Canada-Ontario Contribution Agreement to Support Frontline Health Workers, First Responders and Public Safety Personnel

(the "Agreement")

Between:

His Majesty the King in Right of Canada (hereinafter referred to as "Canada" or "Government of Canada") as represented by the Minister of Health (herein referred to as "the federal Minister")

- and -

His Majesty the King in Right of Ontario (hereinafter referred to as "Ontario" or "Government of Ontario") as represented by the Minister of Health (herein referred to as "the provincial Minister")

Referred to collectively as the "Parties", and individually as a "Party"

Preamble

Whereas, Canada and Ontario agree that collaboration and action is needed among governments to support frontline health workers, first responders and public safety personnel, who face a higher risk of post-traumatic stress injuries (PTSI), with mental health, addiction and substance use services;

Whereas, this funding support also aligns with the national Action Plan, "Supporting Canada's Public Safety Personnel: An Action Plan on Post-Traumatic Stress Injuries," as led by the Department of Public Safety and Emergency Preparedness Canada;

Whereas, Canada authorizes the federal Minister responsible for health to enter into an agreement with Ontario to support the development of facilities that provide dedicated mental health and substance use supports for frontline health workers, first responders and public safety personnel suffering from PTSI;

Whereas, the Ministry of Health and Long-Term Care Act authorized the provincial Minister to enter into agreements with the Government of Canada under which Canada undertakes to provide funding toward costs incurred by the Government of Ontario to support the development of facilities dedicated to comprehensive rehabilitation-focused programs and services for health workers, first responders and public safety personnel suffering from PTSI; and,

Therefore, this Agreement sets out the terms between Canada and Ontario as follows:

1.0 Definitions

1.1 "Agreement" means this contribution agreement and includes Annex 1 and any amendments made to this Agreement in accordance with sections 9 and 10;

1.2 "Fiscal Year" means the period commencing on April 1 of any calendar year and terminating on March 31 of the immediately following calendar year.

2.0 Purpose

The purpose of this Agreement is to provide financial support from Canada to Ontario to support the development of facilities that provide dedicated mental health and substance use supports for frontline health workers, first responders and public safety personnel suffering from PTSI.

3.0 Project plan

Ontario set out in their Project Plan (attached as Annex 1) how the federal investment under this Agreement will be used and outlined expected results.

4.0 Term of agreement

4.1 This Agreement comes into effect upon the date of the last signature of the Parties and will remain in effect until March 31, 2028 ("the Term"), unless terminated in accordance with the terms of this Agreement.

4.2 One-time funding under this Agreement may be used by Ontario for expenditures on eligible areas of investment made under section 5.6 and eligible areas of investment outlined in Annex 1 that are incurred beginning April 1, 2025.

5.0 Financial provisions

5.1 Contribution

Subject to the terms of this Agreement, Canada will make a contribution to Ontario of up to fifteen million dollars ($15,000,000).

5.2 Payment

Canada will make a contribution payment within approximately thirty (30) business days of execution of this Agreement by the Parties, in the form of an advance payment, based on the plan outlined in Annex 1.

5.3 Retaining Funds

5.3.1 Upon request, Ontario may retain and carry forward to subsequent Fiscal Years any unexpended funds remaining from Canada's one-time contribution in 2025-26.

5.3.2 Ontario may only use the amount carried forward for expenditures on eligible areas of investment made under section 5.6 and outlined in Annex 1 incurred that Fiscal Year.

5.3.3 Any unexpended funds at the end of Fiscal Year 2027-28 represents an overpayment subject to section 5.4, unless the Parties agree in writing that any unexpended funds may be retained and carried forward.

5.4 Repayment of overpayment

In the event the payment made to Ontario exceeds the amount to which Ontario is entitled under this Agreement or Ontario is unable to spend the amount of funding provided by Canada and exceeds the carry forward allowance in section 5.3, the amount of the excess is a debt due to Canada and, unless otherwise agreed to in writing by the Parties, Ontario shall repay the amount within sixty (60) calendar days of written notice from Canada.

5.5 Use of Funds

The Parties agree that funds provided under this Agreement will only be used by Ontario in accordance with section 5.6 and Annex 1.

5.6 Eligible Expenditures

Eligible Expenditures under this Agreement are the following:

• information technology/health information infrastructure; and
• capital costs.

