Mental Health Matters: Building Supportive Mains Streets and Downtowns

Paul Johnson All good games start with a whistle and we’re off and running and all good officials always have a Fox 40 whistle in their pocket. Just remember that. And you know, the only … The last sports story I’ll tell you because any Toronto people here will know that I can drone on about them, is that by, you know, interesting coincidence, I talked to a friend of mine, a colleague in the officiating side of my life. His name is Bob Delaney. He was a New Jersey state trooper went deep undercover with the mob, still has a price on his head, and then when he came out of that and dealt with his own mental health challenges as a result of the PTSD that he had from being undercover for three years with the mob, he decided he’d pick up refereeing and he refereed in the NBA for decades and decided that getting yelled at by 20,000 people on a nightly basis was his form of recovery. But what Bob does now is what inspires me. He’s part of NBA Cares. He travels around the world talking about why we need to talk about mental health. He’s employed by the U.S. military. He’s traveled to every overseas base for the U.S. military, talking about why we need to talk about mental health. He talks to sports people about why they need to talk about mental health. And so when I told Bob what I was doing and carrying on and I said, “I’m going to Ottawa and I’m going to be part of this panel bright and early on a Thursday morning.” He said, “Paul, it is always important to be talking about mental health.” I’m so pleased to be joined by folks who will be sharing their insights and experience and really framing as well, why we need to talk about mental health, not in the context of our military personnel per se, not in the context of our sports franchises per se, but in terms of why we need to talk about it for our cities. And I couldn’t be happier to be joined by Sarah Kennell, who is the National Director of Public Policy, she’s sitting right next to me, for the Canadian Mental Health Association. And I can tell you, my 15 years working in a nonprofit in Hamilton, we partnered more times with the local organization because, of course, the Canadian Mental Health Association has over 300 community associations and locations across the country. They speak about and promote mental health and support people recovering from mental illness. Mark Garner and I met when I came to Toronto. He had heard about me from Hamilton, and it can go one of two ways. When people say, I heard about you in Hamilton … Well, for Mark, he said, “I’m so glad you’re in Toronto.” Then he promptly left and went to Calgary, so I’m not sure how glad he was that I came to Toronto, but we are glad and I was glad to get to know Mark in Toronto and I’m really glad that he is the Executive Director of the Calgary Downtown Association and wants to share some of those insights and probably draw on his connections to both cities and the impact of mental health on cities. Dr. Eileen de Villa, as many of you will know in this room, is of course, the people’s doctor in Toronto for the largest public health agency in Canada. I just know her as my friend and colleague from the City of Toronto. And Eileen will be sharing her insight over a number of years. And I just want to say, you know, Eileen, as your time with Toronto Public Health comes to an end in … You know, the exact days, hours and minutes and seconds, I just continue to say, I can’t believe it’s coming to an end. But congratulations on  your time and your tenure with Toronto Public Health. And last but not least, Andre Corbould. Andre and I met when he was the City Manager in Edmonton. And you know this group here we convene as City Managers, the largest Canadian cities to have chats about what goes on. And Andre was a huge contributor to that. Today he is the Mental Health Fellow of the Canadian Urban Institute and a senior advisor at Integrated Strategic Partners. So we have a great group here. And I’m going to start, Sarah, with you. You have some information, some new evidence, some of that new conversation that’s always going on about why this matters so much for the cities that we all call home.

