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.

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Read from the beginning of the meeting

Meeting ended

Ministry of Health

01:47:28Official transcript

Mr. Kyle MacIntyre

I think the report identified that there are a number of coordinated access programs that are already across the province. A review was undertaken a couple of years ago and I think we’ve identified over 100 already, not just in the children and youth space but in the adult sector as well. What there is a need for is to standardize that. We do have some work that’s under way around how someone accesses the system, get in somewhat of an assessment and then navigate to the next service if they need the next service. We talked a little bit about One Stop Talk, which does that work. So if someone accesses through the website or does a phone call, there are a few questions that are asked, then an assessment is done. At the end of that session—which is often at least an hour long—if that child or youth requires another type of service, there’s a warm hand-off and referral that happens in the moment to a provider who can do that service with all the information that’s been collected through the conversation such that they know who to go to next and when. So there is a warm hand-off. I think from a provincial perspective, one of the key components of work that’s under way—that really is also tied to the data digital initiative—is the creation of a provincial coordinated access system that’s happening out of the Mental Health and Addictions Centre of Excellence. So they’re developing this, focusing on being able to systematize an approach such that no matter where you are there’s a regional network access point and a provincial one to be able to do that. That is starting to roll out; there have been investments over the last couple of years to try to build that up and understand that. It’s going to take a lifespan approach. It will include the children and youth mental health sector as well, so when people access that point there will be an assessment and a referral to a provider. What’s great about that as well is they’ll be able to help us with some of the other pieces of the conversation that we’ve had about collecting data into the Auditor General’s report around being able to understand demand better. When someone comes in, that’s a data point; when they get referred and we know that they’re getting service, that’s a data point. So the provincial data standard and the provincial coordinated access system will be able to help across the lifespan approach using the core services when they’re rolled out to be able to measure all of that.

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01:50:00Official transcript

Ms. Lee Fairclough

Great. Thank you. I think my colleague may have other questions on that. My last question is really in the spirit of true public accounts. I think that the report identified an outstanding transfer payment reconciliation that was needed for the 2023-24 fiscal year and a plan to recover those unspent funds. Did you want to just comment a little bit on what the plan is to do that?

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01:50:26Official transcript

Ms. Deborah Richardson

Sure, I’ll dive into that one. So the ministry obviously is taking steps and making progress in completing outstanding reconciliations for the transfer payment agreements it oversees, focused on prioritizing reviews by fiscal year and programs with the highest volumes of outstanding reviews. A transfer payment reconciliation is a process where the ministry works with partners that receive government funding to reconcile the funds we see with the actual expenditures incurred during the fiscal year. The reconciliation ensures that funds were used according to the terms of the transfer payment agreement and any unspent or surplus funding is identified and recovered. The results of the reviews also help the ministry assess performance and program effectiveness and provide information to support future decisions. This process requires many steps, including the collection of information and ongoing communication between the ministry and its partners, to complete the reconciliation review. Oftentimes the number that is there isn’t the actual number that comes back because there’s a lot of reconciliation—literally. That’s why it’s called reconciliation; that needs to happen. After the end of each fiscal year, transfer recipients are responsible for submitting detailed reports to support the completion of the reconciliation. These reports include both financial data, including final third-party audited financial statements and data outlining performance against service targets. Child and youth mental health agencies provide this information to the Ministry of Health through the Transfer Payment Ontario system—TPON, we call it—which is the centralized online portal used to manage transfer payment funding and agreements. In these reports, agencies may report estimated unspent or surplus funding amounts. This information supports a detailed review by the Ministry of Health in dialogue with the agency to determine whether funds have been expended in alignment with the eligible expenditures and other requirements, as outlined in the transfer payment agreement. It’s only when this review has been completed that the Ministry of Health can confirm the funds have been spent in accordance with the transfer payment agreement and determine whether a final settlement is required to recover any unspent funds. While a recipient may identify an amount potentially to be recovered in the submitted financial statements, recovery amounts may vary and can only be finalized after a review is finally completed. The Ministry of Health has implemented a plan for completing outstanding reconciliations which has included adding additional dedicated resources. We needed to bring on some extra bodies to actually be able to do this work because it’s quite intensive, and to be able to go through outstanding reviews from previous fiscal years across all programs. In addition, the Ministry of Health is implementing changes to its processes to be more efficient and deliver sustainable reconciliation business practices to limit the accumulation of volume over time and avoid future delays. Supporting this work, there has been a lot of progress over the last year to onboard additional programs to the TPON system. So we’re actually moving on to TPON—I think when I first came into the ministry, we weren’t on TPON, so we’ve got a significant number of programs that are actually on TPON now. That supports a more efficient and timely transmission of documentation from recipients and other reporting tools. We’re really committed to completing all outstanding reconciliations by the end of this fiscal year. As outstanding reconciliations are completed for those reviews which result in an identified amount owed to the ministry—

