Item - 2023.HL3.1

The Board of Health:

1. Requested the Medical Officer of Health to continue to develop the comprehensive Mental Health and Addictions Strategy, which includes the refreshed Toronto Drug Strategy, with targeted actions to address mental health and substance use and present to the Board of Health in fall 2023.

2. Requested the Medical Officer of Health to include the impact of social isolation as a factor towards the development of the Mental Health and Addictions Strategy.

3. Requested the Medical Officer of Health to ensure that the Mental Health and Addictions Strategy for Toronto recognizes and differentiates between the unique challenges and approaches related to mental health compared to those of addictions.

4. Requested the Medical Officer of Health to undertake an Indigenous-specific and distinctions-based approach to ensure that the Mental Health and Addictions Strategy for Toronto be co-developed in true partnership with Indigenous organizations and communities to ensure that approaches and actions that support the unique needs of urban Indigenous people living in Toronto can be collectively activated. 

5. Directed the Medical Officer of Health to continue to support the work of the Drug Strategy Implementation Panel while these new comprehensive strategies are developed.

6. Delegated to the Medical Officer of Health the authority to complete the annual declaration of compliance for the Service Accountability Agreement between Toronto Public Health and Ontario Health, the funder for the Methadone Works – Opioid Substitution Clinic within The Works program.

7. Requested the Medical Officer of Health, in consultation with the City Manager, to convene and chair a Mental Health and Addictions committee of relevant City Divisions and Toronto Public Health, focused on coordinating the City of Toronto's policies and programs related to mental health and substance use.

8. Reiterated its call requesting the Federal government to develop a national framework to permit the simple possession of all drugs for personal use.

9. Requested the Medical Officer of Health to continue working with Health Canada on the conditions that would allow for an exemption approval under Section 56(1) of the Controlled Drugs and Substances Act to decriminalize drug possession within the City of Toronto.

10. Reiterated its calls requesting the Federal and Provincial governments to immediately scale up prevention, harm reduction and treatment services for people who use drugs.

11. Endorsed the Toronto Youth Cabinet’s Joint Statement on Addressing the Rising Mental Health Crisis Facing Children and Youth in Ontario, attached as the Attachment to Motion 1 by Councillor Chris Moise.

12. Requested the City Clerk provide a copy of the Board’s decision to the Minister of Education.

The Director, Toronto Public Health, together with Dr. Tara Gomes, Epidemiologist and Principal Investigator, Ontario Drug Policy Research Network (ODPRN) and Li Ka Shing Knowledge Institute of St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences, and assistant professor at the University of Toronto, and Dr. Andrew Boozary, Primary care physician and the Executive Director of Population Health and Social Medicine at the University Health Network (UHN) gave a presentation on Developing a Mental Health and Addictions Strategy for Toronto.

The mandate of Toronto Public Health (TPH) is to improve the health of the population, reduce health inequities, and prepare for and respond to public health emergencies. In contrast to our health care delivery partners, such as hospitals and community-based health care agencies, public health achieves these objectives using a prevention focused approach, working at the population level. In this context, TPH works to promote mental health and respond to substance use issues across the population, which includes work to prevent and address the harms associated with substances.

The COVID-19 pandemic has negatively impacted mental health and increased the need for services and interventions. An overall increase in the use of substances, such as alcohol and cannabis, has also been observed.1 Further, Toronto continues to be in the midst of a drug toxicity crisis, exacerbated by the continued impacts of the COVID-19 pandemic. In 2021, the Office of the Chief Coroner for Ontario confirmed there were 591 opioid toxicity deaths in Toronto. Drug toxicity deaths are preventable and due in large part to the unregulated drug supply, where unpredictable potency combined with unexpected and concerning substances significantly increase the risk of overdose.

In June 2022, the Board of Health adopted a motion on the need for a mental health and addictions strategy for Toronto, and directed the Medical Officer of Health to update the Toronto Drug Strategy following extensive stakeholder engagement. This staff report provides an update on actions taken by Toronto Public Health to date, and makes recommendations on further steps to develop a Mental Health and Addictions Strategy.

Shelter, Support and Housing Administration (SSHA) and Social Development, Finance and Administration (SDFA) staff were consulted in the development of this report.