First Episode Psychosis Treatment in Canada: CSC and Beyond

By: Meghan Henderson

and Ryan Banfield

This proposal is written from the perspective of the Federal Government!

Background - Psychosis

What is Psychosis?

• A cluster of symptoms that involve a break from reality — 3 core symptoms: sensations outside of reality, beliefs outside of reality, confusing thoughts.

Psychosis affects approximately 4% of people in Canada, or over 1.5 million Canadians.

Risk Factors for Psychosis.

• Genetics, highly populated urban area, complications during birth, older parental age;
• Early life trauma and stress, substance use, racism, poverty, discrimination; and
• Autism Spectrum Disorder.

Source: https://www.psychologytools.com/articles/learn-about-psychosis

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Source: https://www.shutterstock.com/image-vector/4-percent-people-icon-graphic-vectorman-2434666003

Background - Psychosis cont’d

What is the cost of chronic psychotic disorders in Canada?

• $24,441.16 per person in first year,
• $70,754.69 after 5 years,
• $117,136.88 after 10 years, and
• $157,829.01 after 15 years.

Why is a change needed now?

• Prevalence of risk factors — polarization around discrimination, stressful global events — the pandemic increased rates of psychosis in South London;
• Need to treat extra cases.

Background - Psychosis Care (Part 1)

As of 2016, Canada had no national policy, guidelines, or standards for early intervention in psychosis.

In addition, the same source (Nolin and colleagues) found gaps in key components of early psychosis care.

There are now 160+ early psychosis clinics across Canada, connected by the Canadian Consortium for Early Intervention in Psychosis, as of 2025.

Background - Psychosis Care (Part 2)

However, their delivery, design, implementation, and maintenance is managed at the provincial level.

Even within Ontario, early psychosis programs were found to have a high degree of variability despite provincial service standards being in place.

Background - Coordinated Specialty Care

What is Coordinated Specialty Care (CSC)?

• Team-based approach,
• Key roles - see image.

Known to be 340 CSC clinics across all 50 states of the USA.

Source: https://www.nami.org/wp-content/uploads/2023/07/FINAL-Hill-Day-17-Leave-Behind-Early-Intervention.pdf

Background - Coordinated Specialty Care cont’d

Coordinated Specialty Care was shown in 2018 to have better outcomes on many measures than treatment as usual.

It seems obvious that CSC is part of the answer…but is it the whole answer?

Source: https://library.samhsa.gov/sites/default/files/cfri-csc-webinar-slides-pep23-01-00-003.pdf

Policy Options

1

1. Comprehensive psychosis treatment programs, based on Coordinated Specialty Care.

• Pros:
• As explained previously, CSC is seen as very effective.

• Cons:
• May be expensive,
• May conflict with values of specific populations and PWLE if not consulted and involved in the design.

Policy Options

2

2. Coordinated access through MHNP assessments in primary care, hospitals, student mental health programs, integrated youth services hubs, social services*

*with informed consent on behalf of the patient/client.

• Pros:
• People with psychosis may seek care for other mental health concerns in the years leading up to their first episode — may offer an earlier intervention opportunity.

• Cons:
• May be affected by stigma,
• May not be enough qualified MHNPs.

Policy Options

3

3. Lived experience leadership, co-design, etc.

• Pros:
• A scoping review found beneficial effects of co-designing services,
• Makes sure services align with those with lived experience.

• Cons:
• Expensive,
• May run into power dynamics and other roadblocks,
• Not as comprehensively evaluated in the literature as CSC.

Source: https://unikahypolite.wordpress.com/2013/05/27/three-approaches-to-strategic-planning/

Recommendation

A combination of all three approaches:

• CSC,
• Lived Experience,
• Integrated Assessments.

Co-design a pilot for a psychosis service - CSC employees, PWLE.

Continuous evaluation - “Show Me You Care”, traditional evaluation.

Pilot in Ontario → spread across Canada - national coordination effort, adapt as necessary.

Also, integrated, co-designed assessments and referral services.

Recommendation - Further Exploration (Pros)

Pros:

• Reduces initial costs,
• Ensures academic and lived experience-based rigor,
• Provides much-needed psychosis services, and
• Minimizes long-term costs.

Recommendation - Further Exploration (Cons)

Cons:

• Short-term costs,
• Doesn’t address risk factors and prevention, stigma, and
• May be slower than spreading CSC across Canada.

