Health Minister Jane Philpott says her government is prepared to make mental health a big priority, but she will not be writing a blank cheque to the provinces and territories until she knows how it will be spent.
Philpott made the comments in Ottawa a day after meeting the provincial health ministers in Toronto to discuss the future of health-care funding in Canada.
"If they have great ideas on how they want to improve mental health, I will be their advocate to discuss opportunities for us to support them on that," Philpott said.
"I can't go to the finance minister and ask for that money and simply say we're going to write them a cheque and we're going to trust that they do something, because we've seen that before," she added.
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Philpott said that if her government is to make an investment in mental health it needs to know where the money is going to go, and to be able to measure that the "system has improved."
She gave the example of the provinces saying they wanted to fund cognitive behavioural therapy through short-course structured psychotherapy. In that instance, she said, Ottawa could track the number of therapy sessions delivered as evidence their health-care money was being put to good use.
But that approach has Terry Lake, B.C.'s health minister, scratching his head as to how the provinces could make their pitch in a darkened stadium.
"It really does make it difficult for us to put anything forward when we're not sure what the amount of money might be, how long it might last," said Lake. "We don't want to start something and have to stop it two years later."
After meeting with her provincial counterparts on Monday and Tuesday in Toronto, Philpott emerged without a long-term funding plan, or health accord, for health care in Canada.
The provinces left the meeting upset that the federal government plans to proceed with cutting the annual increase in the Canada Health Transfer, from six per cent to three per cent, next year.
The federal government has so far refused to raise that amount, while the provinces continue to argue they need the increase just to maintain the health-care system, let alone improve it.
To reassure the provinces, Philpott said the three per cent funding increase was just the beginning and that her government would be boosting health spending with funds targeted toward specific initiatives.
Strings or no strings
One of those initiatives is home care, which Prime Minister Justin Trudeau promised during the election he would fund with a $3-billion investment, which has yet to surface. Philpott said another initiative her government would consider funding was improvements to mental health care in Canada.
Some of the provinces have already pushed back at the notion that the federal government should be telling the provinces where to spend the health transfer, insisting the delivery of health care is a provincial concern.
But at least one province, Alberta, has come forward to say it is willing to have bilateral talks to get access to home care money, even if it comes with strings.
On Wednesday, however, Philpott seemed far from certain that there would be any more health-care money in next year's budget for home care or mental health, beyond the three per cent annual increase to the health transfer.
"It's my absolute hope that we will have increased investments in health in next year's budget. That is my very firm goal," Philpott told reporters.
The discussions between the federal and provincial health ministers appeared to end on a tense note, with Quebec's health minister suggesting Philpott may have difficulty getting any money for mental health because it won't help the Liberals politically.
"What is the most disappointing issue is for me to hear from Mrs. Philpott that she has trouble convincing her counterpart, [Finance Minister Bill] Morneau and Mr. Trudeau of investing actual money in mental illness therapy because they don't see, that's what I've been told, they don't see a political gain on that," Gaetan Barrette said in Quebec City.
But Philpott dismissed the suggestion that she told other health ministers and staff in Toronto that there was no political gain from funding mental health, but rather that she can't get money without being able to make an argument about what it will be used for.
B.C.'s health minister seemed to back up Philpott's account Wednesday.
"I don't think Minister Philpott indicated that the federal government was not genuinely interested in improving mental health and substance use. I don't think that that's the message she was sending," Lake said.
"She was saying, 'If I'm going to my colleagues and ask for more money for health initiatives across this [country], I need you to make that case for me.' Well, I would argue she is the minister of health. She knows where the needs are."