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Knowledge Exchange > Health Policy and Systems > Mental Health and Addiction Systems > Submission to the Select Committee on Mental Health and Addictions > Key Components of an Integrated System: Getting the most from investments in specialized health care

Key Components of an Integrated System: Getting the most from investments in specialized health care 

From: Submission to the Select Committee on Mental Health and Addictions. Presented by Paul Garfinkel, June 3, 2009.

Ontario’s provincial mental health strategy should support efforts by institutions to build community capacity and innovative mechanisms to support people in the community.

Teaching hospitals such as CAMH play an essential role in delivering a range of health services to Canadians. They are where our most complex cases are treated; they play a critical role in training the next generation of health providers; and they conduct the majority of health research in Canada. They are also expensive institutions to operate. In the area of mental health and addictions, the gaps in available, accessible treatments are so significant that it can be challenging to offer highly specialized clinical services. That is why CAMH is determined to help build an integrated system of care.

CAMH has a strong interest in improving the capacity of lower intensity treatments offered by others. Simply put, the intensity and acuity of the problem should be matched by the intensity and acuity of the treatment. CAMH devotes considerable resources to supporting community-based health promotion and prevention initiatives, and providing education and training to both primary care clinicians and community providers. This is consistent with stepped models of care that would expand the reach of screening and brief treatment tools in primary care (see above). This type of support – with appropriate resources from government – allows community providers to play a larger role in providing specialized care. This is consistent with the objective from Making It Happen that “People with serious mental illness will achieve greater independence; that is, the ability to live in the community with the least intervention from formal service…” (Ministry of Health and Long-Term Care, 1999, p. 4).

Making It Happen recognized the need to invest in specialized community providers, as part of its commitment to the least restrictive and the least intrusive interventions. At the time, CAMH was the only provincial psychiatric hospital that had been divested to the community. Since that time all of provincial psychiatric hospitals have been divested (the last one only last year), and the province has made significant new investments in community mental health. These investments have been successful, in that they have served many more clients, and significantly re-energized parts of the system. CAMH has collaborated with community providers in advocating for increased community resources for mental health and addiction treatments.

Yet the need for care continues to exceed available treatments. In an efficiently run system, teaching hospitals such as CAMH will focus on providing care to the most complex cases. Community providers would have greater capacity – and greater access to affordable accommodation – so that those with chronic problems were better served in a community, rather than a hospital. CAMH is committed to this model. We have begun working with community partners to develop joint arrangements that combine the specialized care of a hospital with a setting more conducive to recovery and community participation.

For example, CAMH’s Geriatric Mental Health Program had entered into a partnership with LOFT Community Services. LOFT is providing high support housing to geriatric clients who have been long-stay CAMH patients. CAMH continues to assume responsibility for medical and nursing care of the clients, within a community setting. CAMH also will provide a hospital bed for any clients in the event that they return to a state of illness significant enough to warrant hospitalization. This initiative received funding from the Toronto Central LHIN in 2008-09.

CAMH believes that the work of focusing specialized clinical resources on patients with the most complex needs is critical to building a system of care. But it is not more important than improving the reach of mental health and addiction treatment in primary care, or providing community-based specialized treatment for people with mental health and addiction problems. Specialized hospital care depends on a system of care that is responsive to the needs individuals, and constitutes an active partnership between providers and the person receiving the care. Too often, barriers have been placed by parts of the system that prevent client-centred care. All of us must work more diligently to build a system of care.


In Submission to the Select Committee on Mental Health and Addictions:

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