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01:54:48Official transcript

Ms. Deborah Richardson

—there will be steps that we’ll take to recover the funds from the recipient, either through reductions of future payments, where possible, or other direct payment arrangements. Basically, we have completed over 236 settlements and recovered a total of $9.2 million. We’re still working on 318, but those will be done by the end of this fiscal.

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01:55:12Official transcript

Ms. Lee Fairclough

Just a quick follow-up: Is there a mechanism with this sector that, if it looks like they’re tracking to underspend and you know that there might be demand for services in other areas and those funds could be used, do you actively manage that closely with the sector to really limit the need to even recover funds at all in that final year? Do you do that with this sector?

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01:55:38Official transcript

Mr. Kyle MacIntyre

Yes, we do, and just generally at the Ministry of Health, we get quarterly reports and monthly forecasts as well. We use that to understand where there may be underspending that’s happening and if there is a need somewhere else, there often is an approach to be able to reallocate that.

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01:55:58Official transcript

Ms. Lee Fairclough

Okay, that’s great. Thanks very much. I appreciate all the questions.

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01:56:03Official transcript

The Chair (Mr. Tom Rakocevic)

Okay, we are now moving to the final rounds of questions, for the official opposition. MPP Gélinas.

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01:56:10Official transcript

Mme France Gélinas

I will start by bringing you way back, when Christine Elliott put the motion in front of the House. At the time, she was in opposition. We had a majority Liberal government and she got the Select Committee on Mental Health and Addictions to be put together. Sylvia Jones, the present Minister of Health, was on that committee; so was I. We made 23 recommendations at the time. I am speaking about this committee because the need at the time to improve children’s mental health was huge. It motivated people on all sides of the House. She was in opposition, she was a brand new MPP and she brought this forward, and the majority Liberal government accepted to put this select committee together because we all recognized that things needed to change. I will always remember: We stood in the media studio, all three parties—Liberal, NDP, Conservative—and we all agreed that this needed to be moved forward. It is the only time that all three parties have stood in the media studio and said things need to change. We made 23 recommendations. I’m sad to say that we only moved on two of them. We moved on the recommendation that says that children’s mental health should be moved under the Ministry of Health, which happened, and to create a centre of excellence, which has happened. The other 21 recommendations are still there and are very, very similar to the 22 recommendations that the Auditor General has put in the report 16 years later. What we heard in 2009, 16 years ago, is that children’s mental health agencies cannot recruit and retain a stable workforce because they are too underfunded compared to other parts. They were hoping that moving them from community and support services into health would help, but it has not. Just like the MPP was saying, not a month goes by that I don’t have a family come to my office. I go to Costco to buy Kleenex, because this is how much crying happens in my office. It’s a child with complex mental health that is on a wait-list that by the time anything happens, the family will have fallen apart. Dad thinks that we should do this and mom thinks that we should do that, but none of them are mental health workers. They do their best, but the stress on the family—they’ll end up split up. Often, children’s aid has to come in. In my neck of the woods, I represent 33 small, rural northern communities. The child will be taken away from its community and shipped somewhere else. Why is it so hard to properly fund children’s mental health so that they can recruit and retain a stable workforce? Why do we have, in recommendation number 12—you say all the right things, but why does it never get done? To tell me that in 2019 you had a 5% increase across the board and in 2023 we had a 5% increase and in 2025 we had a 4% increase across the board will never change the fact that if you work in children’s mental health, you make 50% less than if you do the exact same job in another—go to the hospital, go to public health, go to the education sector, open up your own business and you will make more money than if you choose to help children with complex mental health issues. So my question to you is, can you give me hope that we will fund children’s mental health agencies in a way that will allow them to recruit and retain a stable workforce?

