National Jurisdictional Review of Mental Health and Addiction Service Delivery Models

Transcription

1 National Jurisdictional Review of Mental Health and Addiction Service Delivery Models A supporting document for Nova Scotia s Mental Health and Addictions Strategy

2 Report prepared by: Margaret Turnbull, BSc, MSc candidate 1 Donald Langille, MD, MHSc 1 Mark Asbridge, PhD 1 Steve Kisely, MD, PhD 1,2 Alexandra Borwein, BSc, MSc candidate 1 John Campbell, PhD 3 1 Dalhousie University Department of Community Health and Epidemiology 2 University of Queensland, Brisbane, Australia 3 Annapolis Valley District Health Authority September, 2011

3 Brief Introduction to this Document This review document is the result of a Nova Scotia Health Research Foundation call for proposals to carry out a national jurisdictional review of mental health and addictions services (MHAS). That RFP emerged from the March 2010 throne speech where the Nova Scotia government committed to developing an evidence-based Mental Health and Addictions Strategy for the province, and from a recommendation from the office of the Auditor General. It also builds on the Mental Health Strategy Background document released in February, The goal of this review was to identify and describe the approaches and models of delivering mental health and addictions services being used in Canada so as to inform the development of a mental health and addictions strategy for Nova Scotia in light of Nova Scotia s particular demographics, economic situation, human and physical geography, as well as the need to provide services to unique and marginalized populations. While the request for proposals asked for an investigation of the utility of models being implemented in other jurisdictions at various points along the continuum of care, it should be recognized that very few mental health and addictions services offered across Canada are evaluated on an ongoing basis, so that there is limited capacity to comment, other than in a general and qualitative way (and only in some instances) how such services are performing where implemented. Similarly, the degree to which the services implemented within Nova Scotia and across Canada are based on best evidence is also limited. Services are often offered based on historical conveniences rather than efficacy, effectiveness, and patient outcomes. Through the methodology outlined below, we were able to examine the mental health and addiction services in most provinces. The work was carried out over a short time period and was limited by difficulties in some cases of reaching individuals in other provinces for validation of availability of services and interpretation of the sources of information used for the report. The document will, despite these limitations, help the Steering Committee responsible for overseeing the Mental Health and Addictions Strategy for Nova Scotia understand what services are being delivered in other jurisdictions across Canada, how they are being delivered, and to whom, so as to be able to compare such efforts with those being made, or planned to be made, in Nova Scotia. Additionally, this report may be useful during the strategy s implementation phase as a resource for consulting other jurisdictions to identify programs of interest. Work was begun on the review in May 2011 by a research team from the Department of Community Health and Epidemiology at Dalhousie University. Initial work centred on appropriate approaches to data gathering, followed by concerted efforts to be as comprehensive as possible within the time limitations. By the end of July, progress was sufficient to allow the sharing of the approach taken and some preliminary results with the Steering Committee. Feedback from that meeting was very positive and the work was continued as outlined, while reflecting on comments from the Committee. A penultimate draft of the document was ready by mid-august and the final document was delivered in electronic format on September 6 th It is our sincere hope that this work makes a significant contribution to the Steering committee s capacity to carry out its important mandate. i

4 TABLE OF CONTENTS Section A: Provincial review of mental health and addiction services 1 Introduction 1 Methodology 1 Continuum of Care 3 Evaluation 4 Newfoundland AND Labrador 5 Summary of the Mental Health and Addiction Services in Newfoundland and Labrador 6 Mental Health Services in Newfoundland 6 Population Specific Services 7 Community Based Services 7 Hospital based Services 8 Addiction Services in Newfoundland 8 Community Based Services 8 Hospital Based/Residential Services 9 Bibliography 9 Prince Edward Island 11 Summary of the Mental Health and Addiction Services in Prince Edward island 12 Mental Health Services in Prince Edward Island 13 Child and Youth Services 13 Community Based Services 13 Suicide Prevention Services 16 Emergency Services 16 Addiction Services in Prince Edward Island 17 Child and Youth Services 17 Community Based Services 18 Hospital-Based Services 19 Bibliography 19 New Brunswick 21 Summary of the Mental Health and Addiction Services in New Brunswick 22 Mental Health Services Offered in New Brunswick 23 Community Mental Health Centres (CMHC) 23 Psychiatric Units 26 Psychiatric Hospitals 27 Non-Profit Organizations that Serve Persons with Mental Health Problems and Consumer-Run Programs 27 Services Offered Through the CMHA 28 Addiction Services Offered in New Brunswick 29 ii

