Can data shape the future of mental health support? – The Guardian 20160907

From: Can data shape the future of mental health support? – The Guardian 20160907

Open data is being used to design resources for people with mental health conditions to help them find the right support

Head on digital screen.

If you’re experiencing a mental health issue, one of the people you probably least want to speak to about it is your employer. Disclosing depression or anxiety has long been seen as the last workplace taboo, for fear of repercussions. This is despite the existence of the Equality Act 2010, which protects employees with physical and mental disabilities from discrimination.

But just over a third of workers with a mental health condition discuss it with their employer, according to a survey of 1,388 employees carried out by Willis PMI Group, one of the UK’s largest providers of employee healthcare and risk management services. The research found that 30% of respondents were concerned that they wouldn’t receive adequate support, 28% believed their employer wouldn’t understand, and 23% feared that disclosing it would lead to management thinking less of them.

A culture of fear and silence can have a huge impact on productivity – the charity Mind estimates [pdf] that mental ill health costs the economy £70bn a year. The challenge is that seeking help involves taking ownership of the problem, says Mark Brown, development director of social enterprise Social Spider and founder of the now defunct mental health and wellbeing magazine One in Four. And finding support online can be a time-consuming and frustrating experience.

“Just serving up ever great slabs of information – the internet is awash with it – isn’t going to help anyone to know what to do,” says Brown. “We often confuse the provision of information with the solving of problems. Knowing information is different from knowing how to put that information into action.”

Brown believes that bringing together information with public and open data into a single digital space is one way that could innovate how advice is delivered.

Plexus is aiming to achieve just this. Built by the digital studio M/A, with funding from the Open Data Institute, the knowledge base is being used to design resources for people with mental health conditions, their families, and even employers, to find support available in local areas, seek advice on how best to cope with returning to work after a period off and understand employee rights and employer responsibilities.

Plexus has pooled data from a couple of dozen organisations including NHS Choices, Department for Work and Pensions, the Office for National Statistics and Citizens Advice. In some cases the information has been pulled from APIs; in other instances it has been scraped using web data platform import.io.

The first tool Plexus developed is a chatbot called Grace, which is currently in beta testing. It enables users to record thoughts and feelings anonymously, receive feedback in the form of a newsletter and log in to an online dashboard to see a more detailed analysis, including whether there are any patterns in mood emerging over a period of time. The tool also offers guidance from the various governmental and charity websites under easy-to-navigate sections, such as legal rights and preparing for work.

“Through machine learning, Grace will intuitively know when our users are mostly likely to want to speak with us, be able to see the positive and negative nature of the user’s reply, and adapt the questions to encourage more positive responses,” explains Martin Vowles, creative director and co-founder of M/A. “We’re hoping this approach will allow us to offer a unique tool to each user which helps them understand and develop their mental wellbeing.”

Brown says that the potential for machine learning to tailor information and services is exciting. “It’s very good at looking at big piles of data for patterns. When we know certain things to be correct from one dataset, it can begin to make guesses about lots of other things based on what the machine is being fed.”

The sensitive nature of data being submitted by users on a platform like Grace, though, means many people are likely to be uneasy about their data being made accessible. To get round this, Plexus allows users to decide how their data is shared, with data licences lasting between 13 and 26 weeks. Vowles hopes that “as users become more trusting of Grace and what it can do for them, they’ll become more trusting with [us] using their anonymised personal data.”

Plexus aims to release a series of open datasets, including qualitative, quantitative and information on resources accessed by Grace users, to enable NGOs and local authorities to understand the country’s mental health provision. It’s hoped that they’d then use the knowledge to devise new strategies and ensure targets are met and resources and services available in local areas are of an acceptable standard.

There are also plans to make certain data available to employers, but “this has to be on the employee’s terms”. Vowles imagines that involving employers in the process of receiving support could allow them to get a clearer picture of mental health in the workplace. They could then adapt to make employees feel more comfortable and ensure their business has adequate support in place.

The potential to use open data to shape how future mental health support is delivered is an area that has been underexplored. At the end of last year, the Royal Society of Arts launched an interactive platform with Mind that allows members of the public to find out how well local health providers are looking after people with mental health conditions. The full dataset is available to download and includes data extracted from Public Health England, as well as metrics such as percentage of people with a mental health condition in employment in local areas. Plexus, however, is the first tool to use open data with the aim of providing people with a holistic view of their mental wellbeing.

Brown supports the idea of using open datasets and combine them, but stresses that any tool or platform has to benefit users. The data and information must be digestible and it needs to help them understand and take away from it what they need.

“It’s often extremely easy to forget that people with mental health difficulties are people first and foremost – not objects or problems.”

