Canada-Saskatchewan 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 SASKATCHEWAN (hereinafter referred to as “Saskatchewan” or “Government of Saskatchewan”) as represented by the Minister of Health herein referred to as “the provincial Minister”)

REFERRED to collectively as the “Parties”

PREAMBLE

WHEREAS, on January 17, 2017, Canada and Saskatchewan 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 Saskatchewan 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 Saskatchewan 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 Executive Government Administration 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 Saskatchewan for the provision of health services which includes  home and community care and mental health and addictions initiatives;

WHEREAS, Saskatchewan 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 Saskatchewan agree as follows:

1.0 Objectives

1.1 Building on Saskatchewan’s existing investments and initiatives, Canada and Saskatchewan 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 Saskatchewan 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 Saskatchewan’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 Saskatchewan’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 Saskatchewan and Canada’s agreement on a new five-year action plan.

3.2.2 The renewal will provide Saskatchewan 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 Saskatchewan under the Canada Health Transfer to support delivering health care services within their jurisdiction.

4.2 Allocation to Saskatchewan

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 Saskatchewan 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, Saskatchewan’s estimated share of the amounts will be:

Annual Funding for Home and Community Care and Mental Health and Addiction Services
Fiscal Year Home and community care
Estimated amount to be paid to SaskatchewanFootnote * (subject to annual adjustment)
Mental health and addictions services
Estimated amount to be paid to SaskatchewanFootnote * (subject to annual adjustment)

Footnotes

Footnote 1

Amounts represent annual estimates based on StatCan 2017 population

Return to footnote * referrer

2018-2019 $19,020,000 $7,930,000
2019-2020 $20,610,000 $14,270,000
2020-2021 $20,610,000 $19,020,000
2021-2022 $28,540,000 $19,020,000

4.3 Eligibility Criteria

4.3.1 The province will become eligible to receive the funding as described in section 4.2.5 as follows:

Eligibility Criteria
Fiscal Year Eligibility  Criteria
2018-2019 Upon signing of the Agreement
2019-2020 Upon providing the annual financial statement as per section 5.1.2(b)
2020-2021 Upon providing the annual financial statement as per section 5.1.2(b)
2021-2022 Upon providing the annual financial statement as per section 5.1.2(b)

4.4 Payment

4.4.1 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 Saskatchewan for the Fiscal Year as determined under sections 4.2.5 and 4.2.3.
  4. Canada will notify Saskatchewan 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 Saskatchewan 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 Saskatchewan 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.

4.5 Carry Over

4.5.1 At the request of Saskatchewan, Saskatchewan may retain and carry forward to the next Fiscal Year the amount of up to 10 percent of the contribution paid to Saskatchewan for a Fiscal Year under subsection 4.2.5 that is in excess of the amount of the eligible expenditures actually incurred by Saskatchewan 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 Saskatchewan 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.

4.5.2 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 Saskatchewan under subsection 4.2.5 of this Agreement in the next Fiscal Year.

4.5.3 In the event this Agreement is renewed in accordance with the terms of section 3.2.1, and at the request of Saskatchewan, Saskatchewan may retain and carry forward up to 10 percent of funding provided in the last Fiscal Year of this Agreement for eligible expenditures 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 Saskatchewan 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.

4.6 Repayment of overpayment

4.6.1 In the event payments made to Saskatchewan exceed the amount to which Saskatchewan 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, Saskatchewan shall repay the amount within sixty (60) calendar days of written notice from Canada.

4.7 Use of Funds

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

4.8 Eligible Expenditures

4.8.1 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, Saskatchewan 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. Saskatchewan will designate an official or official(s), for the duration of this agreement, to work with CIHI and represent the interests of Saskatchewan related to performance measurement and reporting for home and community care, as well as mental health and addictions services. An official will participate in this indicator development and reporting process on an ongoing basis for the Term of this Agreement.

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, Saskatchewan agrees to:

  1. Provide data and information (based on existing and new indicators) 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. Beginning in Fiscal Year 2019-2020, provide to Canada an annual financial statement, with attestation from the Ministry of Health’s Executive Director of Financial Services, of funding received from Canada under this Agreement during the previous Fiscal Year compared against the action plan, and noting any variances, between actual expenditures and Saskatchewan’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 Saskatchewan 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.

5.1.3 Saskatchewan will ensure that expenditure information presented in the annual financial statement is, in accordance with Saskatchewan’s standard accounting practices, complete and accurate.

5.2 Evaluation

5.2.1 Responsibility for evaluation of programs rests with Saskatchewan in accordance with its own evaluation policies and practices.

6.0 Communications

6.1 Canada and Saskatchewan 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 Saskatchewan, 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 Saskatchewan 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 Saskatchewan 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 Saskatchewan reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and bilateral agreements. Saskatchewan 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 Saskatchewan 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 Saskatchewan 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 Saskatchewan, as the case may be, may notify the other party in writing of the failure or breach. Upon such notice, Canada and Saskatchewan 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 Saskatchewan responsible for Health, and if it cannot be resolved by them, then the respective Ministers of Canada and Saskatchewan 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 Saskatchewan, by Saskatchewan’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 Saskatchewan, 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 Saskatchewan, 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 Saskatchewan, if requested by Saskatchewan. 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 Saskatchewan by giving at least 12 months written notice of its intention to terminate. Saskatchewan 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 Saskatchewan 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 Saskatchewan shall be:

Ministry of Health
3475 Albert Street
T.C. Douglas Building
Regina, SK
S4S 6X6

Email: mark.wyatt@health.gov.sk.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 Saskatchewan.

12.4 No member of the House of Commons or of the Senate of Canada or of the Legislature of Saskatchewan 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 14th day of May, 2018.

The Honourable Ginette Petitpas Taylor, Minister of Health

SIGNED on behalf of Saskatchewan by the Minister of Health this 14th day of May, 2018.