5 Bathurst 30 Restigouch 30 Northwest zone (regional health authority four) 31 Fredericton 32 Miramichi 32 Saint John 32 Upper river valley 32 Bibliography 33 Ontario 34 Kingston, Ontario 35 Ontario Mental Health Services (Kingston) 36 Youth-Specific Services 36 Adult Services 36 Emergency Services 38 Ontario Addiction Services (Kingston) 39 Youth-Specific Services 39 Adult Services 39 Emergency Services 40 London Ontario 40 Mental Health Services Offered in London 41 Health Prevention and Promotion Services 41 Community Based Programs 41 Intervention and Treatment Programs 44 Addiction Services in London Ontario 47 Health Promotion and Prevention 47 Community Support 48 inpatient and Emergency Services 48 North Bay, Ontario 50 Ontario Mental Health Services (North Bay) 51 Youth-Specific Services 51 Adult Services 51 Emergency Services 53 Ontario Addiction Services (North Bay) 54 Youth-Specific Services 54 Adults Services 54 Emergency Services 56 Bibliography 56 Manitoba 57 Summary of the Mental Health and Addiction Services in Manitoba 58 Mental Health Services 59 iii

6 Health Promotion and Prevention 59 Supportive Housing 60 Treatment and Rehabilitation 60 Community Based Services 62 Crisis Intervention and Emergency Services 63 Addiction Services 63 Child and Youth Services 63 Community Based Services 64 Treatment and Rehabilitation 65 Bibliography 66 Saskatchewan 67 Summary of the Mental Health and Addiction Services in Saskatchewan 68 Saskatchewan Mental Health Services 68 Child and youth services 68 Adult Community Services 69 Psychiatric Rehabilitation services 72 Mental Health inpatient units 73 Saskatchewan s Addiction Services 744 Youth-Specific Services 74 Adult Services 75 Smoking Cessation 77 Emergency Services 77 Bibliography 78 Alberta 79 Mental Health Services in Alberta 80 Addiction Services in Alberta 85 Bibliography 86 British Columbia 87 Mental Health and addiction Services in British Columbia 87 Provincial health service authority 88 Northern Health 89 Fraser health 90 Interior Health 93 Vancouver Island Health Authority 93 Bibliography 94 Section B: Observations about services in Nova Scotia 96 Vulnerable Populations 96 The Aboriginal Population 96 The Rural Population 97 iv

7 The Immigrant Population 98 Concurrent Disorders 99 The Homesless Population 99 The Francophone and Acadian Populations 100 Age Specific And African Nova Scotian Services 101 Further Observations About Nova Scotia 101 Long Term Care Facilities 101 Evidence Based Practices 101 Prescription Medication 102 Methadone Maintenance 102 General Services In Nova Scotia Along The Continuum of Care 102 Section B Bibliography 104 Complete Bibliography 105 Appendix B: List of key informants 108 v