Sarah Kennell Thanks so much. It’s really a pleasure and an honor to be here. And before we get started, just want to echo what Mary said. One stat that we use at the Canadian Mental Health Association is that over the course of our lifetimes, 1 in 3 of us will experience a mental illness or a substance use disorder, but 5 in 5 of us have mental health. And I think that’s a really important place to start the conversation, to say this is an issue facing all of us, every single one of us. Some people are particularly challenged during certain moments of their lives, and it’s important for us, therefore, to create the infrastructure, the systems, the supports needed to keep those people well and part of our our communities so that they can thrive. I also want to shout out everyone in the room and my fellow panelists, you folks are on the front lines doing the hard work. And I think there are a few places where we can all agree we care deeply about our community members. We know our communities are struggling. We’re facing incredibly complex and intersecting issues where there’s no silver bullet and no quick fix solution. So I just want to really echo my support for all the hard work you’re doing and the hard choices that you’re making every day. At the CMHA we released late last month a report called the State of Mental Health in Canada. And it really is the first time that we, at a national level, are taking a step back, looking at data across a series of 24 indicators to reflect on how is our system performing? How are Canadians doing? What are the gaps and how can we address them? And so I wanted to speak to a few of our findings from the report and then also speak to some of the innovations that we’re seeing in cities in particular and talk about the solutions. So first off, one of the major finding is that Canadians are not okay. Their mental health is three times worse than it was prior to the pandemic. And 2.5 million people in this country cannot get the help that they need, and that’s equivalent to the provinces of Saskatchewan and Manitoba put together. The second finding is that we’re not spending enough on mental health. So our research, looking at provincial and territorial budgets across the country showed that the average spend in health care budgets on mental health is only 6.3%, 6.3% of our health care budgets going to mental health. And even less within that. The poor cousin to mental health is substance use health and addiction. And that unfortunately, is below what was estimated by the Mental Health Commission 12 years ago. So we backslid on what we estimated to be spending, which was 7% in 2012. And it’s way below what our peer countries, OECD and G7 countries spend, which is on average about 12%. So the other piece I wanted to speak to in the research is that Canadians can’t afford to get the mental health care that they are entitled to. Mental health is a privilege when it should be a right. And that’s because of the system that we created 40 years ago through the enactment of the Canada Health Act, which effectively at that time made a decision, Parliamentarians on the Hill decided we are going to carve out mental health and leave it to the provinces and territories to do. Meaning that services like counseling, psychotherapy, eating disorder treatments, addiction treatments, those services all fall outside of what’s considered our public universal health care system, meaning that folks have to rely on either limited insurance benefits or to pay out of pocket. And what our research found is that folks are having to make hard decisions, pay for therapy, pay for rent, go to addictions treatment, pay for food. These aren’t choices that Canadians, in what we tout to be an incredible health care system should have to make. And certain populations are bearing the brunt of that. Over 57% of young people between the ages of 18 and 24 with a mental illness said cost is their main barrier to getting the health care that they need. We also know that mental health is so much more than the care that you’d receive through your family doctor or in a hospital. It is reliant on the social determinants of health. And so when we take that broader and holistic view, we know that the correlation between mental health outcomes and access to housing, access to safe and reliable food supply, access to safe drinking water, access to income supports are all critically important and make our job so much more complicated when we talk about the solutions and the interventions needed to address them. So we know, for example, that Canadians with poor mental health are 50% more likely to live in inadequate housing compared to those with good mental health. And people with mental illness disabilities are 50% more likely to be unemployed. So when we think about the economic impact of not ensuring that people with mental illnesses are able to live well and contribute to our economy, it’s a huge hit to our overall economic stability.

Paul Johnson Let me just jump in there. I’m going to come back to some of what we’re doing well. But what a great jumping off point, because when it comes to social determinants of health, there’s somebody sitting not too far away from me today who gets up every day thinking about that in the role of public health. Lots of vigorous nodding, Eileen, from you on this, but just reflect on that piece as you think about how do we become healthy as a city, in the city of Toronto’s context, healthy as a population? And where does this fit in and why the vigorous nodding, I think. Let me just be blunt. Why the vigorous nodding?

