Top Three Challenges to Implementing Moving on Mental Health

Will Children’s Mental Health Services finally get the system overhaul that the province of Ontario has wanted to do for so long?

In light of a number of child and youth mental health services system challenges, the Ministry of Child and Youth Services (MCYS) has been planning and rolling out an ambitious and much needed transformation of the way child and youth mental health services are planned, funded and managed across the province of Ontario.

Called “Moving on Mental Health”, this strategy and action plan includes improving access to high quality child and youth mental health and addictions services, strengthening worker capacity, creating a responsive and integrated system, and building awareness and capacity about mental health issues within communities. Click here for more information about Moving on Mental Health.

The Plan’s 5 Components

The aim of Moving on Mental Health action plan is to transform the experience of families seeking help by:

• Creating and supporting pathways to care – Creating more efficient, clear and standardized ways for clients and their families to access care, and creating connections between primary care, schools and community-based supports and services;
• Defining core services – Reviewing and defining a consistent set of core mental health services that will be available in communities across Ontario, with other specialized services available regionally or provincially;
• Creating Lead Agencies – Selecting one agency in each region to coordinate and manage the services in that area;
• Transforming the Funding Model – Revision of the funding model in a way that acknowledges local needs and service requirements;
• Revising regulations – Revising the legislation and regulations touching on these services to ensure accountability and standard levels of care across the province.

The full implementation of the action plan will span over 3 years. Naturally, this kind of large, system-wide transformation will generate waves of significant changes across Ontario:

• The way services are planned, organized and delivered will change;
• Related policies and regulations will be revised, added, transformed, or deleted;
• Processes for delivering care will be changed;
• People will be impacted in that staffing models may need to change as services within communities are adjusted;
• Relationships between organizations that deliver services will change; and,
• Agency budgets may be impacted.

Although the transformation has the right end goal - and based on our experience and discussions many in the system would like to see improvements - we see the system facing many challenges on the road ahead based on the concerns raised by child mental health organizations. Following are the three most important challenges facing the successful roll-out of Moving on Mental Health:

1. Implementation Uncertainty:
   • Who will provide services not covered in the ‘core services’, such as prevention that falls outside of ‘targeted prevention’? Will these services drop off?
   • What are the funding model details and how will that affect various people and programs?
   • What is the detailed roll-out plan?
   • Will there be an impact on CMH organization structures and roles? Will there be an impact on jobs?
   • How will lead agencies balance the administrative aspect of the rollout, leading system change as well as maintaining service levels?
2. Impact on Relationships
   • How will the fact that one of their peers has become a system lead impact the relationship between the lead agencies and other agencies in their catchment?
   • Given that the new funding formula may impact the way some services are delivered, will there be an impact on relationships between service delivery organizations?
   • Will there be an impact on CMH organizational relationships due to governance and accountability changes?

1. Complexity:
   • Is there an inherent conflict of interest for the lead agency to be a system lead with responsibility for planning service delivery in the region, while also being a service provider?
   • How will services be re-arranged in each catchment without impacting service levels?
   • How will service provider organizations rise to adapt and support the system change?
   • How will Board governance be impacted?
   • How will other changes in related sectors – such as health, developmental services and education – be completed in alignment?

Perhaps the most important question is how will clients and families be engaged and involved along the way.

Do you think these are the most important challenges? What is the most important one facing your organization? What should the system focus on to make this work? Let me know – I would love to hear from you.