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02:00:00Official transcript

Ms. Deborah Richardson

There were a few things that you were asking—the first was the select committee. There have been more than two things that have been implemented—

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02:00:12Official transcript

Mme France Gélinas

I’m interested in recruiting and retaining a stable workforce in children’s mental health agencies.

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02:00:20Official transcript

Ms. Deborah Richardson

That’s what we spoke about a little bit earlier—the importance of having that health human resource strategy that’s specific to mental health and addiction. So we are working with the Treasury Board on—they’re doing that labour market analysis. We need to be able to tell that story and build that case to be able to make those decisions. We’re developing a specific HHR strategy in children’s mental health.

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02:00:55Official transcript

Mme France Gélinas

In your response, you said that cycle 4 of the TBS survey is expected to be launched in the sector in November 2025. The results are expected in the spring of 2026—I’m reading your response here—and implementation of this will come in 2027. Really? This is my hope—that in 2027 we will have a plan? When will we act upon the recommendations of the Auditor General that say there is a wage disparity? We knew in 2010 that there was a wage disparity. We did a study that showed this, which was supported by all parties. The Minister of Health was there, sitting beside me during those audits. We know that there’s a wage disparity. Why is it so complicated to address that?

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02:01:52Official transcript

Mr. Kyle MacIntyre

It goes back to an earlier question that was raised around this. There has been, you did mention, the 5%, 5%, 4%, which is a significant investment in the sector as an across-the-board—but there has been an increase of over $200 million to the sector itself since 2019, which is a significant investment. When we talk about the health human resource aspects that you’re talking about, it isn’t just looking at wage either. An approach that we need to develop will be looking at the supply of health workers as well, which goes towards something that you’ve been saying before, that requires us looking at the types of training that would be required. We have started to roll out training programs to support the providers in this space—

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02:02:54Official transcript

Mme France Gélinas

I live in northeastern Ontario, a rural area. We have providers willing to take those jobs. They just don’t want to work for $30,000 a year when they can make $70,000 doing the same job in a hospital. We do have them, even in northern Ontario, but we don’t pay them.

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02:03:17Official transcript

Ms. Deborah Richardson

Just to reiterate, we are working on a specific health human resource strategy. And I hear you in terms of the timelines. We can take that back and look at what the timelines are as we’re gathering all of that data. The increases that we have made, I think, are making a significant difference. We’ve heard from the sector—the 5%, then the 4%—those are starting to be able to address some of the wage issues that these agencies experience.

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02:03:54Official transcript

Mme France Gélinas

But the 5%—they had computer systems that were so, so old that they took some of the 5% to upgrade the old computer system. Most of it didn’t work anymore. Most of them are still with Windows 10, which you can’t upgrade anymore, because they haven’t got the money to buy new ones. That means the staff doesn’t see a 5% increase. The staff doesn’t see that they’re finally going to have a pension fund. The staff doesn’t see that they’re finally going to have—none of this, like a benefits package that buys you glasses and allows you to go to the dentist. They haven’t got the money to provide any of this, when anywhere else, they will have a pension plan, they will have a benefit plan, they will have—none of that exists in children’s mental health. Why? Why not? Why aren’t they important?

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02:05:01Official transcript

Mr. Kyle MacIntyre

I would say that some providers do have pensions and benefits. I think that’s fair to say. Also, our understanding when we’ve engaged with the associations and sectors where the 5% is—90% is gone to wages is what we’re told, to wages and salaries. So, when that funding does get made, it is going towards more on the salary side and compensation side. There have been other one-time investments that the government has taken to improve the capacity of the sector—that happened during COVID and after COVID—for things like computers, renovations to spaces. We’ve invested in making sure that if there’s a need to address an issue with a roof, there’s funding available—

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02:05:59Official transcript

Mr. Kyle MacIntyre

—that gets to providers to be able to do that. There has been a range of different funding opportunities that are outside of the across-the-board that you’re talking about to go towards improving the capacity and the office space and otherwise for those organizations.

