A mental health strategy for city

“People (are) being hospitalized or dying before receiving care.”

That sounds like the situation in a war-torn country, or one struggling with the fallout of a natural disaster. But it concerns a situation closer to home — much closer in fact, since it’s happening right now, right here in Toronto.

That’s according to Our Health, Our City, Toronto’s new five-year strategy to promote mental health and well-being and reduce the harms of substance use.

At first blush, the strategy might seem impossibly idealistic, utopian even, in that it prescribes nothing less than an entire societal makeover. Yet with recent developments, that goal, if not utopia, might finally be within our reach.

As Our Health, Our City documents, the current situation is anything but utopian. In 2021, 55 per cent of adults in Toronto described their mental health as excellent or very good, down from 71 per cent in 2017.

Youth are faring even less well, with just 44 per cent reporting excellent or very good mental health in 2019, and more than one in six saying they have contemplated suicide.

Needless to say, this has increased the demand for mental health services, and that demand has frequently gone unmet: In a 2021 report, the Canadian Institute for Health Information found that half of Canadians wait up to one month for ongoing counselling, while 10 per cent wait for at least four months.

Sadly, youth are also faring less well on this metric. In 2020, Children’s Mental Health Ontario reported that children wait an average of three months for intensive treatment, and some remain on wait-lists for two-and-a-half years.

While waiting for help, many people self-medicate, thereby fuelling the overdose crisis. In 2022, more than 500 Torontonians lost their lives to opioid toxicity, a 271 per cent increase from 2015. That, however, pales in comparison to the damage done by alcohol, which claims more than 800 lives in Toronto each year.

As with mental health services, this has led to increased demand for treatment. And as with mental health services, that demand has gone unmet, the result being that, yes, people are “being hospitalized or dying before receiving care.”

Our Health, Our City therefore recommends the full panoply of prevention, harm reduction and treatment supports, along with programs to promote mental health across the lifespan. These are not novel recommendations, but they’re necessary ones nonetheless.

What is novel — or more accurately, what is utopian — is the impassioned emphasis on addressing the social determinants of mental health. Virtually everything affects mental health, stresses the strategy, including “access to quality housing, ease of commuting through the city, exposure to green space and the ability to exercise and access nutritious food.”

The strategy therefore recommends that in addition to improving mental health and addiction services, we must create, among other things, more affordable and supportive housing, better income supports, food security programs, and increased access to education, employment services and green space.

This utopian vision might seem like so much wishful thinking. We’ve introduced such best laid plans before, but they’ve inevitably gone awry, casualties of insufficient cash and limited support from other orders of government.

This time, however, things could be very different. The recently announced accord between Ontario and Toronto will provide at least $9 billion for the city — a sum that, according to Mayor Olivia Chow, will allow us to build “complete communities with child care, community centres, parks and more.”

The accord also includes significant funding specifically earmarked for transportation and housing, including $600 million in operational support for shelters and homelessness prevention.

However, that sum will be conditional on federal funding for asylum and refugee claimants, and some of the funding for transportation will similarly be contingent on federal support. It’s therefore incumbent on Ottawa to join the city and the province in improving mental health for everyone.

Because doing so is now within our grasp. And because mental health is everyone’s responsibility. And most of all, because no one should die before receiving care.