The Honourable Jim Reiter, Minister of Health

Annex 1 to the Agreement

A Common Statement of Principles on Shared Health Priorities

Annex 2 to the Agreement

Saskatchewan Action Plan on Home and Community Care and Mental Health and Addictions

March 2018

Introduction

Under the Canada-Saskatchewan Bilateral Health Funding Agreement, announced on January 17, 2017, the Government of Canada will provide Saskatchewan with an estimated $348.7 million over the next 10 years for investments in home and community care and mental health and addictions.  Of this, $190.2 million is targeted for incremental investments to improve access to home and community care, including palliative care, and $158.5 million for mental health and addictions.

Patient flow and mental health and addictions are among the Saskatchewan health system’s top priorities.  The Connected Care Strategy for patient flow, together with the Mental Health and Addictions Action plan, provides a framework to address the critical issues of an over-emphasis on hospital-based care and growing service demands.

Federal investments in home and community care will support improved access to community health services and primary health care for those patients who can be appropriately served in a home or community setting while reducing our health system’s reliance on high-cost emergency department- and hospital-based care.

The federal investments for mental health and addictions will target the recommendations put forth in Saskatchewan’s 10-Year Mental Health and Addictions Action Plan, including improving access to services for children and adolescents, improving care for individuals with complex and persistent mental health issues, improving the system’s capacity to integrate with other sectors and settings, and ensuring a stepped care approach to mental health and addictions where individuals are matched to the care they need, in the most appropriate setting.

The following plan outlines key initiatives that will be implemented or expanded in Saskatchewan between 2017-18 and 2021-22 that will support A Common Statement of Principles on Shared Health Priorities, while advancing strategic priorities within Saskatchewan.

Home and Community Care

Home and Community Care in Saskatchewan

Saskatchewan hospitals are often overcapacity and this, along with a shortage of community-based health services, leads to long waits for patients in emergency departments.  Our health care system’s high reliance on hospital-based care is not sustainable.

Over the past five years, Saskatchewan has invested in programs to address home and community service gaps and strengthen primary home care services, including several pilot initiatives that aim to provide intermediate care for complex patients:  Home First/Quick Response, Seniors’ House Calls, Community Paramedicine, and Connecting to Care.

Multidisciplinary home care teams currently deliver coordinated, comprehensive services in various settings that make the best use of global funding provided to the Saskatchewan Health Authority by effectively and efficiently serving those with the greatest needs.  Despite efforts to offer equitable services across the province, there are increasing challenges due to the vast geographic areas served, as well as the need to offer services after-hours and on weekends. Additionally, given Saskatchewan’s aging population, there are challenges in providing home care services to clients with increased complexity and the need to offer services after-hours and on weekends.  This can contribute to unnecessary transfers into acute care settings and caregiver distress.

For residents in the former Regina, Saskatoon, Prince Albert Parkland and Prairie North Health Regions, Home First/Quick Response provides enhanced home care for intensive short-term needs to sustain seniors in their homes, facilitate appropriate discharge from acute care to community settings, and engage service providers to prevent admission to long term care facilities. Community Paramedicine uses Advanced Care Paramedics to provide medical care, treatment, and support to patients in their homes, including after-hours services, to stabilize patients, and eliminate the need to transfer to an acute care facility.  Seniors’ House Calls programs in Regina and Saskatoon provide seniors who have complex medical needs with home-based physician or nurse practitioner visits and health care services using a team-based model.  Connecting to Care, or Hotspotting, provides outreach and inter-disciplinary intensive case management services to Regina and Saskatoon clients with complex health needs who require a more individualized approach.

Building on the work of these pilot programs to provide outreach services and comprehensive case management to target populations, Regina has invested in primary health care redesign through the establishment of primary health care networks to reorganize and integrate primary health services in the community, build capacity for community-based comprehensive care, and prevent overreliance on the hospital-based system.  Networks contain interdisciplinary care teams that work with the client to promote independent living, prevent disease, and promote self-management of existing health conditions.

There exists a wide variation in costs to deliver hospital- versus community-based care. In Saskatchewan, one day in hospital costs $1,381Footnote 1, and a day in a long-term care facility costs $218 (system cost), on average.  In contrast, patients cared for in the community will cost the system much less, at an average cost of $108 (system cost) for one hour of home care servicesFootnote 2.  Of even greater importance, however, than cost considerations, many conditions are more appropriately treated in the home or community and these care settings are often preferable from the patient’s perspective.

Despite convincing arguments in favour of home- and community-based care, 28.3%Footnote 3 of Canada’s $242 billion total health expenditure in 2017 was directed towards hospital care (excluding physician costs), while only approximately 3.7 to 4.5%Footnote 4 was directed towards home care. In Saskatchewan, 2016-17 home care expenditures represented approximately 3.6% of overall health expenditures.  A shift in investment away from hospital towards home- and community-based care supports a corresponding shift towards more proactive approaches to health than the traditional model of episodic acute care.

Based on a review of the evidence, provincial modelling, and outcomes from community care pilot programs, Saskatchewan is focusing on those areas where the predicted impact is greatest for shifting emphasis away from emergency- and hospital-based care and improving the connection and flow of patients into other care settings.  Saskatchewan’s Connected Care Strategy includes home, community, primary care, palliative, and acute care, and is focussed on providing safe, seamless care for patients as they move from one care setting to another, and ensuring that patients receive care in the setting that best matches their needs.  It is a collaborative, team-based, approach that is designed so that patients are supported to manage their care in the community, admitted to hospital only when they need that level of service, and transitioned back into the community after a hospital stay with all needed supports in place.

The federal investment into the home, community, primary health care, and palliative elements of the Connected Care Strategy will complement Saskatchewan’s investment into hospital Accountable Care Units as well as build community capacity for patients whose needs can be better met outside of a hospital environment.  It will support high quality transitions between hospitals and community-based services, including improved care coordination among team members and teams across care settings, improved medication safety, post-discharge symptom management, and outpatient follow-up and advance care planning.  Enhancements to home and community care infrastructure could include the design and implementation of a Shared Care Plan accessible to all health professionals within the circle of care that will improve digital connectivity and flow of patients’ health information for use in shared decision-making.

