On March 21, 2018 the Ontario’s Office of the Premier announced that “Premier Kathleen Wynne visited the Centre for Addiction and Mental Health in Toronto to announce the biggest provincial investment in Canadian history in mental health and addictions services -- a four-year investment of $2.1 billion that will reframe the system to deliver more accessible and better integrated care” (Ontario Making Historic Investment in Mental Health Care, 2018). Sadly, following a June election, on July 26, 2018 it was announced that this decision had been reversed. Robert Benzie (2018) reporting for The Star reported, “…instead of delivering, the premier is dragging Ontario backwards. The premier has cut $2.1 billion over four years and replaced it with $1.9 billion over 10 years.” “The premier’s cut of $330 million annually is not going to end the crisis that we continue to have in mental health care in this province” (Benzie, 2018).
The Canadian Mental Health Association (CMHA) (n.d.) reports that “mental illness affects one in five Canadians and has a profound impact on individuals and families, as well as exacting costs on society.” “The economic burden of mental illness — reflected in the costs to society of health care utilization, lost productivity due to absenteeism from work and long-term disability, and deterioration in health-related quality of life — is estimated to be $51 billion per year in Canada” (Lim et al., 2008). The opioid crisis in Canada is further straining mental health and addictions resources, so much so that “the growing number of opioid-related overdoses and deaths [has been declared a] national public health crisis… [and] the Minister of Health has made addressing this crisis a top priority” (Canada, 2017).
In response to the opioid crisis, the Government of Canada published the “Federal Action on Opioids” (2017). This publication highlighted that:
British Columbia has been at the forefront of this crisis, declaring a public health emergency in April 2016. However, the impact of the crisis is now being felt, to varying degrees, in many communities across the country - from inner cities to suburbs as well as in northern and rural communities and in First Nation communities. Problematic substance use has historically been viewed as a problem for a certain segment of society and has long been stigmatized. But the current opioid crisis has highlighted that problematic substance use is a public health tragedy affecting all socio-economic, gender and age groups.
This paper will highlight some divergences between the provinces of Ontario and British Columbia in terms of regional difference in response to the opioid crisis and how determinants of health are being subsequently affected.
The Government of Canada is taking a leadership role in addressing the opioid epidemic, which is responsible for approximately 10 deaths a day across Canada (Canada, 2017). On November 18 and 19, 2016, the Federal Minister of Health hosted the Joint Statement of Action to Address the Opioid Crisis bringing together federal, provincial and territorial representatives, as well as over 30 interdisciplinary stakeholders, to work collaboratively in developing an action plan to address the crisis (Canada, 2017). It was clear that “no one level of government or single sector can address this complex social, health and safety issue alone. Reversing the trajectory of the current overdose epidemic is a shared responsibility and requires collaborative action by many stakeholder groups and all levels of government across health, public safety, social, legal and economic sectors” (Canadian Centre on Substance Use and Addiction & Health Canada, 2017). In response to the “Joint Statement of Action”, each province and territory published their commitments in addressing the crisis. These commitments, addressing social determinants of health in response to the opioid crisis, can be found here.
Although the opioid crisis is described as a health crisis, the reality is that many determinants of health have led to this crisis, and the responses, similarly, must address these determinants. For the response to be effective, “policies and programs must address individuals, their connections within the community and the broader environment in which they live” (CMHA, n.d.). The three most significant determinants of mental health are social inclusion, freedom from discrimination and violence, and access to economic resources (Keleher & Armstrong, 2006).
Being the hardest hit province thus far, British Columbia has led the way, in partnership with the federal government in responding to the opioid crisis. In July 2017, British Columbia promoted New Westminster’s MLA, Judy Darcy, as B.C.’s first, and Canada’s only, Minister of Mental Health and Addictions. In her current role, “the minister’s highest priority has been tackling the opioid overdose crisis through increased access to naloxone and expanded treatment and recovery options” (BC Pharmacy Association, 2018). In contrast, Ontario designated their “Chief Medical Officer of Health as Ontario's first-ever Provincial Overdose Coordinator” and did not create a governmental position specifically to tackle this complex issue (House of Commons of Canada, 2017).
