• Key Messages for LHIN Workshops, Nov. 10, 2004  
• A covering letter providing an overview of the two accompanying documents
• A summary of proceedings from the September 14, 2004 session
• A document outlining work done since the September 14, 2004 session (all of which has been based on the work done at the session)

• LHIN Workshop Summaries by Regions
• Local Health Integration Networks Bulletin 
• Local Health Integration Networks: Response to Government Consultation Questions Released October 6th, Oct. 15, 2004.
• Mental Health and Addiction Sector Responds to the Ontario's Transformation Agenda, Oct. 8, 2004.

May 8, 2003





Honourable Tony Clement

Minister of Health and Long-Term Care

Hepburn Block

80 Grosvenor St., 10th Floor

Toronto, Ontario

M7A 2C4





Dear Minister Clement:



I am writing on behalf of the Board of Directors of the Ontario Federation of Community Mental Health and Addiction Programs to request that the Ministry of Health and Long-Term Care make public the final reports of the various Mental Health Implementation Task Forces and inform the public of its intended response to the recommendations made by these Task Forces.

May 6, 2003





Honorable Tony Clement

Minister of Health and Long-Term Care

Hepburn Block

80 Grosvenor St., 10th Floor

Toronto, Ontario

M7A 2C4





Dear Minister Clement:





I am writing on behalf of the Board of Directors of the Ontario Federation of Community Mental Health and Addictions Programs about the planned MIS/CDS implementation. A number of our member agencies have been asked to participate in the pilot year of this exercise.



The Federation is pleased to see the Ministry taking steps to create a more standardized accountability and data systems. The Federation whole-heartedly supports the development of accountability mechanisms, the measurements of outcomes and the need to demonstrate the effectiveness of community based mental health and addiction services.

July 11, 2003

The Honourable Allan Rock

Minister of Industry

11th Floor East Tower, CD Howe Building

235 Queen Street

Ottawa, ON K1A 0H5

Dear Minister:

Re: The Personal Information Protection and Electronic Documents Act

The Ontario Federation of Community Mental Health and Addiction Programs represents 217 providers across the province who work with the some of the most vulnerable populations within the province. Members’ services include residential addiction treatment, case management, supportive housing, counselling and the many other types of support needed to help people maintain their independence within their community.

On behalf of the Ontario Federation of Community Mental Health and Addiction Programs attached are recommendations and rationale regarding the Request for Proposals to provide the review of Community Treatment Orders as required by the Act.



That the contract is awarded to an organization at “arm’s length” from the Ministry or any provider associated with CTO’s (e.g. A university without a CTO program or a consulting group that has not and is not working with an agency that provides CTO support).



Rationale: To be credible with all stakeholders it is critical that this review must not only be free from any real or perceived conflicts of interest but it must be done in the most impartial manner possible with sound research practices.



That the review seeks understanding of who is on a CTO, specifically: age, gender, ethno-racial characteristics, socioeconomic status, housing, marital status, geographic location, education, diagnoses.



Rationale: Such demographics provide for a better way of comparing CTO’s with other options for the client group and may point out strengths and weaknesses.



That the review seeks understanding of why someone is on a CTO.



Rationale: Much information needs to be gathered and analyzed to determine why someone was put on a CTO and why others were not. Data regarding previous treatments, including number and duration of voluntary and involuntary hospitalizations, previous police apprehensions, previous case management/ACT contacts, previous homelessness, episodes of both aggression and victimization would need to be analyzed.



That the review seeks to understand why some physicians are using CTO’s and some are not.



Rationale: It is critical to understand if and why some demographic groups are over represented. It would be important to get a sense from physicians about whether they have clients they believe would benefit from a CTO, but who may not meet criteria. Also of interest is the reasons CTOS are considered, but then not issued (i.e. consent withheld, lack of services, client doesn't meet criteria, other treatment deemed more suitable, etc.)



That the review seeks an understanding of the impact of a CTO.



Rationale: Impact on the individual, their family and community was a major objective of the legislation. The review must therefore include: qualitative research (e.g. the perspectives of patients, families, room mates/house mates, landlords, community treatment teams, psychiatrists signing CTO’s, CTO related staff (CTO coordinators and case managers)), and quantitative research (e.g. duration of CTO itself and its renewals, number and duration of voluntary and involuntary hospitalizations, police apprehensions, case management/ACT contacts, homelessness, episodes of both aggression and victimization, number of contacts with crisis services



That the review seeks an understanding of whether, all else being equal, some sub-populations are placed on CTO’s more frequently than others.



Rationale: It is essential to determine whether CTO’s are being disproportionately used in dealing with some populations. It has been suggested that some minority groups are over represented amongst those placed on CTO’s.



That the review include a comparative study on a similar client group to see whether intensive community supports achieve similar results without resorting to CTO’s.



Rationale: Social and monetary cost-effectiveness should also be reviewed.

