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The committee met at 1345 in room 151, following a closed session.
Legislative Assembly of Ontario · Committee
Monday, October 20, 2025
Standing Committee on Public Accounts
The official transcript of the meeting, from Hansard, by heading. Ministers, officials and witnesses appear as the transcript names them; committees have no live transcript, so the record appears once the Assembly publishes it.
Ministry of Health
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Consideration of the Performance Audit: Community-Based Child and Youth Mental Health Program.
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The Chair (Mr. Tom Rakocevic)
Good afternoon, everyone. I would like to call this meeting of the Standing Committee on Public Accounts to order. We are here to begin consideration of the 2025 Performance Audit: Community-Based Child and Youth Mental Health Program. Joining us today are officials from the Ministry of Health. You will have 20 minutes collectively for an opening presentation to the committee. We will then move into the question-and-answer portion of the meeting, where we will rotate back and forth between the government, official opposition and the third party caucuses in 20-minute intervals. Before we begin, the Clerk will administer the oath of witness or affirmation.
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The Clerk of the Committee (Ms. Thushitha Kobikrishna)
I’ll begin with Ms. Richardson. Deborah Richardson, do you solemnly affirm that the evidence you shall give to this committee touching the subject of the present inquiry shall be the truth, the whole truth and nothing but the truth?
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The Clerk of the Committee (Ms. Thushitha Kobikrishna)
Thank you. Kyle MacIntyre, do you affirm that the evidence you shall give to this committee touching the subject of the present inquiry shall be the truth, the whole truth and nothing but the truth?
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The Chair (Mr. Tom Rakocevic)
Thank you very much and welcome. I would invite each of you to introduce yourselves for the first time that you speak for the purposes of Hansard. So again, welcome, thank you very much and please begin.
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Remarks in Mi’kmaq.
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Good afternoon. My name is Deborah Richardson and I’m the Deputy Minister of Health.
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Mr. Kyle MacIntyre
Good afternoon. My name is Kyle MacIntyre. I’m the assistant deputy minister of the mental health and addictions division of the Ministry of Health.
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Ms. Deborah Richardson
Good afternoon, everybody. It’s really nice to be here. It started out being a little rainy, but it was beautiful on the walk over here. Chair and honourable members of the committee, joining me here is Kyle MacIntyre, who introduced himself. He’s the assistant deputy minister of the mental health and addictions division. Thank you so much for the opportunity to speak with you about the Office of the Auditor General of Ontario’s 2025 children and youth mental health program performance audit. The Ministry of Health appreciates the work that the Auditor General’s office has done in developing this report, which speaks to ensuring children and youth throughout Ontario have access to timely, equitable and effective mental health care. The findings of the Auditor General’s report identified where progress has been made supporting children and youth getting the care they need. It also identified gaps and systemic challenges that impact the quality and consistency of mental health services for young people in Ontario. These are challenges that our ministry has been actively working to address, and the report reinforces that we need to continue to focus on those efforts. The recommendations provide a clear path forward for the ministry to improve the children and youth mental health system in this province. I’d like to provide the committee, firstly, with some background information on some key mental health initiatives that have been under way at the Ministry of Health. In 2020, the government established Roadmap to Wellness, a plan to build a comprehensive, connected and world-class mental health and addiction services system, supported by a commitment to invest $3.8 billion over 10 years. Roadmap to Wellness is based on four pillars: improving quality, expanding existing services, implementing innovative solutions and improving access. Roadmap to Wellness is adding capacity to meet demand and fulfill gaps in the care continuum. It’s creating a provincial infrastructure for a mental health and addictions continuum of care, which connects community, primary and acute care so that these services better support the needs of people with mental health and addiction issues. A key achievement under the Roadmap to Wellness has been the creation of the Mental Health and Addictions Centre of Excellence within Ontario Health. The Mental Health and Addictions Centre of Excellence within Ontario Health was created with the passing of the Mental Health and Addictions Centre of Excellence Act, 2019. Working with the Ministry of Health, the Mental Health and Addictions Centre of Excellence is a centre point of accountability and oversight for mental health and addictions care: responsible for standardizing and monitoring the quality and delivery of evidence-based services and clinical care across the province, to provide a better and more consistent patient experience; responsible for creating common performance indicators and the infrastructure to collect and disseminate evidence and set service expectations; and, of course responsible for implementing Roadmap to Wellness. Historically, mental health and addiction care in Ontario has lacked a centralized body to oversee quality access and delivery. Now, the Mental Health and Addictions Centre of Excellence helps to embed mental health and addictions as a core component of Ontario’s broader health care system. Since 2019-20, almost $800 million in new base funding has flowed into services and supports through the Roadmap to Wellness, including more than $200 million specifically for the child and youth mental health sector. This funding is focused on improving access to specialized mental health treatment, reducing wait-lists and wait times, expanding existing programs and creating new programs to help manage patient stress, depression and anxiety. I’d like to provide an overview of the important work of the children and youth mental health program. Children and youth mental health services are delivered by over 200 community-based, not-for-profit providers that offer a range of mental health services for children and youth up to the age of 18 and for their families. Services are primarily based on a set of provincially defined children and youth mental health core services. The program services more than 120,000 young people each year. Community-based children and youth mental health services are directly funded and overseen by the Ministry of Health and are governed under the authority of the Child, Youth and Family Services Act, 2017. The Ministry of Health provides more than $525 million in annual base funding each year for children and youth mental health initiatives. Children and youth mental health lead agencies, designated under the Child, Youth and Family Services Act, 2017, are responsible for planning the delivery of core services and coordinating services and supports for clients across various sectors, including health, education and child welfare, within their respective service areas. Most agencies delivering these supports are multi-service agencies that are funded by the Ministry of Health for children and youth mental health services and other ministries; for example, for services and supports such as child welfare, youth justice and special needs, such as autism. Some children and youth mental health agencies also provide services for all ages: There are also some Indigenous-owned and operated organizations as well. As mentioned, services in this program are primarily based on a set of provincially defined children and youth mental health core services, ranging from prevention services to counselling and therapy to intensive and specialized services. In 2024-25, the Ministry of Health convened a technical working group to assist in the development of a draft core services framework for community-based mental health and addiction services and supports, using an across-the-lifespan approach. The framework will identify the types of mental health and addiction services for the community-based mental health and addiction sector required for someone’s lifespan, from children and youth to adulthood. Work that has been done to date in this space includes: —research and jurisdictional scans on Canadian and international approaches to mental health and addiction systems planning and developing core service frameworks; —engagement with mental health and addiction stakeholders and partners across the province, seeking advice on how to approach a core services framework in Ontario, and; —meetings of the 22-person technical working group that provided advice to the ministry on how to adapt the Health Canada-funded national needs-based planning project core services framework, and incorporating the existing child and youth mental health core services in program requirements and guidelines. The implementation of the core services framework will include elements such as the development of minimum program expectations or program standards that will provide guidance and standardize expectations for the delivery of core services across the lifespan. Implementation of the core services will also address many of the Auditor General’s recommendations. Before I speak more directly about the Auditor General’s recommendations, I’d like to describe