6.0 Reporting

6.1 Funding conditions and reporting

6.1.1 By no later than October 1, in each Fiscal Year, in respect of the previous Fiscal Year, Ontario agrees to:

1. Provide a report annually on progress made on expected results outlined in Annex 1.
2. Provide to Canada an annual financial statement, with attestation from the province's Chief Financial Officer, of funding received from Canada under this Agreement compared against Annex 1, and noting any variances, between actual expenditures and Annex 1:
   1. The revenue section of the statement shall show the amount received from Canada under this Agreement;
   2. The total amount of federal funding used;
   3. If applicable, the amount of any funding carried forward under section 5.3; and
   4. If applicable, the amount of overpayment that is to be repaid to Canada under section 5.4.

6.1.2 Ontario agrees to provide quarterly reporting to Canada on the management and spending of the funds retained to the next Fiscal Year.

6.2 Audit

Ontario will ensure that expenditure information presented in the annual financial statement is, in accordance with Ontario's standard accounting practices, complete and accurate.

6.3 Evaluation

Responsibility for evaluation of programs rests with Ontario in accordance with its own evaluation policies and practices.

7.0 Communications

7.1 In the spirit of transparency and open government, Canada will make this Agreement, including any amendments, publicly available on a Government of Canada website.

7.2 Each Party will receive the appropriate credit and visibility when investments financed through funds granted under this Agreement are announced to the public, including acknowledging that Ontario is the primary funder of the Project Plan outlined in Annex 1 of this Agreement.

7.3 The Parties agree to providing notice prior to conducting public communications, announcements, events, outreach and promotional activities about this Agreement. The Parties agree to provide five (5) business days advance notice and advance copies of public communications related to this Agreement, and results of the investments of this Agreement.

7.4 Canada, with prior notice to Ontario, may incorporate all or any part of the data and information in section 6, or any part of evaluation and audit reports made public by Ontario into any report that Canada may prepare for its own purposes, including any reports to the Parliament of Canada or reports that may be made public.

8.0 Dispute resolution

8.1 The Parties are committed to working together in good faith and avoiding disputes through government-to-government information exchange, advance notice, early consultation, and discussion, clarification, and resolution of issues, as they arise.

8.2 If at any time a Party is of the opinion that the other Party has failed to comply with any of its obligations or undertakings under this Agreement or is in breach of any term or condition of the Agreement, that Party may notify the other Party in writing of the failure or breach. Upon such notice, the Parties will endeavour to resolve the issue in dispute bilaterally through their Designated Officials (as listed in section 11).

8.3 If a dispute cannot be resolved by Designated Officials, then the dispute will be referred to the Deputy Ministers of Canada and Ontario responsible for health, and if it cannot be resolved by them, then the federal Minister and the provincial Minister responsible for health shall endeavour to resolve the dispute.

9.0 Amendments to the agreement

9.1 The main text of this Agreement may be amended at any time by mutual consent of the Parties. Any amendments shall be in writing and signed, in the case of Canada, by the federal Minister, and in the case of Ontario, by the provincial Minister.

9.2 Annex 1 may be amended at any time by mutual consent of the Parties. Any amendments to Annex 1 shall be in writing and signed by each Party's Designated Official.

10.0 Termination

10.1 Either Party may terminate this Agreement at any time if the terms are not respected by giving at least three (3) months written notice of intention to terminate.

10.2 As of the effective date of termination of this Agreement, any unexpended funds are a debt due to Canada and, unless otherwise agreed to in writing by the Parties, Ontario shall repay the amount within sixty (60) calendar days of written notice from Canada, and Canada shall have no obligation to make any further payments.

10.3 Sections 5.3, 5.4 and 6 of this Agreement survive the termination or expiration of this Agreement until reporting obligations are completed and/or any overpayments are repaid.

11.0 Notice

11.1 Any notice, information, or document provided for under this Agreement will be effectively given if delivered or sent by letter, email, postage or other charges prepaid. Any communication that is delivered will be deemed to have been received in delivery; and, except in periods of postal disruption, any communication mailed by post will be deemed to have been received eight (8) calendar days after being mailed.