Eileen de Villa Well, because Sarah was talking like a public health person, right? She was actually talking about health. So when we talk about mental health, most people are actually talking about mental illness, exactly to your first point that 1 in 3 of us in our lifetimes are likely to experience or are going to experience some kind of mental health challenge or substance use challenge. But five out of five of us experience mental health, and that’s the reality. And that’s what public health is all about. We’re actually all about trying to find those things that help us to start life healthy and to stay that way for as long as possible. And they’re exactly the things that make us mentally healthier, the things that make us physically healthy. They’re the things that make us socially healthy, the things that make us spiritually healthy. They are the determinants of health. Exactly as Sarah said, housing, income, food, clean air, clean water, social connections, sense of belonging, purpose, and the feeling that you can actually reach your full potential. So, you know, to my mind, the kinds of things that Sarah was speaking about were the kinds of things that we’re seeking to achieve in public health, whether we’re talking about a mental health outcome or whether we’re talking about just general health outcomes, period. And it’s interesting to me … Recently I was in Copenhagen speaking to public health officials there and city officials interestingly there, and their concept, the conversation that they are having in and around health in their city, is this concept of “what makes a good life?” Right? What is it that we’re aiming for when we’re talking about how do we have a good life here in this city? I did want to make one comment, though, Sara, in respect of … So I did have the opportunity to read, you know, the excellent report by the CMHA, which I would commend to all of you. It’s really well done. And I think a really nice summary of the kinds of things that we need to work on collectively. But I think the one comment I want … I agreed absolutely with the need for greater investment. I agreed completely with the notion of focusing more on equity on data. You’ll see this all in the report. The thing that I was interested about is this notion of commenting on system. And I think if we’re really candid about it, if we’re really honest about the way things are organized, whether it’s within the public sector, the private sector, the not for profit community sector, we talk about systems and frankly, we have silos, right? That’s the reality. We do not … So even if we get to that level of investment that we’re talking about, even if we get to the 12% and start to match other OECD nations or G7 nations, if we don’t actually use those resources in a way that actually connects, you know, the different sectors, that actually has some coherence – we have seen this time and time again, people fall through the cracks. You have little, you know, nodes of activity, each trying to do something significant, but without actually thinking about people and how they navigate through the different services systems. And these are not necessarily, you know, as secure systems. It’s just how do people live in their community? How do we actually organize ourselves to support better health, to support the ability for people to reach their true potential? That requires systems thinking. It requires actually articulating goals. Focusing on them together and working on them together in a very concerted fashion.

Paul Johnson Andre, you have focused your public service around how do we build these teams, collaborations, coalitions that actually can move through some of the tough challenges? How difficult is it? What I just talked about … To build that sort of systems approach when everybody wants to say, well, housing is housing, so we’ll get housing people in a room, we’ll get housing funders in a room. And then we hear, of course, that, oh housing, that has an impact on mental health. But the mental health people are in the room down the hall and they’ve closed the door and there are no more registrations allowed for that conversation. How big a challenge is this system level approach that we need to take?

Andre Corbould Yeah, I mean, it’s a huge challenge for sure. I don’t think it’s as complicated as we all tend to argue. I think we have to de-complicate the system and there are lots of easy ways to do that. And I’ll give you an example in a second. But yeah, I mean, first of all, I have to point out, you know, when you first mentioned the housing issue, you know, I’ve been advocating for a long time when infrastructure and housing got together, I thought that was a great move. But I’ve been constantly asking, where is the health ATM in the room? Why is not the health person in that discussion? Right? So that needs to be sorted out. But we just have to de-complicate the system. And I’ll give you one specific example. There’s 100 other things we could do, but I’ll give you one specific example. I’m a veteran. I have mental health issues from my time and my PTSD. Veterans Affairs was a disaster a while ago, and the veterans were having a hard time getting benefits to support, and support to get therapy and go through the PTSD therapy. And what they did to de-complicate the system is they completely overhauled the system so that if if you phone in, within 24 hours you get a Blue Cross card, an automatic two years of 100% coverage for your mental health supports. That’s the time where you go through your diagnosis and go through the pieces. It has completely uncomplicated the system and provided access to mental health that people didn’t have before. Why aren’t we doing that for every Canadian is my question. And the obvious answer is probably, well it would be expensive. Yeah but, you know, the cost of the back end of all this stuff, from health systems to criminal systems to justice systems to everything else is way more expensive. So like, I just think we have to acknowledge that there’s a mental health crisis in the world, in our country, and de-complicate the system because it’s not rocket science. Actually, if you … If your tooth hurts, you go to a dentist. It’s pretty simple. If you have mental health issues, you go to a psychologist. It’s not complicated. So let’s just de-complicate the system. Make it easy for people to get access, invest in our country and our people and get to fixing it. So … I sort of … I don’t like the concept of talking about how complicated the system is. We’ve complicated the system. We can uncomplicate it if we want to.

Paul Johnson Yeah, yeah, yeah. You talked a little bit about impact and, you know, I will say the reports … They come out and across everything, the impact of this is this, this and this happening. Mark, on the ground, you’ve worked a lot, seen the impact of it from the standpoint of what it does to business, to tourism, to people’s life in the downtowns of our cities. And I think there’s broad agreement downtowns of cities, you know, can be and should be vibrant places that have all sorts of interactions. You have never once said “this is about not having the impact of social issues”, whatever that might be. It’s about that right balance. But the impact is there. If we don’t have the economic investment, if we don’t have the cultural investment, if we don’t have the visitor investment in our downtowns, challenges can arise. So talk a little bit about that on the ground impact that you see and have seen in your work.

