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This resource was published in 2018. The data may be out of date.
Over the last few decades, more and more countries have come to recognize the immense impact of mental health problems and illnesses — including addiction — on individuals, families and communities. This has driven changes to policy and practice in Canada and other jurisdictions. It has also triggered calls for better data to determine if such steps are having a positive impact and to inform further system change.
This report identifies strategic areas of focus for developing a pan-Canadian information and performance measurement framework specific to mental health and addiction (MHA). Such a framework could be parlayed into a performance measurement system that would make it possible to measure and report on MHA outcomes across the country — stimulating data-informed service change, enabling greater collaboration and making a difference in the lives of Canadians from coast to coast to coast.
The Mental Health Commission of Canada (MHCC) initiated the project that led to this report with four main goals:
Making the case for a framework
A pan-Canadian MHA framework would help focus performance measurement on aspects of Canada’s complex system that are key to effecting change. It would articulate a “system” vision that, ideally, aligns with common policy directions and shared stakeholder values — increasing the likelihood of impact. It would also help ensure balance across sets of indicators, protect against unintended effects, clarify relationships among indicators and reveal gaps (i.e., where indicator development is needed). It would be designed to complement, rather than duplicate, existing and planned provincial/territorial performance measurement initiatives.
The full benefits of a framework could be realized through a pan-Canadian performance measurement system with the capacity to compile and report on common system-level measures and with a forum for sharing improvement practices and solutions across jurisdictions. There are reasons to be optimistic this vision can be realized, including the fact that other federations around the world have established national, system-level MHA performance measurement initiatives. There is also a strong Canadian example in the pan-Canadian performance measurement framework of the Canadian Partnership Against Cancer (CPAC), which includes mechanisms for reporting and collaborative improvement.
This report provides insight into the five key steps involved in developing a performance measurement framework as follows:
Systematic engagement and consultation processes
The task of developing a pan-Canadian MHA performance measurement framework is value-laden, which creates a divergence of opinions. A systematic and intentional approach is necessary to develop a framework and set of indicators that stakeholders can endorse despite their plurality of views. The process of deliberative dialogue used to create the Mental Health Strategy for Canada is an important general model. The research team also found five specific initiatives that involved and reported on systematic processes for MHA service or performance measurement frameworks, which can inform pan-Canadian framework development.
SMEs stressed that engagement must be “meaningful,” which includes a co-designed/participatory process with reflection on and acknowledgement of social-historical context and biases, as well as recognition of who gets to decide and who benefits. This requires time and resources.
Getting from framework to system
Performance measurement has been criticized for stalling at the conceptualization stage. The capacity to regularly generate and report on existing indicators, and resources to develop strategic, aspirational indicators are required to realize the ultimate objective — in this case, to improve Canada’s MHA system. While the plurality of data systems across Canada’s makes coherent performance measurement as challenging within this country as it is between countries in other parts of the world, there are exemplary models for a pan-Canadian system. These include CPAC’s Cancer System Performance initiative, which has been reporting by province/territory since 2009, with indicator values available to all stakeholders online. While the cancer field has some distinct advantages that MHA lacks, it is reasonable to aspire to a system with similar features.
Thinking big, starting small, acting now
The resources SMEs compiled for the current project can inform and support a plan for developing a pan-Canadian MHA performance measurement framework. They are grounded in provincial and territorial policy priorities, features of existing frameworks and lessons learned from systematic developmental processes used for framework development in Canada.
While there is substantial diversity among existing performance measurement frameworks, there is also a richness and depth of approaches that, with thoughtful selection, could inform an effective process and a quality outcome for MHA.
In the research team’s view, work should begin immediately on developing a pan-Canadian, policy-driven performance measurement framework with key stakeholders. Once a framework is in place, existing strategic indicators that fit that framework can be selected and critical gaps for immediate indicator development work identified. With the necessary capacity for indicator development and reporting, the production of a first collaborative pan-Canadian report on MHA system performance is an attainable goal. Ideally, this would include capacity for a mechanism that enables logically connected and collaborative activities aimed at system improvement.
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