The Government of Saskatchewan has emphasized the strategic importance of this work in ensuring Saskatchewan patients have sustainable access to the care they need when and where they need it.

Population Demographics

Saskatchewan’s population shows modest growth (an increase of 6% between the 2011 and 2016 Census populationsFootnote 5) but the seniors population aged 65 years and older is growing at almost twice the rate of the general populationFootnote 6 and is predicted to almost double over the next 20 years.  Provincially, seniors account for almost one fifth of emergency department visitsFootnote 7, over one third of inpatient hospitalizationsFootnote 8, and 43% of total provincial government health expendituresFootnote 9. As well, about four out of 10 Canadian residents aged 18 years and older have at least one chronic disease and about 6% have more than one chronic diseaseFootnote 10. In 2014-15, more than 400,000 Saskatchewan residents aged one year and older (approximately 35%) met the case definition for one or more of 14 chronic diseasesFootnote 11. A growing seniors’ population, coupled with an increasing number of patients with complex needs, is placing additional strain on a system that is already stretched to the limit.

Across Canada, 93% of seniors age 65+ live in their own home, and most state that they wish to “age in place” for as long as possible and die at homeFootnote 12. Despite this, patient care is predominately hospital-based and hospitals remain the provider of end-of-life care for the majority of Canadians. In Saskatchewan, almost one-third of acute care beds are occupied by patients of all ages who no longer require acute services and may be better managed in community settings (alternate level of care (ALC))Footnote 13. This includes those patients who are deemed palliative and could be cared for outside a hospital setting with appropriate supports in place.

Representing 12% of the total population in 2016, the Saskatchewan Indigenous population is the fastest growing segment of the overall population – showing a 23% increase between 2006 and 2016 census populationsFootnote 14; by 2031, population forecasts show that approximately 21 to 24% of Saskatchewan residents will be Indigenous, which would represent the highest proportion of Indigenous residents among all provincesFootnote 15. Indigenous people are a high-risk population for obesity and chronic diseases such as diabetes and cardiovascular disease, as well as addictions and suicidesFootnote 16. National data shows that age-standardized hospitalization rates for all-cause acute care hospitalizations among Indigenous people are consistently higher (2.6 times) than among non-Indigenous peopleFootnote 17. As such, the Saskatchewan Indigenous population is predicted to have higher health care utilization and costs than the general population and points to the need in our planning to address challenges faced by this population.

Priority Areas for Investment

As specified within the accountability framework for the federal funding for home and community care, Saskatchewan will be expected to improve access to appropriate services and supports in home care and community care for Canadians and their families by pursuing one or more of the following actions:

  • Spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care;
  • Enhancing access to palliative and end-of-life care at home or in other facilities;
  • Increasing support for caregivers; and,
  • Enhancing home care infrastructure, such as digital connectivity, remote monitoring technology, and facilities for community-based service delivery.

Federal funds targeted for home and community care will be invested in three key areas: Community Health Centres and teams; Palliative Care enhancements; and, subject to a fulsome  evaluation, implementing a Shared Care Plan that can be accessed by health professionals across the continuum of care. 

1. Community Health Centres and Community Health Teams

Saskatchewan’s emergency, acute, and community health care systems often function independently of one another with no or few structured processes or accountabilities for transitions between care teams. This leaves patients and families to bridge the gaps and navigate the complex system on their own.

As evidence of a gap between what is currently provided by primary health care and home care services and the need, Saskatchewan reported 182 more hospitalizations per 100,000 residents under 75 years old in 2015-16 for conditions that could have potentially been managed outside of the hospital than Canada as a wholeFootnote 18.  This is approximately 1,900 hospitalizations that could potentially be avoided each year if Saskatchewan’s rate was the same as the overall Canadian rate.  In 2016-17, approximately 7% of hospitalizations (ambulatory care sensitive conditions)Footnote 19 and 11% of visits to emergency departments (family practice sensitive conditions)Footnote 20 in Saskatchewan were considered ‘potentially avoidable’ with appropriate community and primary care (e.g., for chronic conditions such as chronic obstructive pulmonary disease (COPD), asthma, and diabetes).  The current system of primary health care, home care and community care pilot programs is not well-aligned. By shifting the strategic focus and resourcing away from hospital to community-based care, better integration will occur.

Introduction of Community Health Centres

The 2017-18 provincial budget included investments to support a multi-year strategy to improve patient access to appropriate health care services in the community by shifting the delivery of care for non-emergent conditions away from hospitals. A key feature of the announcement was the establishment of Community Health Centres that would be situated in high-needs neighbourhoods in Regina and Saskatoon. These centres would bring together teams of health providers to deliver both on-site and community/home-based services, with connections to broader primary care networks.

Both Regina and Saskatoon identified neighbourhoods with large senior populations with high prevalence of complex chronic conditions and high rates of hospital utilization. Existing services are not sufficient to meet the needs of these complex older adult populations, creating the opportunity through Community Health Centres and expanded teams to increase access to primary health care, urgent chronic care, and home visits, while exploring new ways of partnering with family physician practices and providing navigational supports.

Regina and Saskatoon hired staff in 2017-18 to expand their teams and are planning towards each opening one Community Health Centre in 2018 in key neighbourhoods: Regina’s South network, and Saskatoon’s Nutana Suburban Centre (where 6% self-identify as IndigenousFootnote 21) are home to many frail, low income, seniors suffering from multiple chronic conditions who are high users of the acute care system.

