One of the important learnings of my time as mayor of Toronto has been that around every corner – whether you are dealing with the issue of housing and homelessness, with policing, with public health, with transit or employment – you will find the issue of unaddressed mental health and addiction needs. I am careful in my use of the word crisis, but I think mental health in our cities is a crisis.

It’s something we contend with as an employer of more than 33,000 Toronto public servants, with the stresses and strains on our own front-line workers. It’s something we contend with trying to keep people safe, and housed, and making sure they have access to employment and opportunities. It is an issue that we hear about from the police and the TTC and our public health nurses and our community centres and our 311 staff, and, of course, our diverse residents from every walk of life. It is something that affects every demographic and every neighbourhood in what is the largest and most diverse city in Canada.

But even though the issues of mental health and addictions affects so much of our work and represents a growing pressure across so many of our budget lines, no one is in charge of a city’s mental health. We do not have a division tasked with just that issue, we do not have a designated funding stream or provincial or federal ministries of mental health that are driving funding and policy development specifically in this field. There is no coordinated national approach, or shared set of objectives and best practices when it comes to urban mental health.

And, as a country, we have not yet had a frank conversation about the very real budget pressures that unmet mental health needs are placing on our cities, how it is straining our resources and impacting our residents. Because, increasingly, it is cities who are on the front lines of our nation’s unmet mental health issues. Cities are where the majority of Canadians live and we know that mental illness is experienced by one in three Canadians during their lifetime.

I tabled the topic of mental health at a meeting of Canada’s Big City Mayors last November, and again this January. I talked about the complex issues of mental health and addiction that are often faced by low-income, vulnerable Torontonians who are also impacted by issues of systemic racism, trauma, violence, and other forms of discrimination and marginalization. I talked about how we see these issues in our efforts to provide low-barrier access to our emergency shelter system, and how 24,000 of our Toronto Community Housing households include at least one person with a mental illness. I talked about areas like our downtown east, where there is a concentration of poverty and people struggling with mental health and addictions issues that requires real collaboration and real action.

I thought, perhaps, that this was an issue that Toronto was alone in facing. But after I was finished, every single mayor around that table started talking about how the issues of mental health and addiction was manifesting in their municipalities, from Saskatoon to Halifax to Vancouver to Kitchener-Waterloo. As one mayor put it: the feds have the money, the province has the jurisdiction and the cities have the problems.

On Monday at the University of Toronto’s Hart House, many of these mayors will convene at my invitation for the Mental Health and Cities Summit. At this summit we will be asking attendees to help us answer some important questions. How do we better address the upstream issues of mental health to keep our citizens healthy? How do we support urban university campuses in keeping their students healthy and strong, especially those from marginalized communities? How do we measure these issues and learn from available data while protecting the privacy of our citizens? What are the best practices? What should we try? And, most importantly, what do we need?

I want this summit to result in real recommendations to our provincial and federal partners. Because this is a reality for our city and far too many of its residents every single day. We can and we must do better.

John Tory is mayor of Toronto.

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