Bill 8 - Commitment to the Future of Medicare Act 2003

Submission to the Standing Committee on Justice and Social Policy The Federation of Community Mental Health and Addiction Programs and St. Jude Community Homes May 2004   The Ontario Federation of Community Mental Health and Addiction Programs and St. Jude Community Homes welcome the opportunity to make a submission in support of Bill 8, the Medicare Commitment Act.    This legislation speaks to issues that are very important for people with mental illness, for the volunteers who lead the organizations that provide services and for the public.   The Ontario Federation of Community Mental Health and Addiction Programs (The Federation) envisions a community mental health and addiction system which is accessible, flexible, comprehensive and responsive to the needs of individuals, families, and communities, shaped by many partnerships, respectful of human dignity and rights, and accountable to those it serves.  The Federation brings together over 200 community mental health and addiction services in the province of Ontario to help members provide effective, and accountable high quality services.    St. Jude Community Homes is a private not for profit supportive housing program in Toronto. The organization is governed by a Voluntary Board. Its mandate is to provide high quality housing and housing supports for individuals with serious mental health problems and to support these individuals on their unique journey of “Recovery”.   Much has been written about Recovery and the concept has been highlighted in the Mental Health Implementation Task Force Reports. Simply put…recovery is learning to live with the effects of having a mental health problem…the stigma, isolation, low self-esteem and poverty, successfully managing symptoms and getting on with life to the best of one’s ability.   St. Jude Community Homes opened in 1991, serves 36 citizens and hopes to serve 30 more by 2005 with a grant under Phase two of the Ministry of Health Homelessness Initiative.   Together, we are here today to speak specifically to Part 3 of Bill “Accountability” and briefly comment on other aspects of the Bill. The response to Bill 8 is divided into three sections.  The first section deals Accountability and the establishment of the Ontario Health Quality Council; the second with the preamble and commitment to Medicare and the Canada Health Act; and the third to insured health services. Part 1: Accountability Framework Bill 8, 2003, which has received second reading and has been referred to committee, would require “health resource providers” (including hospitals) to enter into an accountability agreement with the Minister of Health and Long-Term Care. That agreement would permit the Minister to issue compliance directives and impose sanctions in the event of non-compliance. Until that Bill is passed, health care institutions are under no specific legislated obligation to account for the billions of dollars of public money they spend.   For community mental health and addiction programs, those accountability mechanisms are already in place.  In addition, these current agreements seem to hold community mental health and addiction programs to a higher standard than are proposed in Bill 8.   In 1998, the Government directed that Ministries establish written agreements with all agencies receiving transfer payment funding. As well, service agreements for mental health programs were identified as one of the characteristics of a reformed mental health system in “Making It Happen” and are consistent with the work of the Mental Health Accountability Reference Group as well the document “The Road Ahead” identified similar issues for the Addiction sector. The Ministry of Health and Long-Term Care reviewed the application of the existing operating plan process of Mental Health and Addiction Programs. Subsequently, the Mental Health and Addictions Branch decided that it was appropriate to develop and implement a common transfer payment agreement for community mental health and addiction programs in addition to the operating plan process. The Ministry of Health and Long-Term Care Transfer Payment Accountability Project was initiated with the intention of improving compliance with the 1998 Directive on Transfer Payment Accountability, raising awareness of accountability issues, and encouraging continuing improvement of transfer payment management with reference to best practices (Memo from John King, Assistant Deputy Minister, Health Care Programs May 9, 2002).   At that time, the Government of the day stated: “The experience of government overall is that clear expectations, terms and conditions of funding, performance monitoring and reporting requirements documented in an agreement between the Ministry of Health and Long-Term Care and funded agencies is the most appropriate way to provide certainty and protection for both sides. The agreements are designed to deliver on these elements. The agreements represent a significant benefit for both the agencies and the Government in terms of clarifying expectations and the conditions of the funding”  (Letter to Board Chairpersons from Marnie Weber, Regional Director, Toronto, Region undated).   Community Mental Health and Addiction Programs understood why the Ministry of Health and Long-Term Care thought it appropriate to implement a standard form of Funding Agreement uniformly across the sector. We understood that a uniform funding agreement gave the impression that all parties were being dealt with in a consistent manner and we appreciated the ease of administration in such an approach could be beneficial in certain circumstances and it was because we recognized and respected the need for the provincial government to ensure that its programs were administered in an effective manner that transfer payment agencies signed these agreement, which were standard contracts and could not be tailored to the needs of individual agencies and in many cases the current agreements do not completely satisfy all legitimate concerns raised by agencies. However, failure to sign the TPA would result in funding being withdrawn.   The TPA that each agency signed requires that agency to:

•  Ensure that funds are only used for the purposes set out in the annual Operating Plan.
• Not make any changes to the Operating Plan without prior written consent of the Ministry

The TPA also grants the Ministry these powers among other:

Methadone Maintenance Treatment
Concerns in Ontario

History:



Over the last decade, methadone maintenance as a treatment option for opiate addiction has increased significantly in Ontario. A continuum of treatment programs began to evolve, offering different services to different client groups. Some programs were abstinence based, while others operated from various points on the harm reduction continuum. Initially two types of programs existed: those operated by community agencies usually overseen by the Ministry of Health and Long Term Care (MoHLTC) and those operated by physicians in private practice governed by the College of Physician and Surgeons. In the last five years, a large number of clinics operated by a physicians group have opened up across Ontario. These clinics are very large, often with client bases of 200 to 300 people

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.