some of the work that is under way at the ministry, which is expanding services and will be important in addressing many of the Auditor General’s findings. The Auditor General’s report included some recommendations on intensive service for children and youth, and I’m pleased to share that work is under way to establish a new, community-based service model called the Ontario intensive treatment pathway. It is being designed to facilitate improved access to new and existing services for children and youth with complex mental health needs. This Ontario intensive treatment pathway will do a few things. I’d like to share those with you: —create regional treatment networks that will be responsible for delivering and managing access to a coordinated system of intensive treatment for children and youth within their geographical service area; —establish quality guidelines and standards for live-in treatment programming so that children and youth with complex mental health needs have consistent, high-quality services no matter where they are in the province; and —address long-standing treatment gaps in the community by increasing the availability of evidence-based and specialized clinical treatment to improve equity of access and of service outcomes, optimize existing investments and support innovative local approaches. The ministry is also working with system partners to help fill gaps in service and reduce wait times across the province. I just want to speak to some of those steps that we’re taking. Expanding One Stop Talk/Parlons maintenant: This is an innovative provincial virtual walk-in mental health counselling service that enables more children, youth and their families to access the care that they need. As of the end of the first quarter of 2025, almost 4,500 clinical sessions have been delivered to children, youth and their families. Expanding the Complex Transition Fund: This provides short-term flexible funding to support children and youth with complex mental health needs as they transition into or out of community-based live-in treatment programs. Creating four new Step-up Step-down live-in treatment programs across the province of Ontario: This program is for children and youth with complex mental health needs who require short-term supports to step down from hospital care to less intensive community-based services or to step up from less intensive supports to provide stabilization through more intensive interventions outside of the hospital setting. The ministry is also investing to increase the capacity of the children and youth mental health workforce. Up to 2,200 clinicians who treat children and youth with complex service needs are being provided evidence-based training to build the skills they need to address the growing acuity of the need within the children and youth mental health system. This year, the provincial budget included an investment of more than $303 million over the next three years to stabilize the community-based mental health and addiction services sector. This funding will provide a 4% increase in the sector’s base funding to support community-led and deliver mental health programs, including services that children, youth and their families rely on. The Auditor General’s report also describes the need to support youth transitioning into adult programming. As a mom who had a child who experienced that, I can totally relate to this. That’s why this is so important. The ministry has been investing in youth wellness hubs, which consist of a network of 23 hubs operating across Ontario, with an additional nine youth wellness hubs in development. Youth wellness hubs are Ontario’s model of integrated youth services, which is an evidence-based, developmentally appropriate addictions service for youth aged 12 to 25. In addition to offering addictions treatment, youth wellness hubs offer mental health treatment and primary care. If any of you have ever been to one—or if you haven’t, please go to one. They’re incredible. These are just some examples of the work that is under way to support children, youth and their families. The Auditor General’s report provides 22 recommendations. The government has committed to addressing all 22 of those recommendations, which will require a coordinated, phased approach to enhance mental health services for children and youth right across Ontario.
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Ms. Deborah Richardson
The ministry will also continue to collaborate, of course, with the Mental Health and Addictions Centre of Excellence at Ontario Health to better support families. Across the mental health sector, there’s lots of really good examples. We all know those community organizations that just do tremendous work for our families. Some of the examples: Woodview Mental Health and Autism Services, celebrating 65 years of serving families in Brantford. In the northwest, the Indigenous-led Kenora Youth Wellness Hub, opened in November 2019. There’s just so many positive examples—I know have two minutes. We know that early identification and support to address mental health challenges leads to better outcomes for children and youth. We accept the Auditor General’s recommendations and are fully committed to acting on them. Thank you so much, Auditor General Spence and the team, for the work that you’ve done and the collaboration. We really appreciate it. It helps us deliver better services to the citizens of Ontario, no matter where they live. Thank you so much for your time today, and we welcome the questions.
00:11:46Official transcript
Ms. Deborah Richardson
The Ministry of Health is already undertaking several initiatives with partners across government as well as Ontario Health and its Mental Health and Addictions Centre of Excellence to prioritize actions that respond to the recommendations from now through to 2027, and you’ll hear we’ve already started to implement many of them. The ministry is focused on actions that will have direct, timely impact on the services provided to children and youth, and build on initiatives already under way. This includes—and I spoke to this—the Ontario intensive treatment pathway, which is focused on improving service for children and youth with intensive mental health needs, starting with live-in treatment services. This Ontario intensive treatment pathway has formalized a governance structure, including advisory subgroups and research. Reports have been completed that provide an overview of existing intensive services, focusing on live-in treatment and on a clinical population report that identifies profiles of children and youth who are most likely to benefit from live-in treatment. Work has begun to develop quality standard for live-in treatment services as well. Parallel to the Ontario intensive treatment pathway, the ministry established an Indigenous steering committee, to work with the ministry to design and implement an intensive services model that is culturally grounded and structured to better meet the needs of Indigenous children, youth and their families. We are collaborating also with the Ministry of Children, Community and Social Services and the Ministry of Education to develop a cross-sector protocol to support earlier collaboration and coordinated service delivery across various sectors that support children and youth and define roles in planning and providing comprehensive multidisciplinary support for youth with complex special needs. That protocol is expected to be in place by 2027-28. We’re continuing to improve data collection, which is so important, and the quality of data already collected at the ministry and also through the work of the Mental Health and Addictions Centre of Excellence’s data and digital initiative. You’ll hear more about that as well. The focus of the data and digital initiative includes, at a high level, creating a standard provincial data set to provide health system insights across the lifespan, building a central repository of mental health and addiction data and providing the mental health and addiction sector with recording and analytics to drive quality improvement. Over the next two years, we’re focusing on the following: —filling service gaps, including those related to intensive treatment services; —supporting better coordination and creating more consistency across sectors and across the province; —improving the quality of data we gathered to inform programs and services and to improve outcomes for children and youth; and —strengthening how we manage and oversee the system in place to deliver mental health services to children and youth. I will note that implementing some of the Auditor General’s recommendations will take more than two years. These actions are dependent on a broader system change which can take time to implement effectively and we want to ensure that the actions we take are effective and improve mental health outcomes for children and youth as they progress into adulthood. For example, the ministry agrees with the Auditor General’s recommendation to “establish performance indicators and timelines to measure progress in improving access to, and facilitate cross-sector coordination among ... service sectors such as autism and child welfare....” However, to advance this recommendation meaningfully, our first step would be to work with partners to develop a cross-sector protocol. This protocol will serve as a foundational framework for the indicators, providing shared definitions, standards and outcomes. These elements are essential prerequisites for the development of robust and meaningful performance indicators. We intend to build on system change initiatives already being undertaken to implement Roadmap to Wellness, Ontario’s mental health and addictions strategy. There’s also more work to be done to better coordinate work across health, education, child welfare and community health agencies to come together in building a more responsive and inclusive child and youth mental health system—and, I would argue, primary care, of course, as well, and public health.