Expansion of Community Health Centres

In 2018-19, Regina will establish a Community Health Centre or Centres in its Central network which serves a population that is predominately low income and high needs. Approximately 16% are registered as Indigenous; this figure excludes non-status Indigenous and MetisFootnote 22.  Similarly, Saskatoon will be implementing an integrated, multi-disciplinary community health team in 2018-19 that will serve residents in six core neighbourhoods where residents are also predominately low-income and high needs. On average, 26% of residents of these neighbourhoods self-identify as IndigenousFootnote 23.  Additional Community Health Centres or community health teams will target high needs populations in Prince Albert (where approximately one in three residents is IndigenousFootnote 24), and other communities in 2018-19, and be sustained beyond. 

Federal funds will support the hiring of interdisciplinary teams, including nurses, nurse practitioners, pharmacists, physiotherapists, occupational, and mental health therapists, care assistants, case managers, navigation coordinators, health educators, social workers, addictions counselors, community paramedics, dieticians, Indigenous outreach cultural support workers, and ceremonial and Elder supports.

In addition, federal funds will support facility costs for Community Health Centres that will serve as physical hubs for co-located community health teams that will provide health services and home visits in targeted communities and neighbourhoods.  These Centres and teams are being co-designed with family physicians and patients and families to meet the specific health care needs of the unique and diverse patient populations they will serve.  Their focus will be on improving and integrating access to primary health care and home- and community-based services as well as supporting a shift away from acute care, wherever it is appropriate to do so.

Key elements of the federal investment include:

  • Co-located interdisciplinary teams including: physicians, nurses, therapists, social workers, and other providers, to deliver both on-site and home-based outreach services;
  • Outreach services for patients who are unable to get out of their homes to seek services in traditional clinic settings;
  • Strategically located and tailored services to meet the unique needs of each neighbourhood; and,
  • Urgent chronic care and other basic health services provided on-site, with expanded operating hours and after-hours on-call, seven days a week.

Care teams (physicians, nurses, and allied health providers) at Community Health Centres will participate in daily interdisciplinary team huddles, case conferencing, shared care planning, patient rounding (includes patient in-person or on the phone), and warm handoffs between team members at the Centres, between the Centres and outreach and home care staff members, and between the Centres and hospital teams when patients are going into or returning home from hospital.  Complex patients will have longer appointments and access to members of the team to assist with preventative health and self-care.  Centres will serve as hubs to redirect patients in personal care homes and long-term care facilities with urgent need to the Centre’s extended hours services or home visits provided by the outreach teams.  Outreach teams will supplement and integrate with primary home care services to provide enhanced home-based supports to complex clients who require an additional level of support, thus reducing the burden on caregivers. 

While focused work on Community Health Centres and teams will be supported by federal funds, this work merges with steps being taken across the province in urban and rural locations towards increased access to primary health care, team-based care, and improved transitions between hospital and community.

These investments align with the agreed upon A 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; and,
  • Enhancing home care infrastructure, such as digital connectivity, remote monitoring, technology, and facilities for community-based service delivery.

2. Palliative Care Enhancements

In Saskatchewan, palliative care services are provided through a variety of settings that include inpatient facilities, special-care homes, hospice and community-based home care. The delivery of palliative care is focused on quality of life, maintenance of human dignity, and comfort for the terminally ill individual and their family, rather than cure.  Service provision can vary among communities. However, in urban centres, services are typically provided by palliative care teams and, in rural areas, services are provided by nursing teams and other health care providers.

In September 2016, a provincial consultation reviewed the current state of palliative care services across the province and identified potential areas for improvement. Participants included representatives from the Ministry of Health, Saskatchewan Cancer Agency, former Regional Health Authorities, and community-based organizations, such as the Canadian Cancer Society, Sanctum, and AIDS Program South Saskatchewan. Three physicians who specialize in palliative care and four patient and family advocates were also in attendance.

Several improvement ideas emerged such as the enhanced use of nurse practitioners and paramedics, development of provincial palliative care standards, and the implementation of Learning Essential Approaches to Palliative Care and End-of-Life Care (LEAP) training.

Following the consultation, a Palliative Care Working Group was established and developed recommendations to guide palliative care improvement work.

The palliative care enhancements presented herein have been developed to align with these recommendations and A Common Statement of Principles on Shared Health Priorities by enhancing access to palliative and end-of-life care at home or in other facilities.  As well, palliative care enhancements are in full alignment with the goals of the Connected Care Strategy to shift emphasis towards community-based care and ensure patients receive the care they need in the setting that best matches their needs. These funds will assist in further enhancing Saskatchewan’s Palliative Care Program.

The intent of the palliative care enhancements is to provide palliative care services in the right place, by the right providers, at the right time, in a cost-effective manner, taking into consideration cultural sensitivities and diverse needs of Saskatchewan people, including Indigenous populations, and the client’s individual preferences.  For example, if a palliative patient wishes to receive end-of-life care in a palliative care setting, as opposed to an acute care setting that is not designed to meet specific end-of-life care needs, every effort should be made to accommodate this. In Saskatchewan, approximately 54% of all deaths occur in hospital (Statistics Canada, Canadian Vital Statistics, Death Database, 2014); although less than the Canadian average of 62%, this falls short of the expressed desire of most Canadians to die at home in the presence of loved ones.

Key elements of the federal investment include:

  • Training for physicians, registered nurses (RNs), and nurse practitioners (NPs), continuing care aides, and paramedics in end-of-life care;
  • Palliative Care Coordinator (RN) positions that support the multidisciplinary team with assessments, care planning, coordination of services, and provide clinical recommendations on pain and symptom management;
  • Palliative care physicians who will provide clinical recommendations on pain and symptom management and support a decrease in alternate level of care bed days during the final six weeks of life by managing patients’ care outside the hospital setting;
  • NP positions will lead integrated palliative care service teams in rural and remote areas to increase access to palliative care for patients who are typically underserved; and
  • Further enhancements identified by the palliative care consultation and working group to support a comprehensive end-of-life strategy.

These investments align with the agreed upon A 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;
  • Enhancing access to palliative and end-of-life care at home or in hospices; and,
  • Increasing support for caregivers.