… and then there were 33

In a series of previous posts, I have been exploring the use of D3 (Data Driven Documents) – a Free and Open Source Software package – to visualize geo-spatial data associated with the Children and Youth Mental Health (CYMH) Service Areas that have been established recently by the Ministry of Children and Youth Services (MCYS) in Ontario. To avoid confusion, I wanted to alert users of some of the resources that I have published of an important development.

The MCYS has been resourcing the administration and functions of the CYMH Service Areas, including the designation of Lead Agencies, over the past few years. During this time, there has been some uncertainty about whether there were to be thirty-three or thirty-four CYMH Service Areas – turning on whether the James Bay Coast would be its own Service Area or would be merged with the Timiskaming/Cochrane Service Area.

When I began to explore the use of d3 to visualize the CYMH Service Areas, the geo-spatial data published by the Ontario government mapped thirty-four Service Areas (e.g. see the Wayback Machine archive of September 6, 2015!) and the resources that I have published reflected this configuration. Now the geo-spatial data published by the government maps only thirty-three CYMH Service Areas.

I’ve completed the revision of resources for users in the past few days – a slight inconvenience for us all. There is a bigger issue, though:

The Ontario government is providing an incredibly valuable resource when it publishes the geo-spatial data associated with the administration of public services, like children and youth mental health services. I would only urge that the government’s web pages that describe and make geo-spatial resources available to us should retain and present the different versions of these resources over time. This approach would not only avoid possible confusion as revisions are made, but the differences between the versions may themselves be of interest to the public.

Overlaying the boundaries of the Local Health Integration Networks and Children and Youth Mental Health Service Areas in Ontario

Preamble

This article was originally posted on May 14, 2016 and revised on July 28, 2016 to take account of changes in the geospatial representation of Children and Youth Mental Health Service Areas in Ontario. For more details, see … and then there were 33.

In a series of previous posts, we have visualized the boundaries of the MCYS Integrated Service Regions (ISRs) and the MCYS Children and Youth Mental Health (CYMH) Service Areas.

Now we want to merge the digital boundaries of the CYMH Service Areas with the MOHLTC’s Local Health Integration Networks (LHINs) in Ontario.

The boundaries of the LHINs in 2015 are provided in the ESRI ® shapefile format (HRL035b11a_e.zip) by Statistics Canada. The .zip file contains four familiar files:

  • HRL03b11a_e.dbf
  • HRL03b11a_e.prj
  • HRL03b11a_e.shp
  • HRL03b11a_e.shx

The projection information in the HRL03b11a_e.prj file indicates that the geospatial data for the LHINs uses the EPSG 3347 PCS Lambert Conformal Conic projection. 1 So we convert the original shapefile for the LHINs to the same projection (EPSG 4269) used for the CYMH Service Areas:

ogr2ogr -f 'ESRI Shapefile' -t_srs EPSG:4269 lhins.shp HRL035a11a_e_Sept2015.shp

Next we convert the new shapefile lhins.shp to a GeoJSON file and then to a TopoJSON file (see Visualizing the MCYS Integrated Service Regions Using d3.geo for the details of this process):

ogr2ogr -t_srs EPSG:4269 -f GeoJSON lhins_geo.json lhins.shp
topojson -o lhins_topo.json --properties -- lhins_geo.json

Finally, to merge the TopoJSON file for the CYMH Service Areas and the TopoJSON file for the LHINs into a single TopoJSON file, we need to install the utility geojson-merge:

npm install -g geojson-merge

and then run:

geojson-merge cymhsas_geo.json lhins_geo.json > cymhsas_lhins_geo.json

The properties of cymhsas_lhins_topo.json include:

HR_UID -> idHealth Region ID

Property Value
area_index Identifier of CYMH Service Area
area_name Name of CYMH Service Area
ENG_LABEL -> lhin_name Name of LHIN (English)
FRE_LABEL Name of LHIN (French)

We use Notepad++ to rename ENG_LABEL to lhin_name. We then promote HR_UID to the id property of the TopoJSON file.

topojson -o cymhsas_lhins_topo.json --id-property HR_UID --properties -- cymhsas_lhins_geo.json

And finally, we use Notepad++ to add the isr and color properties to the CYMH Service Areas.

