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TORONTO — Canada's mental health crisis demands a national summit with representation from all levels of government, Toronto Mayor John Tory said Wednesday, claiming a lack of provincial and federal support is offloading responsibilities onto "ill-equipped" municipalities.

In a statement, Tory called for a summit that would see mayors, ministers, premiers and the prime minister discuss how better to support people living with mental health and addiction challenges.

Coming out of the COVID-19 pandemic, Tory said the lack of spending on mental health is "painfully clear on the streets" of Canadian municipalities.

"This summit must be the moment we start treating mental health care as health care. That we clearly decide on who has responsibility to do what, and to get on with doing much more together," he said.

The mayor has routinely linked issues of mental health support with recent random violent attacks on Toronto public transit. Police have reported three incidents on the city's transit system in the past four days alone.

After a woman was stabbed to death during a random attack on a subway in mid-December, Tory said more mental health investments were required to ensure people in crisis had places to go other than the transit system.

"When the federal and provincial governments don’t fully and adequately fund mental health care, the responsibility is offloaded to ill-equipped municipalities across Canada," he said in Wednesday's statement.

"It is offloaded to our shelters, to our police services, to our transit systems, and to hospital emergency departments."

Asked to respond to Tory's comments, Ontario Health Minister Sylvia Jones pointed to the province's investments in crisis response teams that match mental health professionals with police officers.

Canada's mental health crisis demands a national summit with representation from all levels of government, Toronto Mayor John Tory said Wednesday. #MentalHealth

"There is no doubt more work needs to be done," said Jones, speaking at a news conference Wednesday morning. "And I am always willing to work with whether it is police forces or municipal governments."

The office of federal Mental Health and Addictions Minister Carolyn Bennett said making mental health-care an equal part of the universal health-care system is a core part of the government's plans.

It said the department is continuously working with provincial, territorial, municipal and Indigenous governments on a comprehensive mental health and substance use strategy.

"The Prime Minister will be meeting with premiers on Feb. 7 to ensure sustainability of our system for years to come, and to ensure our investments deliver real, tangible outcomes, including: reducing backlogs and wait times; ensuring access to family health teams; improving mental health services; advancing use of health data; and supporting seniors," Bennett's office said in an email.

The best evidence of the ongoing mental health crisis is issues related to substance abuse, Tory said, noting the thousands of people who have died from opioid overdoses.

Tory says he first made the proposal for a national mental health summit directly to Trudeau in December.

"Three years ago, we confronted the COVID-19 pandemic and in that moment all governments worked together to help people and to help each other get through those tough times," Tory said.

"Now we are facing a mental health crisis that requires that same level of dedication, co-operation and commitment."

This report by The Canadian Press was first published Jan. 25, 2023.

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Please note the continuing, pervasive, stigma and discrimination against people with substance use problems, present again, here in this article.

Mental health and substance use were ganged together about twenty years ago, and there were good aspects to that--increasing emphasis on evidence-based treatment, and harm reduction, as examples. And a faint attempt at establishing standards for practice. The CCSA launched a national consultative and action program on that--it's still on their website. I don't know that any body has ever implemented it. We know what to do--we just don't care enough to do it. It's too "icky". That's stigma. That's discrimination.

But mental health, with its long roots in medicine and a medical perspective, has always been the dominant sibling. Substance use, with its roots in mutual-aid groups (which benefit many, but not all) and their anonymity traditions, has been in the closet for far too long.

I've worked in both, and lived with both. Every time I saw a merger between a mental health, and an addictions, organization, mental health essentially took over. It's "professional". And the stigma against mental illness has been drastically reduced over time, largely due to the influence of strong and vocal survivors--and some very influential people who have lost family members. Substance use, again largely due to the anonymity tradition, and the absence of any influential people with experience *outside* that tradition, has not.

Fundamentally, no-one thinks any longer that mental illness is chosen. You may not want to sit beside someone with an obvious problem on the bus, but you don't blame them for being ill. Substance use is still seen as a choice, self-willed--including within the medical community. "After all, they can just quit."

The funding differential between the two is astronomical. Including within government departments, federal and provincial.

There is a dramatic difference between the research efforts dedicated to the two health problems. The last time I checked, about four years ago, there was not a single medical school in Ontario that had a mandatory core course in substance use and misuse, its prevention, harm reduction, or treatment. Training in substance use is generally at the community college level, rather than university. Public information has diminished horribly over the years since I retired. Community involvement by senior addiction and mental health organizations has plummeted.

Ontario, years ago, instituted a law addressing fentanyl misuse, accepted by all parties. When the regulations rolled out, every single action that was originally proposed as mandatory, for prescribers and dispensers, had vanished. And then Chinese fentanyl, almost impossible to detect on entry, came in, and that was all she wrote.

We need a hero, a champion. We need a voice. We need action--equal action, equal attention, equal profile, equal funding, equal status.

There are still excellent people in Canada working in high-level approaches to substance misuse--some still in Ontario, many migrated to B.C.

There is knowledge, experience, and wisdom there--and there can be more.

A lot (by no means all, but a lot) of the mental health trouble out there is mass cases of "My-life-sucks-itis". John Tory as mayor of Toronto has mostly worked on making that a more common ailment. Now he wants shrinks for the people he helped fuck up. Well gee thanks.