DATE: April 2, 2014 REPORT NO. PHSSS Strategic Planning and Community Development

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1 DATE: April 2, 2014 REPORT NO. PHSSS TO: FROM: PREPARED BY: Chair & Members Social Services Committee Dan Temprile, General Manager Public Health, Safety & Social Services Susan Evenden, Manager Strategic Planning and Community Development 1.0 TYPE OF REPORT CONSENT ITEM [ x ] ITEM FOR COUNCIL CONSIDERATION [ ] 2.0 TOPIC Community Mental Health Services 3.0 RECOMMENDATION THAT the report on Community Mental Health Services, April 2014, BE RECEIVED. Public Health, Safety and Social Services 220 Colborne Street, P.O. Box 845 Brantford, ON N3T 5R7 Phone Fax:

2 Report No. PHSSS Date: March 5, 2013 Page PURPOSE This report responds to the following resolution, which was passed at the Social Services Committee meeting on March 5, 2014: WHEREAS an integrated, complete system of mental health services that is simple for consumers to navigate is integral to building a safe and healthy community; and WHEREAS the direct suffering of individuals experiencing a mental health disorder and their families can be significant; and WHEREAS local government can play a role in supporting community agencies and consumers in preventing mental health problems, and promoting mental health and well-being for all; THEREFORE BE IT RESOLVED THAT Council DIRECT staff to prepare a report outlining the local availability of specialized services for individuals experiencing a mental health concern along with any current efforts to coordinate and integrate these services. 5.0 BACKGROUND By the time people reach 40 years of age, nearly 1 in 2 people will have had, or have, a mental illness. 1 The federal 2 and provincial 3 governments have released recent comprehensive mental health strategies. Along with the direct suffering of individuals and families grappling with a mental health disorder, the costs associated with mental illness are significant to all levels of government. Local government is on the front lines of the mental health system, through its first responders, housing and homelessness programs, seniors services and provision of various other social services. This report provides a snapshot of the current mental health system in Brantford and Brant County. 1 Mental Health Commission of Canada, Fact Sheet: How Municipalities Can Help Improve Mental Health Outcomes f

3 Report No. PHSSS Date: March 5, 2013 Page STRATEGIC PLAN CONTEXT Brantford will be recognized as a safe and healthy community one that promotes and enables the well-being of its citizens, and supports access of all citizens to a full range of health and community services. Strategic Action 2.8 Develop and coordinate partnerships with community organizations and other levels of government to address and support the needs of those most in need; Strategic Action 2.7 Examine the feasibility of proceeding with initiatives to enhance community health and wellness. 7.0 INPUT FROM OTHER SOURCES N/A Further consultation with community agencies can occur as directed from this initial report. 8.0 ANALYSIS Appendix A outlines the continuum of locally available mental health services. The continuum ranges from intervention at a point of crisis to mental health promotion, and includes inpatient hospital based programs and community supports. The Provincial Mental Health Strategy contained a three year child and youth strategy, aimed at providing fast access to service, identifying and intervening early with mental health disorders, and closing critical service gaps for vulnerable children. New funding and funding enhancements have resulted in local improvements in services for children and youth, such as mental health specialist positions at both school boards which coordinate mental health services for students, and mental health nurses in schools. The integrated mental health crisis response service, a partnership between St Leonard s Community Services, Woodview Mental Health and Autism Services, Brant Community Healthcare System (BCHSYS), Behaviour Supports Ontario and the Alzheimer Society of Brant, has significantly impacted the experience of individuals who are in acute mental health distress. The presence of a regulated mental health professional (nurse or social worker) on site at the walk in clinic location facilitates timely and appropriate treatment. The BCHSYS staff member has remote access to the patient s electronic hospital record, can arrange