00:12:44Official transcript
The Chair (Mr. Tom Rakocevic)
Great. Thank you very much. This week, we’ll be proceeding in the following rotation, which is 20 minutes to the government, 20 minutes to the third-party members and 20 minutes to the official opposition. We will follow this rotation for two rounds, beginning with the government. MPP Smith.
00:13:26Official transcript
Mr. David Smith
Thank you, and good afternoon. I am very pleased for that well-illustrated talk that you brought forward to us to give us sort of a road map as to where your industry is taking us, from the auditor’s report. Today, some of the questions that I have—when you talk about nine hubs, do you feel that is an adequate number to meet the needs of individuals here in Ontario, and where are they located?
00:14:24Official transcript
Ms. Deborah Richardson
Just for clarification: There’s already 23 hubs that are located right across the province. There’s nine additional hubs that are in the works. We definitely can tell you where they are. We’re just calling it up. We can tell you the locations.
00:14:59Official transcript
Mr. Kyle MacIntyre
As the deputy has said, right now, we’ve got 23 across the province that are operational across all of the regions of Ontario. We’ve got a number in Toronto, we’ve got some in Kenora, Guelph-Wellington, Windsor-Essex, London, Sudbury, North Simcoe etc., and we’ve got another five hubs that are in full development right now, across Brampton, Oxford county, Port Hope, Thunder Bay and Vaughan–Woodbridge. These are the ones that are being more or less planned to be opening up this year, and then we’ve got another set of four that will be opening up next year.
00:16:21Official transcript
Mr. David Smith
Thank you. I’m glad to hear that these are additional hubs that you’re opening. In terms of timelines, I’m glad to hear that you’re taking seriously what the Auditor General has suggested, and I’m hearing, Deputy Minister, that you made mention that two years might not even be sufficient time to implement all of this. But my concern is, what do you see as the endgame to meeting this urgent need that is before us?
00:17:21Official transcript
Ms. Deborah Richardson
Like I said, as a parent of somebody who—one of our five kids had some pretty serious mental health issues, and this was a number of years ago. It’s amazing now that, through the centre of excellence, there’s an actual body that takes the research and coordinates things in a way, so having to navigate—I’m in a position of privilege. I’m an executive in the government and know how to manoeuvre. Many people are not in that position, and I’m just so happy that we’re centralizing things so that people will have more access to services and eliminate barriers. I think being able to provide virtual care—a lot of kids now, this is how they like to communicate, right? And so the fact that we’re also providing tools that kids can access in different forms—whether it’s intensive and they need intensive treatment, whether they need a youth wellness hub with some mentoring or whether they need somebody to actually talk to and then get a referral if they’re in trouble, I think that would be a system where everybody knows where and how to access services. I think that’s pretty critical.
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Mr. Kyle MacIntyre
Thank you for your question. The government’s approach and plan starts with Roadmap to Wellness which is the strategy for building a comprehensive and connected mental health and addiction system across the province. It starts with a $3.8-billion investment over 10 years. Since 2019, that investment continues to grow. The government has added over $800 million in new base funding for mental health and addictions writ large, including over $200 million for children and youth mental health itself. That is going towards mental health treatment, wait-lists and expanding existing programs across the care continuum. That includes the investment that the deputy was mentioning earlier, called the Ontario intensive treatment pathway, which is a $22-million investment focusing on community-based intensive services, which was one of the key areas that the Auditor General spoke about in terms of looking at things like enhancing the number of beds and the services across the province. The deputy mentioned in her remarks that we’re creating regional networks using a hub-and-spoke model for the delivery to better coordinate access for intensive services and then establishing quality guidelines, as well as identifying where there may be gaps in services for these really needed, intensive live-in treatment services which we’re starting to focus on. While that is being built and under way, the government has also invested across a number of other services to address both wait-lists, treatment options and opportunities for children and youth. For example, I’m not sure if folks have heard about One Stop Talk, if you’ve got a small child or children at school. This is really an innovative program that we invest about $4 million each year in. You can think about it as a virtual walk-in clinic where people can access free mental health services. It’s low barrier—pretty easy to access. I think it’s made available in over 200 languages, including sign language. What happens is you can call up a number or access it through a website, and you’re immediately talking to a therapist. There are zero wait times for this. It actually is really helpful because it supports folks who might have difficulty getting access to care of the province. Sometimes we know in more rural areas or in northern, remote communities, it might be more difficult to access services. What One Stop Talk allows people to do is, say you’re in a remote community, if you have access to the Internet, you might be speaking to a clinician in Windsor. It makes people’s access available across the province, as I said, without any wait times.
00:22:52Official transcript
Mr. David Smith
Thank you. I think your answers suffice. Chair, I would like to yield the rest of my time to my colleagues.
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Ms. Jess Dixon
Thank you so much, both of you, for coming. I have sort of a two-part question, which I’ll give you all at once. The first part: The minister has talked a lot about how we can’t improve what we don’t measure, so I am curious about what types of key performance indicators or outcome measures the ministry is either using or developing to evaluate your progress, and also how that data will be published. And then, second to that: Is there any plan as far as collecting or linking that data in a way that could ultimately show return on investment? For example: reduced emergency visits, less justice involvement, fewer hospitalizations for youth that get mental health support. That was my two-part question.