Notes:

Our visualization of the MCYS and MOHLTC geospatial data includes the following features:

  • the five Integrated Service Regions and their respective CYMH Service Areas are distinguished with different hues
  • the boundary and name of a Local Health Integrated Network are displayed when the user hovers the mouse over one of the thirteen LHINs
  • the user may pan and zoom in on the visualization

Our visualization requires only these few modifications of the Javascript we developed to display the names of the CYMH Service Areas:

/* CSS */
...
.lhin_area:hover{
  stroke: #000;
  stroke-width: 1.5 px;
}

/* Javascript */
...

function draw(topo) {

var service_area = g.selectAll(".area_name").data(topo);

/* Visualize the CYMH Service Areas in colour, use id index to assign transparent colour to LHINs */
service_area.enter().insert("path")
.attr("class", "lhin_area")
.attr("d", path)
.attr("id", function(d,i) { return d.id; })
.style("fill", function(d,i) { return i <= 32 ? d.properties.color : 'transparent' });

/* define offsets for displaying the tooltips */
var offsetL = document.getElementById('map').offsetLeft+20;
var offsetT = document.getElementById('map').offsetTop+10;

/* toggle display of tooltips in response to user mouse behaviours*/
service_area

.on("mousemove", function(d,i) {
var mouse = d3.mouse(svg.node()).map( function(d) { return parseInt(d); } );
tooltip.classed("hidden", false)
.attr("style", "left:"+(mouse[0]+offsetL)+"px;top:"+(mouse[1]+offsetT)+"px")
.html(d.properties.lhin_name);
})

.on("mouseout", function(d,i) {
tooltip.classed("hidden", true);
});

}

… yielding the following visualization (interactive version):

Overlay LHINs on CYMH Service Areas
Figure 1. Screenshot of LHIN superimposed on CYMH Service Areas.

Next time: We’ll begin to merge the geospatial data in our TopoJSON files with demographic data in the public domain.

 

  1. Using Prj2EPSG.

Adding pan and zoom to a visualization of the CYMH Service Areas in Ontario

Preamble

This article was originally posted on May 14, 2016 and revised on July 28, 2016 to take account of changes in the geospatial representation of Children and Youth Mental Health Service Areas in Ontario. For more details, see … and then there were 33.

In previous posts, we have described:

  1. method for partitioning the Ontario government’s Shapefile archive of the thirty-four thirty-three MCYS Children and Youth Mental Health (CYMH) Service Areas into five groupings, corresponding to the MCYS Integrated Service Regions (ISRs)
  2. a method for using the TopoJSON files to visualize the CYMH Service Areas within the separate ISRs
  3. the addition of tooltips to display the names of the CYMH Service Areas across Ontario
  4. the addition of a responsive framework to ensure that our visualizations accommodate to the display capabilities of various PCs, laptops, tablets, and smart phones

Here we highlight the additional code that’s required to allow the user to pan and zoom the visualization of the CYMH Service Areas with tooltips (#3  above):

<!DOCTYPE html>
<meta charset="utf-8">
<style>

/* CSS goes here */

/* define the container element for our map */
#map {
 margin:5% 5%;
 border:2px solid #000;
 border-radius: 5px;
 height:100%;
 overflow:hidden;
 background: #FFF;
}

/* style of the text box containing the tooltip */

div.tooltip {
 color: #222; 
 background: #fff; 
 padding: .5em; 
 text-shadow: #f5f5f5 0 1px 0;
 border-radius: 2px; 
 box-shadow: 0px 0px 2px 0px #a6a6a6; 
 opacity: 0.9; 
 position: absolute;
}

/* style of the text displayed in text box of the tooltip when mouse is hovering over a CYMH Service Area */

.service_area:hover{ stroke: #fff; stroke-width: 1.5px; }

.text{ font-size:10px; }

/* otherwise, the text box of the tooltip is hidden */
.hidden { 
 display: none; 
}

</style>
<body>

/* create the container element #map */
<div id="map"></div>

/* load Javascript libraries for D3 and TopoJSON */
<script src="//d3js.org/d3.v3.min.js"></script>
<script src= "//d3js.org/topojson.v1.min.js"></script>

<script> // begin Javascript for visualizing the geo data

/* define some global variables */

var topo, projection, path, svg, g;

/* 1. Set the width and height (in pixels) based on the offsetWidth property of the container element #map */

var width = document.getElementById('map').offsetWidth;
var height = width / 2;

/* Call function setup() to create empty root SVG element with width, height of #map */

setup(width,height);

function setup(width,height){

/* 2. Create an empty root SVG element */
d3.behavior.zoom(), constructs a zoom behavior that creates an even listener to handle zoom gestures (mouse and touch) on the SVG elements you apply the zoom behavior onto

svg = d3.select('#map').append('svg')
 .style('height', height + 'px')
 .style('width', width + 'px')
.append('g') 
.call(zoom);

g = svg.append('g')
    .on("click", click);

} // end setup()

/* 3. Define Unit Projection using Albers equal-area conic projection */

var projection = d3.geo.albers()
 .scale(1)
 .translate([0,0]);

/* 4. Define the path generator - to format the projected 2D geometry for SVG */

var path = d3.geo.path()
 .projection(projection);

/* 5.0 Start function d3.json() */
/* 5.1 Load the TopoJSON data file */

d3.json("http://cartoserve.com/maps/ontario/cymhsas33_data/cymhsas_topo.json", function(error, cymhsas_topo) {
if (error) return console.error(error);