4 Report No. PHSSS Date: March 5, 2013 Page 4 consultation with an on-call psychiatrist, and in the event that the patient s risk level indicates a hospital admission, pre-admission can be facilitated from the clinic. These system improvements reduce the probability that individuals in mental health crisis will be subjected to frustratingly long emergency room waits. These are welcome improvements, however, known system gaps still exist. There are continued wait lists for children, youth and their families seeking clinical treatment for serious emotional, behavioural and social concerns. Service providers are attempting to mitigate by offering drop in clinics for families who are waiting. These services are accessed centrally through Contact Brant. All publicly funded counselling programs restrict the number of sessions (usually 6), which does not provide for sufficient time to resolve more serious issues. Services such as intensive case management, which help individuals with mental illness live independently and functionally in the community, are reserved for individuals with serious mental disorders, and are always at capacity with long wait lists. Mood disorders such as anxiety and depression can interfere profoundly with an individual s functional ability, however, intensive services are not available. There is a chronic shortage of supportive housing for individuals with mental illness. The demand for specialized psycho-geriatric support services will exceed system resources as a result of the aging population. The mental health system continues to be difficult to navigate: locating services and obtaining the necessary referrals can often be beyond the capacity of a person who is incapacitated by their illness. In Brant, there are currently two multi-agency coordinating tables in the Mental Health sector. Creation of the Brant-Haldimand-Norfolk Addictions and Mental Health Network was driven by the Local Health Integration Network and was developed to identify local Addiction and Mental Health priorities and collaborate on shared/integrated services to address these priorities. The integrated mental health crisis response is an example of the solutions that have been generated from this table and subsequently supported by the LHIN with operating funds. A City of Brantford representative from the social services department participates in this group. The Children s Services network focusses on child and youth mental health system coordination. The major child and youth serving agencies are involved in this network including St Leonard s Community Services,

5 Report No. PHSSS Date: March 5, 2013 Page 5 Woodview Mental Health and Autism services, both school boards and the Aboriginal Health Centre. 9.0 FINANCIAL IMPLICATIONS None 10.0 CONCLUSION Efforts towards strategic local planning, combined with additional provincial investments have resulted in recent improvements to the mental health response system in Brantford-Brant. More work remains to be done to address remaining gaps for individual and families experiencing mental illness. Susan Evenden, Manager Dan Temprile, General Manager Strategic Planning & Community Development Public Health, Safety & Social Services Attachments: Copy to: Appendix A Continuum of Mental Health Services in Brant NA In adopting this report, is a by-law or agreement required? If so, it should be referenced in the recommendation section. By-law required [ ] yes [ x ] no Agreement(s) or other documents to be signed by Mayor and/or City Clerk [ ] yes [ x ] no Is the necessary by-law or agreement being sent concurrently to Council? [ ] yes [ x ] no

6 Inpatient Services Acute Psychiatric Inpatient Care - Adult Services include assessment, diagnosis, treatment, stabilization and short-term rehabilitation of people with serious mental illnesses admitted voluntarily or involuntarily to a hospital psychiatric unit, which often include emergency psychiatric care. Services include assessment, diagnosis, treatment, stabilization and short-term rehabilitation for children or adolescents admitted voluntarily or involuntarily to a hospital psychiatric unit, which often entails emergency psychiatric care. Brant Community Healthcare System Acute Psychiatric Inpatient Care Children & Youth No specialized service McMaster Children s Hospital is the regional centre offering acute inpatient services to children and youth Referral to CPRI (Child & Parent Resource Institute) in London when needed for intensive residential service. Treatment at this facility is voluntary

7 Community Crisis Stabilization Unit Partial Hospitalization Programs - Day Hospital treatment and Day Treatment Services This service is an alternative to Acute Inpatient Care and provides crisis response and stabilization services for individuals and families. Services are available 24 hours a day, seven days a week. The facility offers short-term interventions for adults admitted voluntarily and include assessment, treatment and stabilization, and referral for follow-up services. These services are provided in a safe, supportive environment to assist individuals in managing their immediate crisis and continue ongoing treatment. These programs include Day Hospital treatment programs and Intensive Day Treatment Services. Services include structured individual, group and family mental health treatment services for individuals with a mental health disorder. Services are usually provided within an acute care setting while individuals remain in their home environment. Brant Community Healthcare System Brant Community Healthcare System Community Mental Health Services Service Description Local provider Comments Case Management Services include screening, assessment, treatment, psycho-social education, referral services, and coordination of client s care, selfmanagement support, relapse prevention, crisis management and ongoing support. Canadian Mental Health Association () Physician referral and diagnosis of serious mental illness required. Wait list applies.

8 Assertive Community Treatment (ACT) A service delivery model that provides flexible, comprehensive services to individuals with mental illness and/or addiction and who have multiple complex needs. ACT is distinct from the above case management approaches in its key components, which include a low client-to-staff ratio, operating after hours and weekends, multidisciplinary team approach, client-directed delivery of care, assertive outreach and continuous services. Serves young people with early psychosis, usually between the ages of 13 to 35 years, and their families. These programs bridge youth and adult mental health services, and link community with hospital. The programs are community-based and devote much effort to early detection and rapid assessment. Clinical services include single-entry intake and assessment, as well as treatment for people who have had their first episode of psychosis, including schizophrenia and severe depression with psychotic symptoms. Treatment components include individual, group and family intervention. Other program components include community education, evaluation, and research, as well as assessment and monitoring for young people at high risk of developing psychosis. These Programs serve youth and adults with eating disorders, primarily anorexia nervosa and bulimia nervosa. Depending on the severity of the disorders, services include: St Joseph s Health Care (Hamilton delivered locally) Serious Mental Health Diagnosis and application required. Wait list applies. Early Psychosis Intervention (EPI) Program St Leonard s Community Services/Brant Community Healthcare System partnership Eating Disorders Program No specialized services McMaster Children s Hospital is the regional centre for child & adolescent