00:23:45Official transcript
Ms. Deborah Richardson
I think that’s a great question. I think in the short term, we need to get this right. So it’s kind of linked to your question and your question, because we have the short-term, the medium-term and then the longer-term, more systemic things. In the short term: By March 2027, we want to be able to have a performance-monitoring framework for oversight of agencies and lead agencies, and then improve, obviously, wait-time definitions and data consistency, because right now how wait times are being tracked is all different. We need to have the standards so that we can know what we’re measuring and do that collectively. That’s the work we’re doing through the centre of excellence. Obviously, enhanced transition policies—this is all connected, right? You need to have the data, you need to have everyone measuring the same and the transition policies for youth and then expanding access to coordinated services through initiatives like the one that Kyle just spoke to. And then agency-level data attestation and reporting tools will be important. I think that’s really key. I don’t know if you have specifics, Kyle, about some of the indicators.
00:24:59Official transcript
Mr. Kyle MacIntyre
Yes. As the deputy is saying, there is the infrastructure side, to make sure that there’s the capability for organizations to submit data. Then there is the approach of requiring standardization of that data so you can compare across different organizations. Then there is what you do with the data and how you performance manage with that data. Right now in the children and youth mental health space we’ve got two systems that we’re using to collect data from the children and youth mental health providers. One is called the business intelligence solution, which pulls in data from our providers and asks a number of different types of questions. So we get data from them related to wait times, for example, across the seven different core services that the children and youth mental health sector provide.
00:25:52Official transcript
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Mr. Kyle MacIntyre
We also collect data about what other services they’re providing. We get data around the perception of care and whether or not positive outcomes are happening. We get a range of those types of stuff coming in through the business intelligence solution. We also have something that is more focused on the financials. We have something called the Transfer Payment Ontario system. Organizations are required to submit data more on the financial side of things, so we collect data on that front as well. Then there is the future that we’re looking at, that the deputy had mentioned, which is the work being led by the Mental Health and Addictions Centre of Excellence and Ontario Health. As part of the work, one of the key elements of system transformation under way is improving the type of data we get. In the mental health and addiction system sometimes we get too much data in terms of folks submitting, but it might not be the right kind of data. In some cases we need to be collecting more data from providers and we certainly need to be standardizing it. Through the work of the data digital initiative at the centre of excellence a number of things are happening. One, what we’re doing is we’re rolling out a provincial data standard so that every organization that receives funding for mental health and addictions in the community space is required to provide data that is to one standard. That will evolve over time. We’re starting the process of having the second version of that being rolled out. The second piece of that is, you want to make it as easy possible for the providers to be able to submit data, and so we’re funding opportunities to move to compliant data systems and information systems so that the different pockets of technology can speak to one another. We want to make it as easy as possible. The technology allows us to pull that data on a nightly basis, so it’s not manual. They don’t need to submit it. That is a key component of being able to measure change over time, measure performance of organizations in a standardized way, collecting a similar type of data and then being able to use it on the performance side. The deputy talked a little bit about two things on the performance side, which I think gets at your question about how we know we’re getting results for the funding that we’re doing. We do get some data, as I said, on the performance side, particularly on the financial side, through Transfer Payment Ontario and the business intelligence solutions. Eventually, once we onboard the children and youth mental health space into this data digital initiative, we’ll be able to collect a whole range of indicators, not just financial, and assess quality outcomes. A key element of being able to do that is the establishment of something called the core services framework. If you’ve seen the Roadmap to Wellness, one of the commitments there is to develop a core services framework that’s across the lifespan. Right now we have seven core indicators for children and youth mental health. We’re going to be expanding that and building in more core services for the adult and addiction community mental health space. Once those are established as part of the legislative authorities that are identified for the centre of excellence for mental health and addictions, they’ll be developing what are called minimum program expectations and quality standards for each of those core services. When those are established, it allows the ability to compare apples to apples, performance to performance, against a set of expectations that each provider is meant to provide, and through the broader accountability framework and performance measurement, that’s how you start to understand better if are you foreseeing more quality outcomes for the investments that you’re making.
00:30:00Official transcript
Ms. Jess Dixon
Just to follow up on that: Given that we’re in public accounts, I’m still curious about the about the concept of what types of financial or performance measures are going to help you demonstrate that the investments are delivering value. I’m also curious; you talked about partnering with MCCSS and education, but one of the things that is challenging in this area is the measure of the non-event, the fact that a child that receives an early intervention that has a preventative impact does not end up in an emergency room and often does not end up in the justice system specifically, with police involvement. I wonder if there’s any discussion from the ministry as far as tapping into those other areas, because from an academia perspective, that is one of the most challenging things to demonstrate and also one of the most challenging things to demonstrate for the service providers, is to show that ROI that extends beyond just their own sector.
00:31:01Official transcript
Mr. Kyle MacIntyre
Yes. A key component of that is that data digital initiative that I was saying about. One of the initiatives that is rolling out as part of that is using OHIP-level data collection, and so that you can start to see a person’s card through the system. So we would be able to see, if they access a children and youth mental health program, did they turn up in the emergency department at a future date, for example. As a way of mapping across the different sectors, whether that’s primary care, acute care or in the community, that’s in the early stages. It’s first being rolled out in the adult community and mental health sector, so we’re going to be working with Ontario Health about how do we maximize that investment so that it also goes to the children and youth mental health providers so that we can start to track them across the system.
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00:32:00Official transcript
MPP Mohamed Firin
It’s very important to me that young people in my community, whether they be accessing youth services or transitioning into adult services after turning 18, have seamless access to mental health and addiction support. Deputy Minister, can you outline the steps that the province is taking to ensure this?
00:32:19Official transcript
Ms. Deborah Richardson
So I spoke a little bit about this in my opening remarks. The information on the significant steps that we’re taking to meet the needs of transitional-aged youth and youth experiencing addiction issues, in alignment with several of the Auditor General’s recommendations: In 2020, the government released—we spoke about Roadmap to Wellness, our plan to build a world-class mental health and addiction system supported by a commitment to invest $3.8 billion over 10 years. The road map is adding capacity to meet demand, filling gaps in the care continuum and creating a provincial infrastructure for a mental health and addictions continuum of care that creates community, primary and acute care to better wrap around the needs of children with mental health and addictions. So, ADM MacIntyre, I know we just have a few minutes left, but maybe you could just give some of the details.
