Ministerial Advisory Council on Mental Health (MACMH) Summary of Discussion for June 14 and 15, 2018

Office of the Minister of Health

• The Right Honourable Ginette Petitpas Taylor, Minister of Health (Thursday only)
• Kate Moussouni, Policy Advisor, Office of Minister of Health

Ministerial Advisory Council on Mental Health Members (MACMH)

In attendance

Ex-Officio Members

• Helen McElroy (Ex-Officio), Health Canada
• Anna Romano (Ex-Officio),  Public Health Agency of Canada

Ministerial Advisory Council on Mental Health Secretariat

• Marie-Anik Gagné, Manager, Mental Health Unit, Health Canada
• Susan Phillips, Senior Policy Analyst, Mental Health Unit, Health Canada

Thursday, June 14, 2018; 4:00 p.m. - 8:30 p.m.

1. Opening Remarks

• The Minister of Health welcomed members and briefly outlined her 5 priorities for mental health:
  • Suicide;
  • Youth;
  • Data and Metrics;
  • Federal Role in Mental Health; and
  • International Collaboration

2. Approval of the draft Terms of Reference

Decisions:

• It was recommended and agreed that the conversations during the Council meeting remain confidential and that a date be placed on the draft Terms of Reference.
• The proposed suggestions were accepted and the Terms of Reference was approved.

3. Roundtable Discussion

• The Minister of Health asked the Council, “What do you think is needed at a national level for an optimal mental health system in this country, in regard to improving mental health for all Canadians, not just for those that can pay for it?”

Key Points of Discussion/Suggestions for Initiatives as per themes:

Develop Mental Health Human Resources Plan for Canada

Include:

• Identify number of health care providers that are required across the country (e.g., pharmacists, social workers, psychiatrists).
• Clarify roles of various health professionals re: mental health.
• Define different care models.
• Review impact of funding models on mental health care (e.g., lack of remuneration for health professionals to work together;  lack of public coverage for psychotherapy; reliance on medication (versus psychotherapy) as first-line intervention given funding; experience of countries such as the Netherlands which reimburses health care providers based on the outcome of the care provided). 

Standardize Mental Health Care

• Coordinate, communicate, align, and standardize care across provinces/territories.
• Develop and implement professional standards and expectations via national organizations.
• Seek international standards and apply what is working internationally to Canada (e.g., standardize suicide screening in all EDs with a follow-up in 24 hours).
• Incorporate gender into the understanding of addictions/mental health issues, especially as it pertains to suicide.

Develop National Priority Research Agenda

• Review existing research to identify areas where the research is non-existent or inconclusive (e.g., look at countries internationally that have success rates for prevention of suicide).
• Exercise scientific rigour when reviewing existing research (e.g., need Critical Cochrane review).
• Establish national priorities for research with a focus on successful interventions.

Accredit/Standardize Mental Wellness Interventions

• Have independent body regulate interventions (e.g., school-based suicide prevention programs).
• Identify interventions that work based on evaluations (e.g., evaluate the vendors that sell mental health treatment programs– regarding the efficacy of their treatment (using the same rigour as medication).

Develop National Mental Health System Strategy

• Implement a whole of government approach.
• Emulate Australian approach – community based care; crisis and home treatment; early intervention; assertive community outreach).
• Ensure adequate financial resources.
• Design a strategy that is patient and family centred; coordinated across the system and sectors to facilitate transitions; and responsive to the needs of the various populations.

Role of Federal Government

Improve Data Collection

• Measure for acuity of care and measure of quality of care.
• Invest in longitudinal mental health surveys.
• Mandate child health surveillance in each jurisdiction.

Examine and Address Policy and Legislation

• Address gaps in justice and legislation (e.g., discrimination against people with mental illness).
• Address disincentives in the system that are barriers to collaborative care (e.g. Canada Health Act, pharma care).
• Reduce complex legislative frameworks that dictate how programs/policies, interventions and funding work.

