenous people to ensure culturally safer and trauma-informed approaches.

Expected Outcomes

  • Increased access for youth and young adults to integrated youth services centres by providing youth-friendly services that are easily accessible in person or virtually.
  • Increased access to virtual clinic supports for youth and young adults, familiar with online mediums and web-based services, with an opportunity to receive MHSU care in a discreet and low-barrier point of engagement.
  • Increased access and quality for crisis line service users.

This investment aligns with the Common Statement of Principles on Shared Health Priorities by:

  • Expanding availability of integrated community-based mental health and addiction services for people with complex health needs.
  • Expanding access to community-based mental health and addiction services for children and youth (age 10–25), recognizing the effectiveness of early interventions to treat mild to moderate mental health disorders.

4. Increase Access for Students to Mental Health and Addictions Prevention and Early Intervention Services

Researchers estimate that 12.6% of children and youth aged 4-17 years may be experiencing mental disorders at any given time, totalling 84,000 young people in BC. Only 31% are estimated to be in receipt of specialized mental health services.  The same researchers report estimates of 29% of children and youth meeting criteria for two or more disorders at any given timeFootnote 23.

In response to this need, the Province has increased the workforce capacity of mental health professionals in the K-12 system by 90 FTEs over the past two years, and there is an ongoing commitment to increase the number of mental health and substance use professionals within school settings. To support this increase, work is underway to complete a comprehensive review and analysis of how to meet the increasing workforce needs across the school sector and beyond.

For 2018/19, the Province intends to target the federal investment against the following actions:

  • Sector-wide training to improve mental health and substance use literacy amongst parents, students, school staff, and teachers.
  • Sector-wide training to identify and intervene early with mental health and addiction problems amongst student populations.

Funding would develop and deliver mental health and wellness training to school communities with the aims of reducing stigma and discrimination, improving student connectedness, improving the likelihood of early identification and help seeking, while improving opportunities to dialogue about mental health and wellbeing in school and at home. It is anticipated that training will include an emphasis on recognizing and understanding early signs of distress, practical ways to provide immediate support and connect to resources, plus training about how to respond in the event of a suicidal crisis. There are good examples of existing curricula, including Mental Health First Aid adapted for youth and SafeTALK and ASIST focused on suicide prevention.

Training initiatives would include a focus on the need to respond to the diversity of students across BC, including Indigenous, LGBTQ2, immigrant, refugee, and newcomer student communities.

  • Focused planning and development to build the foundation for a direct increase in mental health and addiction services in school settings.

Sector-wide training, coupled with the Province's analysis and review of workforce needs in mental health and substance use, will create a stronger foundation for future initiatives focused on the school sector. Specifically, Ministries will seek to deliver on commitments to (a) ensure more students can access specially trained adolescent mental health professionals within the school system and (b) make mental health counsellors available where schools identify need so children can get the help when they need it.

The federal funds would provide a significant investment in schools as a critical setting to improve the mental health and wellbeing of students. Investment here will build capacity for school personnel to recognize and respond to students experiencing mental health and addiction problems. This will prime the system for future investments to increase the number of mental health and addictions professionals in K-12 schools across the province.

Expected Outcomes

  • Increase mental health and substance use literacy within school settings.
  • Reduce stigma and discrimination, and identify and intervene early with mental health and addictions problems amongst students.
  • Improvement in outcomes relating to student mental health, emotional development, belonging and perceived educational barriers as a result of mental health related issues.

This investment aligns with the Common Statement of Principles on Shared Health Priorities by:

  • Expanding access to community-based mental health and addiction services for children and youth (age 10–25), recognizing the effectiveness of early interventions to treat mild to moderate mental health disorders.

5. Expand Access to Evidence-based Prevention, Early Intervention, Treatment, and Recovery Options for Vulnerable Populations

In BC, some people and groups of people are more vulnerable to mental health problems and/or addictions than others. Health disparities persist among certain vulnerable groups, suggesting the need for further focused attention across the continuum of services. Vulnerability may be influenced by social and cultural inequities or be due to family history or genetic predisposition. Social factors, such as exposure to violence and trauma, poverty, inadequate housing, or lack of social support, can be mitigated through the strategic provision of appropriate supports.

Federal funding will support investment in actions targeting intervention and treatment for certain vulnerable populations to identify and mitigate problems at an early stage, to reduce risk and enhance protective factors.

These include:

  • Expansion of best practice community-based interventions for pregnant women who use substances.