00:33:16Official transcript
Mr. Kyle MacIntyre
Sure. As the deputy mentioned, there has been significant investments, both base funding for the mental health and addiction system writ large but also for children and youth. The Auditor General’s report did specifically talk about the need for developing coordinated pathways for children and youth who are of transition age. There are different ways to define that age, for sure. They also made mention of a quality standard that’s in place. One of the things just to remark on—currently, right now our children and youth mental health providers are required to make sure that they are engaging in transition planning across a number of different transition points already. We do have guidance towards those children and youth providers that they should be preparing for those transitions to support children and youth as they come into adulthood. That can be across a number of different providers, whether that is related to school, discharging out of a children and youth provider or into a community mental health space that is more targeted for adults. This is outlined in the program guidelines and requirements that the ministry has issued to support child and youth mental health programming. It’s a partnership-based approach. One of the things that we’ve heard loud and clear from the Auditor General’s report is the need to do better and work with the centre of excellence of mental health and addictions to be able to do that.
00:34:49Official transcript
The Chair (Mr. Tom Rakocevic)
We’re at time. We’re now going to move to questions from the third party. You have 20 minutes.
00:34:55Official transcript
Ms. Lee Fairclough
Thank you very much for the description you’ve given today. I do want to start off by commending one thing that we heard about today, which was that in the last budget there was an over $300-million investment into the community mental health sector, which I think was needed, particularly around some of the issues on wages. I do want to commend that that has occurred, and I hope that it will make a difference in this sector. They hadn’t had an increase in some time. I will say, though, I do hear a lot from families still trying desperately to access service for youth and young people. When I read this report, it highlighted that we really need to bolster intensive services. It was the first recommendation in the report. You’ve talked a little bit about the creation of networks and the pathway, the $22 million, but we see big geographic differences in access to service today. I just wondered if you could speak a little more around how quickly we will see that money translating to services for young people, because I think it’s pretty desperate out there.
00:36:04Official transcript
Mr. Kyle MacIntyre
Thank you for the question. You’re right. There’s an orientation that we’ve sort of talked about, the Ontario intensive treatment pathway, which is the $22-million investment. Just, again, for folks to understand, it’s focusing on live-in treatment, part of the intensive services care continuum. We are establishing, first, the regional networks. We hope by the end of this fiscal year, we will have issued the call for proposals to identify who are those providers that are going to be the main hub and centre for delivering a good chunk of that care. It also requires us to establish quality standards for the programming as well as doing some work to assess where those gaps are. While that work is under way, the Ministry of Health has continued to invest in this space in preparation for the creation of that pathway to go live. For instance, there have been investments that are supporting our ability to understand the landscape and the clinical profile for the children and youth who would go in there. We know that not all children and youth would benefit from this related type of access to treatment, so we want to be thoughtful about who can enter that service there. As of last year, for example, we invested almost $14 million in that intensive services space to support stabilization, the reduction of wait-lists and building sector capacity. That happened with supporting clinicians with advanced tools. We built the capacity through supporting providers so that they could do some hiring as well. There was an element of training involved for the support services. What we’re finding is that the range of complexity for children and youth mental health is increasing, so we want to make sure that clinicians and others are being able to be prepared to handle that change for the population. There was also a number of investments that were related to capital renovations to support the therapeutic value of physical spaces. There are other sorts of investments that have been happening as well so that we’re continuing to address the care continuum through a number of different kinds of investments. We spent almost up to $3 million in expanding Indigenous-led intensive services in the north, for example. I did talk about the almost $4-million investments around One Stop Talk, which allows children and youth to access care right away. We spend up to $2 million annually on a basis and a multi-year $1 million to support the Complex Transition Fund as well, which provides short-term, flexible funding for children and youth with complex needs. The Ministry of Health has also invested up to $8.5 million in new annualized base funding to create four new Step-Up Step-Down programming, which helps folks in live-in treatment programs across Ontario. They may need short-term supports to step down from a hospital to get into the community for a less intensive service space, or maybe they need more intensive services to step up and receive care. That expansion occurred in the last couple of years and builds on existing programming for that as well. Those new programs are in Kenora, Sudbury, Hamilton and Waterloo. There’s also been an increase of funding of almost $6 million and one-time funding that we’ve been doing over multiple and multiple years, supported through the Children’s Mental Health Ontario association, again, focused on that clinical training for complex needs. Over 2,000 clinicians who treat children and youth in that complex mental health space have accessed that kind of training. We also have some money that—we’ve been doing some pilots as well of different types of treatment in this space to see what works.
00:40:00Official transcript
Ms. Lee Fairclough
I guess my next question will be, then, given that: Are you pretty confident you’re going to see a big jump in volumes between, say, last year to the end of this year in who’s been able to access those intensive services? Right now, when we say that we’ve got 13 of 33 service areas that don’t have live-in treatment, are you going to see more of those service areas actually receiving treatment in this year? I think the work of the network—I’ve come from working in health care. I know what it takes to create these things. Again, I just really hope we’ve got a way to measure whether we actually cared for more people this year and are confident on that. It’s not just money, right? It’s actually—did it reach people? I worry a little because the service, the framework that you’ve described has been in development since 2018, right?
00:41:24Official transcript
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Ms. Lee Fairclough
And so, how are we going to be sure people are going to get the care they need?
00:41:34Official transcript
Mr. Kyle MacIntyre
We do track a couple of things. One is the volume of service within a core service space. We would be able to see whether volumes are increasing. We also do track wait times associated with those services, so that helps with that. Then, of course, we engage with the providers as well to see what they’re seeing. For that Ontario intensive treatment pathway, what we will see is not just an increase in service, but really the children getting the right kind of service. Because, right now, you could have 12 people access the service—I’m just making a number up; it could be 1,000, whatever the number is—but not all of those children should be in that service. They should be in something else that’s more suitable to the treatment they require. So that following year, it might go down, but it is the right people getting the right access to the right service in that space.
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Ms. Lee Fairclough
That’s wonderful. So then I guess my other question is really around the data. I just wanted to pick up on the theme of the data and making sure that we are developing out the systems that we need. I think sometimes this is a challenge for agencies when they’re not funded, to be able to support those data systems and data collection systems and support the standards themselves. Does part of this plan include funding some of that infrastructure for these agencies?
