Nova Scotia’s Auditor General has concluded that the Office of Addictions and Mental Health is not effectively overseeing mental health and addiction services in the province — five years after the office was created to do exactly that.
The June 2026 report by Auditor General Kim Adair found the office lacks service access standards, does not know the full range of services available across Nova Scotia, has no formal performance targets for health authorities, and does not publicly report on system outcomes. All 10 recommendations in the report were accepted by the office.
Role remains unclear five years after launch
The Province of Nova Scotia created the Office of Addictions and Mental Health in 2021 and gave it a dedicated minister. But the auditor found its responsibilities are still not clearly distinguished from those of the Department of Health and Wellness in legislation, policy, or practice.
The current Health Authorities Act, introduced in 2014, contains no reference to the office and assigns no responsibility to it or its minister. Accountability Framework Agreements with Nova Scotia Health (NSH) and IWK Health (IWK) — the province’s two major health authorities — assign oversight of mental health and addictions services to the Department of Health and Wellness, not the office.
The office also has no corporate administrative policy manual, a basic document that outlines an organization’s role, responsibilities, and structure. The Department of Health and Wellness has one.
Service providers told auditors the overlap created problems. One noted challenges from having to provide budget information and reporting to two ministers. Another said they do not distinguish between the office and the department.
The audit found the office did not issue its own funding letters to NSH and IWK for mental health and addictions services until the 2025–26 fiscal year — three years after it became fully operational. Previously, those letters came from the Department of Health and Wellness.
No access standards, incomplete picture of services
The office has not established service access standards for mental health and addictions care. The auditor noted that standards around hours of operation, service locations, transportation options, and regional and cultural considerations — including language services and Indigenous communities — would be expected from an oversight body.
The office also does not maintain a complete inventory of provincially funded services or service locations. NSH and IWK each maintain their own lists, and the office keeps only a record of community-based organizations it funds directly. Organizations that receive funding through other sources are not included.
Of 50 mental health and addictions programs and services listed by NSH on its website as of March 12, 2026, only 28 — or 56 per cent — were available across all four of Nova Scotia’s health zones. The Central zone had the most, with 42 of 50 services available, while the Eastern zone had the fewest, at 32.
The office’s website did not include crisis or intake line contact numbers on its homepage at the time of the audit. While those numbers were accessible through a link, the auditor found the link was not clearly labelled or easy to locate.
Performance measures incomplete, monitoring limited
Government committed to universal mental health and addictions care in 2021. As of March 31, 2026, performance indicators to measure that commitment were still not finalized.
The office told auditors it completed six indicators covering the first four of six outcome areas in December 2025. Indicators for “effective partnerships” and a “sustainable mental health and addictions system” remain in development. The auditor found the indicators that do exist are missing targets, benchmarks, specific data collection requirements, and monitoring responsibilities.
The office receives biannual performance reports from NSH and IWK, but those reports have significant gaps. Reviewing the Fall 2025 data request — the most recent available during the audit — the auditor found:
- NSH: Provided information on 55 of 64 measures requested; of those, 38 lacked trend data, 27 lacked 2024–25 data, and 30 lacked first-quarter data for 2025–26.
- IWK: Provided information on 31 of 45 measures; of those, 18 lacked trend data and 10 were missing 2024–25 data.
- Missing entirely: Nine measures from NSH and 14 from IWK were not covered at all, including data on outpatient service volumes, crisis and urgent services, and youth services.
The audit also found the biannual report requests themselves were unclear. For two measures, the request did not specify whether NSH, IWK, or both were to provide the information. The office provided no evidence of a formal process for reviewing the reports it receives or providing feedback to health authorities.
Oversight committees missing meetings, leaving actions unresolved
The office relies primarily on two committees to monitor implementation of universal care: the Universal Mental Health and Addictions Care Steering Committee and the Strategic Deployment Review Committee.
The auditor reviewed minutes from 28 Steering Committee meetings held between April 2024 and October 2025 and found they offered little more than meeting agendas. Decisions were clearly documented in only three of the 28 sets of minutes. The committee also missed 12 of 40 expected meetings — 30 per cent — over its first 18 months of operation.
The Strategic Deployment Review Committee maintained an action log, but as of August 26, 2025, 33 items remained outstanding. Two dated back to June 2024. Two others showed a “not started” status more than eight months after being added. The office itself was responsible for 16 of the outstanding items.
Public reporting limited to wait times
The office’s annual accountability reports include progress updates but no performance indicators or benchmarks. Beyond those reports, the office does not publicly report on how mental health and addictions services are performing.
The province currently reports two mental health and addictions indicators publicly through the Action for Health strategic plan: the percentage of urgent and non-urgent first treatment wait times within benchmark. A separate January 2026 audit found those indicators omit the referral period, meaning they do not reflect the full time patients wait. The Department of Health and Wellness agreed to correct the reporting by November 2027.
The auditor compared Nova Scotia’s public reporting to that of other Canadian jurisdictions and found other provinces report a broader range of indicators, including treatment completion rates, housing stability after recovery programs, changes in hospitalization rates over time, and distribution of publicly funded naloxone kits.
The office spent $349.8 million in 2024–25 on mental health and addictions services. Over the past three fiscal years, total spending reached $945.3 million, with the bulk going to NSH ($674.9 million) and IWK ($179.5 million).