/* 5.2 Convert the TopoJSON data back to GeoJSON format */
/* and render the map using Unit Projection */

var areas_var = topojson.feature(cymhsas_topo, cymhsas_topo.objects.cymhsas_geo);

/* 5.2.1 Calculate new values for scale and translate using bounding box of the service areas */
 
var b = path.bounds(areas_var);
var s = .95 / Math.max((b[1][0] - b[0][0]) / width, (b[1][1] - b[0][1]) / height);
var t = [(width - s * (b[1][0] + b[0][0])) / 2, (height - s * (b[1][1] + b[0][1])) / 2];

/* 5.2.2 New projection, using new values for scale and translate */
projection
 .scale(s)
 .translate(t);

/* redefine areas_var in terms of the .features array, assign array to topo */
var areas_var = topojson.feature(cymhsas_topo, cymhsas_topo.objects.cymhsas_geo).features;

topo = areas_var;

/* make the map by calling our draw() function initially within the d3.json callback function */
 
draw(topo);

}); // end function d3.json

function draw(topo) {

var service_area = g.selectAll(".area_name").data(topo);

service_area.enter().insert("path")
.attr("class", "service_area")
.attr("d", path)
.attr("id", function(d,i) { return d.id; })
.style("fill", function(d, i) { return d.properties.color; })
.attr("title", function(d,i) { return d.properties.area_name; });

/* define offsets for displaying the tooltips */
var offsetL = document.getElementById('map').offsetLeft+20;
var offsetT = document.getElementById('map').offsetTop+10;

/* toggle display of tooltips in response to user mouse behaviours*/
service_area
// begin mousemove
.on("mousemove", function(d,i) {
var mouse = d3.mouse(svg.node()).map( function(d) { return parseInt(d); } );
tooltip.classed("hidden", false)
.attr("style", "left:"+(mouse[0]+offsetL)+"px;top:"+(mouse[1]+offsetT)+"px")
.html(d.properties.area_name);
}) // end mousemove
// begin mouseout
.on("mouseout", function(d,i) {
tooltip.classed("hidden", true);
}); // end mouseout

} // end draw()

function move() {

 var t = d3.event.translate;
 var s = d3.event.scale; 
 zscale = s;
 var h = height/4;

 t[0] = Math.min(
 (width/height) * (s - 1), 
 Math.max( width * (1 - s), t[0] )
 );

 t[1] = Math.min(
 h * (s - 1) + h * s, 
 Math.max(height * (1 - s) - h * s, t[1])
 );

 zoom.translate(t);
 g.attr("transform", "translate(" + t + ")scale(" + s + ")");

 //adjust the Service Area hover stroke width based on zoom level
 d3.selectAll(".service_area").style("stroke-width", 1.5 / s);

}

/* our function click() uses the .invert() configuration method */
/* to project backward from Cartesian coordinates (in pixels) to spherical coordinates (in degrees) */

function click() {
 var latlon = projection.invert(d3.mouse(this));
 console.log(latlon);
}

</script> // end Javascript for visualizing the geo data

Giving us the following interactive visualization of the CYMH Service Areas in Ontario.

Next time: We will show how to merge our visualization of the geography of the CYMH Service Areas with other data about the populations and service providers within these Service Areas.

Consolidating and enhancing the visualization of CYMH Service Areas in Ontario

Preamble

This article was originally posted on May 14, 2016 and revised on July 28, 2016 to take account of changes in the geospatial representation of Children and Youth Mental Health Service Areas in Ontario. For more details, see … and then there were 33.

In previous posts, we provided the following:

  • method for partitioning the Ontario government’s Shapefile archive of the thirty-four MCYS Children and Youth Mental Health (CYMH) Service Areas into five groupings, corresponding to the MCYS Integrated Service Regions (ISRs)
  • a method for using the TopoJSON files to visualize the CYMH Service Areas within the separate ISRs
  • the addition of a responsive framework to ensure that our visualizations accommodate to the display capabilities of various PCs, laptops, tablets, and smart phones

In this post, we describe how to enhance the functionality of our visualization of the Integrated Service Regions and CYMH Service Areas and Integrated across the entire province of Ontario.

Consolidated Geodata Files for CYMH Service Areas in Ontario

In a previous post, we provided a set of GeoJSON and TopoJSON files for the individual CYMH Service Areas and their groupings into the five distinct ISRs.

For present purposes, we have created two geodata files – in GeoJSON and TopoJSON formats – for the entire set of CYMH Service Areas in Ontario.