Investments in these areas are targeted because there is an unmet demand for both the required hospital and community-based services to support at-risk pregnant and postpartum women and their newborns challenged with substance use and opioid withdrawal, respectively. There are gaps in hospital-based services in other regions to accompany existing community-based programs and to ensure the needed hospital-based specialized care and best practices for substance-using women and newborns in withdrawal.

In 2018/19, the federal funds will increase the availability of community-based interventions for pregnant women who use substances in the Interior and Fraser regions of the Province. An example of a community-based intervention would be Sheway. An increased number of mothers will have access to this service. Funds will also be applied to province-wide training and education efforts focused on acute and community-based mother-baby care to ready the system for more expanded access in subsequent years. It is important to note that federal funds will only be applied to the community-based components in future years.

  • Increased access to treatment and recovery options for adults at higher risk of poor health outcomes and death due to substance use.

Additionally, funding will support the expansion of evidence-based treatment options as part of the continuum of care for individuals with severe addiction, including both the clinical provision of evidence-based interventions and intensive case management (psychosocial services). The evidence-based treatment options will focus specifically on Opioid Agonist Therapy (iOAT and methadone).

Expected Outcomes

  • Improved maternal-child connections.
  • Decreased numbers of children apprehended.
  • Reduced addictions mortality by increasing access to evidence-based treatment options.

This investment aligns with the Common Statement of Principles on Shared Health Priorities by:

  • Expanding availability of integrated community-based mental health and addiction services for people with complex health needs.

Funding allocation

Mental Health and Addictions Funding Allocation
Federal Funding Allocation for Early Action Initiatives
($ millions)
2017/18Table 3 Footnote * 2018/19Table 3 Footnote ** 2019/20Table 3 Footnote ** 2020/21Table 3 Footnote ** 2021/22Table 3 Footnote ** TotalTable 3 Footnote **
Strengthen the capacity of primary care to respond to mental health and addictions, with a focus on prevention/early intervention and children/youth $5.89 $14.33 $26.25 $28.75 $31.25 $106.47
Expand access to culturally safer and trauma-informed mental health and addictions services for Indigenous communities across BC - $3.25 $5.75 $8.25 $10.75 $28.00
Improve seamlessness across systems of care so that people can ask once and get help fast - $3.35 $3.35 $3.35 $3.35 $13.40
Increase access for students to mental health and addictions prevention and early intervention services - $3.00 $4.50 $6.00 $7.00 $20.50
Expand access to evidence-based treatment and recovery options for vulnerable populations $7.20 $8.88 $19.20 $32.39 $26.39 $94.06
Total $13.09 $32.81 $59.05 $78.74 $78.74 $262.43
Table 3 Footnote *

Funding already provided through legislation

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Table 3 Footnote **

Allocations are notional. Funding allocations are subject to annual adjustment based on the formula described in section 4.2.3 of the Agreement

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Summary of Expected Results

BC is working with the Canadian Institute for Health Information (CIHI), as well as other provinces and territories, to define a set of pan-Canadian indicators that will be used by CIHI to measure progress on the shared commitments outlined in the Common Statement of Principles on Shared Health Priorities.

The draft outputs in the table below are intended to measure progress on the initiatives in this action plan, while aligning with the pan-Canadian indicators that will be defined in collaboration between CIHI and federal, provincial and territorial governments.

Home and Community Care
Initiative Output/Outcome Target

Community Care Services

Increased community based services: (Increased home support hours, increased adult day services (spaces and/or hours), Increased respite services (beds and/or hours).

Number of FTEs hired by discipline.

Measures, targets, and baselines are under development.

Palliative and End-of-Life Care

Number of staff trained using standardized palliative care training.

Number of new clinical consultative resources hired.

Measures, targets, and baselines are under development.

Mental Health and Addictions
Initiative Output/Outcome Target

Strengthen primary care capacity to respond to mental health and addictions, with a focus on prevention/early intervention and children / youth

An increase in the number of adults receiving an evidence-based intervention for mild to moderate depression and anxiety through a primary care referral

An increase in the number of parents or caregivers receiving an evidence-based intervention for mild to moderate anxiety or behavioural difficulties to support their child

Measures, targets, and baselines are being finalized.

Potential outcome target: At least 50% of participants should report an improvement in symptoms to a sub-clinical level on assessment tools

Expand access to culturally safer and trauma informed mental health and addictions services for Indigenous communities

An increase in the number of Indigenous people with access to land-based and cultural treatment and healing services for youth and families

Measures, targets, and baselines are being finalized.

Improve seamlessness across systems of care so that people can ask once and get help fast

An increase in the number of communities with access to integrated and community-based mental health and addiction sites for young people

Measures, targets, and baselines are being finalized.

