TALE OF TWO WORLDS

FORCES OF CHANGE

INFRASTRUCTURE INTEGRATION

DEMOCRATIZING HEALTH

OUTCOME ORIENTATION

SOCIAL DISTANCING

After a yo-yoing of government priorities and spending in the early 20s, there are significant cuts to mental health and social services in the mid-late 20s leaving the desperate population with little government support and unimaginable waitlists. While mental health has emerged from the twilight of people’s lives, formal services are irrelevant for most. With a large population of old, low-income boomers, marginalized and segregated minority groups in urban areas, immigrants with unmet health needs, and First Nation, Inuit and Métis communities that have been long neglected, mental health issues are reaching unprecedented levels, especially related to chronic stress. Still, meeting the basic necessities of life are a much higher priority for the majority of the population. Publicly visible mental health crises are a regular occurrence in communities, with trained police officers providing the initial response. Segregated population groups are highly-networked using simple technological advances that allow for monitoring and instant virtual connection between individuals anywhere. Caregivers rarely stay at home with the individuals they are caring for, instead they connect with them regularly while at work or elsewhere. Social enterprises are creatively working to fill the government void by addressing environmental factors of health and meeting the needs of targeted population groups, making exciting progress at a small scale. On the other hand, the small group of elite in Ontario are finding ways to take advantage of exciting medical advances through private practice, personal connections or international purchasing. They are obtaining the newest technology, medications and interventions that enable real time adjustments that ensure mental health issues rarely interfere with functional abilities.Can scattered, but purposeful, grassroots efforts combat structural inequities?

Illustration by: Ken Orvidas

TIME LINE

2014 20342024INCREASING GOVERNMENT DEBT DRAMATIC CUTS TO SERVICES

STRENGTHENING OF TWO-TIERED SYSTEM

Mismanaged govern-ment spending on economic stimulus

Prime minister speaks publicly about mental health struggles

20 year wait list to see a publicly-fund-ed psychiatrist

20 jails built in Ontario in last decade

50% of the population in Ontario identifies as hav-ing a MH issue

DIS/CONNECTED COMMONS

FORCES OF CHANGE

With early legislation to unlock electronic health records and provide open access to these records, Ontario experienced a digital health boom in the 20s that resulted in a variety of tools to support communication and collaboration between clinicians, peers and patients. What emerged from this era was a platform or commons in which almost all health information, communication and knowledge is linked, creating a virtual one-stop shop for big data and specific patient information, despite disparate applications and devices. This infrastructure enables distributed collaboration between highly-linked providers, empowering all providers, as well as caregivers and peers, with specialized support to address mental health needs.Many private companies have entered the market, taking advantage of open access standards to provide direct-to-consumer products that meet the growing demand. The product space is fragmented, but offers people choices in supports and connections. With advanced monitoring and communication techniques, outpatient visits are a thing of the past. Most patients and caregivers connect with providers, peers, or businesses through cloud channels. When individuals with mental health needs do connect directly in with providers, the continuity of this relationship seems less important because all providers have an instant comprehensive overview of the individual’s history and preferences, and can make informed decisions with specialized support. Ontario mental health services have become a web of products, networked health care providers and social service providers with protocol for instant and ongoing collaboration. Specialized mental health providers are easily accessible knowledge supports for primary providers and informal supporters. Given the track record of mental health services, will people willingly give over their privacy for the promise of improved connection and support?

Illustration by: Ken Orvidas

TIME LINE

2014 20342024DIGITAL HEALTH BOOM

ORGANIZATIONAL LINKAGES AND MERGERS

Ontario makes it mandatory to unlock EHRs

2000 new MH businesses in Ontario each yr

Patients access EHR & open access to anony-mized information

Emergence of common cloud medicine platform

All health care providers are connected to spe-cialized mental health

INFRASTRUCTURE INTEGRATION

DEMOCRATIZING HEALTH

OUTCOME ORIENTATION

SOCIAL DISTANCING

THE PEOPLE ASSEMBLE

FORCES OF CHANGE

As a response to the overburdened, perpetually underfunded mental health system, people affected have mobilized to support each other and enhance their power within services. Through greater access to health and medical information, patients and caregivers are increasingly informed about health choices and connect to each other for support and knowledge. Citizens are taking needs into their own hands and are increasingly vocal about their vision for services. The general perception of mental health is that it is a snowballing issue requiring action and activism. Instead of stifling this emerging movement, funders and formal mental health service providers recognized the assets of the community and the economic benefits of a ‘people powered’ approach. The system responds through a shift to client-directed services, engaging peer supporters, employing group visits, connecting to non-medical alternatives, and providing some funding for the development of advanced community support networks. Through this recovery orientation, individuals are encouraged to build capacity for long-term self-management with support from tools and advanced social monitoring techniques. Many feel like it is a new era for mental health survivors and are celebrating the progress made by people helping people.Still, individuals with complex and severe mental health issues are neglected resulting in a rise in homelessness and significant caregiver burden. The system of services remains fragmented, but individuals cope through social connection, peer navigator roles and offerings from curatorial health enterprises.With increased ‘people power’ within the system, how will the relationship between traditional providers and patients shift?

Illustration by: Ken Orvidas

TIME LINE

2014 20342024UNDERFUNDED MENTAL HEALTH SERVICES

WIDESPREAD ACTIVISM AND CITIZEN ACTION

Legal case sets presi-dent for requirement of shared care planning

LHINs invest in peer and patient engagement

Most of patients seen regularly in group visits

Mental health riots in 6 major cities

Global MH network reaches 100 M members

25% of staff in mental health services are peers

INFRASTRUCTURE INTEGRATION

DEMOCRATIZING HEALTH

OUTCOME ORIENTATION

SOCIAL DISTANCING

COLLECTIVE IMPACT

FORCES OF CHANGE

Supported by inter-ministerial collaboration and aggressive funding models, Ontario becomes a leader in holistic mental health care. Through the creation of “endowments” for individuals with complex mental health needs, funding enables extreme flexibility of goods and services to support mental health and wellbeing. Increased ability for monitoring health outcomes and a shared accountability for population health has enhanced the integration of services and comprehensive client outcome tracking. Financial incentives for effective, low-cost interventions have encouraged health care providers to connect patients to a spectrum of alternative services, tools and supports including, physical activity interventions and peer networks. Most services provided are reimbursed based on short and medium-term health outcome measures. Many mental health service providers establish a focus on a specific patient population to improve efficiency and outcomes. This leaves some diagnostic populations, such as those with obsessive compulsive disorder, significantly under-resourced in Ontario. While providers support individual medical and lifestyle-based interventions, governments work at environmental interventions to support health and ensure that all new policies encourage health equity.The public perception of mental health is that of a serious problem that needs to be solved collectively. The conversation has shifted away from individual shaming toward a reliance on government to meet the diversity of individual needs at every level, regardless of cost.With increased demands for collaboration and outcome tracking at all levels, how nimble will the system be to respond to emerging needs?

Illustration by: Ken Orvidas

TIME LINE

2014 20342024ENHANCED MEASUREMENT OF HEALTH OUTCOMES

ALLIANCES WITH SHARED TARGETS AND ACCOUNTABILITY

Interministerial mental health com-mittee established

“PopCan” partner-ship of Stats Can and Health Canada

Performance pay-ments are 15% of MH funding

Release of ‘Health in All Policies’

“Endowments” for individuals with complex MH needs

“Operation Out-comes” changes payments

INFRASTRUCTURE INTEGRATION

DEMOCRATIZING HEALTH

OUTCOME ORIENTATION

SOCIAL DISTANCING