00:44:02Official transcript
Mr. Kyle MacIntyre
Yes, that’s right. So a couple of different themes: We’ve invested over $4 million over the last two years to support more of the children and youth mental health providers to come on to the business intelligence unit. That funding also goes towards things like replacing—so that they’re on a compliant system for them to send us data and for us to receive the data. That also comes with an investment of quality, so giving them some support to improve the quality of the data that they’re sending as well. So that will continue. I think the biggest, more transformative space for this is around that data digital initiative from the Mental Health and Addictions Centre of Excellence that I was talking about around the standardization of the data set itself and then funding that goes towards them being able to get compliant systems and on to that process. It is, as you understand, quite a transformative process and something that will take time to be able to do that. I think the last stats that we had from the centre of excellence, the number of organizations that have onboarded or are plan to be onboarded, it’s about 90% of the funding space that they’re on. So a lot of progress is being made on that. The children and youth sector is going to start a little bit after the adult sector, in part for two reasons: (1) we already have a data system that we are able to collect information and data from the children and youth space; and (2) we wanted to make sure that the adult space and the addictions space were starting to get onboarded—that’s also where the majority of the money is relative to the different programming—and to be able to learn from that approach that’s happening. Working with this Mental Health and Addictions Centre of Excellence, we’re on track to start onboarding children and youth mental health providers onto that data digital initiative, meaning they’ll come on a compliant system, that they’ll be submitting data toward a provincial data standard, starting next fiscal year. There has been some trial work already under way. We’re working with four pretty large providers just seeing if there’s any additional issues that we need to manage because they’re transitioning on and they’re coming from a different space. One of the most important things that we’re making sure that happens is that, as we’re building up the children and youth mental health centre onto the data digital initiative, we’re not losing the data that we’re collecting from the business intelligence unit solution or the Transfer Payment Ontario solution. We want to be careful that we’re not creating too much burden for the providers themselves and that we’re not losing the data that we actually have, so we want to do that in a thoughtful way.
00:48:40Official transcript
Ms. Deborah Richardson
Maybe just to add: We do spend $2.1 million just for the BI right now, and as ADM MacIntyre said, we will be transitioning it to the broader system. So we are investing money right now to help service providers.
00:49:01Official transcript
Ms. Lee Fairclough
And that will fix the issues around different definitions on wait times and all of these other—
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Mr. Kyle MacIntyre
That’s right. That provincial data standard should be defining not only the data you’re doing, but how you describe that data, which would require the providers to work in a way that meets that definition. So that will be across the lifespan, across all the children and youth mental health providers, but also all the adult and addictions providers as well.
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Ms. Lee Fairclough
Okay, great. There has been a lot of discussion today about the centre of excellence, and then in the report there’s a lot of discussion about the oversight, the role of the Ministry of Health—and also the benefits around that transitional-age youth into the adult system. Are you looking for the child and youth mental health system to be led in more of a similar way out of the centre of excellence, for the adult system? Sorry, I’m tripping on my words here. It feels like, from the report, I’m sensing there’s still confusion on where the direction is coming from and where the accountabilities lie. Is the idea here that we’ll transition that accountability in more of a model to the centre of excellence and the relationship that health care providers have with OH?
00:50:53Official transcript
Ms. Deborah Richardson
Those are the options that we’re looking at, but as you know, there are two pieces of legislation, so we need to make sure that there’s legislative authority to do those things. I think that as OH has really developed the centre of excellence—it’s awesome—but we’re still kind of working with agencies on placing children and doing different things, right? And that’s a legislative responsibility that we have, so we have to figure out how to give policy options to how you can do that and streamline it and move it over to one. But I think it does make sense at one point. We’re slowly getting there and we’re building as we bring forth those changes. I don’t know if it would be helpful to talk about CIHI when we’re talking about data, so I don’t know, Kyle, if you want to—
00:51:47Official transcript
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Mr. Kyle MacIntyre
Yes, I’ll just answer part of it and then get into CIHI. As the deputy said, there’s two different constituting legislations that manage both the authorities and the role in the children and youth mental health space: the Child, Youth and Family Services Act and then there’s the Connecting Care Act for Ontario Health and the centre of excellence, definitely moving towards making sure that there is a lifespan approach about collecting data, monitoring a person going through the system to help manage transition-age and the like, for sure. Again, we’ve sort of outlined the approach and what’s happening on that front. But there are special and particular things that we want to make sure happen in the children and youth space that is different than adult. They’re much more vulnerable people, different age group. There are requirements under different acts that treat children and youth up to the age of 18 differently than they would be as an adult, so we want to be thoughtful about making sure that we’re capturing them. But we work with both the centre of excellence and the lead agency consortium as well and are thinking through what kind of additional governance mechanisms we can do to make sure that we’re looking at things across the lifespan, including the establishment of a core services framework, for example. With respect to that CIHI-related data that was identified in the report, I think the Auditor General made a recommendation. I won’t say it exactly, but it was around two different things. One is maybe move towards a paying Canadian indicator for wait times, in this case particularly around counselling, and then there was an observation around making sure that, as part of that indicator, you’re looking at being consistent in how you measure a wait time. There’s a CIHI indicator right now that only four provinces are actually reporting fully into; the remainder of the provinces, like Ontario, are partial or incomplete. That’s one observation. The data that we pull and the indicators that we report on internally to ourselves around wait times is the average wait time for a person waiting for a core service like counselling or something like that. What the Auditor General’s report said is, take a look at when someone is counted as coming into the system and take a look at when they’re counted as leaving the system. And so, in the business intelligence solution, it looks at when someone enters—
00:54:37Official transcript
00:54:39Official transcript
Mr. Kyle MacIntyre
—the wait time part of the spectrum and then when it leaves the wait time. What the Auditor General’s report said is maybe look at the referral piece and then when they start to service, which is sort of what the CIHI indicator said. When they identified that in the report it looked like if you used the process for the CIHI side it might add a little bit more time in terms of the wait time. But if we were to use the CIHI process and their actual indicator, they use the median wait time data. So if we were to look at the wait time data on the median scale for the CIHI it would be 25 days, as opposed to I think what was in the report, 120 days. So if anything we’re over-reporting if we use the median CIHI data. So that’s something that we’re looking at. We are able to take our data, use the process that CIHI uses for that indicator and submit to CIHI in that way. Eventually what we want to do, to your question, is move towards a consistent lifespan approach, perhaps using the referral and then leaving service as a way of measuring that. But that work, we want to make sure that that’s happening with DDI—that digital initiative—led out of the Mental Health and Addictions Centre of Excellence as well.