Mark Garner Thanks for that, Paul. And I think when you talk about impacts and I’m just looking at the clock, we don’t have enough time to talk about the impacts that are impacting our downtown cores. You have to read the report, if you haven’t read the report, read the report. But also the tools that are there for the report show you on a province by province basis of what is being spent. And as Sarah mentioned, 6% is not enough, 12% to elevate it … 12 probably is not enough. But that should be a goal. The impacts … And it says very clearly in the report and I usually say at this moment of time, there’s usually a reason why …. This is usually not at this type of podium or table because in the report it says very clearly, “if you don’t measure it, you can’t solve it.” And I think we as urbanists, downtown city builders, we have access to data. We know what’s happening on the street better than most. We deal with individuals every day. And I would even say our retailers, our business owners, our property owners are dealing with mental health and addictions more than most. We’re starting to train people to deal with those things. So we are seeing sort of the economic impact. Where business plays a role is to really identify where the data and be a part of that room or that table to clearly articulate what’s working, what’s not working and what should be the future. My time in Toronto, and Paul was part of this process, we had penned something called a seven point action plan from a business perspective, and Eileen was part of that conversation and that strategy. Getting to Calgary, I wrote a nine point action plan for Calgary, which was delivered to the city. And what that brought too is a business focus. And our mayor, Mayor Gondek, struck a committee called the Downtown Safety Leadership Table, which businesses role was to work with various different partners that deploy service into the community and identify the gaps and the issues on street. And then you have to follow the money because there’s a friend in the room that will tell you that downtowns are economic islands and you have to follow the impact of that cash, of where we’re spending money and where we should be spending money. And the economic impact that’s happening with mental health and addictions as one of the priorities that needs to be addressed, as well as housing and a multitude of other things. Yeah. Business. We are there. We deal with it every day. We’re dealing with mental health and addictions. We’re dealing with encampments. We’re dealing with the complexity of those problems and trying to bring back, you know, economics to downtowns. And I think the pandemic didn’t help us to some degree. We never used to do this work in the past. I like to call it BIA 2.0, where we used to just be retail marketers, promoters, events and festivals, beautification. But we’re in a frontline now, dealing with mental health and addictions, and are a true partner to be at the table to bring that data, to make all the organizations that deploy service more effective and more efficient and get people somewhere into that service of wellness.

Paul Johnson So, Sarah, I’m going to come back to you because we’ve now heard a couple of of comments about what can work. And, you know, I love Andre’s comment, sometimes it’s not that complicated. It isn’t. You know, we can make it work. Veterans Affairs, a great example, the fact that business isn’t just writing letters to mayors saying do something about this issue or that issue, but actually saying, how can we play our role … I”ll boast a little bit about Toronto. We now have a Toronto Community Crisis Service, 100% of our community covered by a non-police response to certain mental health calls. Are you seeing innovations across the country that give us a little sense of hope as a way of framing the conversation about why the deeper investment must follow?