8 LIST OF TABLES TABLE 1: SUMMARY OF METHODOLOGY FOR SECTION A: JURISDICTIONAL REVIEW OF MENTAL HEALTH AND ADDICTION SERVICES 2 TABLE 2: CONTINUUM OF CARE DESCRIPTION 3 TABLE 3: SUMMARY OF THE MENTAL HEALTH SERVICES AVAILABLE IN NEWFOUNDLAND AND LABRADOR 6 TABLE 4: SUMMARY OF THE ADDICTION SERVICES AVAILABLE IN NEWFOUNDLAND AND LABRADOR 6 TABLE 5: DEMOGRAPHIC COMPARISON OF PRINCE EDWARD ISLAND, NOVA SCOTIA, AND CANADA AS TAKEN FROM STATISTICS CANADA 2011 HEALTH PROFILE 11 TABLE 6: SUMMARY OF THE MENTAL HEALTH SERVICES AVAILABLE IN PRINCE EDWARD ISLAND 12 TABLE 7: SUMMARY OF THE ADDICTION SERVICES AVAILABLE IN PRINCE EDWARD ISLAND 12 TABLE 8: DEMOGRAPHIC COMPARISON OF NEW BRUNSWICK, NOVA SCOTIA, AND CANADA AS TAKEN FROM STATISTICS CANADA 2011 HEALTH PROFILE 21 TABLE 9: SUMMARY OF THE MENTAL HEALTH SERVICES AVAILABLE IN NEW BRUNSWICK 22 TABLE 10: SUMMARY OF THE ADDICTION SERVICES AVAILABLE IN NEW BRUNSWICK 22 TABLE 11: DEMOGRAPHIC COMPARISON OF ONTARIO, NOVA SCOTIA, AND CANADA AS TAKEN FROM STATISTICS CANADA 2011 HEALTH PROFILE 35 TABLE 12: SUMMARY OF THE MENTAL HEALTH SERVICES AVAILABLE IN KINGSTON ONTARIO 35 TABLE 13: SUMMARY OF THE ADDICTION SERVICES AVAILABLE IN KINGSTON ONTARIO 36 TABLE 14: SUMMARY OF SERVICES PROVIDED BY WESTERN AREA YOUTH SERVICES 46 TABLE 15: SUMMARY OF THE MENTAL HEALTH SERVICES AVAILABLE IN NORTH BAY ONTARIO 50 TABLE 16: SUMMARY OF THE ADDICTION SERVICES AVAILABLE IN NORTH BAY ONTARIO 51 TABLE 17: DEMOGRAPHIC COMPARISON OF MANITOBA, NOVA SCOTIA, AND CANADA AS TAKEN FROM STATISTICS CANADA 2011 HEALTH PROFILE 57 TABLE 18: SUMMARY OF THE MENTAL HEALTH SERVICES AVAILABLE IN MANITOBA 58 TABLE 19: SUMMARY OF THE ADDICTION SERVICES AVAILABLE IN MANITOBA 58 TABLE 20: DEMOGRAPHIC COMPARISON OF SASKATCHEWAN, NOVA SCOTIA, AND CANADA AS TAKEN FROM STATISTICS CANADA 2011 HEALTH PROFILE 67 TABLE 21: SUMMARY OF THE MENTAL HEALTH SERVICES AVAILABLE IN SASKATCHEWAN 68 TABLE 22: SUMMARY OF THE ADDICTION SERVICES AVAILABLE IN SASKATCHEWAN 68 TABLE 23: SERVICES AVAILABLE IN THE INPATIENT MENTAL HEALTH UNITS 73 TABLE 24: DEMOGRAPHIC COMPARISON OF ALBERTA, NOVA SCOTIA, AND CANADA AS TAKEN FROM STATISTICS CANADA 2011 HEALTH PROFILE 79 TABLE 25: LIST OF CHILD AND YOUTH SERVICES IN ALBERTA 81 TABLE 26: LIST OF POPULATION SPECIFIC COMMUNITY HEALTH SERVICES IN ALBERTA 81 TABLE 27: LIST OF COMMUNITY BASED OUTPATIENT SERVICES IN ALBERTA 82 TABLE 28: LIST OF CRISIS AND EMERGENCY SERVICES IN ALBERTA 83 TABLE 29: LIST OF MENTAL HEALTH INPATIENT CARE SERVICES IN ALBERTA 83 TABLE 30: LIST OF SERVICES FOR SENIORS IN ALBERTA 84 TABLE 31: LIST OF PROGRAMS FOR CHILDREN AND YOUTH IN ALBERTA 85 TABLE 32: LIST OF COMMUNITY BASED OUTPATIENT SERVICES IN ALBERTA 85 TABLE 33: LIST OF ADDICTION IMPATIENT CARE SERVICES IN ALBERTA 86 vi