Field Property of the CYMH Service Area
area_name Name
id ID
isr Integrated Service Region
color Color

Simple Maps of the CYMH Service Areas

By way of a quick review, let’s start with a simple map outlining the CYMH Service Areas in Ontario:

<!DOCTYPE html>
<meta charset="utf-8">
<style>

/* CSS goes here */

/* define the container element for our map */
#map {
 margin:5% 5%;
 border:2px solid #000;
 border-radius: 5px;
 height:100%;
 overflow:hidden;
 background: #FFF;
}

</style>
<body>

/* create the container element #map */
<div id="map"></div>

/* load Javascript libraries for D3 and TopoJSON */
<script src="//d3js.org/d3.v3.min.js"></script>
<script src= "//d3js.org/topojson.v1.min.js"></script>

<script> // begin Javascript for visualizing the geo data

/* define some global variables */

var topo, projection, path, svg, g;

/* 1. Set the width and height (in pixels) based on the offsetWidth property of the container element #map */

var width = document.getElementById('map').offsetWidth;
var height = width / 2;

/* Call function setup() to create empty root SVG element with width, height of #map */

setup(width,height);

function setup(width,height){

/* 2. Create an empty root SVG element */

svg = d3.select('#map').append('svg')
 .style('height', height + 'px')
 .style('width', width + 'px')
 .append('g');

g = svg.append('g');

} // end setup()

/* 3. Define Unit Projection using Albers equal-area conic projection */

var projection = d3.geo.albers()
 .scale(1)
 .translate([0,0]);

/* 4. Define the path generator - to format the projected 2D geometry for SVG */

var path = d3.geo.path()
 .projection(projection);

/* 5.0 Start function d3.json() */
/* 5.1 Load the TopoJSON data file */

d3.json("http://cartoserve.com/maps/ontario/cymhsas33_data/cymhsas_topo.json", function(error, cymhsas_topo) {
if (error) return console.error(error);

/* 5.2 Convert the TopoJSON data back to GeoJSON format */
/* and render the map using Unit Projection */

var areas_var = topojson.feature(cymhsas_topo, cymhsas_topo.objects.cymhsas_geo);

/* 5.2.1 Calculate new values for scale and translate using bounding box of the service areas */
 
var b = path.bounds(areas_var);
var s = .95 / Math.max((b[1][0] - b[0][0]) / width, (b[1][1] - b[0][1]) / height);
var t = [(width - s * (b[1][0] + b[0][0])) / 2, (height - s * (b[1][1] + b[0][1])) / 2];

/* 5.2.2 New projection, using new values for scale and translate */
projection
 .scale(s)
 .translate(t);

/* redefine areas_var in terms of the .features array, assign array to topo */
var areas_var = topojson.feature(cymhsas_topo, cymhsas_topo.objects.cymhsas_geo).features;

topo = areas_var;

/* make the map by calling our draw() function initially within the d3.json callback function */
 
draw(topo);

}); // end function d3.json


function draw(topo) {

 var service_area = g.selectAll(".area_name").data(topo);

 service_area.enter().insert("path") 
 .attr("class", "service_area")
 .attr("d", path);

} // end function draw()

</script> // end Javascript for visualizing the geo data

Giving us the following visualization of 33 Service Areas [actual web page]:

CYMH Service Areas 33
Figure 1. Basic outline of 33 CYMH Service Areas in Ontario.

Note that the Javascript for creating our map includes three functions:

  • d3.json() – a built-in function to load geo data from a TopoJSON file
  • setup() – our function to create an empty root SVG element
  • draw() – our function to render the geo data

By adding just two lines of code to our draw() function, we can colour the CYMH Service Areas:


...
function draw(topo) {
 var service_area = g.selectAll(".area_name").data(topo);
 service_area.enter().insert("path") 
 .attr("class", "service_area")
 .attr("d", path)
 .attr("id", function(d,i) { return d.id; })
 .style("fill", function(d, i) { return d.properties.color; });

...

Giving us this figure [actual web page]:

CYMH Service Areas 33 colour
Figure 2. Thirty-three CYMH Service Areas in Ontario.

Adding Tooltips

Figures 1 and 2 suffer from one obvious shortcoming: none of the CYMH Service Areas is labelled. Unfortunately, our approach to labeling the CYMH Service Areas within a single Integrated Service Region breaks down when we have to contend with the scale of Ontario taken as a whole:

cymhsas02.html w labels screenshot
Figure 3. CYMH Service Areas cluttered with fixed labels.

Our best alternative is to use a tooltips to display the name of a CYMH Service Area when the user’s mouse hovers over the corresponding area of the visualization. Adding this functionality requires two sorts of modification of our Javascript.

First, we must style the Tooltips, including:

  • styling the <div> container element corresponding to the text box within which the name of the CYMH Service Area will be displayed
  • styling the text that is displayed when the user’s mouse is hovering over a service area
  • styling the tooltip so that it is hidden when the user’s mouse is not hovering over any service area

… like so:

<style>

...

