Who Does What Report | 2025

The Municipal Role in Mental Health

More than 5 million Canadians experience significant symptoms of mental illness. Each year, more than 4,500 people die by suicide, and over 5,500 lose their lives to opioid poisoning. While health services have traditionally been seen as being outside of the scope of municipal responsibility, local governments are increasingly responsible for delivering much of the front-line services addressing Canada’s mental health crisis - often with limited fiscal resources.

The tenth report in the Who Does What series from the Institute on Municipal Finance and Governance (IMFG) and the Urban Policy Lab examines the role that municipalities play in harm reduction and mental health and provides recommendations for action. The authors argue that while municipalities have a lead role to play, cooperation with other local agencies and other orders of government is essential to tackle these issues effectively.

R. Marcus Hammond, Barb Fornssler, and Elaine Hyshka explore how municipalities can better position themselves to effectively respond to mental health and addiction challenges. They outline how municipal governments can adopt a harm reduction approach to mitigate the issues they face, while providing recommendations for reforms in direct service delivery, land use, organizational policies and procedures, and drug policy and enforcement.

Kwame McKenzie, Rishika Wadehra, Sophie Baker, and Jesse Rosenberg highlight the vital role municipalities play in addressing social factors that influence mental health, such as housing, racism, and public safety. They emphasize the unique insight local governments have into their communities, and advocate for the leveraging of local networks to develop more coordinated and effective responses to the challenges they face. The authors also offer a practical framework for municipal action, supported by case studies of cities leading efforts to improve well-being.

Read the online report

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