9 psychological and psychiatric interventions, including group counselling and support groups, individual counselling and family counselling consumer and family education and informational sessions about recovering from eating disorders interventions to initiate re-nourishment, increase body weight, and promote medical stabilization, when eating disorders are severe / life threatening. These include the following services: Personal Life Skills Services, Employment Support Services, Supported Volunteer Services, Therapeutic Volunteer Program (TVP), Peer Support Services, Leisure Support Services, Education Support Services and System Advocacy Services. These services include education and support for individuals and families to increase the understanding of mental illness and addictions including coping strategies and selfmanagement support. treatment St Joseph s Health Care (Hamilton) is regional centre for adult treatment Psychosocial Rehabilitation Alternatives Activity Centre Support Groups St Leonard s Community Services Woodview Mental Health & Autism Services Alzheimer Society Brant Community Health Care System Family Counselling Centre of Brant Frequency times and criteria vary by provider

10 Pre-Employment Vocational Services Services include specialized assessments, career planning, pre-vocational skills training, transitional employment services, supported employment services, work experience, selfemployment support and consumer-run businesses or co-operatives. Services provided by trained clients to provide social and recreational companionship and personal life skills services, including peer-topeer education to other clients. Peer support services are coordinated within a formal structure linked to the treatment team. A wide variety of services and supports including, self management support, counselling, and respite care, which is temporary, short-term care, designed to give relief or support to a family caregiver who has the responsibility for the ongoing care of a family member. Respite can be provided inside or outside the home. Offers short-term interventions including assessment, stabilization, and referral for followup services. These services provide a safe, supportive environment to assist individuals in managing their immediate crisis and continue ongoing treatment. Crisis response services include the following services: Crisis/Warm Line, Walk-in Crisis Stabilization Services, Emergency Shelter/Transition Housing, and Community Crisis Residential Stabilization Services. Works for Me Peer Support Family Support Crisis Response/Mobile Crisis St Leonard s Community Services/ Brant Community Health Care Centre partnership Includes the following services: 24-7 telephone crisis counselling Mental Health Walk In clinic (1-6 sessions), no appointment necessary 11:00 a.m. 8:00 pm 7 days/week Available mobile response Addiction Services Mental Health Crisis risk

11 assessments by BGH mental health crisis nursing/social work staff Psychogeriatric crisis services Referral for psychiatry consultation and follow up Mental Health Counselling (Adult) Paid or EAP Guthrie and Associates Family Counselling Centre of Brant Services may be paid by Health Canada for First Nations individuals Family Counselling Centre offers sliding fee schedule No Cost St Leonard s Community Services Brant Community Healthcare System Sexual Assault Centre of Brant Grand River Community Health Centre Various primary care practices Eligibility criteria and Session limits apply Mental Health Counselling (Child and Individual and Family Counselling Reaching Out to Kids in Schools - provides support to students JK Gr 12 Woodview Mental Health and Autism Referrals through Contact Brant Wait lists apply. Woodview provides a

12 Adolescent) in both GEDSB and BHNDSB who are experiencing emotional, behavioural and/or social issues that impact negatively on school success Telepsychiatry consultations TAPP-C arson prevention program Court Ordered assessments under the Youth Criminal Justice Act Housing Services Services: Brantford Child & Family Centre weekly walk-in clinic supplying crisis intervention and brief therapy for families on the wait list Supported Housing Services include provision of safe, secure and affordable accommodation and support services, such as assistance with personal life skills and crisis management. currently offers 2 sites in Brantford: Lyons Avenue Phoenix Place Wait lists apply Group Homes Clients share a communal home and participate in shared living arrangements. Support services, such as life skills and crisis management in preparation for independent living, are provided. Rosewood House

13 Mental Health Promotion Mental Health Promotion Initiatives, including Public Education, that support individuals, families, and communities to take control over their lives and improve their mental health, recognizing that mental health is linked to environmental and lifestyle factors. These initiatives include mental health literacy. Brant County Health Unit Grand River Community Health Centre Grand Erie District School Board Brant Haldimand Norfolk Catholic School Board