There is a mental health crisis in Toronto.
- The number of people visiting CAMH’s Emergency Department (ED) due to amphetamine use (mostly methamphetamine) increased by more than 700 per cent between 2014 and 2021.
- The number of people requiring inpatient admission at CAMH due to amphetamine use (mostly methamphetamine) increased by nearly 300 per cent between 2014 and 2021.
- Across Ontario, there has been a 15x increase in amphetamine-related emergency department visits over the last 20 years.
- The number of youth visiting CAMH’s ED due to substance use problems increased by 50 per cent between July 2022 and January 2023.
- Nearly 50 per cent of youth visiting CAMH’s ED and receiving outpatient care have some symptoms of psychosis.
- The risk of death for someone in late adolescence or early adulthood (aged 16-29) in the first year of a psychotic episode is 13x that of someone of the same age in the general population.
- 10,702 people were homeless in Toronto between November 2022 and January 2023 with shelters at critical capacity.
We need actionable solutions and urgent investments in programs that will make a difference.
CAMH is proposing evidence-informed early intervention and treatment solutions that target serious mental illness and substance use disorders and can make an immediate impact. It is imperative that we take a multi-pronged approach to tackle this issue—addressing not only the immediate needs, but also the causes of this crisis. There must be a real and ongoing commitment to address poverty and homelessness in the city.
Our recommendations are:
- Urgently ensure that Toronto’s substance use treatment system is set up to deal with an influx of people who use methamphetamine and other stimulants by investing $500,000 to establish a Rapid Access Addiction Medicine (RAAM) clinic and Hub with related supports for methamphetamine and other stimulant users in the city.
- Investing $1.2M/year over three years to scale up the effective and proven ‘NAVIGATE’ Early Psychosis Intervention program across the province so that young people in Ontario can live healthy and productive lives, regardless of their mental health condition.
- For all levels of government to invest to ensure that 18,000 new, affordable, good quality supportive housing units are available in Toronto by 2030.
CAMH is ready to support all levels of government tackling this crisis. To begin this work, CAMH has formulated a three-pronged approach of both short- and long-term solutions to start to alleviate Toronto’s mental health and addictions crisis.
- Substance Use Treatment
New substance use trends and increasing drug usage are complicating the mental health crisis in the city.
Data shows that the City of Toronto is currently experiencing a significant increase in the use of stimulants, particularly crystal methamphetamine (meth). Methamphetamine use is associated with heightened agitation, fear and violence. Delusions and hallucinations are common.
Methamphetamine’s widespread availability and inexpensive price tag are making it a drug of choice for many of those experiencing substance use issues. Treatment programs for methamphetamine use have historically proven to be extremely effective but are severely limited in the city.
Toronto’s substance use treatment system is not currently set up to deal with an influx of people who use methamphetamine and other stimulants. Existing services do not have the capacity or expertise to meet the needs of this population.
Investments are desperately needed to expand substance use treatment programs and services for this population, and particularly a stimulant-focused Rapid Access Addiction Medicine (RAAM) clinic and Hub with related supports.
RAAM is a type of walk-in clinic that provides people who use substances with immediate access to treatment and referrals to community services. Right now, there are limitations to the typical RAAM approach because existing clinics do not usually provide psychiatric assessment services (which are frequently required by people using methamphetamine and other stimulants) and often lack appropriate interventions for this population of substance users.
While there has been much-needed focus on the opioid crisis, there have been less resources for other substance-using populations and government investment to create a stimulant-focused RAAM and Hub would add a much-needed service to the treatment landscape. With nominal funding, CAMH and our partners are in a position to open a stimulant-focused RAAM clinic and Hub within the next three months. This RAAM clinic and Hub could provide treatment to at least 250 methamphetamine and other stimulant users in the next year.
Recommendation: We are calling on the City of Toronto to work with the Government of Ontario to invest $500,000 to establish a RAAM clinic and Hub with related supports for methamphetamine and other stimulant uses in the city.
- Early Intervention
One of the most serious and potentially life-altering mental illnesses experienced by youth is a first episode of psychosis. While evidence-informed interventions do exist, many young people in Ontario are unable to recover due to the inconsistencies in care provided by early psychosis intervention (EPI) services across the province. This can result in life-threatening consequences; suicide is the main cause of death in young people with psychosis, and the risk of death in the first year of a psychotic episode is 15x that of a person in the general population. Early psychosis programs have been shown to decrease that risk of death by 4x.
To improve the lives of young people with early psychosis, CAMH and our partners across Ontario are currently working to scale up the ‘NAVIGATE’ program, an evidence-based outpatient program specialized in treating youth aged 14-35 who are experiencing psychosis. NAVIGATE is an evidence-based, structured and cost-effective way to ensure that EPI services across the province provide standardized, quality care and improve outcomes for people with psychosis. It has been shown through rigorous clinical trials to be superior to standard mental health care.
NAVIGATE provides standardized, manualized interventions using four key pillars: medication to treat the acute effects of psychosis, individualized resiliency training, family education (to support family members), and supported employment and education. Collectively, this type of team-based care helps reduce the risk of suicide and violence, and gives a person the best chance of recovery.
With investment from the province, CAMH and our partners can use our combined expertise, resources and structures to improve EPI services across Ontario and make a real difference in the lives of young people with psychosis. Investments will provide education, training and resources to improve the consistency and quality of care offered to our young people with early psychosis. We have already expanded the NAVIGATE model to several community sites across the province from north to south, and have the potential to expand across all 52 EPI services across the province. This would create a true system of care in Ontario, ensuring every person with early psychosis has access to gold-standard evidence-based care. We know that investment in young people is an investment in the future.
Recommendation: We recommend that the Government of Ontario invests $1.2M/year over three years to scale up the NAVIGATE program across the province to ensure that young people in Ontario can live healthy and productive lives, regardless of their mental health condition. These funds would be used to train new sites and ensure every region in the province can deliver the best care for those dealing with early psychosis.
- Supportive Housing
We know that safe and affordable housing is crucial for mental wellness, as mental health, addiction, poverty, and housing are inextricably linked to one another. Without urgent action to improve access to affordable and safe supportive housing, we will not see an improvement to the current crisis. Supportive housing — housing that provides both a home and mental health and addictions supports — leads to improved personal, health and social outcomes for people with mental illness, including those with serious mental illness who have long histories of hospitalizations, trauma, and complex needs. Supportive housing benefits communities and contributes to long-term cost savings for governments.
Enhanced and sustained investment in supportive housing is crucial for addressing Toronto’s mental health crisis in the long-term. We need commitment from all levels of government to build and sustain affordable housing with a range of support options for people with serious mental illness.
One important initiative is the Toronto Supportive Housing Growth Plan, an evidence-informed and sector-driven strategy to expand the supportive housing system in Toronto to meet the needs of people with serious mental illness and end chronic homelessness. The 10-year strategy aims to assist the city to achieve its target of creating 18,000 affordable, supportive homes by 2030. The Toronto Alliance to End Homelessness — the organization responsible for moving the strategy forward — recently provided a list of specific commitments that the provincial government could make this year to help contribute to the success of the strategy. The growth plan itself includes recommendations to all levels of government on how they can support the creation of supportive housing in Toronto. These investments are needed to build more affordable housing, provide more rent supplements and ensure that people living in these homes have the supports they need to live successfully in the community.
We have the plan, we just need action.
Recommendation: We are calling on the Federal, Provincial and Municipal governments to ensure that 18,000 new, affordable, supportive housing units are available in Toronto by 2030.