Increase access for students to mental health and addictions prevention and early intervention services

An increase in the level of mental health and substance use literacy among school-based staff, parents, and students

Measures, targets, and baselines are being finalized.

Expand access to evidence-based prevention, early intervention, treatment, and recovery options for vulnerable populations

An increase in access to community-based mother-baby care services for pregnant women, who use substances.

Measures, targets, and baselines are being finalized.

Note #1 – These outputs and outcomes are subject to review and change in consultation with Health Canada pending the development of BC's provincial mental health and addiction strategy;

Note #2 – The outputs and outcomes are subject to change in order to align with the set of common indicators for mental health and addictions that will be selected through the Federal-Provincial-Territorial development process with CIHI.

Footnotes

Footnote 1

BC Stats, BC-Level Population Projections, May 2017 (https://www.bcstats.gov.bc.ca/Files/67c5357c-896a-4e00-b0cf-e9af5e2071b1/BCProj1705.pdf)

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Footnote 2

2017-0994 HCC Expenditures and Client Services Volumes Updated (From 2017-0755 HCC Annual Client Counts, Volumes, Rates 2016-2017.xlsx; Data extracted July 14, 2017

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Footnote 3

ibid

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Footnote 4

2017-0763 HCC Residential Bed Inventory Updated (for March 31, 2017), HSIAR Division, Ministry of Health

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Footnote 5

Assisted Living Database, October 10, 2017

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Footnote 6

BC Palliative Care Benefits. 2016.  https://www2.gov.bc.ca/assets/gov/health/health-drug-coverage/pharmacare/palliative-patientinfo.pdf.

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Footnote 7

Health System Matrix 8, Health Sector Information, Analysis and Reporting, Ministry of Health. July 2017.

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Footnote 8

https://www.seniorsadvocatebc.ca/osa-reports/report-monitoring-seniors-services-2017/

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Footnote 9

https://www.seniorsadvocatebc.ca/osa-reports/caregivers-in-distress-a-growing-problem-2/

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Footnote 10

https://www.seniorsadvocatebc.ca/osa-reports/listening-to-your-voice-home-support-survey-results-released/

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Footnote 11

Office of the Seniors Advocate, BC. 2017. Monitoring Seniors Services. https://www.seniorsadvocatebc.ca/osa-reports/report-monitoring-seniors-services-2017/

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Footnote 12

Office of the Seniors Advocate, BC. 2017. Caregivers in Distress: A Growing Problem. https://www.seniorsadvocatebc.ca/osa-reports/caregivers-in-distress-a-growing-problem-2/

Return to footnote 12 referrer

Footnote 13

Rabow M, Kvale E, Barbour L, Cassel BJ, Cohen S, Jackson V, Luhrs C, Nguyen V, Rinaldi S, Stevens D, Spragens L, Weissman D. (2013). Moving Upstream: A Review of the Evidence of the Impact of Outpatient Palliative Care. Journal of Palliative Medicine, 16(12): 1540-1549.

Return to footnote 13 referrer

Footnote 14

Waddell, C., Shepherd, C., Schwartz, C., & Barican, J. (2014). Child and youth mental health disorders: Prevalence and evidence-based interventions. Vancouver, BC: SFU.

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Footnote 15

BC Coroners Service. (2018). Illicit drug overdose deaths in BC. January 1, 2008 – January 31, 2018. Victoria, BC: Author.

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Footnote 16

BC Coroners Service. (2017). Suicide deaths in BC. 2006-2015. Victoria, BC: Author.

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Footnote 17

Clatney, L., MacDonald, H., & Shah, S. (2008). Mental health care in the primary care setting. Canadian Family Physician, 54, 6, 884-889.

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Footnote 18

Weinerman, R., Campbell, H., Miller, M., Stretch, J., Kallstrom, L., Kadlec, H., & Hollander, M.  (2011). Improving mental health care by primary care physicians in British Columbia. Healthcare Quarterly, 14, 1, 36-38.

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Footnote 19

Institute for Healthcare Improvement. (2003). The Breakthrough Series: IHI's Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston, MA: Author

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Footnote 20

First Nations Health Authority. (2017). Overdose data and First Nations in BC: Preliminary findings. Vancouver, BC: Author.

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Footnote 21

Ibid.

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Footnote 22

Representative for Children and Youth. (2013). Still waiting: First-hand experiences with youth mental health services in BC. Victoria, BC: Author.

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Footnote 23

Waddell, C., Shepherd, C., Schwartz, C., & Barican, J. (2014). Child and youth mental health disorders: Prevalence and evidence-based interventions. Vancouver, BC: SFU.

Return to footnote 23 referrer

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