3. Shared Care Plan

Too often, Saskatchewan patients experience breakdowns in the care that they receive, or in the communication about their care, when they move between community and hospital.  Without proper communication and coordination across the care teams working in different health care settings and the active involvement of patients and families, patients experience readmissions for conditions that could be prevented or effectively managed in the community.

A lack of interconnectedness between a patient’s health information recorded by different providers in different care settings is one of the most formidable barriers to full implementation of the Connected Care Strategy and a team-based approach to care. The goal of a Shared Care Plan is a consistent clinical care plan for each patient to which all providers have access and can contribute. An integrated care plan supports continuity of care across the health system and, ultimately, improves patient outcomes.

Key elements of the federal investment include:

  • One care plan for each patient where all health care team members (e.g., physicians, nurse practitioners, nurses, therapists, continuing care aides, dieticians) can access and add to a patient’s clinical health information; and,
  • Removal of barriers to clinical information flow between hospital and community or home-based settings so that decisions about a patient’s care can be made based upon information recorded in all health care settings.

Linking a patient’s health information that is captured across health care settings will be instrumental to supporting high quality transitions in care.   Whereas community providers currently need to enter the same health information for a patient in multiple places (allowing for potential transcription errors) and are unable to access the patient’s health information entered by other providers, a Shared Care Plan would support shared decision making and better patient care.   Patients and providers would have access to the most up-to-date and complete set of health information at all times and communication breakdowns and delays between hospitals and primary health care providers, for example, would be minimized.

Patient

  • Core clinical information will be available to providers and the patient from any point of care
  • Patients feel connected to a team of professionals with a single point of access
  • Patients information will be available for validation vs collection at multiple points of care
  • Improved continuity of care and patient outcomes
  • Empowering patients by involving them in care, providing patients with information so they are informed and ready and participative in their care process

Provider

  • Improved information flow leveraging other information assets such as the Provincial EHR
  • Providers have access to patients care plan and contribute to shared care across the health system
  • eHealth Saskachwan has a healthy, strong relationship that work together to provide many services including the Saskatchewan Medical Association (SMA), Saskatchewan Health Authority (SHA), Ministry of Health (MoH) and Health Quality Council (HQC)

Health System

  • Alignment and ability to leverage other investments eHealth SK is currently working on EMR Interoperability, EHR Viewer optimization activities, and technology strategies
  • Improved information flow leveraging other clinical repositories and community systems such as Home Care, Long Term Care and Mental Health & Addictions
  • With electronic shared care plans there is an ability to report/measure health status of patients and the population, and will identify gaps and successes in care across the continuum

Development of a Shared Care Plan would build upon foundational provincial and Canada Health Infoway investments from other initiatives:

  • Citizen Health Portal: providing patients access to their health information;
  • Electronic Medical Record (EMR) Interoperability Initiative (supported by Canada Health Infoway):  Visits and Clinical Patient Summary from EMRs available in the Provincial Electronic Health Record (EHR) and notifications sent to providers when new information is available in Provincial EHR;
  • Launch in Context:  ability to access Provincial EHR from the hospital system and EMRs with the click of a button; and,
  • EHR/ClinDoc Initiative: increasing the availability of core clinical documents in the EHR.

With one-time funds in 2019-20, 2020-21, and 2021-22, development of a Shared Care Plan would move through multiple phases.  Initially, users (across the continuum of care) would be able to enter a patient’s clinical health information into a stand-alone Shared Care Plan in a central location.  This would not yet be integrated with existing health information systems.  Next, the Shared Care Plan would be linked and accessible to all downstream point-of-care health information systems (in a staged and resource-dependent manner) and allow for a patient’s health information to flow in both directions. 

These investments align with the agreed upon A 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; and,
  • Enhancing home care infrastructure, such as digital connectivity, remote monitoring technology, and facilities for community-based service delivery.

Allocation of Health Accord Funding – Home and Community Care

The following table summarizes the proposed allocation of federal funds (2017-18 to 2021-22) towards three priority areas of focus for home and community care in Saskatchewan:

Funding Breakdown by Initiative
Initiative 2017-18Footnote *
($000s)
2018-19
($000s)
2019-20
($000s)
2020-21
($000s)
2021-22
($000s)
Total
($000s)

Footnotes

Footnote *

Funding already provided through legislation.

Return to footnote * referrer

Community Health Centres and community health teams 5,640 16,600 15,210 14,030 14,030 65,510
Palliative Care enhancements 700 2,420 3,820 5,000 5,000 16,940
Shared Care Plan - - 1,580 1,580 9,510 12,670
TOTAL 6,340 19,020 20,610 20,610 28,540 95,120

Performance Measurement

The Saskatchewan Ministry of Health and Saskatchewan Health Quality Council, in collaboration with stakeholders from the Saskatchewan Health Authority, have partnered to develop a measurement framework for the Connected Care Strategy.  This framework includes indicators that target system-level strategic outcomes as well as each of three areas of focus:  community care, acute care, and high quality care transitions.  The work of establishing operational definitions and baselines and targets for improvement is ongoing, and there is recognition of the importance of this foundational work in order to demonstrate impact of targeted interventions. 

Saskatchewan will participate in the Federal-Provincial-Territorial indicator development process, and will continue to work with the Canadian Institute for Health Information (CIHI) to develop a focused set of common indicators for home and community care and will share relevant data in order for CIHI to produce annual public reports on pan-Canadian progress.

Summary of Expected Results
Initiatives Outputs/Outcomes Target by 2021
Home and community care
Community Health Centres and Community Health Teams

Lower 30-day hospital re-admission rate.


Fewer unnecessary hospital admissions (i.e. for ambulatory care sensitive conditions).

Fewer days that patients are in hospital when they no longer require hospital care (i.e. ALC length of stay).

More clients seen by in-home outreach teams.

By March 31, 2019, achieve a 5% reduction in 30-day hospital readmission rate. Future years’ targets TBD.

By March 31, 2019, reduce unnecessary admissions to hospital by 5%. Future years’ targets TBD.