00:56:03Official transcript
Ms. Lee Fairclough
Thank you. I do have more questions around concurrent disorders and access to those, but I’ll leave those for the next session.
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Ms. Lee Fairclough
Oh, I still have 30 seconds? Okay. So maybe I will quickly ask, and maybe we can come back to it. I do think that we talked a lot about a pretty significant gap in concurrent disorders and being able to support people that have got mental illness and some kind of substance use challenge. Maybe I’ll just seed that now, knowing that I’ll come back to that in my next session.
00:56:40Official transcript
The Chair (Mr. Tom Rakocevic)
We’re at time. We’re now moving to the official opposition, beginning with MPP Lennox.
00:56:46Official transcript
MPP Robin Lennox
In the report the vast majority of child and youth mental health agencies reported difficulties with recruiting and retaining staff, and 87% reported that this was largely due to wage disparities between the amount that community child and youth mental health workers are paid when compared to those in the hospital or education sectors. Is the ministry committed to addressing these significant wage disparities in order to address this shortage of clinical staff? If so, how much new funding was dedicated to addressing these wage disparities in this year’s budget?
00:57:25Official transcript
Mr. Kyle MacIntyre
Thank you for the question. Just maybe a couple of points: One, the investments that have happened since 2019 have increased. It’s $800 million in new base funding. That doesn’t include one-time funding generally. If you add that up, it’s certainly well over one billion new dollars into the community mental health space since 2019. In 2019 the government had a 5% across the board for the children and youth space. In 2023 it also had an another 5% across the board, and in this budget this past year there was a reference to an additional $303 million over four years, which amounts to a 4% increase to the sector as a whole as well. So since 2019 there’s been over 14% in the number across the boards in investing in the children and youth mental health sector programming on top of additional funding just generally around programming as well.
00:58:24Official transcript
MPP Robin Lennox
If I may clarify, the $800 million was for both the child and adult mental health sectors? Only $200 million actually went to child and youth mental health?
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MPP Robin Lennox
Those increases that you mentioned, 5% per annum or 4% per annum, are just barely above inflation. These wage discrepancies that are being described are in the range of 20% to 50% below those in the acute sector, in the education sector. How do you expect child and youth mental health agencies to try to match when we’re only giving them a fraction of the disparity that they’re facing in terms of wages currently?
00:59:07Official transcript
Mr. Kyle MacIntyre
I think a key component of that, in response, is one of the recommendations that the Auditor General identified, which is the need for a health human resources plan for it. The ministry has accepted that recommendation, and the Ministry of Health has over the last while developed a health human resource plan that looks at education expansion and clinical supports, scope of practice, looking to see if others can also support providing care, different pathways to international practitioners and looking at different ways for retention and distribution. There’s a need to bring the mental health and addiction sector more into that, and so we’re starting to look at opportunities to be able to do that, mindful of the compensation issues that you’ve raised.
01:00:00Official transcript
MPP Robin Lennox
Thank you so much. In their 2020 report, Children’s Mental Health Ontario called for an additional $150 million per year to be able to hire the amount of staff they would need to reduce the wait time to counselling within 30 days. The amount of investment that you’re describing falls quite short of an additional $150 million per year. How does the ministry reconcile that shortcoming? And what is the ministry’s intended wait time for first point of counselling and how are you going to get there?
01:00:33Official transcript
Ms. Deborah Richardson
I can maybe start on the HHR one. We have been developing a health human resource strategy just globally and we want to do it more specifically for the area of mental health and addictions. We haven’t done it specifically, so that’s kind of our next order of business that we’re going to be working on. We work closely with the Treasury Board to conduct a workforce data survey, in partnership. Some of the things you pointed out—those are what the sector is telling us as well. We need the be able to assess compensation gaps—all of those things as we develop our HHR strategy, health human resources strategy. We need to explore workload guidelines and retention, some of the things that you spoke to. We have done some things, like building the capacity that we spoke to around the training for the 2,200 existing technicians, just to start to give them some additional tools in the space. There’s a lot of work to be done and we definitely want it as a part of our broader HHR strategy. We need to have it specifically for mental health and addictions.
01:01:44Official transcript
MPP Robin Lennox
Great, thank you. In the report, the Auditor General identified an agency in northern Ontario which, over two years, advocated for the development of a secure treatment program to better meet the needs of children and youth in northern communities; to support children staying engaged with their communities and their families while meeting that secure, intensive treatment. The AG identified that there was no action taken on this proposal from the ministry and there’s still no access to these programs in the north. When you spoke about your new Ontario intensive treatment program, you spoke about that $22 million going towards live-in treatment but not secured treatment programs. When can communities in the north expect an investment to fill that gap of secure treatment programs that they’ve been asking for for several years?
01:02:40Official transcript
Mr. Kyle MacIntyre
As part of that $22-million investment, part of it will allow us to understand where there are gaps in the system. In the north, we know that there have been some providers who have identified the need for potential secure treatment. One of our Indigenous providers, Dilico, has raised this as a potential issue in the past. While it wouldn’t technically meet the need of what we describe to be a secure treatment program, the OITP will allow us to be able to identify those opportunities for more secure treatment programming, for sure. We have been working with the existing providers right now to develop a framework so that they’re providing consistent approaches to accessing care. That’s one thing. And there has been investment for government to expand the number of secure treatment placements in the provider out in eastern Ontario and Ottawa. So there is some expansion that is under way, but we know that there are opportunities to assess for more need, for sure.
01:03:46Official transcript
MPP Robin Lennox
Thank you. Speaking more on the issue of concurrent disorders in terms of concurrent mental health and substance use disorders, 70% of the agencies surveyed reported that their services do not meet the needs of youth with concurrent mental health and substance use disorders. At the same time, we’ve seen that rates of opioid-related deaths among Ontario teens and youth have tripled between 2014 and 2021, and rates of treatment initiation in that same group have actually only gone down markedly. What is the ministry doing to address that gap and prevent opioid-related deaths and other substance-related harms among youth with concurrent disorders in Ontario?
