Steinbach MLA and Health, Seniors and Active Living Minister Kelvin Goertzen announced that a new mental health and addictions strategic plan was launched, outlining a path to enhancing access to quality services, increasing co-ordination through community mobilization hubs and improving use of technology to ensure a seamless continuum of services.
“This strategy offers a fresh start for Manitoba,” said Goertzen, upon formally receiving the plan Monday. “It sets out a bold, forward-looking plan to address the silos and gaps that have created significant challenges for Manitobans in accessing the services they need, when they need them.
“While we are realistic in acknowledging the report’s goals will not be accomplished overnight, our government is committed to working with service providers and clinical experts whose voices have shaped both the short and long-term recommendations.”
The Manitoba Mental Health and Addictions Strategy found there is a high need for both mental health and addictions treatment in Manitoba. Long waits to access services, limited availability of services in rural and northern communities, gaps in the continuum from acute to primary care, and an imbalance in how past investment has been directed between acute services and those based in the community were identified as major challenges.
“In general terms, our assessment of Manitoba’s addictions and mental health system concludes that in addition to rectifying long-standing issues related to the structural and functional separation of services in these areas – areas that are significantly more integrated in all other Canadian jurisdictions – some investment will be necessary to bring Manitoba on par with other provinces. This could involve reinvestment of other health dollars or pooled resources from other government departments as a whole-of-government approach,” said Dr. Brian Rush, who co-authored the 279-page report.
“While this additional investment is certainly needed, funding alone will not fix the system, as evidenced by Manitoba having one of the highest provincial per capital health expenditure rates in Canada and yet poorer health outcomes than many other provinces,” added co-author Adair Roberts. “Our report identifies near-universal support for provincial-level planning, includes recommendations for more streamlined governance. It also recommends an increased focus on community-based services which have the potential to reduce long waits that can result in patients accessing the emergency department because they are unable to receive help elsewhere.”
The report reinforced that Manitoba’s system is not able to meet the province’s current level of need. Manitoba has the highest prevalence among provinces of people meeting the criteria for many mental and substance-use disorders.
The limitations were most evident in areas serving women, youth and Indigenous populations. Specific recommendations were made related to more flexible lengths of stay, increased community-based treatment, the integration of addictions and mental health services for children and youth under one umbrella, and the need for more accessible and culturally appropriate services to support the health and wellness of Indigenous Manitobans.
The strategy suggests a number of key themes to shape the future of mental health and addictions care in Manitoba including:
- the creation of a seamless continuum of services, with an emphasis on community hubs or ‘focal points’ that bring key community and service agencies together in one location (24-7 access to psychiatric consultation, cross-trained staff in mental health and addictions, linkages to services in community, centralized intake), enabling person- and family-focused care and culturally relevant treatment options;
- increased emphasis on collaborative care models, building upon the successful model of My Health Teams;
- support for primary care providers through rapid access to psychiatric consultation like the Rapid Access to Consultative Expertise (RACE) pilot and continued opportunities for prescribers to enhance their competencies in addiction medicine; and
- increased access across the province to timely treatment through Rapid Access to Addictions Medicine (RAAM) clinics and expanded Telehealth access.
The report acknowledges increased funding alone will not improve the system but nonetheless recommends a gradual increase in funding over three years. It also points to opportunities to streamline governance and align provincial planning, delivery and performance measurement with the system-level clinical and preventive services planning of Shared Health.
Governance and financial investment recommendations include:
- initiate external reviews of the Addictions Foundation of Manitoba’s residential and community services to assess current screening and assessment tools, appropriateness of reliance on 12-step facilitation in residential programs, opportunities for more flexible program content, appropriateness of current models of service for youth treatment and appropriateness of use of cultural-based approaches for Indigenous clients;
- build a blended funding model for psychiatric support – both salary and fee-for-service billing – and a provincial policy to require other parts of government to contract for psychiatric services through the public system;
- develop provincial standards and instate provincial licensing processes;
- increase funding over the next three years to reach the Canadian guideline of 7.2 per cent of health funding being allocated to mental health and addictions;
- provide an additional two per cent of health funding to make up for the historical funding gap; and
- allocate eight per cent of the total addictions and mental health budget to prevention.
“The report’s emphasis on prevention is consistent with recommendations made in the Provincial Clinical and Preventive Services Planning for Manitoba report authored by Dr. David Peachey,” said Goertzen. “While alcohol addiction is often overlooked during public discussion of addictions, it continues to represent roughly 80 per cent of all addictions problems in Manitoba and has by far the greatest impact on health and social well-being.”
The strategic plan was developed following an intensive public and stakeholder engagement effort. More than 80 consultations took place between June and September 2017 across the province. VIRGO Planning and Evaluation Consultants Inc., led by Rush and Roberts, who are experts in mental health and substance-use system design and planning, reviewed more than 275 documents provided by stakeholders and analyzed population, health and service data. Online surveys received one of the highest response rates to date for provincial surveys, with more than 3,800 respondents from both the general public and service providers.
Following the development of initial recommendations, Rush and Roberts engaged more than 600 individuals including those with lived experience and their family members, Indigenous leaders, new Canadians and key stakeholders who will oversee and implement the strategy to receive feedback on the work.
“This strategy includes the voices of thousands of Manitobans – families, health-care providers, community leaders – from every region of our province,” said Goertzen. “Their stories, perspectives and expertise have been invaluable and the extraordinary interest in this process demonstrates how important support for mental health and addictions is to all Manitobans.”
Over the coming months, Goertzen said Manitoba Health, Seniors and Active Living will evaluate and consider each recommendation, including how they fit within the development of a whole-of-government approach. The implementation of recommendations related to governance and integration will be considered both from within the health system (bringing together organizations with provincial mandates including the Addictions Foundation of Manitoba, Manitoba Adolescent Treatment Centre and Selkirk Mental Health Centre) and across the broader government context (including Manitoba Health, Seniors and Active Living, Manitoba Families and Manitoba Justice).
The implementation plan is expected to be complete by the fall and include identified opportunities to realign existing resources and leverage federal funding opportunities through the Shared Health Priorities funding and Substance Use and Addiction Program.