/* style of the text box containing the tooltip */

div.tooltip {
 color: #222; 
 background: #fff; 
 padding: .5em; 
 text-shadow: #f5f5f5 0 1px 0;
 border-radius: 2px; 
 box-shadow: 0px 0px 2px 0px #a6a6a6; 
 opacity: 0.9; 
 position: absolute;
}

/* style of the text displayed in text box of the tooltip when mouse is hovering over a CYMH Service Area */

.service_area:hover{ stroke: #fff; stroke-width: 1.5px; }

.text{ font-size:10px; }

/* otherwise, the text box of the tooltip is hidden */
.hidden { 
 display: none; 
}

</style>

Second, we must modify our draw() function to display/hide tooltips in response to the user’s mousemove and mouseout behaviours:


<script>

var tooltip = d3.select("#map").append("div").attr("class", "tooltip hidden");

...

function draw(topo) {

var service_area = g.selectAll(".area_name").data(topo);

service_area.enter().insert("path")
.attr("class", "service_area")
.attr("d", path)
.attr("id", function(d,i) { return d.id; })
.style("fill", function(d, i) { return d.properties.color; })
.attr("title", function(d,i) { return d.properties.area_name; });

/* define offsets for displaying the tooltips */
var offsetL = document.getElementById('map').offsetLeft+20;
var offsetT = document.getElementById('map').offsetTop+10;

/* toggle display of tooltips in response to user mouse behaviours*/
service_area
//mousemove behaviour
.on("mousemove", function(d,i) {
var mouse = d3.mouse(svg.node()).map( function(d) { return parseInt(d); } );
tooltip.classed("hidden", false)
.attr("style", "left:"+(mouse[0]+offsetL)+"px;top:"+(mouse[1]+offsetT)+"px")
.html(d.properties.area_name);
}) // end mousemove
// mouseout behaviour
.on("mouseout", function(d,i) {
tooltip.classed("hidden", true);
}); // end mouseout

} // end draw()

Giving us this sort of visualization [interactive web page]:

CYMH Service Areas 33 tooltipsr
Figure 4. Thirty-three Colour CYMH Service Areas in Ontario with Tooltips.

Next time: We’ll enhance the functionality of our visualization to allow the user to pan and zoom our map of the CYMH Service Areas in Ontario.

Optimizing Ontario’s investments in a “basket” of core mental health services for children and youth – background

Some background

The Ministry of Children and Youth Services (MCYS) in Ontario funds service providers to deliver community-based child and youth mental health (CYMH) services under the authority of the Child and Family Services Act, R.S.O. 1990, c.C.11 (CFSA). The paramount purpose of the CFSA is to promote the best interests, protection and well-being of children.

Some terms

Client

The MCYS defines a client  as “the intended recipient of the child and youth mental health core service.” The client is a child or youth under 18 years of age who is experiencing mental health problems. In addition to mental health needs, clients may also be experiencing additional challenges related to their development or have specific impairments and/or diagnoses, including a developmental disability, autism spectrum disorder or substance use disorder. Other conditions or diagnoses do not preclude clients from receiving mental health services, but may add to the complexity of their needs, and the services they require. Similarly, where children and youth are involved in other sectors (e.g. youth justice and child welfare) these circumstances do not preclude them from receiving core services. Where children and youth have additional needs and are receiving a range of services, the focus must be on how the services connect. A coordinated approach to service delivery must be supported. Families (including parents, caregivers, guardians, siblings and other family members) may also receive services from a core service provider, in order to address the identified needs of the child or youth client. This may occur when the participation in treatment is recommended to support the child or youth’s service plan.

Continuum of needs-based mental health services

Children, youth and their families can benefit from access to a flexible continuum of timely and appropriate mental health services and supports, within their own cultural, environmental and community context. Mental health promotion, prevention, and the provision of services to address mental health problems represent different points along the continuum. Children, youth and their families may enter the continuum of needs-based services and supports at any point. The actual services a child/youth needs will vary. For example, some children/youth may benefit from targeted prevention services, while others will require more specialized mental health services. In addition, a child or youth’s mental health service needs may change over the course of their treatment.

The following schematic outlines the full continuum of needs-based mental health services and supports, and shows how core services fit within this continuum. It also represents the relative demand for services – level one reflects all children and youth, while level four focuses on a smaller subset of the child/youth population with the most severe, complex needs. This schematic is for service planning only – it is not used for diagnosis or for determining the appropriateness of specific mental health interventions.

MCYS - Continuum of core mental health services
Continuum of CYMH Needs-Based Services and Supports. *Includes members of a group that share a significant risk factor for a mental health problem(s).