The address of the Designated Official for Canada shall be:

Assistant Deputy Minister: Health Policy Branch
Health Canada
70 Colombine Driveway
Brooke Claxton Building
Ottawa, Ontario
K1A 0K9
Email: sarah.lawley@hc-sc.gc.ca

The address of the Designated Official for Ontario shall be:

Associate Deputy Minister: Clinical Care and Delivery
Ministry of Health
777 Bay Street, 19th Floor
Toronto, Ontario
M5G 2E5
Email: catherine.wang@ontario.ca

12.0 General

12.1 This Agreement, including its preamble and all Annexes attached hereto sets forth the entire Agreement between the Parties with respect to its subject-matter and supersedes and cancels all prior agreements, understandings, negotiations and discussions, both oral and written, between the Parties with respect to the initiative.

12.2 This Agreement shall be governed by and interpreted in accordance with the laws of Canada and Ontario.

12.3 No member of the House of Commons or of the Senate of Canada or of the Legislature of Ontario shall be admitted to any share or part of this Agreement, or to any benefit arising therefrom.

12.4 If for any reason a provision of this Agreement, that is not a fundamental term, is found by a court of competent jurisdiction to be or to have become invalid or unenforceable, in whole or in part, it will be severed and deleted from this Agreement, but all the other provisions of this Agreement will continue to be valid and enforceable.

12.5 This Agreement may be executed in counterparts, in which case (i) the Parties have caused this Agreement to be duly signed by the undersigned authorized representatives in separate signature pages in accordance with the following signature process, which together shall constitute one agreement, and (ii) the Parties agree that facsimile signature(s) and signature(s) transmitted by PDF shall be treated as original signature(s). Electronic signature(s) may be accepted as originals so long as the source of the transmission can be reasonably connected to the signatory.

In witness whereof the Parties have executed this Agreement through duly authorized representatives.