9 TABLE 34: DEMOGRAPHIC COMPARISON OF BRITISH COLUMBIA, NOVA SCOTIA, AND CANADA AS TAKEN FROM STATISTICS CANADA 2011 HEALTH PROFILE 87 TABLE 35: LIST OF MENTAL HEALTH SERVICES 91 TABLE 36: LIST OF ADDICTION SERVICES 92 TABLE 37: LIST VANCOUVER ISLAND MENTAL HEALTH AND ADDICTION SERVICES 94 vii

10 SECTION A: PROVINCIAL REVIEW OF MENTAL HEALTH AND ADDICTION SERVICES INTRODUCTION Section A provides a review of the publicly funded mental health and addiction services within Canadian provinces (with the exception of Quebec). While a brief introduction is provided for each province, a complete analysis of the governance, system structure, and funding by province is available in the sister document Review and Synthesis of Extant knowledge of Mental Health and Addiction Strategies, also carried out by this research group and submitted with this report. The purpose of the document is to review the publicly funded services across Canada. However, it should be understood that there are circumstances in which distinguishing between publicly financed, publicly subsidized and privately financed, is not possible. Thus, it is not a certainty that all services listed are supported by the government. Supporting information on funding and governing was listed where possible. Importantly, this report is only able to address the apparent availability of publicly funded services, NOT the efficacy or appropriateness of these services. Speaking plainly, this report comments only on what services appear to be available in other provinces. There is no consideration or inference of whether these services would be effective in Nova Scotia or whether they are effective elsewhere. METHODOLOGY Gathering information for this section required that several methods of data collection and verification be employed. While we attempted to employ a standardized approach to examining mental health and addiction services, not all provinces could be approached in the same way. The information gathering process depended 1) on how much information was available for each province online; 2) whether key contacts were accessible; 3) how knowledgeable key contacts were; 4) how willing those contacts were to share their knowledge; and, 5) how provincial approaches to the provision for mental health and addictions were structured. For most provinces, the approach taken was to begin by looking on government websites to determine whether there was a list of services in each province or by region. Most provinces have regional health authorities (RHAs). Both provincial websites, as well as individual RHA websites were accessed to see what information was available. Next, the range of services listed on these credible websites was documented. Then each service was examined individually to find out what it was composed of, who was served, and if retrievable, who funded and governed it. If contact information was listed on the websites, then an was sent to 1

11 determine whether appropriate contacts could review the material documented, or and/or provide further information about services in that jurisdiction. If contacts were not listed, or if they were unwilling to review this documentation, other unofficial websites (drugrehab.ca, yellow pages, CMHA) were examined in an effort to validate the services documented. After this validation effort each service was listed along the continuum of care, and if possible, similar services in individual provinces were grouped. Pubmed, Medline and Psychinfo were searched to determine whether any information had been published on specific program evaluation. Once the information was obtained, and separated along the continuum (in a way which best suited each province please see continuum of care below for more information), the section was written and the services available in each province were noted for Section B: Nova Scotia. Please refer to Table 1 which summarizes the methodology. An initial web-search performed to determine whether there is a central document listing services All relevant sources noted, and all services available listed Persons of interest are contacted and comment on the validity of these listings (i.e., are they truly available?) Available information is compiled by province along the continuum of care Each service is researched to determine: objective, target population, governance, funding and evaluation Information is validated, either by a representative of the province, or through a final web search Final report was compiled, and services were compared by province in preparation for section B Table 1: Summary of methodology for Section A: Jurisdictional Review of mental health and addiction services 2

