The Municipal Role in Mental Health

Abstract

Under the Canadian constitution, provincial governments bear primary responsibility for the delivery of health care and often develop their own strategies to address mental health and addiction. In practice, however, local governments shoulder much of the burden of front-line service delivery, often with limited fiscal resources. With rising rates of mortality due to opioid addictions, and the substantial costs of mental illness – not just to the health care system but also to the social and economic well-being of Canadians – urgent coordinated action is needed. The two essays in this paper set out the municipal role in harm reduction and mental well-being and provide recommendations for action. They argue that while municipalities have a lead role to play, cooperation with other local agencies and other orders of government is essential. Municipalities R. Marcus Hammond, Barb Fornssler, and Elaine Hyshka examine how municipalities can effectively respond to substance-related harm through a harm reduction approach. They argue that Canadian municipalities are well positioned to implement harm reduction policies, programs, and practices across key governance domains and through enhanced intergovernmental cooperation. They provide recommendations for organizational policies and procedures, zoning and land use planning, direct service delivery, and drug policy and enforcement reform that municipalities can adopt to reduce morbidity and mitigate impacts on people, families, and communities. Kwame McKenzie, Rishika Wadehra, Sophie Baker, and Jesse Rosenberg note that municipalities have a front-line role in, and unique perspective on, many social factors that can impact mental health and well-being, including housing and homelessness, racism, climate change, substance use and addictions, and public safety. They recommend that municipalities, as the order of government that knows their context and populations best, bring leaders and communities together and leverage their networks, including community organizations and health-care providers, to develop effective approaches – and they offer a practical blueprint for doing so. McKenzie et al. also provide case studies of cities which have taken leadership roles in well-being. Provincial governments Hammond, Fornssler, and Hyshka note that policy support across provinces and territories is variable. Their recommendations include advocating for harm reduction policies and funding from provincial and federal governments; developing local substance strategies with provincial and community partners; and establishing communications and data-sharing mechanisms with all orders of government over the long term to ensure timely release of policies and health data. McKenzie et al. suggest that all orders of government must widen their focus to consider both population and risk-reduction approaches, including not only making targeted interventions but acting on the structural and social determinants of health to foster greater well-being. Given that many policy and funding levers are provincial in jurisdiction, municipalities can advocate for policy and funding changes to drive progress. This paper also points to the role provinces can play in collecting and providing additional data and making it accessible. Federal government Hammond, Fornssler, and Hyshka note that a harm reduction approach to enforcement and drug policy reform should prioritize connecting people to services rather than punishing them. Accordingly, they recommend decriminalization for minor drug offences alongside other harm reduction approaches, while noting this policy has been controversial to date in areas where it has been tried. McKenzie et al. recommend that the federal government provide funding directly to municipalities and civil society groups to lead efforts on well-being. Intergovernmental Cooperation In both essays in this report, the authors strongly recommend intergovernmental cooperation in a range of areas, including in policy areas that are not within (or solely within) municipal jurisdiction (e.g., criminal justice, income supports, schools, job training). Both essays also argue that enhanced intergovernmental cooperation in the areas of data sharing, funding, and service delivery is needed to more effectively reduce harm and improve mental well-being.