Implementation

Funding from Federal Government

Implementation support

Buy-in from PWLE

Buy-in from family caregivers and clinicians

Short Term Timeline

Funding

Reach out to Ontario Health

Reach out to CAMH/ROH

Reach out to PWLE

Reach out to family caregivers and clinicians

0 months

9 months

Longer Term Timeline

1 year

Buy-in

Pilot complete - evaluate

5 years

20 years

At least 1 site in every participating province/territory, along with some integrated assessments - evaluate

40 years

Continue to expand, adjust, and evaluate

Costing - Pilot

Combined CSC and lived experience pilot in Ontario: up to $980,300.75.

Evaluating the resulting pilot in Ontario once: $445,591.25-$856,906.25 (ish).

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Costing (cont’d)

Integrated assessments across Canada: average $1,037,044,760 per year.

Cost of spreading pilot for psychosis care in Ontario across Canada if effective: probably $244,184,000.

This is MAX possible cost

If Federal Government funds ⅔ and participating provinces agree to pay ⅓, this amount -> down to $162,789,333.

Intergovernmental Relations

Healthcare is under provincial/territorial (P/T) jurisdiction (via Section 92 of Constitution Act, 1867 and federal devolution of responsibilities to territories)

Norm with many healthcare programs and related social service programs:

• Federal government provides significant funding (via Canada Health Transfer and other funding; the latter applies here)
• Provinces/territories provide implementation and some funding

Intergovernmental Relations (cont’d)

Approach to dealmaking inspired by federal government’s $10-a-day child care efforts:

• Federal government must gradually make different deals with each province/territory to suit their local needs/preferences (dealmaking on a P/T-by-P/T basis).
• Federal government may not make deals with every province/territory if some are unwilling.

Intergovernmental Relations (cont’d)

Federal government will offer to entirely fund pilot (and its evaluation) for Ontario Health and participating local Ottawa-based healthcare institutions as a gesture of good will (~$2 million max).

Results of pilot should speak for themselves and should help convince provinces/territories of the value of implementing the larger program.

After pilot, federal government will promise to fund ⅔ of the program for any province/territory that is willing to implement the program and fund the remaining ⅓.

Conclusion

Tying together…

• CSC with…
• integrated assessments and…
• lived experience involvement…

…can create welcoming spaces for people with psychosis to receive the care they need, minimizing healthcare and productivity costs in the long run.

Key values: dignity, autonomy, and compassionate, holistic care.

Thank you for watching!

References

https://www.nhs.uk/mental-health/conditions/psychosis/symptoms/

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https://pmc.ncbi.nlm.nih.gov/articles/PMC8935527/

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https://pubmed.ncbi.nlm.nih.gov/38634394/

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https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00018-5/fulltext

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https://pmc.ncbi.nlm.nih.gov/articles/PMC4813422/

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https://www.camh.ca/-/media/driving-change-files/public-policy/prevention-and-early-intervention-in-psychosis--final-february-2025-pdf.pdf

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https://www.nimh.nih.gov/sites/default/files/documents/health/topics/schizophrenia/raise/evidence-based-treatments-for-first-episode-psychosis.pdf

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https://www.nimh.nih.gov/news/science-updates/2023/raise-ing-the-standard-of-care-for-schizophrenia-the-rapid-adoption-of-coordinated-specialty-care-in-the-united-states

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https://pmc.ncbi.nlm.nih.gov/articles/PMC5888116/

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https://www.sciencedirect.com/science/article/pii/S2666560324000148

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https://pmc.ncbi.nlm.nih.gov/articles/PMC10076446/

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https://www.strategiquepartners.com/how-much-does-it-cost-to-open-a-mental-health-clinic/#:~:text=Estimated%20Technology%20and%20Software%20Cost,spend%20up%20to%20$2000%20%E2%80%93%20$5000

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https://www.measureevaluation.org/resources/publications/fs-15-156/at_download/document#:~:text=The%20cost%20of%20an%20evaluation%20is%20dependent,substantial%20and%20should%20be%20considered%20when%20budgeting

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https://www.cna-aiic.ca/en/nursing/regulated-nursing-in-canada/nursing-statistics

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https://www.ziprecruiter.com/Salaries/Psychiatric-Nurse-Practitioner-Private-Practice-Salary--in-Ontario

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https://era.library.ualberta.ca/items/1834e23a-37e1-4b0b-8e25-bbbac4aa333e

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https://pubmed.ncbi.nlm.nih.gov/37731346/#:~:text=Abstract,reimbursement;%20Public%20health;%20Schizophrenia

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https://www.canada.ca/en/health-canada/services/canada-health-care-system.html

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https://www.canada.ca/en/employment-social-development/news/2025/03/toward-10-a-day-an-early-learning-and-child-care-backgrounder0.html

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https://www.cbc.ca/news/canada/childcare-agreements-canada-provinces-territories-1.6400123