There’s some turbulence in Ontario’s public service and worry among mental health advocates following the surprise shutdown of a unique program providing comprehensive mental health services to some of the province’s most troubled at-risk young people — those who are also caught up in the justice system.
The decision is being broadly questioned and the stated reasons for the closure are looking increasingly shaky.
The specialized program at Oakville’s Syl Apps Centre (SAYC), managed by Kinark Child and Family Services, was among 26 youth justice centres shuttered by the Ministry of Children, Community and Social Services (MCCSS) this spring because the ministry determined that the program was underutilized. However, it turns out that the program has a high utilization rate (75 to 80 per cent) of its 24 beds over the past three years, a metric that was apparently not well-understood at MCCSS. For example, it is reported that the other youth justice facilities closed by the province earlier this year had average occupancy rates of only 20 per cent.
On top of this, the ministry asserts that the high-risk kids (aged 12 to 18) previously served by the Kinark program will be covered off elsewhere in the system. This is being challenged by hospital CEOs, child and youth mental health and youth justice providers and youth justice advocates such as Children’s Mental Health Ontario, the Centre for Addictions and Mental Health and former Ontario deputy ministers, including George Thomson, a former family law judge.
For the past decade, SAYC has had the only secure program in the youth justice system designated and capable of providing this specialized mental health treatment capacity, which includes on-site forensic psychiatry, nursing and highly specialized assessment and counselling services.
System insiders and advocates for the retention of this sort of program tell me that since 2004, Canada’s Youth Criminal Justice Act has been successful in diverting over 80 per cent of youth offenders from various forms of lockup. The remaining 20 per cent are the tough cases by definition and of these SAYC clients are at highest risk.
Here’s what this means: SAYC clients had, on average, four mental health diagnoses, some with concurrent addiction; the majority required major psychotropic medications; 51 per cent have attempted suicide and 63 per cent have a history of significant self-harm; the majority are racialized (Black, Indigenous), 35 per cent are Crown wards, 10 per cent are from the north, and many have concurrent developmental issues.
One of the immediate consequences of the program closure is that some former clients of SAYC in crisis have ended up in high-demand, expensive hospital beds. Not surprisingly, hospital CEOs have been ringing alarm bells with Health Minister Christine Elliott. The minister has been warned that the risks from the loss of this program include uncoordinated programming resulting in worse outcomes and elevated risks for these clients and to others — all of which result in higher costs for government and taxpayers.
Worse still, the closure decision appears to have been made without advance discussions with key partner ministries, including health and the attorney general, nor the many service providers who MCCSS assumed would be picking up the pieces, let alone the province’s mental health organizations. So it should have been a wake-up call when hospital CEOs wrote to the minister last month concerned about former youth clients ending up in Ontario’s already overworked hospitals.
Given the important context of joined-up and connected government, which I championed as a public service leader, this decision seems to have been made without much or any consultation with partners in other ministries across government — including the Ministry of Health which in February paradoxically saw its minister announce a $10.5 million boost in mental health spending. Another stream of programming at the Syl Apps Centre, which provides similar care to youth not involved in the justice system, was one of two recipients.
In her announcement, Health Minister Christine Elliott said “Our government is continuing to fulfil our promise of making mental health and addictions a priority and ensure Ontarians have the services they deserve — when and where they need them.”
Since the Ministry of Health already has broad responsibility for mental health programming it would make sense for it to take on the Syl Apps program. It would be an important step toward a more joined-up and integrated youth mental health system.
As things now stand we are likely to go backwards and nobody wants that, least of all the premier and his cabinet whose competence in managing the COVID-19 crisis is under close scrutiny. The pandemic is intensifying the mental health crisis in Ontario and across the country while at the same time providing some cover for what looks like a high-risk program cut. Someone needs to get on top of this. A fast-track second look by an independent reviewer would be a good start.
Tony Dean is an independent senator representing Ontario. He is a former head of Ontario’s public service and former public policy professor at the University of Toronto.