Sarah Kennell Absolutely. And I just want to echo what my fellow panelists have said. And thank you, Andre, for sharing your personal experience. I think that’s how we affect change. And it’s about de-complicating the system, deconstructing the silos and the artificial barriers that are really rooted in stigma and discrimination. Why don’t we invest this? Why do we establish layers of bureaucracy and hoops to jump over, if not for the deeply held negative, harmful beliefs that we continue to hold about people who have mental illnesses or who are struggling with addiction? And so if we can agree upon that, then the solutions become relatively simple. It’s about meeting people where they’re at. Alternative approaches to crisis response, a great intervention that not only achieves better outcomes, but also saves the system hundreds of thousands, if not millions of dollars. When we look at the the Toronto results of the alternative police response team. They are receiving thousands and thousands of calls and less than 1 in 5 will involve an emergency service. Similarly, in the province of B.C., they’re called PACT teams, peer assisted crisis teams, less than 1% of calls received, and they’ve received over 10,000 since they started a couple of years ago, involves police intervention – so police can actually focus on the job that they were hired to do, on the resources that they’re receiving  …to provide service for. Those are innovations. Integrated youth service hubs, another example started in Kelowna, a program called Foundry. We’re now seeing it pop up across the country. And what that does is really create a one stop shop for young people that they can access primary health care, employment supports, mental health and addictions supports, community supports ,educational resources. These are the types of interventions that cut across the silos that unlock access to better health outcomes. And the third thing I’ll mention at the macro level, is when the federal government transfers health dollars to the provinces and territories, it loses all ability to hold them accountable to where those resources go. And so in an environment where we’re in an acute care crisis and we hear about the impacts of E.R. closures, etc., we divert our attention to the acute care crisis where it costs us the most to deliver care and serves the least amount of people. And don’t get me wrong. Those are critical places for people to get quality and comprehensive health care, but it’s at the expense of the frontline organizations and community frontline providers who are doing the work to keep people out of hospital, to keep people out of shelters, to keep people well in recovery. And so we need to disrupt the system of knee jerk reactions, the desire for short term results, the emphasis on data collection solely in hospitals and doctors offices and start pivoting to community.

Eileen de Villa Yeah, Can I pick up on that one? Because actually both Andre and Sarah made some interesting points there that I think are worthy of pick up. So, Andre, you talked about how, you know, the investment upfront actually spares later costs more significant costs down the line. Sarah you said the same thing. That’s the prevention message. The real challenge with that is that it is actually a very difficult it is a difficult message to sell as much as we all, you know, we not our heads, we say, you know, ounce of prevention worth a pound of cure. The real challenge is that when you’re trying to focus on results and you’re showing outcomes when you are successful with prevention and this is the perennial public health challenge. If you are successful in your prevention efforts, it looks like nothing happened. Right. And so the constant joke in public health is that, you know, I’m just I work in public health. I’m going to go to the office and, you know, I’m I’m I’m going to make nothing happened today. That’s my job. Make nothing happen. Most valuable. Nothing there is. And it’s a conversation that we’re not having enough of that we need to really start investing in and engaging in, because it really is. You’re right. We have some fires to put out and we need to be talking about how we put upfront investments to stop the fires from happening in the first place.

Paul Johnson Mark …

Mark Garner Yeah, I’m obviously very sensitive to the conversation around the challenges, but obviously, you know, as Sarah says, there’s this one stop and I think it is needed. But I think when we talk about downtowns and the health of downtowns, we talk about a more distributed model. We’re obviously trying to make downtowns safe and inclusive for everybody, but you can’t put large facilities in a downtown core and expect everybody to get the same service in that location because their specialty, as we know, around the services that need to be deployed. And to Eileen’s point is we’re calculating that back end impact because what’s happening is all the expense around mental health, addictions and the challenges that retailers and downtowns are seeing is all that money comes to the back end and it impacts business and it’s downloaded to business and we have to articulate and be at that table to articulate that money being spent needs to go to the front end and we need to take an active role and measure those outcomes so we know the success of what’s being deployed is actually netting the game for quality of service. But also we do a lousy job of the successes that we all have. We don’t communicate it to the public. We need to educate the community in a more effective way about the investments being made. And we are getting people off the street and into the service of wellness. But we’re on to the next individual, we’re on to the next individual, and we have to, as partners, all collaborate and really articulate. We do have some successes and we know stuff that we’re doing is working.

Paul Johnson So cities, of course, experience all of the impacts of things which jurisdictionally cover, you know, the multitude of of governance that we have in this great country of ours. So let me move to how we might continue to build this conversation in the absence of the pure jurisdiction being here, here and here. Cities have to step in and they are. The challenge is, then you get other types of directional and policy approaches, and we’re seeing it very much so right now in addictions. There has been a sea change in the way policy is being developed and it’s causing, of course, actual services on the ground, Mark, to your point, what we’re trying to do, to be changed and, you know, not to sit here and pass judgment, but how do we then continue a call that says we must include all the voices at the table? You talked about business, not always at the table, sometimes because business didn’t want to be in the past, but many times because we didn’t invite business to the table. So we’re doing more of that. And yet now that challenge remains of policy change, funding decisions that then leave cities holding the bag literally and figuratively, to try not only to continue the good work that’s happening, but also try and pivot to what is happening around us. Andre, why don’t you start off this piece around – how do we think differently about the engagement around jurisdiction? And I would … I’ll throw out, is it better for us to think about how we might manage that rather than trying to sort out whose jurisdiction is actually is? I mean, I spend a lot of times in rooms with people going, we can’t do this because it’s the jurisdiction of the province. And I said, well, that and a buck will buy you a cup of coffee … That’s the saying we have in Hamilton because we have lots of Tim Hortons. Right? So, you know, that’s the piece. And so we spend all this time trying to point that out, some of that might be useful at some level, but what practically should we be focusing more on as we try and build this partnership model to actually get stuff done?