Provide Leadership in Mental Health in Workplace

• Be a role model and leader in workplace mental health in federal departments, agencies and federally regulated workplaces

Address First Nations, Inuit and Métis

• Engage more Métis and Inuit in discussions re: mental health.
• Need more ethnic identifiers and data collection.
• Continue to work on Inuit, FN and Métis at HC and PHAC despite DiSC

International

• Develop vision for mental health at international level.

Wrap-up and Closing

• It was noted that the Advisory Council members brought a wealth of experience in the area of mental health, often identifying personal links to the topic areas discussed. Advisory Council members expressed urgency to get things right for Canadians as it relates to mental health.

4.  Adjournment

• The meeting adjourned at 8:30 p.m.

Friday, June 15, 2018; 8:30 a.m. - 12:30 p.m.

1. Opening Remarks

• Council members were reminded that of the Minister’s 5 key priorities, presentations would focus on the following 3 priorities: suicide, data and measurement, and international collaboration.

2. Presentation by Statistics Canada and Canadian Institute for Health Information (CIHI)

• Jennifer Ali and Ron Gravel from Statistics Canada provided an overview of types of mental health data in Canada.
• Natalie Damiano and Mélanie Josée Davidson from the Canadian Institute for Health Information provided a presentation on data and information pertaining to mental health.

Comments for CIHI and Statistics Canada

Data Collection and Research

• Evaluate the use of Benzodiazepines in the provinces.
• Capture relevant information for different socio-economic backgrounds.
• Capture the complexity of acuity.
• Emphasize the use of longitudinal surveys.
• Move to quality vs. quantity indicators.
• Collect statistics for at risk populations.
• Inform the rest of Canadians about statistics and indicators.
• Build relationships with Centre for Neuro-Informatics.

Primary Care and Mental Health

• Capture what happens with both mental health care in primary care, and links between mental health care and primary health care in the system.
• Capture the role of pharmacists in treating mental illness.

3. Presentation by Public Health Agency of Canada

• Stephanie Priest from the Public Health Agency of Canada provided a presentation on an overview of suicide prevention in Canada.

Comments for PHAC

Government

• Implement an all of government approach. Create a Ministry of Mental Health and Addictions and Suicide Prevention.

Promotion and Prevention

• Train community pharmacists to connect and reduce follow up suicide attempts.
• Provide proper messaging regarding suicide and media (safe messaging and safe reporting).
• Provide training young people regarding suicide prevention.
• Understand the risk factors and protective factors for suicide.
• Identify both protective and risk factors.
• Strengthen coping skills by providing early childhood supports.
• Assess international examples that have success rates for prevention of suicide.

Access and Treatment

• Treat suicide like an emergency response. This is the largest issue for the Inuit.
• Federal government needs to take leadership and highlight standards and use funding for provinces/territories as leverage for strategies.
• PHAC needs to create an independent body to evaluate the claims of vendors selling suicide prevention products (HC has it for pharmaceuticals). Vendors should go through the same standard of evidence as pharmaceuticals.
• Support for health care providers in their work re: suicide.
• Provide mental health first aid for mental health providers, including physicians, other health providers, and emergency room staff. The mental health first aid is also an important toolkit as a measure of prevention.
• Understand stigma: what promotes it and how to reduce it.
• Focus on a holistic approach to care.
• Involve primary care in strategy.

Data

• Eliminate proxy measures.
• Reduce stigma through contact base intervention.
• Incorporate the voices of people with lived experience.
• Engage young people.

4. Presentation by the Office of International Affairs (OIA), Public Health Agency of Canada

• Sarah Lawley, OIA, provided a brief presentation on Canada’s international engagement.

Questions/Comments for Office of International Affairs

• It is important that mental health and climate change be incorporated from an international perspective.

Decision:

• Due to time constraints, OIA was invited to the next Council meeting to provide a detailed presentation to members.

5. Wrap-up and Closing

• Helen McElroy provided closing remarks and indicated that a draft summary of discussion would be sent within a few weeks to all Council members.
• Next meeting may take place around the Canadian Mental Health Conference, October 22-24 in Montreal. 

6. Adjournment

• The meeting adjourned at 12:30 p.m.