Best Practices in Mental Health Reform: Situational Analysis

Executive Summary 

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This document represents the second part of a three-phase 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, Review of Best Practices in Mental Health Reform, 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. They tell us what should be done.

Phase II, Best Practices in Mental Health Reform: Situational Analysis (see below).

Phase III, Best Practices in Mental Health Reform: Discussion Paper 1997, 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. 
 This document, Best Practices in Mental Health Reform: Situational Analysis, consists of an analysis of mental health reform policies, practices and initiatives in Canada which approximated 'best practices'. These are descriptions of what can be done through innovative initiatives. The analysis produced a number of positive conclusions about mental health reform some of which are:

• It is clearly possible to successfully reallocate funds and personnel from institutional to community care. 
• The value of collaboration that involve ministries and agencies beyond health is demonstrated repeatedly.
• The influential role of the Canadian Mental Health Association especially their Framework for Support is evident across the provinces.
• With concerted action, stigmatizing attitudes can be changed and resistance to change overcome.

Factors identified in this analysis that facilitate change are include: skilled leadership and a committed group of expert staff, clearly articulated philosophy and principles, wide stakeholder involvement, infrastructure support and political will and a sustaining vision.