The BC government is also leading the way in terms of harm reduction. In September 2003, Vancouver Coastal Health Authority, opened North America’s first supervised injection site (Vancouver Coastal Health, n.d.). In response to the opioid crisis, several more sites opened in 2016. How these sites address their consumers determinants of health is clear the moment a person enters the site. Stigmatized and punishable by law, substance use has historically taken place in hidden dark alleys and behind locked bathroom doors. Sadly, these individuals are the ones most at risk from opioid overdose death. Using alone is one of the most dangerous contributing factors associated with overdose fatalities; Not surprisingly, 85% of deaths by overdose had no associated 911 call (BCCDC, 2018). Supervised consumption sites are clean, welcoming and warm. Staffs working in these front line, harm-reduction based, sites incorporate empathy, dignity, respect, unconditional positive regard and understanding of the inherent value of every person’s life into their daily practice. They respect the right of the substance user to choose to use drugs as well as their right to have options to use drugs safer. These sites directly address health determinants such as social inclusion, freedom from discrimination and violence, and access to economic resources.
While the Canadian Federal Government continues “to use all the tools at its disposal to respond to the crisis while being a strong partner and encouraging parallel action from provinces, territories, municipalities, health care practitioners, law enforcement, and civil society” it seems that Ontario might be pulling back it’s commitment to address this crisis (Canada, 2017). “While mental health promotion is everyone’s business, the Government of Ontario must assume leadership in developing a coordinated strategy to increase social inclusion, freedom from violence and discrimination, and opportunities for economic participation; and dedicate appropriate resources to do so” (CMHA, n.d.).
References
BC Pharmacy Association (2018, November 27). Meet B.C.’s Minister of Mental Health and Addictions Judy Darcy. Retrieved February 16, 2019, from https://www.bcpharmacy.ca/news/meet-bcs-minister-mental-health-and-addictions-judy-darcy
BCCDC (2018). By the Numbers: The Opioid Overdose Emergency in BC. Retrieved from http://www.bccdc.ca/resource-gallery/Documents/Educational%20Materials/Epid/Other/Infographic_Opioid_Emergency_in_BC.pdf
Canada, H., & Canada, H. (2017, August 23). Federal Action on Opioids [transparency - other]. Retrieved February 16, 2019, from https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/federal-actions.html
Canadian Centre on Substance Use and Addiction & Health Canada (2017). Joint Statement of Action to Address the Opioid Crisis: A Collective Response (Annual Report 2016–2017). Retrieved online from http://www.ccsa.ca/Resource%20Library/CCSA-Joint-Statement-of-Action-Opioid-Crisis-Annual-Report-2017-en.pdf
CMHA Ontario. (n.d.). Mental Health Promotion in Ontario: A Call to Action. Retrieved February 16, 2019, from http://ontario.cmha.ca/documents/mental-health-promotion-in-ontario-a-call-to-action/
House of Commons of Canada. (2017, April 11). GOVERNMENT RESPONSE TO THE REPORT OF THE STANDING COMMITTEE ON HEALTH ENTITLED Report and Recommendations on the Opioid Crisis in Canada. Retrieved February 17, 2019, from https://www.ourcommons.ca/DocumentViewer/en/42-1/HESA/report-6/response-8512-421-134
Keleher H. & Armstrong R. (2006). Evidence based mental health promotion resource. Retrieved online from https://www2.health.vic.gov.au/about/publications/policiesandguidelines/Evidence-based-mental-health-promotion-resource---entire-resource
Lim, K.-L., Jacobs, P., Ohinmaa, A., Schopflocher, D., & Dewa, C. S. (2008). A new population-based measure of the economic burden of mental illness in Canada. Chronic Diseases in Canada, 28(3), 92–98. Retrieved online from https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/publicat/hpcdp-pspmc/28-3/pdf/cdic28-3-2eng.pdf
Ontario Making Historic Investment in Mental Health Care. (2018, March 21). Retrieved online from https://news.ontario.ca/opo/en/2018/03/ontario-making-historic-investment-in-mental-health-care.html
Benzie, R. (2018, July 26). Tories blasted for $335M cut in planned spending on mental health. Retrieved online from https://www.thestar.com/news/queenspark/2018/07/26/tories-blasted-for-335m-cut-in-planned-spending-on-mental-health.html
Vancouver Coastal Health (n.d.) Insite - Supervised Consumption Site. Retrieved February 17, 2019, from http://www.vch.ca/locations-services/result?res_id=964
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