Andre Corbould Again, I don’t think it’s complicated. It’s … I think it’s about mobilizing. I use that term. So this country can mobilize itself when it needs to in a crisis. We mobilized for the pandemic. Was it perfect? No. But we as a country mobilized and we crossed jurisdictional boundaries. I was the Deputy Minister of Education when the federal government started a billion … Several billion dollar school restart program. That’s a provincial jurisdiction. But everybody agreed, they invested $3 billion, we got a whole bunch of money to do the school start ups again and we got the schools and the kids back into the schools. We mobilized as a country. Trump tweets about 25% tariffs and we mobilize as a country. We saw the premiers get together with the Prime Minister and figure something out and go mobilize the country, so we can do this. We’ve done it several times. We used to do it for war. We used to do it for other reasons, but we’ve done it recently for the pandemic. We did it for the school’s restart. We are doing it now, I think, on the tariff issue with the with the United States. Let’s do it for mental health. Let’s mobilize the country, let’s declare a mental health crisis and put all the resources we have together, mobilize the country in a coordinated fashion and get it done. It’s that simple.

Paul Johnson Eileen, you’ve been leading the charge of collaboration on a number of fronts. But on this subject of mental health and addictions within the City of Toronto, bringing colleagues within the city together – to build on Andre’s piece, just a little bit about how we might look at this in a practical way for cities to say, “let’s figure out how we can work together on this crisis” rather than trying to decide who ultimately is going to deliver on this crisis.

Eileen de Villa So, you know, you must have seen I was facing this way. You clearly saw the gears turning in my mind. So I agree with Andre that this can be complicated, right? We have seen that when we pull together with some clear objectives in mind and we say “this is where we’re going” … We’re actually able to do it. And these are huge undertakings we’re talking about. Not simple, you know, singular focused issues. They’re often very, very complicated. So even just getting the people together in the room is the first step, right? Actually having the conversation around what is the objective that we’re seeking here. I think the other thing that struck me was that it is … You know, in the situations you described, Andre, you know, it’s clear the tariff is a problem. We need to, right, this is a challenge. It was a … we all came to a consensus relatively quickly around what the problem was and at least some of the first steps towards the solution. I think to Sarah’s earlier point, one of the challenges when it comes to mental health and substance use issues and actually trying to address the challenges we see on our streets in our cities is this stigma which I think actually comes from fear. Right? It’s … there is a significant component of fearfulness around mental health and substance use challenges, sort of “there but for the grace of God go I.” And I think that, you know, one of the joys of being in medical practice is that you quickly understand, I think, if you’re going to make it in medical practice that you do have to meet the patient where they’re at. And sometimes the patient is the policymaker, right? Sometimes the patient is the policymaker. So how do we go about meeting our decision makers, our policymakers, where they’re at? And figure out how we move them towards the better decision.

Paul Johnson Sarah, you see this work happening at the national level. Your thoughts on how we might bring the relevant parties together. If we do this city by city, even if we do this province and territory, by province and territory, we’re not going to make the movement that we need, nor will we make it fast enough. What’s the advice coming from that national perspective that you would have for this group?

