Host: People with depression and other mental health issues are encouraged to ask for help to get treatment and support and there are various treatments available at least in theory. In reality though, how accessible are they in Ontario. I got insight into access weight times and the state of our system from Camille Kenville, CEO of the Canadian Mental Health Association Ontario Division.

Camille Kenville: I'm great. Nice to be with you.

Host: It's awesome that you can uh be here with us to talk about it. I want to talk big picture first. How would you characterize the level of access for people in this province when it comes to mental health services?

Camille Kenville: Not really as good as it could or should be. Uh there is a lot of work happening to make it better. We are uh working with multiple partners uh across uh both the hospital sector, primary care partners and other nonprofit organizations. All of us trying to collaborate and find ways to make sure that people are getting the services that they need. And we are, I would say, um not nearly as coordinated as we could be on the ground. Uh probably difficult for people to navigate and find the kind of care they need. We're very cognizant of that. and really very interested in ensuring that people know and understand that the community-based system is there to serve them and that we are uh very interested in keeping them out of emergency departments and and even out of their doctor's office and and we can provide the kind of support that they likely need directly uh without having to access those other two um two groups.

Host: when it comes to closing the gap, to what extent is it about resourcing and funding versus sort of the overall design and efficiency of the system?

Camille Kenville: Well, it's a little bit of all of that mix if you want the truth. So, the the design of the system is one in which we're we're not linking uh as as efficiently uh as we might be able to. And I think again there's a lot of effort and energy happening on the primary care front and that is without question where we need to make sure community is connected. The vast majority of people who are looking for support are going to their family physician if they have one. Um and ideally they are are getting a referral to a community-based provider or they're getting some kind of care or treatment through that individual. Um but you know at the end of the day it is a it is a fractured system in the sense that we have multiple providers and and not necessarily the means to to help people get to the exact kind of care they need and you know obviously out of the worst case scenario which is sitting in an emergency department.

Host: Camille, so you had mentioned primary care doctors. As we know, uh not everyone in this province has access to a primary care doctor. It seems like is that is that the first place uh people should be going if they are struggling?

Camille Kenville: Well, to be honest, hopefully not. Uh hopefully there is uh an ability to navigate into community um and to a provider on the ground. Um there is also the Ontario structured psychotherapy program which for many many people who have mild to moderate uh issues are able to access and receive services entirely free of charge. It is a um a fantastic program that gives great accessibility. People can access it as they wish. Uh they learn cognitive behavioral therapy skills. These are skills they can use throughout their lifetime. Anything we can do to really reduce the burden on the acute care system is is uh always our goal in community and to provide the kind of services and resources that people need to stay out of stay out of doctor's offices.

Host: Even there are a whole new suite of cutting edge technology uh for depression anxiety and there's a lot of excitement around it. In our previous interview, uh, psychiatrist Roger McIntyre said he's the most hopeful he's ever been in his three decade career. Do you share that same optimism?

Camille Kenville: I am incredibly enthusiastic about what's happening in the mental health uh, and addictions world and particularly in mental health where we're seeing uh, as you point out new treatments and uh, new methods in which uh, people can get the help and support that they need. Uh we've really suffered with stigma for a very long time in this not only in terms of how people uh either avoid seeking treatment and suffer silently or um really not having the investments to be able to make these kinds of new uh modalities and serving people available. So it is an incredibly exciting time. It's fun to talk to psychiatrists and others who uh have a renewed joy with their work. And we're seeing places like Sunnybrook, the the Gary Hervitz brain sciences program, which I recently had the chance to have a look at. And it is so wonderful to see physical health care and mental health care coming together into one space where there's no stigma and people can come in and get the kind of care they need in the same way that you would access needing an MRI or any of those kinds of treatments. And that is leading edge and so forward thinking and and it's really wonderfully exciting for all of us who have spent a lot of time in their career in mental health.

Host: When you talk about access, we do have to talk about costs and I am curious some of these treatments uh such as ketamine uh for depression can be administered in just a few sessions. Um I am curious are they potentially less expensive than any other forms of treatment?

Camille Kenville: Well, the treatments that frankly we are most familiar with in community are are services that are um available to individuals in in group sessions, in one-on-one sessions, and in ways that that uh avoid having to go the treatment resistant route, which ketamine uh serves. Um so, our world is slightly different in the sense that we're really working one-on-one with individuals. We provide case management. uh we provide services to individuals with very serious and persistent mental illness uh through uh supports that that really meet them where they're at. Um and so the medical world will manage ketamine and be able to provide those services and and ideally bring people out of what has been a long journey as they have been treatment resistant. Now we have these new treatments. Of course, early days for some of these, but do people in this province have proper access to them? Of course, there's lots of excitement and people are probably itching to kind of see is this something that will be suitable for them, but will they have access to it?

Camille Kenville: Well, that that is a a very good question and quite honestly, we have gaps throughout the system and we have geographical gaps as well and it does look different depending on where you are in the province. Though this is something that we routinely advocate for, not just in terms of these unique and new emerging modalities and technologies in some cases, but really for everyday services that people need to access, whether it's um you know uh the ability to have a a home uh through supportive housing, the ability to get the kind of care and treatment for uh bipolar issues, depression, all of these things. Um, you know, we really would like a level playing field across this province where anybody who is diagnosed knows exactly what they can expect in terms of their treatment, in terms of their trajectory within the system. There's great progress being made in building standards around some of this work and we're happy to be part of that, but we we've got a long way to go.

Host: with that. What's one recommendation that you have that could improve access in general uh to mental health services in this province?

Camille Kenville: Well, it's hard to really think about one, but [clears throat] I have an obvious bias towards the community-based system. I think as I travel the province and and visit with our 27 branches and I see what's happening on the ground, it is really in some ways uh the the heart and soul of the system. And if we can put energy and resources into uh my colleagues who are doing the incredibly difficult work of serving the homeless, serving people who have very serious uh illnesses, including uh young people, including individuals who uh have been disenfranchised for various reasons, some who have addictions. If we could put the resources there where it's much more efficient to keep them uh stable and ideally on their medication and outside of the acute care system, saving those resources are really important for those who need that level of care. And I think we could just be doing a great deal more in community and and I know my colleagues would uh ideally love to see much of their work expand.

Host: We're going to leave it there. Camille, thank you so much for your insights. Really appreciate you joining us on the rundown. It's been my pleasure. Thank you.