Best Practices in Mental Health Reform: Discussion Paper

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• Preface
• 1. Introduction

EXECUTIVE SUMMARY

This document completes a three-part project conducted by the Health Systems Research Unit (HSRU), Clarke Institute of Psychiatry for the Federal/Provincial/ Territorial Advisory Network on Mental Health (ANMH) and Health Canada. The project identified best practices in mental health reform and strategies for their implementation, focusing on those with serious mental illness. Since the mid 1980s, provinces have pursued various courses of action to develop mental health care systems that can better support individuals with severe mental illness, maximizing their community tenure, independence and quality of life. There has been remarkable consistency in the goals and value bases that are cornerstones of reform. The project consisted of three phases: Phase I of the project was a critical evidence-based review of the current state of knowledge about 'best practices* relevant to mental health reform, with a focus on chronic and severe mental illness (ANMH). The summary of best practices from Phase I provides the basis for a comprehensive checklist of the key elements that should be present within a reformed system of care for persons with severe mental illness (Tables 1A & 1B). They tell us what should be done. 

Phase II of the project was a situational analysis of mental health reform policies, practices and initiatives in Canada which approximated 'best practices* (ANMH). These are descriptions of what can be done through innovative initiatives.  Factors that facilitate change were identified and include: clearly articulated conceptual bases, wide stakeholder involvement, political vision and will, infrastructure supports, the reallocation of funds and personnel from institutions to community, partnerships beyond health, reduction in stigma, enthusiastic leaders and skilled staff, and the Canadian Mental Health Association National Framework for Support.    This document summarizes and synthesizes the findings from phases I & II, then addresses the implementation of best practices across entire systems of care. The benefits and timeliness of integrating mental health services are discussed, separation from the rest of health care is described as a necessary developmental stage and those best practices which should be given priority are identified. The following recommendations for action were identified: Best practices should be used as guidelines for systems planning and as criteria for the assessment of performance.

Each region should develop strong mechanisms (e.g. assertive community treatment teams and a Mental Health Authority) for service integration with clearly designated responsibility for all aspects of care and sufficient influence to bring together the four solitudes, i.e. Community Mental Health Programs, Provincial Psychiatric Hospitals, general hospitals and consumer and family initiatives.

The creation and protection of a separate, single funding envelope that combines various funding streams for the delivery of mental health care is an essential component of system reform. Greater use of incentive contracts and grants as levers for change is warranted.

The setting of explicit, operational goals and performance indicators within each province is a prerequisite for systems change and for evaluation. The possibility of achieving a national consensus about selected issues should be explored.    This report also discusses future research needs and valued methods of knowledge transfer, recommending that: Further research on the effectiveness of services and supports and the impact of system change needs to be mandated and funded.

The exchange of research and experiential knowledge should be facilitated through commissioning research summaries and convening meetings focussed upon the topics identified.