By March 31, 2019, reduce the number of days that patients are in hospital when they no longer require hospital care by 5%. Future years’ targets TBD.

To be determined.

Palliative Care Enhancements

Increased palliative home care clients and number of service units provided.

More individuals trained in LEAP.

More Palliative Care Coordinators and NPs.

5% increase in number of clients accessing palliative home care services.

To be determined.

To be determined.

 

Shared Care Plan Improved access by care team members to patient clinical information across care settings. To be determined.

Mental Health and Addictions

Mental Health and Addictions Services in Saskatchewan – The Challenge

Saskatchewan is experiencing increased service demands in mental health and addictions that exceed our current rate of population growth.  Saskatchewan’s population has increased approximately 6% (between the 2011 and 2016 Census populations) with service demands increasing by 17%.  In 2016-17, there were over 25,000 admissions to alcohol and drug services, and over 40,000 active clients receiving mental health servicesFootnote 25.  Saskatchewan’s rate of alcohol misuse and abuse remains one of the highest in the country with hospital rates related to alcohol use at 44 per cent above the national averageFootnote 26. Primary care providers, including nurse practitioners and family physicians continue to serve as the first point of contact and ongoing support for many individuals with mental health and addictions issues, and their familiesFootnote 27. In 2016-17, family physicians and other specialists saw approximately 139,400 patients for primary mental health conditions, for a total of 463,872 visits compared to fee for service psychiatrists, who saw approximately 26,000 patients for a total of 140,184 visitsFootnote 28.

The province remains committed to the Joint Statement of Action to address the national opioid crisis. As well, Saskatchewan is experiencing significant increases in the use of crystal methamphetamine. This is creating significant pressures on mental health and addictions services as well as across the health system and through other human service sectors. Saskatchewan is working in collaboration with the Saskatchewan Health Authority to improve the health system’s response to individuals who use crystal methamphetamine and opioids, including access to treatment and follow up care.

Despite targeted efforts to manage service demand and wait times in mental health and addictions services, there are service pressures that impact access across most service lines – this includes child and adolescent mental health services and supports, recovery services for individuals with serious and persistent mental illness and addictions medicine services in northern Saskatchewan.  Given the variation in service needs and resources across rural, urban and northern communities, there have been continued challenges in ensuring adequate access.

In Saskatchewan, it is recognized that addressing mental health and addictions is complex, and often requires a coordinated and collaborative response among service providers, services and sectors. Saskatchewan’s plan for the federal investments will enhance services and supports for most vulnerable populations, including youth and young adults, individuals with serious and persistent mental health issues, those with complex and/or co-occurring addictions, mental health and physical health issues and those living in rural, northern and remote communities

Saskatchewan – Current State

Saskatchewan’s services and supports for individuals with mental health and addictions issues span across the human service sectors, and range from prevention and health promotion through to highly specialized services.  Services are provided in the community, through health centres, mental health clinics, residential facilities such as detox centres and inpatient units, as deemed appropriate for the individual.

The Ministry of Health funds the Saskatchewan Health Authority as the primary provider of mental health and addictions services.  Both the Ministry of Health and the Saskatchewan Health Authority also fund community based organizations to provide mental health and addiction services including residential addiction services. 

Supports for individuals with mental health and addictions issues are also provided under the portfolios of the Ministry of Education, Social Services, Justice and Corrections and Policing through a range of targeted initiatives and supportive services. The goal is to have the services align so as not to create gaps or barriers for individuals and families.

Specifically, a continuum of mental health and addictions services include outpatient treatment; internet delivered cognitive behavioural therapy for anxiety and depression; screening and assessment services; consultation services; and psychiatric rehabilitation services including community residential supports for psychiatric rehabilitation clients. Saskatchewan is redeveloping its only psychiatric hospital, and integrating a secure correctional unit for offenders with mental health issues.  This facility is targeted to open in 2018. Services delivered at this facility are in addition to the 202 acute mental health inpatient beds currently available for adults in inpatient mental health units located across eight major centres.

For youth requiring intensive and specialized treatment for mental health and addictions issues, there are outreach and outpatient services including individual counselling and group programming, mental health inpatient beds, and stabilization, detoxification and alcohol and drug inpatient treatment beds, including a Youth Detox Centre, dedicated to youth mandated to receive services under the Youth Drug Detoxification and Stabilization Act (YDDSA).

Approximately 10% of the total admissions to alcohol and drug services are for youth under 19 years of age, and youth represent almost 38% of new and reopened registrations for mental health services annuallyFootnote 29.

Adult addiction treatment services include outpatient treatment in over 50 centres, detoxification, inpatient treatment, day treatment, and long term residential services. Other services available include Opioid Substitution Therapy for patients with opioid dependence, a provincial needle exchange program, and a Take Home Naloxone Program, as part of Saskatchewan’s response to the National opioid crisis.

In order to ensure more effective and efficient service delivery, the health system in Saskatchewan has taken preliminary steps to implement a stepped care framework across the continuum of mental health and alcohol and drug services.  This work aims to eliminate service gaps, and provide more appropriate services, based on an individual’s identified level of need.  Recognizing that needs may change over time, this framework facilitates adjustments to treatment approaches, as necessary. This approach to service delivery supports Saskatchewan’s commitment to patient and family centred care, and addresses recommendations of the Mental Health and Addictions Action Plan.

In addition, significant effort has been undertaken within the health system to strategically respond to the growing demand for mental health and addictions services and supports.  Some examples of this work include the integration of mental health and addictions services, wait time reduction in outpatient mental health and addictions services and psychiatry, integrating mental health and addictions with primary care, suicide prevention efforts, and responding effectively to problematic drug trends and usage.

It is recognized, however, that there continue to be pressures in mental health and addictions services that require focused attention and investment, in order to better meet the mental health and addictions needs in Saskatchewan.