Service areas

After a thorough review – including an assessment of Statistics Canada’s census divisions – the MCYS has identified 34 service areas in Ontario for the purpose of:

  • ensuring that all clients across the province will be able to access the same core services
  • facilitating planning, and
  • creating pathways to care.

The defined service areas are not barriers to service. Clients will be able to access service from any service area.

Core services

The MCYS has defined a set of core children and youth mental health services (“core services”) to be available within every service area and has established minimum expectations for how core services are planned, delivered and evaluated. Core services may not be available in every service area immediately – the expectation is that they will be made available over time as lead agencies assume their roles and responsibilities.

Core services represent the range of MCYS-funded CYMH services that lead agencies are responsible for planning and delivering across the continuum of mental health needs within each service area. It is recognized that children and youth in receipt of core mental health services may also require other services and supports. For example, children and youth may receive more than one core service as part of a service plan, as well as other services funded by MCYS or other partners.

Seven core services are to be available across all service areas:

  • Targeted Prevention
  • Brief Services
  • Counselling and Therapy
  • Family Capacity Building and Support
  • Specialized Consultation and Assessments
  • Crisis Support Services, and
  • Intensive Treatment Services.

The MCYS funds providers of core services through the following detail codes:

  • A348 – Brief Services
  • A349 – Counselling and Therapy
  • A350 – Crisis Support Services
  • A351 – Family/Caregiver Capacity Building and Support
  • A352 – Coordinated Access and Intake
  • A353 – Intensive Treatment Services
  • A354 – Case Management and Service Coordination
  • A355 – Specialized Consultation and Assessment
  • A356 – Targeted Prevention Term

The MCYS has identified a target population for each core service. This is the population for whom the service is designed, and for whom the service is intended to provide better mental health outcomes. The act of defining a target population is not meant to be exclusionary. Rather, it is a means to support planning and delivery in a way that benefits the children and youth who are in greatest need of the mental health service. In general, the target population for core services includes those children and youth under 18 years of age and their families who are experiencing mental health problems along levels two, three and four of the CYMH continuum. Additional target populations may also be identified within specific core services.

Lead agency

In every service area, the MCYS has identified a lead agency that will be responsible for the planning and delivery of high-quality core services across the continuum of mental health services in the service area.

A lead agency may either directly deliver core services or work with other providers of core services to deliver the full range of core services within the service area. Lead agencies are responsible for engaging cross-sectoral partners in the health and education sectors, including the relevant Local Health Integration Network (LHIN) and school boards. Lead agencies will connect with other providers to plan and enhance mental health service pathways for children and youth and improve transparency, so that everyone will know what to expect.

Providers of core services are required to comply with the Program Guidelines and Requirements #01 (PGR #01): Core Services and Key Processes.

The core services, key processes and functioning of the CYMH service sector will require refinement from time to time as other provincial initiatives and activities are developed and implemented. Within the broader context of these new initiatives, it is important that the roles and responsibilities of all core service providers are made clear and that the linkages between these services are transparent.

Planning to transform child and youth mental health services in Ontario

A key driver of Moving on Mental Health is the need to build a system in which children, youth and their families:

  • Have access to a clearly defined set of core child and youth mental health services
  • Know what services are available in their communities and how they are connected to one another, and
  • Have confidence in the quality of care and treatment. In a mature system, one of the ways in which this vision will be realized is through identification of lead agencies with planning and funding accountability for core child and youth mental health services within defined service areas.

Within each defined service area, the lead agency will be responsible for:

  • Delivering and/or contracting for the range of defined core CYMH services
  • Making them accessible to parents, youth, and children, and

Establishing inter-agency and inter-sectoral partnerships, protocols and transparent pathways to care. These responsibilities fall into two broad categories:

  • Core Service responsibilities – which relate to the defined core services delivered by the community-based child and youth mental health sector, as well as the key processes that enable high-quality service, and
  • Local System responsibilities – which relate to the collaboration of the community-based sector with other parts of the service continuum such as those supports and services delivered by health care providers, schools and others.

The Core Services Delivery Plan and the Community Mental Health Plan for children and youth will set out how the lead agency carries out these responsibilities. The lead agency will be responsible for developing these plans, and is expected to work collaboratively with other mental health service providers and with all sectors that support children and youth and respond to their mental health needs.

The Core Services Delivery Plan will, together with the Community Mental Health Plan, provide critical insight into each service area and guide activities as we move forward with transforming the experience of children, youth and families. The intent is that over time, both of these plans will have a three-year horizon and will be updated annually, since they inform one another. They will also provide content for the Accountability Agreement entered into between the lead agency and MCYS.