Signed on behalf of Canada by the Minister of Health

The Honourable Marjorie Michel, Minister of Health

Signed on behalf of Ontario by the Deputy Premier and Minister of Health

The Honourable Sylvia Jones, Deputy Premier and Minister of Health

Annex 1

Project plan

Description of Initiative and Supported Population

• Runnymede Healthcare Centre (RHC) asserts that the Post-Traumatic Stress Injury (PTSI) Centre of Excellence is currently positioned to be first and only of its kind in Canada, dedicated to delivering care to our First Responders and Frontline workers. RHC will develop comprehensive PTSI rehabilitation-focused programs and services with the intent to address gaps in the catchment area of Ontario, with a particular focus on the Greater Toronto Area. RHC estimates there are 36,730 First Responders suffering from PTSI and seeking care in the Province of Ontario. It is estimated that workers seeking these programs and services will grow to over 46,000 by 2040. The RHC PTSI Centre of Excellence currently forecasts to provide care to 1,500 workers each year and 41,700 visits, with the potential to expand volumes over time based on need.
• Capital funding will support the planning and construction of a two-site model:
  • A new ambulatory facility in Toronto; and
  • A new 40 bed residential treatment facility in Caledon.
• For a broad catchment population in Ontario, services will include: Assessment, Ambulatory and Residential treatment, Virtual Care, 24/7 Crisis Support, Peer Support, and Navigation Support throughout different phases of the First Responders' journey towards recovery. The target population includes, but is not limited to: Police Officers, Firefighters, Correctional Officers, Paramedics and Frontline Healthcare Personnel to address the higher prevalence of PTSI amongst public safety personnel and First Responders compared to the general population.
• Toronto Ambulatory Site ("Station No. 3434")
  • Station No. 3434 will be the main site for all outpatient PTSI program and service delivery.
  • This facility will focus on outpatient services ranging from assessment to routine and accelerated (i.e., multiple sessions of outpatient therapy delivered each day) delivery of evidence-based treatments for the range of conditions that can arise post-trauma (e.g., posttraumatic stress disorder [PTSD], depression, substance misuse) through to aftercare; to support recovery from these conditions.
  • Station No. 3434 will house recreation programs and facilities that encourage health and recovery throughout the recovery journey.
  • The ambulatory program is planned to be delivered in a 34,955 component gross square feet (CGSF) space, in a new 5-storey building, located at 3434 Dundas Street West, Toronto (site is owned by RHC).
• Caledon Residential Site ("Caledon Recovery Centre")
  • First Responders in need of more intensive treatment for their mental health and substance use conditions arising from workplace-related trauma will be referred to the Caledon Recovery Centre.
  • This site will house 40 residential beds where patients will reside for an average length-of-stay of 30 days. The length of stay will be personalized based on patients' presenting mental health and psychosocial circumstances.
  • As part of the care provision on this site, a withdrawal management intensive monitoring bed will be available to support First Responders through the detoxification process.
  • During their stay, patients will receive supportive care through their initial recovery period, as they begin structured intensive psychotherapy and psychosocial treatment.
  • Upon completion of this Program, it is anticipated that patients would be eligible for aftercare therapy and support.
  • The residential program is planned to be delivered in a 42,300 CGSF space, in a new single-storey building, located on 26-acres (donated by the Regional Municipality of Peel) at 27 Calmon Drive, Caledon.
• Both sites of the PTSI Centre of Excellence are considered under the Ontario Ministry of Health's Hospital Model for capital planning and would be eligible for volume-based funding under the Post-Construction Operating Plan (PCOP) model where operating funds are reconciled and recovered for services not delivered.
• The program will address the continuum of services including assessment, diagnosis, therapeutic treatment, aftercare, and return to work.
• Services will be a combination of in-person and virtually-delivered sessions in individual and group formats. The treatment programming will be delivered by appointment and in full-day intensive schedules.
• In order to ensure broad provincial access, virtual options will be integrated throughout all programs and services.
• The Supporting Ontario's First Responders Act, also known as Bill 163, was passed in April 2016. This legislation is part of Ontario's PTSD strategy for First Responders which recognizes that this diagnosis is work‐related, and that care needs to be supported. The intent of Bill 163 was to facilitate faster treatment for First Responders by expediting access to worker's insurance benefits and timely treatment for workers.
• In March 2020, the Ontario Government further recognized the unique needs of First Responders for Mental Health and Addiction services resulting from the occupational trauma to which they are exposed. Ontario's Roadmap to Wellness Plan will see additional funding dedicated to improving PTSD related services for First Responders. It recognizes that these individuals currently encounter challenges such as system fragmentation and poor coordination, programs that do not address their own unique cultures and needs, and finally, the availability of evidence-based treatments with proven outcomes.
• In February 2020, the Federal Framework on Posttraumatic Stress Disorder (PTSD) was released by the Federal Government. The Framework recognized that many Canadians are faced with mental health risks because of the unique demands of their occupation. It not only acknowledged the need to improve our understanding of PTSD and further develop evidence-based approaches in PTSD treatment, but also highlighted the need to eliminate the stigma associated with mental illness.
• Furthermore, in 2019 the Department of Public Safety and Emergency Preparedness Canada published the national Action Plan, "Supporting Canada's Public Safety Personnel: An Action Plan on Post-Traumatic Stress Injuries". The Action Plan focuses on three pillars: research and data collection, early intervention and stigma reduction, and support for care and treatment. This initiative supports 'Pillar 3: Support for Care and Treatment', acknowledging that public safety personnel need to have access to effective, timely, and affordable care and treatment options.

Project activities, expected results and timeframe

The following table outlines an activities/spending areas where the federal funds will be used to support the broader initiative, and expected results and timeframes, against which Ontario will report on progress.

Activity/Spending Area	Expected Result(s) and Timeframe
Station No. 3434 – Construction	Construction Start; contractor deployment to site August 2027
Caledon Recovery Centre – Construction	Construction Start; contractor deployment to site April 2027

Funding allocation

The following table represents an estimated projection of spending:

Activity/Spending Area	Funding Allocation
	2027-28	Total
Station No. 3434 – Construction	$7,500,000	$7,500,000
Caledon Recovery Centre – Construction	$7,500,000	$7,500,000
Total	$15,000,000	$15,000,000

Appendix A

Definitions - In the Agreement, the following terms shall have the following meanings:

"Post-traumatic Stress Disorder (PTSD)"

is a mental health disorder that may occur after exposure to one or more potentially psychologically traumatic events (e.g., actual or threatened death, serious injury, or sexual violence), impacting both physical and mental health. Symptoms can appear within three months; however, sometimes may appear years later. A person may be diagnosed with PTSD if their experiences and symptoms last more than one month and cause significant distress or affect how they function in social, occupational, or other important areas of life. Read the full definition.

"Post-traumatic Stress Injury (PTSI)"

is a non-clinical umbrella term used primarily by public safety personnel (PSP) and researchers in Canada. PTSI is not a mental health diagnosis. It refers to the mental health conditions that an individual may experience after exposure to one or more potentially psychologically traumatic events, but does not constitute a formal clinical diagnosis. PTSI includes symptoms that interfere with daily functioning in social, work, or family activities. Read the full definition.