The Mental Health Commission of Canada’s March 2017 report, entitled “Strengthening the Case for Investing in Canada’s Mental Health System:  Economic Considerations”, sets out direction to Government for investments that support improved outcomes.  This report has helped to inform Saskatchewan’s plan for investments made possible through federal government contributions.

Priority Areas for Investment

In December 2014, the Government of Saskatchewan accepted Working Together for Change: A 10-Year Mental Health and Addictions Action Plan for Saskatchewan as a guide for improving the response to individuals with mental health and addictions issues, and their families. The report’s recommendations are the culmination of extensive community and stakeholder consultation that included individuals and families with lived experience, Indigenous communities and services; spanned the human service sector, and included voices of communities from all across the province. Since the release of the report, the Government of Saskatchewan has been working collaboratively across the human service sector to develop and implement improvement efforts that address the recommendations found within the Mental Health and Addictions Action Plan, under the following shared goals:

  • Enhancing access and capacity, and supporting recovery in the community;
  • Prevention and early intervention;
  • Person and family-centred and coordinated services;
  • Responding to diversities;
  • Partnering with First Nations and Métis peoples;
  • Reducing stigma and increasing awareness; and,
  • Transforming the system and sustaining change.

In addition to provincial investments in mental health and addictions, federal funding will continue to advance Saskatchewan’s 10-Year Mental Health and Addictions Action Plan while building on existing initiatives and strategies aimed at improving mental health and addictions services across the province.  Saskatchewan’s allocation of Federal funding for mental health and addictions is being directed towards meeting previously unmet needs, by investing in innovative, evidence-based and cost effective approaches to service delivery. These investments will result in:

  • Improved access to mental health and alcohol and drug services and supports;
  • Earlier interventions that connect vulnerable individuals to care, including children and youth;
  • Effective and efficient service delivery; and,
  • Reduced emergency department waits and improved patient flow.

Federal funds targeted for mental health and addictions will be invested in three key areas:  Improving Access to Community Mental Health Supports, Enhanced Delivery of Evidence Based Services, and Improved Mental Health and Addictions Services for Youth and Young Adults.

1. Improved Access to Community Mental Health Supports

In Northern Saskatchewan, the rate of hospitalizations for alcohol-related issues is more than five times higher than the national averageFootnote 30. Current addictions medicine capacity is unable to meet the growing demands, particularly with regard to co-morbid conditions.  Expanded addictions medicine services in central and Northern Saskatchewan will result in improved management of addictions and physical health issues that often intersect with the misuse and abuse of alcohol and other substances. These enhancements will result in direct service delivery as well as consultation supports and capacity building among primary care physicians. Given the high number of Indigenous peoples in this part of the province, these enhanced services and supports will directly benefit First Nations and Métis people with addictions issues.

To better support, respond to and address the mental health and addictions needs of individuals coming into contact with police, the expansion of Police and Crisis Teams (PACT) will result in PACT services in additional communities across Saskatchewan. Police and Crisis Teams see a police officer paired with a mental health clinician for service calls related to mental health and/or addictions.  PACT services are currently operating in two urban centres, with funding from the Saskatchewan Ministry of Health.  The federal funding will be utilized to establish and operate new PACT teams in up to four additional communities.  Selected communities will ensure a broader reach to northern, urban and rural-serving locations across Saskatchewan with an identified need, including those communities with high emergency department utilization rates and police calls for service related to mental health and addictions.

Improving the mental health literacy of all residents, to ensure improved responses to individuals with mental health and addictions issues is of importance to Saskatchewan.  Since 2015, Saskatchewan has invested $250,000 to support the expanded reach of the Mental Health Commission of Canada’s Mental Health First Aid (MHFA) courses.  To date, over 2,200 individuals have received MHFA by provincially trained facilitators. Federal funding will support Saskatchewan’s efforts to increase the mental health literacy and capacity of human service system providers to appropriately respond to and support individuals and families with mental health and addictions issues. This will be done by training additional facilitators to deliver Mental Health First Aid to the health, education and social service sectors in Saskatchewan.

We need to enhance the coordination and integration of services and supports for individuals with serious and persistent mental illness who have very complex needs and for whom traditional mental health services are insufficient.  Saskatchewan is currently working towards a modernized approach for the delivery of rehabilitation services, utilizing a stepped care model. Federal funding will support the development and standardized implementation of Community Recovery Teams in those eight communities with inpatient mental health units.This federal investment will enhance current rehabilitation teams and include introducing new positions to ensure a more client-centred response to this population.The development of Community Recovery Teams will support foundational work currently underway in Saskatchewan, and will result in improved and more targeted support for those most in need. Peer Supports will be a key component of the Community Recovery Team model being developed for Saskatchewan.

Saskatchewan understands the benefit to clients when appropriate services and supports are available in their communities. The establishment of residential options that include intensive supports for individuals with serious and persistent mental health issues will improve client outcomes and overall quality of life while addressing health system priorities related to reducing hospitalizations, length of stays and inappropriate presentations to emergency departments. Intensive and step-down supports generally require medium to long-term support, 24-hours per day, 7-days per week, and include client-centred and individualized services and supports that build independent living skills and provide assistance with daily tasks. Saskatchewan’s current composition of supportive residential options is challenged to meet the varied needs of individuals with severe and persistent mental health issues.  These federal investments will facilitate a comprehensive and strategic approach to providing these individuals with new intensive supports that would allow them to reside in their communities.

These investments align with the agreed upon A Common Statement of Principles on Shared Health Priorities, by:

  • Spreading evidence-based models of care and culturally appropriate interventions that are integrated with primary health services; and,
  • Expanded availability of integrated community-based mental health and addictions services for people with complex health needs.