Sarah Kennell Yeah, it’s a great question, and where we sit, we would argue that the federal government needs to step up and play its role of coordination and leadership to the tarrif question. Health is multijurisdictional, there’s no doubt. But at the end of the day, it’s federal legislation. The Canada Health Act guides the administration of health care across the country, and it trickles down layer of jurisdiction to layer of jurisdiction. And to me, we need to go back to the top and say – if we are to acknowledge that we are in a crisis and the evidence is overwhelmingly demonstrating that we are at a crisis point, the kids are not alright. Our communities, our downtowns, are not all right and we are to the point where out of fear we believe the reaction is “lock them up.” That is the negative and harmful discourse that we are turning to in the absence of leadership. And that’s unacceptable because the policy solutions are there. The will and the desire is there because of lived experience. Decision makers themselves, as people walking around the halls of power, have that lived experience. It’s about leadership and accountability. And we need a federal champion. The creation of a new Mental Health and Addictions Minister is a step in the right direction. We need that role to have teeth. Mandate budget to say we are bringing the jurisdictions together at all levels to lock ourselves in a room until we have the budget and the accountability and the plan to address these solutions because we can no longer go piecemeal in a fractured, fragmented way, province by province, community by community, because it further hurts our communities.

Paul Johnson Mark, you mentioned a bit about the role that business in particular can can play in this. And I want to come back to that with you because to use another example around housing and actually housing construction, not the issue of housing, but housing construction, the crisis we’re in now in many cities has brought together people in different ways. I mean, I was just on a panel with developers and they weren’t yelling at me about, you know, the fees and charges that cities provide. They were just saying we just need cities to build infrastructure. We understand that. But we just need some kind of break because right now we cannot get shovels in the ground. And I say we need your shovels in the ground. And so there was this moment of municipal/ developer love on the stage, which people found to be incredibly off-putting. But it leads to things. And I’ve watched cities across this country try new ways of unlocking shovels in the ground, but also unlocking a new way of looking at housing to deal with the bigger issue, which of course is we need to build better housing and cheaper housing for people to come here, for growth. So that’s a long introduction to say, is this the moment that we really do not have business there because it is a vested interest – The downtowns need some attention and some investment, particularly coming out of the pandemic, but actually to look at resetting how, and the correlation to it. And I would imagine when you’re talking with businesses, the reality is this affects their employees as well. So we talk about mental health as is this thing that impacts business. It’s every day within business that it’s a real thing, too. So how can we better solidify this connection with business moving forward?

Mark Garner Well, that’s a complicated question. Great question. I would just say just to. Yeah. Where do you go on this one? I don’t see it as a federal government, provincial government or municipality to solve these problems. It’s a community issue and we have to change the way we’re trying to fix the problems. I don’t disagree, the federal plumbing for cash does not work the way it’s working today. So we’ve got to get more money into the community. Housing affordability … there’s 250 people that move to Calgary every day, but we don’t have the housing. We don’t have the mental health supports and we know the people that are moving there. We’re expecting well, they’re all great Canadians, new Canadians, but they have their challenges as well. So it’s that infrastructure. But business needs to … we want to be at the table and really clearly articulate the work that is done through multiple organizations to make sure that the voices at the federal level, provincial level and at the municipality, we prioritize the things that need to be done. I’m just going to come back to a bit of the downtown safety leadership table. We had penned through seven months, eight months of consultation, 45 agencies, community associations. Normally what happens with the implementation around the impacts of downtown, you build a report. It sits on someone’s shelves. You identify somebody within your organization and say, “Now go deliver that.” And there’s no monitoring of that. With the 28 recommendations that we brought forward just in recent budget, all now fully funded and being implemented with measurements. And they start with things that could be done within a year, things that could be done with 1 to 3 years and then three years out. And it’s a community. So the community is leaning in. And I think that’s where business … we need to be leaning in – into the solutions that have been identified in the spending requirements to make quality of life changes for our community so it’s safe and inclusive for all. And we just need, as an organization, to lean into it because we’re there. Business … to your point, Paul, business is always seen as just a funding source. You’ve got all this money, pass it to us and we’ll take care of it. And the answer is no. We have a more vested interest in the quality of life for our communities and the future of our communities. So a roundabout way, but it’s, you know, we need to be at the table. And I think my fellow BIA’s business improvement areas and business improvement zones that are here today, you need to go back and you need to read the report and you need to talk about that report and your data points for your province every day, to increase the education and visibility to what needs to be done.