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02:06:21Official transcript

Mme France Gélinas

We all know that before the 5% in 2019, there were 12 years without a base budget increase, and then 5% came in 2019—hallelujah. But why is it that we treat children’s mental health with such low priority when we—I am not a mental health provider or anything like this, but I hear it enough that, “If my child had had access to the services they needed, they would not have started to use drugs. They would not have overdosed. They would still be there with us.” I hear this all the time. Two members of my community die of overdose every single week. Most of them are kids, are young, and we’re stuck with a study that will take us until 2027 to deliver a new—anyway, I have to move on. I only have 10 minutes. Health card numbers: I think we could do a lot if we had stronger data to show that if you support children when they need it, it will have a huge impact, including not needing to be admitted into a hospital etc. Your answers were making available a card reader program to support onboarding of CYMH agencies and updating material developed for the adult sector to support onboarding. The implementation date of that is in 2030. Why does it take five years to make an OHIP card reader available?

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02:08:04Official transcript

Mr. Kyle MacIntyre

It’s the full implementation of it and the access to the data digital infrastructure side of things. It’s not just getting a card reader: It is moving the children and youth mental health providers onto the provincial data standard that we talked about and making sure that we’ve got all the compliance systems in place for it as well. And then there is—sort of what you’re talking about—a component of that is the access to a card reader as well.

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02:08:41Official transcript

Ms. Deborah Richardson

But if I could just reiterate that many agencies are already collecting OHIP data as well, so that helps. As we’ve got the BI—I picture this filing cabinet is over here and then we transfer to the main data infrastructure, then we’ll take that data and we’ll move that over there. As you probably know if you’ve implemented data initiatives, it takes quite some time to do it, and we’re talking about people’s health information and all of that, so things have to be done in a proper way.

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02:09:23Official transcript

Mme France Gélinas

Okay. Recommendation number 1 that the Auditor General made was “additional spaces for intensive core services and secure treatment” in all service areas, including northern Ontario. Your answer was that you created regional intensive treatment networks that will be responsible for delivering and managing access to a coordinated system of intensive treatment for children and youth. Is that in all 33 areas that you have done that?

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02:10:00Official transcript

Mr. Kyle MacIntyre

Yes. It will be establishing provincial coverage for the Ontario intensive treatment programs.

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02:10:07Official transcript

Mme France Gélinas

Okay, but you have this under “completed,” so is it completed in all 33 areas? Remember that you gave us the “completed” and the “coming.” Under “completed,” you have “created regional intensive treatment networks”—just curious to see if that includes all 33 areas. I’m not the only one from northern Ontario; we’re all interested in that.

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02:10:34Official transcript

Mr. Kyle MacIntyre

I think the first part of what you were referencing was context setting, so you had an understanding of what the initiative was, so you could see and sort of lead into the first three bullets. It says, “The initiative will.” So that was giving you some context about what the initiative is, just so you could read that a little more clearly. Then it talks about of the following: What were the elements that have been completed? So the formalization of the governance structure and advisory committees. We’ve started the work around the development of a quality standard for it. We’ve done a landscape report to be able to do a cross-province understanding of the services—

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02:11:28Official transcript

Mme France Gélinas

Okay, so although it is under “completed,” you’ve completed the idea of doing that work, but you haven’t done the work?

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02:11:37Official transcript

Mr. Kyle MacIntyre

We’ve established a model of care. We’ve got a governance committee that’s in place that’s developing the standards. We’ve done a landscape assessment of who is being provided there. We’ve developed an understanding of who should be receiving these types of services, so the clinical profile of it—

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02:12:01Official transcript

Mme France Gélinas

Okay, you said that before. I got you. I want to use my time wisely. Under “outstanding undertakings,” you say the ministry will also work with the secure treatment provider to improve access to these services. Are you committed that the new treatment facility will be not-for-profit, or are you considering for-profit and not-for-profit in the future?

