Mental health services have been undervalued compared to other medical services for decades, disadvantaging those with mental illness needing care and leading to gaps in care for the most vulnerable. Historically these disparities were further magnified year after year as ‘across-the-board’ percentage funding increases led to even more resources being diverted to the already highest resourced areas and away from mental health care. This only served to increase the absolute disparities between undervalued psychiatric services and other medical services, fueling recruitment and retention challenges and risking worsening service gaps.

Dr. Gaind was instrumental in changing provincial policy in Ontario, Canada’s largest province, that magnified these disparities. At the November 2001 OMA General Council meeting, after effective lobbying and advocacy, he successfully passed the precedent setting motion that changed OMA policy away from traditional across-the-board increases towards more equitable distribution of resources. Combined with ongoing extensive submissions and advocacy for improved relativity, this pivotal motion paved the way for eventual sea change towards more equitable resource distribution in Ontario, including the 2008 OMA/Ministry of Health agreement, the only agreement that has ever allocated 50% of new resources towards correcting relativity inequities.

The small motion from 2001 that shifted the course of a behemoth, turning OMA policy and resource allocation towards a more equitable distribution [CLICK ABOVE to view] — The small motion from 2001 that shifted the course of a behemoth, turning OMA policy and resource allocation towards a more equitable distribution *[CLICK ABOVE to view]*

In early 2007, another pivotal issue regarding disparities of resource allocation arose. The otherwise innovative model of Family Health Teams (FHTs) implemented by the OMA and Ministry of Health unfortunately embedded existing inequities into their new time-based model, with psychiatric services, pediatric services and geriatric services all receiving 34% less funding for identical time compared to other medical services.

The uphill climb towards parity begins...November 2007 speech to OMA General Council on parity for Family Health Teams services (motion unanimously passed by Council and reversed OMA policy) [CLICK ABOVE to view] — The uphill climb towards parity begins...November 2007 speech to OMA General Council on parity for Family Health Teams services (motion unanimously passed by Council and reversed OMA policy) *[CLICK ABOVE to view]*

Dr. Gaind recognized that such overt devaluing of mental health services, made transparently obvious in a time-based model, reflected a devaluation of mental illness, the mentally ill, and mental health providers, and that it would inevitably lead to service gaps over time. Beyond realizing the importance of challenging the disparities in this new time-based model, he also saw the unique opportunity for achieving not only improved relativity, but parity for mental health services for the first time.

Effective advocacy through to the national level over several years led to remarkable success in correcting the FHT model. Dr. Gaind was successful at reversing OMA policy 180 degrees (initially the OMA supported the 34% disparity), so that by November 2007 official OMA policy supported parity for these services; subsequently for several years the disparity was reduced by 50% (to a 17% disparity); and as of January 2014 there is full parity for all services (including mental health/psychiatric services) in the FHT model.

Fast forward to 2019…while relativity still has not been solved, progress has been made and there is widespread recognition that relativiy can no longer be ignored, since it jeopardizes the most vulnerable patient populations. Dr. Gaind was appointed to the new OMA Relativity Advisory Committee (RAC) in 2018, and subsequently elected by colleagues as Chair of the RAC, and helped produce the first ever relativity plan with a Success Metric and Implementation Plan (a first in Canada). This plan was overwhelmingly adopted by OMA Council (80% plus mandate) at its fall 2018 Special Meeting on Relativity. Similarly, following wide consultation and member engagement, Dr. Gaind led RAC in developing a novel approach to relativity, the FAIR (Fee-Adjusted Income Relativity) approach (DOI 10.13140/RG.2.2.12742.22088/1), that was overwhelmingly approved by OMA Council (90% plus mandate) at its fall 2019 Council meeting, and continues to work with RAC on developing this model.

Fee-Adjusted Income Relativity (FAIR) Approach

**National Canadian Psychiatric Association Position Statement on Parity in Time-Based Models**

**Communication to Canadian Psychiatric Association members about parity issue**

“I have known Sonu for over 15 years. He has been a very active member of the OMA Section on Psychiatry Executive and delegate to OMA council. He has been and still is a very effective Medical Practice and Tariff Chair who has worked tirelessly and successfully to get increased resources for psychiatric services in Ontario. He is articulate and hard working, and will do a great job as CPA president.”

— Dr. Rayudu Koka, Chair of Psychiatry, Northern Ontario School of Medicine, Sudbury; Past-Chair, OMA Section on Psychiatry

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Dr. Sonu Gaind