01:04:30Official transcript
Mr. Kyle MacIntyre
I think that I might take parts of your question the next go round. I would say that the children and youth mental health program is focused on seven core services; addiction isn’t one of them. Most of the addiction programming comes from Ontario Health, so we have a different funding line that’s associated with supporting children and youth addiction-related programming. So there are different investments that are under way. The gentlemen over here raised youth wellness hubs as an opportunity, and the deputy spoke a little bit about that. Part of that is the expansion to 32 youth wellness hubs. We have 23 that are operating right now. We also invest in programming—things like PreVenture, which is an evidence-based prevention program that targets children and youth who might have known risk factors for substance use. It is rolled out in schools through community organizations and also youth wellness hubs. I think we’re at 28 school boards right now, focusing on grades 7 to 9, and I think it’s expanding more. That’s more on the prevention side of things. And then there’s other programming that we have that is also maybe considered transitional-age youth as well. Amani, which focuses on Black youth, also has a substance use focus for that specific population, so there’s additional funding and programming that goes towards that as well for folks with concurrent disorders.
01:06:04Official transcript
MPP Robin Lennox
I did recall that you mentioned youth wellness hubs initially as providing evidence-based addiction treatment, but I wonder what you consider evidence-based addiction treatment that is currently delivered at youth wellness hubs?
01:06:19Official transcript
Mr. Kyle MacIntyre
The program itself is part of an integrated youth services model that is actually happening across Canada. It’s actually a big programming focus of our federal, provincial and territorial organizations, and also a big focus of the federal government in terms of funding—what have you.
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Mr. Kyle MacIntyre
The program is based off of that integrated youth model and is supported by a number of data. It is run through a backbone organization called Youth Wellness Hubs Ontario, which sits out of CAMH and is being led by Dr. Jo Henderson—very well-known in the children and youth mental health space. They use a number of clinical assessment tools, and it is very data-oriented. It engages each of the youth along the way with surveys, including surveys when they leave the service. They use the best clinical knowledge to support children and youth with substance use disorders and in a measurement framework as well.
01:07:21Official transcript
Ms. Deborah Richardson
If I could just add, there are a couple of other programs that I think are important that touch on what you were trying to get at. We’ve got the Ontario Structured Psychotherapy Program, which offers cognitive behavioural therapy for youth aged 15-plus with depression and anxiety, often reoccurring with substance abuse. A lot of times, people will use to ease the symptoms of what they have in terms of their anxiety and depression—so they’ve got cognitive behavioural therapy skills. Kyle spoke about the Amani program for Black youth, which has been a really good program. It’s a culturally responsive program for Black youth aged 12 to 29, which includes integrated mental health and substance abuse services. I spoke about the Step-Up Step-Down programs earlier as well—that would kind of touch on that demographic as well, to support youth with complex needs that require stabilization either before or after hospital care. Then we did speak about the cross-sector protocol development, because you can’t operate in a silo. What’s happening on the child welfare side, what’s happening in the school—we need to have that protocol, which is what we’re working on as well. Those are other kinds of tools that we’re pulling all together.
01:08:45Official transcript
Mr. Kyle MacIntyre
Just maybe some extra data points on the youth wellness hubs themselves: There have been studies published in the American Medical Association journal that show that these youth wellness hubs are diverting children and youth away from the emergency department into the community. They’re seeing the same levels of improvements in the community mental health space as they would in an outpatient hospital program as well. We’re seeing something like 39% of the youth that have access to youth wellness hubs in Ontario right now say that, without that service, they wouldn’t know where to go. We’ve got a 99% youth satisfaction rate of the services they have received from the hub themselves. They find 98% of them are saying that it’s the right way of helping that they need, and 90% of youth are satisfied with the length of time that it takes to get the service that they’re in there, so a lot of really positive metrics in terms of both the outcomes and how they are receiving the service in youth wellness hubs. I think we’ve had almost 365,000 visits up to March 31, 2025, so I am sure more have happened there.
01:10:00Official transcript
MPP Robin Lennox
Thank you, and I agree. I think youth wellness hubs provide a fantastic service, but they historically have not actually provided the full flight of evidence-based treatment for youth with substance-use disorders. Most often, we’re seeing those youth being referred from youth wellness hubs to adult-focused services to access opioid-agonist therapy, for example, and other medication-based services. Is there any effort within the ministry to adapt to the ongoing substance and toxic drug crisis that we’re seeing in Ontario and actually expand the offerings of the youth wellness hub to match the needs that we’re seeing among our youth, who are increasingly using substances that create more harms and increase the risk of death?
01:10:19Official transcript
Ms. Deborah Richardson
There are definitely referral pathways for OAT from the hubs. With the youth wellness hubs, the whole goal is almost like one-stop shopping because you can get somebody in, and then you can refer them or bring them in. I think that is what’s happening within. They’re creating a whole network. All of the hubs also have primary care. They have access to primary care, so they are able to have physicians who can prescribe. That’s why primary care connecting into that was so important.
01:10:32Official transcript
Mr. Kyle MacIntyre
To develop your point, it also isn’t a place to get all care. If you need withdrawal management services, you’re not going to go to a youth wellness hub; you’ll go to a different provider. We have a number of providers that do provide live-in treatment for children and youth, so there is opportunity for pathways into that for sure.
01:10:41Official transcript
MPP Robin Lennox
Great. Thank you. We know that the child and youth mental health sector has been drastically underfunded in recent years. Actually, over the past 20 years, the funding has been sort of based on historical allocations, as the auditor identified, which has meant that some regions are receiving far too little and can’t offer the programs the communities need. What action has the ministry taken to address this? Are we able to move to a needs-based funding model, and on what timeline are you anticipating that might happen?
01:10:56Official transcript
Ms. Deborah Richardson
There’s been an increase of close to 30% since 2019-20, so there’s been a pretty significant increase in terms of the budget.
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01:11:02Official transcript
Mr. Kyle MacIntyre
So there has been that increase. There’s also, then, additional programming. We talked about Step-Up Step-Down, for example, and adding new programming there. We’ve also added programming that, irrespective of where you are in the province, you can access without any wait times. One Stop Talk is a really good example of that brief service access to that. We’ve also invested in different programming like Telemental Health, which allows access, no matter where you are, to a psychiatrist in order to get an assessment and referrals. And we’ve heard a little bit about the Ontario intensive treatment pathway; we’ve set up a network for intensive services for that. A key component of what we’re working towards is the establishment of a core services framework for across the lifespan. Right now, we have a core service framework that’s for children and youth. We’ve engaged with a technical table with a number of clinicians and providers across the care continuity, whether that’s children and youth mental health or on the adult and addictions space, to be able to get advice about what the core services are from a lifespan perspective that we should be establishing.
01:11:33Official transcript