Navi Boparai, Matthew Hollingshead, and Stephen Canning
Global mental health systems are at an interesting juncture; there is growing awareness and understanding of mental illness; however, there remains significant unmet public needs for care. Alongside this awareness are demands for greater access, improved quality and evidence-based interventions. To address these issues, the Centre for Addiction and Mental Health (CAMH) has adopted systemic design perspectives to drive towards arcs of impact via its strategic plan. CAMH is Canada’s largest mental health teaching hospital and one of the world’s leading research centres in its field, with an additional advocacy agenda to shift attitudes and eliminate stigma around mental health. The history of the field, evolution of patient care and entrenched cultural attitudes all have an impact on relational approaches in the mental health context, where in many cases, system fragmentation is exacerbated by these factors and contributes to how system interventions evolve over time.
This paper explores the progression of strategic plan implementation utilising relationality as an instrument to build health system resilience in both the aspirations for change and in the mechanics of delivering change. Three strategic directions and three drivers form the foundation of a bold strategic plan, including the need to consider mental illness across the lifespan—getting to people earlier in the care trajectory and intervening at key points in patients’ lives to promote brain health, improve outcomes and prevent people at all stages of life from developing serious and chronic illness. ‘Getting Upstream’, as we have described it, requires novel models of care with a renegotiation of how relationships and power dynamics on care teams take shape. ‘People and Culture’ or the way our organisational culture functions unveils interrelationships as the core of our working culture with a direct impact on quality of care, and ‘Lifting Societal Health’ outlines the need to honour relational factors in order to achieve our goals to reduce health disparities amongst marginalised groups.
Relationships and interdependencies being at the centre of strategic plan implementation invite systemic design approaches to unlock meaningful change agendas, and through the creation of three taskforces to support “Getting Upstream, People and Culture and Lifting Societal Health” opportunities to shift paradigms emerge. This paper outlines the role of taskforces and systemic design models to harness the past, present and hope for the future in the context of relationships within a fragmented system to initiate and sustain longitudinal change.
Keywords: systemic design, health system transformation, mental health, complex social issues