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Key Components of an Integrated System: Health promotion and prevention 

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

Ontario needs to provide targeted, evidence-based prevention and health promotion efforts, such as those described by the government's Roots of Youth Violence report.

The Roots of Youth Violence report contained a stirring call for improved action to prevent youth violence. Justice McMurtry and Dr. Curling concluded that the government’s focus is “on interventions once the roots had taken hold rather than on actions to prevent that happening” (p. 1).  The commissioners were passionate in their descriptions of the need to “enhance prevention through programs that promote health, engagement and activity for youth” (McMurtry & Curling, 2008, p. 37).  This message of health promotion and prevention must also play a central role in a provincial mental health and addiction strategy.

Prevention and health promotion in the area of mental health and addictions may seem like a daunting challenge for governments. Mental health status is affected by income inequality and poverty, lack of affordable housing, and weak labour force attachment. Positive mental health is promoted through vibrant, healthy communities. These are big problems, not easily addressed programmatically or without enormous public investment. Yet we have sufficient empirical evidence to describe the type of programs and initiatives that work to promote mental health and prevent substance use problems. The provincial mental health and addiction strategy can suggest an approach to mental health and addictions prevention and health promotion that is grounded in evidence in what works, and build from success.

Promoting mental health and preventing mental illness depends on initiatives to strengthen the resilience of individuals, families, and communities. These efforts should be focused and subject to rigorous evaluation. Children and youth are a logical starting point. As Justice McMurtry and Dr. Curling point out in their report, there is strong evidence that locally available mental health services that provide early identification of problems for children and youth are effective interventions. They point out that the best programs are integrated with local communities, rather than a time-limited ’fix’ to a problem. This is consistent with empirical evidence on the effectiveness of prevention initiatives (Wolfe, Jaffe & Crooks, 2006). The most effective youth health promotion interventions “emphasize the development of specific skills, and have a focus on building positive capacity in youth” (Wolfe, Jaffe & Crooks, 2006, p. 150). The least effective youth health promotion efforts “are often oversimplified, with an implicit assumption that a particular negative behaviour is caused by a single determinant” (Wolfe, Jaffe & Crooks, 2006, p.150).

While there are elements of mental health promotion that are universal, prevention activities can be effectively targeted. There are different methodologies for targeting prevention efforts where they can make the greatest impact. The Roots of Youth Violence recommends using an approach that identifies areas using five indicators of disadvantage. CAMH has been working with the City of Toronto and community partners to deliver one award-winning prevention initiative in targeted neighbourhoods. Strengthening Families for the Future targets children aged 7 to 11, and their families, and works to reduce risk factors, build individual resilience, and enhance family protective factors. It is one example of an effective, community-based prevention campaign built on what we know about effective practice.

In addressing and preventing addiction problems, it should be noted that the provincial government plays an enormous policy, enforcement, regulatory, and operational role in the area of tobacco, drugs, alcohol, and gambling. While the committee is likely focused on prevention and treatment within a health context, the most effective prevention efforts use all government’s policy levers to promote health and prevent health problems. This is particularly important in areas with the greatest impact on health: tobacco and alcohol.  Tobacco remains Ontario’s single most harmful addiction, and significant work remains to be done to address rates of smoking and the effects of second hand smoke.  Yet tobacco is also an example of what can be achieved by a coordinated government response that involves targeted prevention efforts with legal and regulatory initiatives.  The Smoke Free Ontario program has been successful in addressing rates of smoking, and this work must continue.

This kind of comprehensive approach has been taken in addressing alcohol at the national level.  CAMH participated in the development of a National Alcohol Strategy, Building a Culture of Moderation. Recognizing the enormous health burden that alcohol represents, a national strategy was developed by a broad cross section of stakeholders, including the organizations representing alcohol producers. They recommended a range of interventions to reduce the health burden of alcohol, such as the development of minimum retail social-reference pricing, a commitment to maintaining existing systems of control over alcohol sales, and creating incentives for lower-alcohol drinks. CAMH would be pleased to provide a more extensive briefing on alcohol policies that can better promote health and prevent problematic and dangerous use.

Similarly, CAMH has recommended that Ontario develop a comprehensive drug strategy. International evidence suggests that the most effective approaches to reducing drug-related harm are grounded in a coordination of the state’s role in prevention, treatment, enforcement and harm reduction efforts. One urgent priority for drug policy work is the alarming increase in the use and misuse of prescription opioid drugs, such as oxycodone or morphine. This increase has highlighted the uneven access of methadone maintenance treatment across Ontario; a proven, effective treatment for opiate addiction that has helped thousands of Ontarians reclaim their lives.


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

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