Andre Corbould Yeah, I just want to double down on that because I just want to say that the people who are most empathetic are the people closest to what they’re seeing every day. And I want to just shout out like, from a business perspective, my experience in Edmonton is the business leaders are leading. They’re working on this. They’re investing in this issue. They’re coming up with good plans. I mean, and I would say talk to, you know, Alex here, who’s here from the Downtown Recovery Coalition in Edmonton and Pineda Downtown Business Association. And I think Doug is here from the Chamber of Commerce. These people are working really hard, in Edmonton anyways, to really tackle this problem. And they’re also the most empathetic people. And, you know, the other most empathetic group is, you know, the people that work in the shelters and the people who work in the social sector system and the police. I have walked downtown in these encampments with police. The police officers know everybody’s name. They know these people as individuals and family and citizens. And so, you know, the strength, where we have the opportunity and strength is with business, with people who are interacting with the problem every day with Canadians who can fix this problem. So there’s lots of positive hope as well, and lots of people that want to help. And so let’s use that as a strength as we move forward.

Paul Johnson I’d like, as I see by the clock on the wall, we need to wrap up. I’d like each of you to provide just a 30 second concluding comment. You notice how I said 30 seconds there? Because the clock on the wall is ticking down. Just something you want to leave this group with and maybe some practical – What can I do tomorrow? kind of commentary. We talk lots about what needs to change and we’ll continue to move that. But a concluding thought and what people might take away that they can actually start working on tomorrow within their own communities. And let me just run down the line here. Sarah, I’ll start with you.

Sarah Kennell Thanks. I just … Picking up on what Andre said, you know, I think the strength of our mental health and addiction system is in the frontline workers who deliver care. And I and I want to make sure that we are prioritizing their health and wellness, because coming out of the pandemic, they’ve had a rough go. They make less money than what their peers would make in hospital or other health care settings. And they’re hurting right now. They’re experiencing high levels of trauma and burnout, and we risk losing them. And I just want to reiterate the impact that’s going to have on that labor force to deliver on the solutions that we’ve talked about. So just want to shout out my frontline workers and echo support for their well-being.

Mark Garner  Another good question,  and I think what we’re dealing with, again, is being front line business. You know, there’s some compassion, exhaustion right now based on coming through the pandemic and surviving your business to then once again be able to open your door to the community. And now having to deal with elevated mental health and addiction issues, we really just all need to lean in and understand we’re all part of the solution versus organizations or entities that we feel should be responsible. It is a community issue. Lean into it. Do your research, become educated and clearly articulate the solutions and advocate for the money that’s needed to solve this problem.

Eileen de Villa Yeah, dangerous in the last minute to, you know, leave us with the mic and let us talk freely on things. But let me start with this. One of the things that I was just noticing was that, you know, Mark, you talked about how business is taking a different approach to this and really leaning into it, recognizing that they’re part of the community and part of the response to real health challenges that are being experienced in our cities and on our streets. As exhausted as the health system is, having lived through the last few years, I do wonder about whether we should be having more of a conversation in the health system around how we can help and refocus. Yes, of course we need to focus on health, but we also need to focus on productivity and our businesses within our community as part of community health. That is part of our responsibility. So you’re seeing more of us in public health starting to talk about not just the monolith of health, but thinking about how we can advance productivity and how that is a maneuver that actually lifts the health experience of the community and ideally addresses inequities in health status. So with that in mind, I would just encourage people here in the audience – actually go and … Andre, you talked about how police know people on the streets. They know them by name. You’re out and about in the downtowns. You probably see the same people on the street day in and day out. I would encourage you talk to them, right? Find out their story. And that’s a huge step that each of us can take towards addressing this issue of stigma and fear.

Andre Corbould And I’ll just say mobilize as a country. De-complicate. And the other thing I would say, answering your question about what can all of you do, today? Ask yourselves if you’re contributing to the stigma issue – by either neglect because you’re not talking about it or things that you have said. The moment I started talking about my mental health challenges was the moment, and not specifically, but my bosses in the past have started to doubt my abilities. It it … like stigma is alive and well and it’s discriminatory in our system. And so that’s what I would ask you all, and challenge you all today. Are you contributing to that either through neglect or actively? And if you are, think about it and stop.

Mark Garner Let’s show our appreciation to an amazing group of people. You know, this was an intense way to start the day, but I don’t know of any better way to ground us in our discussions about how we build amazing cities, amazing downtowns within those cities, but just amazing communities across this country. If we don’t get the people part of it right, the rest just doesn’t matter. Thank you so much. And thanks to everybody here.