These scenarios were used in a reverse archaeology workshop hosted by MaRS and CAMH to explore the future of mental health services. Four groups filled a bathroom cabinet with artefacts from their future world. Full report to come.

1. TALE OF TWO WORLDS
FORCES OF CHANGE
INFRASTRUCTURE INTEGRATION
DEMOCRATIZING HEALTH
OUTCOME ORIENTATION
SOCIAL DISTANCING
After a yo-yoing of government priorities and spending in the early 20s, there are
significant cuts to mental health and social services in the mid-late 20s leaving the
desperate population with little government support and unimaginable waitlists.
While mental health has emerged from the twilight of people’s lives, formal services
are irrelevant for most. With a large population of old, low-income boomers,
marginalized and segregated minority groups in urban areas, immigrants with unmet
health needs, and First Nation, Inuit and Métis communities that have been long
neglected, mental health issues are reaching unprecedented levels, especially related
to chronic stress. Still, meeting the basic necessities of life are a much higher priority
for the majority of the population.
Publicly visible mental health crises are a regular occurrence in communities, with
trained police officers providing the initial response. Segregated population groups
are highly-networked using simple technological advances that allow for monitoring
and instant virtual connection between individuals anywhere. Caregivers rarely stay
at home with the individuals they are caring for, instead they connect with them
regularly while at work or elsewhere. Social enterprises are creatively working to fill
the government void by addressing environmental factors of health and meeting the
needs of targeted population groups, making exciting progress at a small scale.
On the other hand, the small group of elite in Ontario are finding ways to take
advantage of exciting medical advances through private practice, personal
connections or international purchasing. They are obtaining the newest technology,
medications and interventions that enable real time adjustments that ensure mental
health issues rarely interfere with functional abilities.
Can scattered, but purposeful, grassroots efforts combat structural inequities?
Illustration by: Ken Orvidas
TIME LINE
2014 20342024
INCREASING GOVERNMENT DEBT DRAMATIC CUTS TO SERVICES
STRENGTHENING OF TWO-TIERED SYSTEM
Mismanaged govern-
ment spending on
economic stimulus
Prime minister speaks
publicly about mental
health struggles
20 year wait list to
see a publicly-fund-
ed psychiatrist
20 jails built in
Ontario in last
decade
50% of the population in
Ontario identifies as hav-
ing a MH issue

2. DIS/CONNECTED COMMONS
FORCES OF CHANGE
With early legislation to unlock electronic health records and provide open access to
these records, Ontario experienced a digital health boom in the 20s that resulted in
a variety of tools to support communication and collaboration between clinicians,
peers and patients. What emerged from this era was a platform or commons in
which almost all health information, communication and knowledge is linked,
creating a virtual one-stop shop for big data and specific patient information,
despite disparate applications and devices. This infrastructure enables distributed
collaboration between highly-linked providers, empowering all providers, as well as
caregivers and peers, with specialized support to address mental health needs.
Many private companies have entered the market, taking advantage of open
access standards to provide direct-to-consumer products that meet the growing
demand. The product space is fragmented, but offers people choices in supports and
connections. With advanced monitoring and communication techniques, outpatient
visits are a thing of the past. Most patients and caregivers connect with providers,
peers, or businesses through cloud channels. When individuals with mental health
needs do connect directly in with providers, the continuity of this relationship seems
less important because all providers have an instant comprehensive overview of
the individual’s history and preferences, and can make informed decisions with
specialized support.
Ontario mental health services have become a web of products, networked health
care providers and social service providers with protocol for instant and ongoing
collaboration. Specialized mental health providers are easily accessible knowledge
supports for primary providers and informal supporters.
Given the track record of mental health services, will people willingly give over
their privacy for the promise of improved connection and support?
Illustration by: Ken Orvidas
TIME LINE
2014 20342024
DIGITAL HEALTH BOOM
ORGANIZATIONAL LINKAGES AND MERGERS
Ontario makes
it mandatory to
unlock EHRs
2000 new MH
businesses in
Ontario each yr
Patients access EHR &
open access to anony-
mized information
Emergence of
common cloud
medicine platform
All health care providers
are connected to spe-
cialized mental health
INFRASTRUCTURE INTEGRATION
DEMOCRATIZING HEALTH
OUTCOME ORIENTATION
SOCIAL DISTANCING