Core Services Delivery Plan

The development of a Core Services Delivery Plan (CSDP) is a key planning and communication tool that will document expectations, obligations and commitments for the provision of core services and associated key processes in each defined service area. This reflects the need to establish a consistent approach that will support critical insights into local and provincial child and youth mental health service issues, while recognizing the unique circumstances of lead agencies and service areas. The Core Services Delivery Plan documents how core services will be delivered in the defined service area. It consists of three areas of content:

  • Service Commitments
  • Continuous Improvement Priorities, and
  • Budget.

In developing the plan, the lead agency and child and youth mental health service providers should ask themselves some key questions:

  • Can we demonstrate that the full range of core services is available in our service area, and that minimum expectations set out in the Service Framework are being met?
  • Can we show how our services are getting better at meeting the mental health needs of children and youth in our communities?
  • Are we making the best possible use of limited resources to deliver high-quality services?
A. Service Commitments

This section of the plan will:

  • Identify, with specific activities and time frames:
    • How the lead agency and other child and youth mental health service providers in the service area will address the expectations set out in the Service Framework, including who will deliver what services over the projected three-year time horizon
    • Where changes to services or service providers are proposed, the plan will document how the changes will result in improvement to child and youth mental health outcomes, service quality and efficiencies
  • Indicate how, if a change in service providers or in contracted relationships is proposed, it will be handled in a transparent manner with due regard to minimizing disruption to service
  • Set out how services will be designed and delivered in a culturally responsive manner to address diverse populations including francophone and Aboriginal populations
  • Document how a clear, stable point of contact for children and youth with mental health needs and their families, as well as those seeking services on their behalf, will be established and/or maintained
  • Report on the reach and efficacy of programs and services, including how input from parents and youth has been incorporated to ensure that what has been developed works for them, and
  • Describe the process by which the lead agency has engaged and will continue to engage respectfully with all core child and youth mental health service providers in the service area.
B. Continuous Improvement Priorities

This section of the plan will:

  • Monitor and report on the impact of current programs and services
  • Identify improvement priorities, taking into account priorities established by MCYS and the expectations set out in the Service Framework, in areas such as service quality and outcomes, a purposeful approach to wait list and wait time management, and others over the three-year horizon of the plan
  • Set out specific activities and time frames that will support continuous improvement goals and priorities, and
  • Address matters such as data sharing protocols between the lead agency and other child and youth mental health agencies in the service area, that will support monitoring and reporting on performance indicators in order to enable tracking of trends, challenges and opportunities for continuous improvement.
C. Budget

This section of the plan will:

  • Forecast activities, resource allocations and budget over the three-year horizon, including financial implications of planned changes to service delivery.

Community Mental Health Plan for children and youth

System responsibilities are built on key partnerships and collaborations developed at the local level to support young people and their families across the full continuum of needs. Although service areas may differ in terms of their service profile, service patterns, as well as the degree of pre-existing cooperation and collaboration across systems and sectors, the lead agency will be responsible for bringing partners together to create coherence for children, youth and their families. MCYS is working, together with the Ministry of Health and Long-Term Care and the Ministry of Education, to put in place conditions that will support this important work.

The Community Mental Health Plan for children and youth will be a public document that is developed by the lead agency and describes the processes by which:

The lead agency has engaged and will continue to engage respectfully with sector partners such as organizations funded by Local Health Integration Networks, District School Boards, public health units, hospitals, primary health care providers, and those delivering MCYS-funded services (e.g., child welfare, autism services) and others, and

Input from parents and youth has been incorporated to ensure that what has been developed works for them. It will cover the following topic areas:

  • Understanding current needs and services
  • Collaborative planning, and
  • Pathways to, through and out of care.

In developing the plan, the lead agency, child and youth mental health service providers and partners from all sectors involved with child and youth mental health should ask themselves some key questions:

  • Are all those who serve children and youth working together systematically to address mental health needs in the service area?
  • Are the roles and responsibilities of everyone across the continuum of needs and services clear to parents, youth and those seeking services on their behalf, including how services are accessed?
  • Are there shared commitments to address service gaps and expand on opportunities to better meet identified needs?
A. Understanding current needs and services
  • Report on a needs assessment of the current state of child and youth mental health services across the service area, identifying gaps and opportunities for meeting needs across the continuum, and
  • Identify and maintain an inventory of who is providing which services to meet the needs identified.
B. Collaborative planning
  • Establish mechanisms to explore, on an ongoing basis, opportunities to leverage resources, reduce duplication, enhance outcomes, and create added value for children and youth with mental health needs through collaboration and joint planning, and
  • Identify and document commitments and actions to be taken to address shared and agreed upon priorities, together with associated timelines and measures to assess results.
C. Pathways to, through and out of care

Develop and document protocols, processes and partnerships that exist, or will be developed, that will streamline and strengthen clear pathways to, through and from care across sectors.

Next: Applying Multi-Criteria Decision Analysis to the “basket” of core mental health services for children and youth in Ontario