2. Enhanced Delivery of Evidence Based Services

Saskatchewan is proud to be a leader in e-mental health, and has supported the introduction of internet delivered cognitive behavioural therapy (I-CBT) into the continuum of mental health and addiction services, in partnership with the Online Therapies Unit at the University of Regina.  In Saskatchewan, a significant portion of presentations to mental health outpatient services are for mood disorders, including anxiety and depressionFootnote 31.  I-CBT is an evidence based service delivery model that sees efficacy rates that meet or exceed traditional clinical service delivery approaches, while addressing challenges and barriers related to access and system capacity.  With federal funding, Saskatchewan will continue to expand access to internet-delivered cognitive behavioural therapy services and work to develop new internet delivered supports that serve targeted populations and/or address identified needs within mental health and addictions.  Since first introduced into Saskatchewan in 2014-15, I-CBT has been delivered to over 2,100 individuals from across Saskatchewan. The expansion of this service will ensure that more individuals with anxiety and depression will have access to this innovative service.

Saskatchewan currently has limited capacity to ensure that client files and treatment information are available regardless of where an individual presents for services.  An electronic client record and service matching tool was piloted in 2017-18, in four former Regional Health Authorities. To foster improved client outcomes, federal funding will be used to facilitate the provincial-wide implementation of a mental health and addictions electronic client record aimed at better supporting clients transitioning between services and locations and matches clients to services that best meet their needs within a stepped care approach.

In Saskatchewan, the health system has engaged in focused work to improve the experiences of clients engaged in mental health and addictions services.  The health system has begun to implement a patient reported outcome tool to improve client outcomes, support clinical supervision and community needs planning.  This work has been initiated in pilot locations and service lines including adult community mental health and addiction services.  Federal funding will expand on current provincial efforts, and ensure that patient reported outcome monitoring is implemented provincially in both adult and child and youth outpatient mental health and addiction services.

These investments align with the agreed upon A 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; and,
  • Spreading evidence-based models of care and culturally appropriate interventions that are integrated with primary health services; and, expanded availability of integrated community-based mental health and addictions services for people with complex health needs.

3. Improved Mental Health and Addictions Services for Youth and Young Adults

Saskatchewan is experiencing significant pressures in child and adolescent mental health services in northern, urban and rural areas of the province.  Federal funding will be used to support strategic enhancements aimed at expanding the capacity to deliver child and youth mental health and addiction treatment along the service continuum, including programs and services that promote better emotional health for children and youth in schools and other places where they spend time. This includes supporting community developed strategies aimed at preventing suicide in targeted communities and building clinical capacity to recognize, assess, and treat mental health concerns in children and youth.

The Saskatchewan Mental Health and Addictions Action Plan highlighted that physicians and primary care providers are often the first point of contact for individuals seeking help for their mental health and addictions issues. It further acknowledged that physicians and primary care providers feel ill equipped to address the mental health and addictions needs of their patients. To this end, Saskatchewan will use federal funding to introduce a targeted training program for physicians and pediatricians, aimed at strengthening skills and knowledge in the area of child and adolescent mental health and improving interactions with specialists.

Further, this funding will result in additional child and adolescent mental health specialists in Saskatchewan to provide more intensive treatment capacity, assist in reducing wait lists and alleviate pressures in child and adolescent psychiatry. It is anticipated that populations currently over-represented with the burden of mental health and addictions will benefit from these enhancements.

These investments align with the agreed upon A 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;
  • Spreading evidence-based models of care and culturally appropriate interventions that are integrated with primary health services; and,
  • Expanded availability of integrated community-based mental health and addictions services for people with complex health needs.

The following table summarizes the proposed allocation of Federal funding for mental health and addictions between 2017-18 to 2021-22:

Funding Breakdown by Initiative
Funding Breakdown by Initiative 2017-18
($000s)
2018-19Footnote *
($000s)
2019-20
($000s)
2020-21
($000s)
2021-22
($000s)
Total

Footnotes

Footnote 1

Includes allocation for 2018-19 and $1.49M in funding from 2017-18.

Return to footnote * referrer

Footnote 2

The value of all per-jurisdiction allocations are to be revised each year based on the previous year’s July 1st population estimate published by Statistics Canada. Equal per capita allocations will be determined based on each province and territory’s share of the Canadian population. Note: totals may not add due to rounding.

Return to footnote ** referrer

Improved Access to Community Mental Health Supports $880 $5,239 $8,180 $11,280 $11,280 $36,859
Enhanced Delivery of Evidence Based Services $400 $1,511 $1,140 $1,140 $1,140 $5,331
Improved Mental Health and Addictions Services for Youth and Young Adults $400 $2,670 $4,950 $6,600 $6,600 $21,220
Total Federal Funding $1,680 $9,420 $14,270 $19,020 $19,020 $63,410Footnote **

Performance Measurement

Saskatchewan is participating in a Federal-Provincial-Territorial Working Group, led by the Canadian Institute for Health Information, to develop common indicators and share data for the purpose of measuring and reporting on pan-Canadian progress related to mental health and addictions.

Mental Health and Addictions
Initiatives Outputs/Outcomes Targets by 2021

Footnotes

Footnote *

Outputs/Outcomes and 2021 targets 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.

Return to footnote * referrer

Mental Health and Addictions
Improved Access to Community Mental Health Supports

Improved access to mental health and addictions services and supports in the community.

Improved capacity to support individuals with serious and persistent mental health and addictions needs.

Improved responses for individuals with mental health and addictions issues.

Number of physicians attaining addictions medicine specialty designation.

Number of long stays (60+ days) in mental health acute care units.

Enhanced Delivery of Evidence Based Services

Enhanced access to clinical services, through the use of technology.

Improved client outcomes.

Number of individuals receiving I-CBT

Number of clinicians using Better Outcomes Now.

Improved Mental Health and Addictions Services for Youth and Young Adults

Enhanced skills and knowledge in child and adolescent mental health among primary care providers.

Improved access to child and adolescent mental health and addictions services.

Improved outcomes for children and youth.

Suicide rates in communities which have implemented targeted intervention projects.

Number of individuals accessing specialized mental health services.

Reduced wait times for children and youth to access mental health and addictions services.

Number of physicians and primary care providers receiving targeted mental health and/or addictions training.

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