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02:12:29Official transcript

Mr. Kyle MacIntyre

The children and youth mental health programming and the secure treatment programming funding is publicly funded.

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02:12:38Official transcript

Mme France Gélinas

Yes, but right now, also delivered by not-for-profit—the 220 agencies that you fund are all not-for-profit.

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02:12:48Official transcript

Mme France Gélinas

If we are to open up new secure treatment providers—you say also work with new secure treatment providers—are we committed that those providers will be not-for-profit, or it makes no difference and it could be for-profit?

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02:13:05Official transcript

Ms. Deborah Richardson

That hasn’t been considered. To date, we fund not-for-profit organizations, so we haven’t explored private at this point.

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02:13:15Official transcript

Mme France Gélinas

Then you go on to say you will hold a symposium on intensive treatment services for CYMH providers and system partners to continue to contribute to this design of Ontario’s new live-in treatment models in the fall of 2025. Has this been done, or when is it scheduled to be done?

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02:13:45Official transcript

Mme France Gélinas

Very good. Okay. The next one is—again, you’re answering the number 1 recommendation of the auditor, and you say the protocol is expected to be in place by 2027-28. When you say the protocol will be in place, does that include the services will be in place, or just how the services will be provided? Is it the how or the actual delivery that we’re talking about?

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02:14:14Official transcript

Mr. Kyle MacIntyre

We expect services for the live-in treatment, the Ontario intensive treatment, to be starting in 2027-28 in the full capacity, but starting some in 2026-27.

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02:14:27Official transcript

Mme France Gélinas

Okay, and the goal is to have them in all 33 geographical areas?

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02:14:32Official transcript

Mr. Kyle MacIntyre

The goal of the Ontario intensive treatment pathway is provincial coverage. So we’ll be moving to a hub-and-spoke model. We’ll have, I think, six regions, six hubs, that will work as a hub and then linking up through other providers to provide that coverage. The protocol itself is about how the sectors work with one another.

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02:15:02Official transcript

Mr. Kyle MacIntyre

I think I had mentioned earlier: We’re going to be doing a call for proposals for folks to be able to apply to be a hub.

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02:15:12Official transcript

Mr. Kyle MacIntyre

Yes. So that requires an engagement with the sector for them to see what the criteria will be, to see if they are going to able to be the type of provider that could provide that service.

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02:15:27Official transcript

Mme France Gélinas

Recommendation number 5 from the Auditor General talks about “define the roles and responsibilities of the two organizations in the current mental health” that is for children. You’re under the ministry; the rest of them are under Ontario Health. What is your plan for this? Are we going to see children’s mental health fully integrated with the rest of the mental health system or continue to have two organizations?

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02:16:00Official transcript

Ms. Deborah Richardson

This is where I sort of spoke to the fact that we need to be able to look at some policy options because of the legislative responsibilities of supporting children on the Ministry of Health side. We would have to make legislative changes to have Ontario Health be able to do that type of work, so that’s the work that we need to do. We’ve been really focused in on responding to this report directly, getting this up and running—all the things that we spoke about today. I think that those will be options that we’ll have to be able to present to government at some point, sooner than later, but as we’re starting to move all of that over to Ontario Health.

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02:16:52Official transcript

Mme France Gélinas

Recommendation number 6: “children and youth with complex needs.” You’re talking about protocol expected to be in place by 2027-28. I was just wondering if you had considered integrated services for northern children as a way to deliver services to children and youth with complex needs, which are used in other parts of the health care system but are not used for children’s mental health.

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02:17:30Official transcript

The Chair (Mr. Tom Rakocevic)

That concludes the time for questions this afternoon. Thank you very much for your attendance today and for answering the questions. You are dismissed. We are now moving into recess.

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02:18:22Official transcript

Ms. Jess Dixon (Kitchener South–Hespeler / Kitchener-Sud–Hespeler PC)

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