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Mental health service delivery in Ontario, Canada: how do policy legacies shape prospects for reform?

Published online by Cambridge University Press:  01 October 2007

GILLIAN MULVALE ,
JULIA ABELSON  and
PAULA GOERING
GILLIAN MULVALE*
Affiliation:
Centre for Health Economics and Policy Analysis, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
JULIA ABELSON
Affiliation:
Centre for Health Economics and Policy Analysis, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
PAULA GOERING
Affiliation:
Health Systems Research and Consulting Unit, Centre for Addictions and Mental Health, University of Toronto, Toronto, Canada
*
*Corresponding author: Gillian Mulvale, Centre for Health Economics and Policy Analysis, Health Sciences Centre, HSC 3H26, McMaster University, 1200 Main Street, West Hamilton, Ontario, L8N 3Z5, Canada. Email: [email protected]
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Abstract

Like many jurisdictions, mental health policy-making in Ontario, Canada, has a long history of frustrated attempts to move from a hospital and physician-based tradition to a coordinated system with greater emphasis on community-based mental health care. This study examines policy legacies associated with the introduction of psychiatric hospitals in the 1850s and of public health insurance (medicare) in the 1960s in Ontario; and their effect on subsequent mental health reform initiatives using a qualitative case study approach. Following Pierson (1993) we capture the resource/incentive and interpretive effects of prior policies on three groups of actors: government elites, interests, and mass publics. Data are drawn from academic and policy literature, and key informant interviews. The findings suggest that psychiatric hospital policy produced important policy legacies which were reinforced by the establishment of Canadian medicare. These legacies explain the traditional difficulty in achieving mental health reform, but are less helpful in explaining recent promising developments that support community-based care. Current reform of the Ontario health system presents an opportunity to overcome several of these legacies. Analysis of policy legacies in other countries which had an asylum tradition may help to explain the similarities and differences in their subsequent paths of mental health reform.

Type
Articles
Information
Health Economics, Policy and Law , Volume 2 , Issue 4 , October 2007 , pp. 363 - 389
Copyright
Copyright © Cambridge University Press 2007

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