3. THE PEOPLE ASSEMBLE
FORCES OF CHANGE
As a response to the overburdened, perpetually underfunded mental health system,
people affected have mobilized to support each other and enhance their power
within services. Through greater access to health and medical information, patients
and caregivers are increasingly informed about health choices and connect to each
other for support and knowledge. Citizens are taking needs into their own hands
and are increasingly vocal about their vision for services. The general perception of
mental health is that it is a snowballing issue requiring action and activism.
Instead of stifling this emerging movement, funders and formal mental health service
providers recognized the assets of the community and the economic benefits of a
‘people powered’ approach. The system responds through a shift to client-directed
services, engaging peer supporters, employing group visits, connecting to non-
medical alternatives, and providing some funding for the development of advanced
community support networks.
Through this recovery orientation, individuals are encouraged to build capacity for
long-term self-management with support from tools and advanced social monitoring
techniques. Many feel like it is a new era for mental health survivors and are
celebrating the progress made by people helping people.
Still, individuals with complex and severe mental health issues are neglected
resulting in a rise in homelessness and significant caregiver burden. The system of
services remains fragmented, but individuals cope through social connection, peer
navigator roles and offerings from curatorial health enterprises.
With increased ‘people power’ within the system, how will the relationship
between traditional providers and patients shift?
Illustration by: Ken Orvidas
TIME LINE
2014 20342024
UNDERFUNDED MENTAL HEALTH SERVICES
WIDESPREAD ACTIVISM AND CITIZEN ACTION
Legal case sets presi-
dent for requirement of
shared care planning
LHINs invest in
peer and patient
engagement
Most of patients
seen regularly in
group visits
Mental health
riots in 6 major
cities
Global MH
network reaches
100 M members
25% of staff in
mental health
services are peers
INFRASTRUCTURE INTEGRATION
DEMOCRATIZING HEALTH
OUTCOME ORIENTATION
SOCIAL DISTANCING

4. COLLECTIVE IMPACT
FORCES OF CHANGE
Supported by inter-ministerial collaboration and aggressive funding models,
Ontario becomes a leader in holistic mental health care. Through the creation of
“endowments” for individuals with complex mental health needs, funding enables
extreme flexibility of goods and services to support mental health and wellbeing.
Increased ability for monitoring health outcomes and a shared accountability for
population health has enhanced the integration of services and comprehensive client
outcome tracking. Financial incentives for effective, low-cost interventions have
encouraged health care providers to connect patients to a spectrum of alternative
services, tools and supports including, physical activity interventions and peer
networks. Most services provided are reimbursed based on short and medium-term
health outcome measures.
Many mental health service providers establish a focus on a specific patient
population to improve efficiency and outcomes. This leaves some diagnostic
populations, such as those with obsessive compulsive disorder, significantly under-
resourced in Ontario. While providers support individual medical and lifestyle-based
interventions, governments work at environmental interventions to support health
and ensure that all new policies encourage health equity.
The public perception of mental health is that of a serious problem that needs to
be solved collectively. The conversation has shifted away from individual shaming
toward a reliance on government to meet the diversity of individual needs at every
level, regardless of cost.
With increased demands for collaboration and outcome tracking at all levels,
how nimble will the system be to respond to emerging needs?
Illustration by: Ken Orvidas
TIME LINE
2014 20342024
ENHANCED MEASUREMENT OF HEALTH OUTCOMES
ALLIANCES WITH SHARED TARGETS AND ACCOUNTABILITY
Interministerial
mental health com-
mittee established
“PopCan” partner-
ship of Stats Can
and Health Canada
Performance pay-
ments are 15% of
MH funding
Release of
‘Health in
All Policies’
“Endowments” for
individuals with
complex MH needs
“Operation Out-
comes” changes
payments
INFRASTRUCTURE INTEGRATION
DEMOCRATIZING HEALTH
OUTCOME ORIENTATION
SOCIAL DISTANCING