cityscape How Torontonians are Modernizing the Mental Health Care System

Resources, like the City of Brains Project and 211, help those in the city get the help they need.

Mark Freeman did what many of us do when he experienced mental health issues a few years back: he started looking online for help. In Toronto, many mental health resources can be costly when not covered by the Ontario Health Insurance Plan, and wait lists can be long. Online, he found alternatives. His search led to some great resources (forums, support, community). But some of his findings were problematic; being part of a global community accessing non-global resources, for example, meant that he’d meet someone on a forum with a great lead on a clinic, only to find out the service was located in another continent.

For many, OHIP-covered services are the only option. But what some need is not always what they get. Psychiatrists, for instance, are medical doctors, and are covered by OHIP. But psychologists—and many other types of therapists—are not.

Slide the timescale back 50 years and you’ll begin to find the reasons for this OHIP coverage split: these were times when therapy and counselling were new and confusing to a system built on assumptions of broken bones and hospital stays. Fast-forward to 2016, and while nothing about the coverage model has changed, people are finding new ways to improve their mental health. Torontonians, like Freeman, are instead Googling their way to communities for discussions, support, and resources to find mental health services.

When his search failed him, Freeman decided to improve circumstances on his own, and he founded the City of Brains Project.

Freeman, along with Kejo Buchanan and James Teow, runs the project, which collects stories from people in Toronto about their experiences with the city’s mental health care system. The stories touch on topics such as diagnoses, challenges and successes in accessing care, therapies, medications, and cultural issues.

The project’s site is slowly taking shape via weekly hack nights at Civic Tech Toronto. Buchanan leads on content management and policy, including privacy considerations, and Teow leads on tech and design.

“I think we have always navigated our communities through stories,” Freeman says. “When I tried to get help I bounced from one person to the next, to the next, to the next, trying to navigate the system.”

On its face, the project is not a typical civic tech project: there’s nothing new and shiny here from the tech side. But the project may be stronger for it. It uses standard tech that works (a website and a form) to crowdsource stories. There’s a focus on the stories, not the tech.

Eventually, by examining both good and bad stories of local experiences, the project will begin to build a space to share information about Toronto mental health services.

The project is still in its early days, and the team’s current focus is on collecting stories. Anyone—yes, that means you—can add their story to the project.

“This is a great example of people with lived experience of an issue designing systems from a grassroots upward perspective,” says Ushnish Sengupta, a researcher at the University of Toronto. “Most of the service systems are designed institutionally, top down. In spite of best efforts in terms of consultation and involving users in the design, an institutionally designed top-down system will never be the same as a user-centered and user-designed system.”

Many, like Freeman, opt to use the internet to find mental health services. Others may choose to go to their family doctors. But what if neither of those are options?

Enter 211.

You likely know about 311: it’s the number you dial to learn about City services—your go-to when there is an injured bird on the sidewalk, when you need to know how to dispose of your fridge, when you have questions about your lead pipes.

The Province has now applied that formula to those looking to find programs or services locally—including mental health care. Calling 211 (or heading to their website, if you’re more tech savvy) will help you navigate 18 broad types of programs and services.

If you didn’t know about 211, you’re not alone. As Andrew Benson of 2-1-1 Ontario puts it: “We’ve found that people don’t find us until they need us.” 211 oversees a network of call centres, geographically aligned with Ontario’s 14 Local Health Integration Networks. One of them is open 24/7, so there is always someone there to answer your call.

To get a sense of the kind of data records that 211 uses to answer calls, take a look at the open data set they created in collaboration with the City for youth services (including youth mental health).

Our city is doing well at modernizing how to find mental health services. There’s iamsick.ca, a Toronto-based site to help you find local healthcare options, and Open Referral, which focuses on improved management and sharing of information records data.

But the foundation of our mental health care system—what is covered by OHIP, acceptable wait times, and general access to services—still needs to be modernized. This is the priority upgrade we need—it’s long overdue.

Thanks to Barney Savage for his help in understanding the mental health services landscape in Ontario.

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