This article describes recent work to support recommendations for improving Ontario's system of housing for people with serious mental illness. This multifaceted project engaged stakeholders in discussions concerning strategies for improving the system based on (a) values that underlie housing programs, (b) evidence of effective housing practices, (c) the current status of the system, and (d) international practices for monitoring community mental health systems. Stakeholders reviewed summaries of the work and discussed implications for improving the provincial system of housing and supports. Recommendations are made for improving the system, focusing on both regional and provincial level actions. Housing is an essential component of an effective community mental health system for people with serious mental illness. Without accessible, good quality housing and support, successful community living and recovery are not possible. Ontario has provided housing dedicated to people with serious mental illness since the onset of deinstitutionalization. Since the 1960s, the system has grown substantially to encompass a variety of forms of housing and to become a cornerstone of the community mental health system. Despite its growth and importance, this housing system faces a number of significant challenges. It remains inadequate for meeting consumer demand, with very long waiting lists reported by most programs in the province. There is a lack of good data on the system, documenting who is being served and how they are being served, as well as on the needs of those who cannot access the system. This lack of information makes it difficult to effectively manage the system and to plan for its future.In 2003, the Ontario Ministry of Health and Long-Term Care funded a research project to examine the province's dedicated housing system and to make recommendations for improving it. This paper describes the multifaceted project that was conducted to develop a foundation for planning system improvements. The project developed three foundations for system planning: (a) a vision for the system by identifying values that should guide the delivery of services, (b) research evidence about the status of the system and effective practices, and (c) consultations with stakeholders from across the province about directions for system improvement.

This project used the Colorado Client Assessment Record to compare individuals being seen by mental health teams in primary care with individuals being seen in outpatient services in the same community and to look at the implications for service delivery. While more individuals with a psychotic illness were seen in outpatient settings, many individuals seen in primary care had similar levels of need to those in outpatient clinics. Family physicians were more actively involved in the care of patients being seen in primary care. These findings suggest that a stronger role could be played by primary care in delivering mental health care, while differentiating which populations are best served in which setting.

The province of Ontario, Canada, with a population of 13 million people, has a large Assertive Community Treatment (ACT) program. Despite the large uptake of ACT in Ontario, to date there has been no comprehensive evaluation of the degree to which the model has been successfully implemented. This project assessed the fidelity of 67 ACT teams (85%) in the province using the Dartmouth Assertive Community Treatment Scale. Scores fell in the high fidelity range in the human resources and organizational boundaries domains, and in the medium fidelity range for the nature of services domain. Areas requiring more attention include achievement of higher caseloads; recruitment and retention of staff (specifically vocational, substance abuse, and psychiatry staff); and key areas of recovery, specifically employment and substance abuse.

Welcome to this special edition of the Canadian Journal of Community Mental Health. We are delighted to be guest editors of this issue and to be given the privilege to assist in presenting the hard work of many outstanding researchers committed to bringing new understandings to the community mental health sector. We gratefully acknowledge the instrumental role of dr. paula goering in creating this unique opportunity for researchers and other mental health system stakeholders in ontario.Beginning in 2005, ontario's Ministry of health and Long-term care made a 52% increase in investments to the community mental health sector. A total of $167 million was infused into community mental health services in the province. this enhancement included increases in funding for crisis services, intensive case management, court diversion and support, assertive community treatment, and early intervention in psychosis. the Ministry also committed dollars to evaluating the impact of these investments. the result of that investment in evaluation is contained in these pages. the researchers presenting their findings are all dedicated to the ongoing challenge of figuring out what is working and what we can do better. this was the goal of the Systems enhancement evaluation initiative (Seei).the health Systems research and consulting Unit, centre for Addiction and Mental health, directed by dr. goering, led the Systems enhancement evaluation initiative. the projects brought together researchers and stakeholders to develop and undertake system evaluation research to better understand the impact of increased investments in community mental health. After a peer-reviewed process facilitated by the ontario Mental health Foundation, nine studies were approved. the studies cover a wide range of approaches including system-level and site-specific evaluation projects, and use a variety of research methods. the results are rich in detailing the complexity of program development and implementation in mental health care.What is most exciting for us is the unique opportunity to tackle messy, real-world evaluation researchmuch like the messy, real world people find themselves in when they seek help for mental health problems. our research world is not about undertaking the perfectly designed research study. it is about joining with persons living with mental illness, families, providers, decision-makers and other researchers to try to figure out what is working and what we can improve on. the research studies presented here involved investigators from a variety of backgrounds in the work. these individuals helped us to develop the research questions