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Establishing the Basket of Services for a National Home Care Program for Mental Health and Addiction Clients  A Perspective from the Ontario Federation of Community Mental Health and Addiction Programs   The Ontario Federation of Community Mental Health and Addiction Programs (OFCMHAP) would like to extend its thanks for the opportunity to participate in the building of a national basket of home care services for the mental health clients.    To understand the complex needs of the mentally ill it is necessary to determine what core services are required to support people and to ensure timely access to the full range of mental health and addiction services based on level of need.    The content of this consultation is based on provincial and federal Ministry of Health studies, best practice principles, and reviews of mental health and addiction services too numerous to mention.   OFCMHAP has determined that the Mental Health and Addiction services needed for a National Home Care Program are those supports that are essential to reduce or prevent the need for tertiary hospital care or other institutional sectors such as criminal justice system.       Services that allow people to live a full, productive and meaningful life within their community are those needed in a National Home Care Program.  This basket may include but not be limited to assessment services, outreach services, intensive case management,  individual psychotherapy/counselling, personal care, assistance with the Activities of Daily Living, supportive housing, affordable housing, and the full range of social and addictions rehabilitation and recovery services.   Also, for the purpose of determining a National Home Care Program, it is crucial to include the full range of treatment options for substance abuse and addictions.  Addiction services are sidelined in a system where the impact of substance abuse continues to divert much needed resources.  Inclusion of Addiction services in a National Home and Community Care Basket of Services will strengthen the entire health sector.    Approximately, half of individuals who suffer with serious mental illness also struggle with substance abuse and addiction issues.  This extremely high rate of concurrent disorders represents a significant strain on the existing institutional sectors such as hospitals and the criminal justice system.  Therefore, it is essential to include addiction services to ensure the effectiveness of a complete health care delivery system.    OFCMHAP would suggest that a National Home Care Program look to the extensive work completed in Ontario and Canada identifying the reform of mental health services.  A short list of this work would include: 
  • Putting People First:  The Reform of Mental Health Services in Ontario (1993)
  • Best Practices in Mental Health Reform and a Review of Best Practices in Mental Health Reform as prepared for the Federal/Provincial/Territorial Advisory Network on Mental Health (1997)
  • Making it Happen:  Operational Framework for the Delivery of Mental Health Services and Supports (1999)
  • Setting the Course, Ontario Substance Abuse Bureau, 1999
  • Best Practices in Concurrent Mental Health and Substance Use Disorders, Health Canada 2001
OFCMHAP would also identify the extensive work and reports of the Mental Health Implementation Task Forces that have recently completed their submissions and numerous recommendations to the Province of Ontario.   Making it Happen clearly states that “a comprehensive continuum of supports and services that responds to all the aspects of a person’s life” is required.  Supportive services must span across all levels of need, as outlined in the next section, and are a vital part of the continuum of care.  Individuals can enter the support and service system at a number of points within the comprehensive range and will be able to move with ease within the system.  Linkages need to be established within the system and with other health and social service systems (ie. Ministry of Community Family and Children’s Services, ODSP, OWAT and Corrections).     The services included in the following extensive list are not readily available across the country or the province of Ontario.  OFCMHAP recognizes that competing needs have strained the resources of the different health care systems across the country.  Within the province of Ontario, the Federation has demonstrated that community based services actually save health care dollars as reported in the recent publication Outcomes and Effectiveness:  The Success of Mental Health and Addiction Programs.   This document clearly illustrates that support, enhancement and expansion of community based programs in the addiction and mental health sectors will result in a more cost effective and efficient health care delivery system.   A successful comprehensive National Home Care Program for those with mental illness, addictions and concurrent disorders would be respectful of cultural diversity and include the following: 
  • Health Promotion/Education                          
  • Alternative Emergency Shelters (Hostel)           
  • Early Intervention                                 
  • Affordable Housing
  • First Episode Treatment/Support               
  • Supportive Housing
  • Assessment Services                          
  • Income Supports
  • Assertive Case Management/Outreach       
  • Pharmaceutical Subsidies
  • Peer Supports                                     
  • Mobile Crisis Teams
  • Self-Help and Indigenous supports            
  • Safe Beds
  • Drop-Ins                                            
  • Schedule 1 Emergency Services
  • Activities of Daily Living Programs             
  • Inpatient Services
  • Vocational and Employment Programs        
  • Outpatient Services
  • Consumer-Run Businesses                     
  • Intensive Case Management                          
  • Family Supports/Respite services            
  • Assertive Community Treatment Teams
  • Social/Recreational Programs                   
  • Mobile Outreach Teams
  • Primary Care Physicians and Nursing          
  • Residential Treatment Facilities
  • Health Service Organizations                   
  • Specialized Forensic Services
  • Community Health Centers                       
  • Court Diversion Services
  • 24-Hour Crisis Telephone Lines                
  • Community Treatment Orders
 In addition, key addiction components would include:
  •  Medical Withdrawal Management
  • Withdrawal Management for Special Needs Populations:  Opiate Dependent, Youth, Older Adults, Young Adults, Women, HIV.
  • Addiction Assessment Services
  • Day Treatment
  • Home Withdrawal Services
  • Residential Concurrent Disorder Treatment Programs
  • Aftercare and Follow up
  • Family Programs
The complexity of service requirements for persons struggling with serious mental illness, addictions or  concurrent disorders illustrates the need for a comprehensive basket of services that goes beyond the traditional view of what is considered “home care”.  In order to have the greatest positive impact on the health care system as a whole and ensure the successful development of a National Home Care Program, a full range of services are required.  These services must be client-focused, based upon the broad determinants of health and establish vital linkages which will promote and support client participation as active members of their community.