12 CONTINUUM OF CARE According to the World Health Organization, national mental health and addiction policies should not be concerned solely with mental health and substance use disorders, but should also recognize and address the broader issues that predispose to and promote these conditions. The review therefore includes not only an assessment of the jurisdictional approaches to the clinical continuum of care, but also mental health and addiction promotion and prevention, early diagnosis programs, and programs which are designed to help people maintain themselves in the community following diagnosis and treatment. Mental health and addiction programs frequently provide services that fall within different categories of the continuum of care. For that reason, services in each province were categorized slightly differently depending on how the overarching mental health and addiction system was structured. It is important to note that the continuum of care is just that, a continuum, and services should not be thought of as static, or belonging exclusively in one category. Summary tables of the mental health and addiction services are located at the beginning of sections for each province (with the exceptions of Alberta and British Columbia, whose systems did not lend themselves to being summarized in such a manner). The summary tables typically have three columns (in some cases wording was changed to incorporate unique services. The columns are labelled: Health Promotion and Prevention, Community-Based Services, and Inpatient Services and Crisis Intervention. Below is a rough description of the three labels. Location on the Continuum Health Promotion and Prevention Community-Based Services Inpatient Services and Crisis Intervention Description Services that are designed to enhance health and well-being. These services are designed to encourage healthy behaviors and encourage people to avoid risk-taking behaviors. Services which support individuals or groups within the community by providing a range of specialized mental health or addiction supports. These services are located within the community, and enable people to actively participate in their recovery, or maintenance of health. Inpatient services and programs require the individual to live in the treatment facility, while they are receiving intensive care. These services often provide highly specialized and intensive care. Crisis Intervention services provide a range of emergency services that are focused on providing timely care in cases where immediate intervention is required. Table 2: Continuum of care description 3

13 In addition to the initial summary table which categorizes services along the continuum, each chapter is divided according to separate classifications. These titles vary by province depending on the range of services available. As previously mentioned, these titles and classifications are simply tools to organize the material, and at best provide some description of the structure of services along the continuum of care. These categories should not be viewed as a finite description of what specific services the programs provide within the continuum, as many programs provide a range of services that would fall along multiple locations on the continuum. Additionally, it should be noted that many different provinces have different meanings for similar terminology. For example, two provinces may both have Trauma Centres but one may be for people who are experiencing a mental health crisis, while the other might be an informationbased program for victims of sexual assault. It is important to read the description of each service for clarification. A bibliography is provided at the end of each chapter, with a list of all sources used to inform the document. Unless otherwise noted, the information was primarily gathered from the provincial or municipal government official websites. A demographic comparison is provided at the beginning of each province. The table includes social demographic factors which are known to influence the provenance and incidence of mental health difficulties and addictions. The information in the table was taken from Statistics Canada 2011 Community Profile, found online at EVALUATION In its Mental Health Policy and Service Guidance Package, the World Health Organization recommends that publicly funded mental health services be carefully assessed through regular service monitoring and evaluation. Initially, a service evaluation section was to be included in this report. However, after assessing the degree and quality of mental health and addiction service evaluations it has become clear that there is insufficient material to form the basis of such a section. Of the services which were evaluated, many were measured based on utility or popularity, rather than efficacy and effectiveness. It was noted that there are inherent difficulties in measuring outcomes in mental health and addiction research. In the s and telephone interviews with mental health and addiction service providers the question if or how are your services evaluated were asked. Frequently, services are not formally evaluated, but are occasionally evaluated using consumer input, whereby the clients rate the services. Such evaluations are not included in the report because of their subjectivity. The exception to this is Methadone clinics, which have been empirically evaluated in Nova Scotia, as well as in other Canadian provinces. A number of services are currently undergoing formal evaluation using objective outcome measures; as such it may be prudent to reassess service evaluation periodically over the next few years. 4

14 NEWFOUNDLAND AND LABRADOR On October 1 st Newfoundland s House of Assembly passed the Mental Health Care and Treatment Act, in order to provide more adequate and uniform care for persons suffering from a severe mental illness. As a result, Newfoundland has a range of services designed to promote mental wellness and treat mental disease. Newfoundland and Nova Scotia Canada Labrador Total Population 509, ,506 34,108,752 Patients with repeat 13.8% 10.8% 11% hospitalization for mental illness Perceived Mental Health 75.0% 73.6% 73.9% to be very good or excellent Percent Aboriginal 4.7% 2.7% 3.8% Percent Heavy Drinker 24.5% 20.5% 17.3% Percent living off a low 14.7% 13.8% 15.3% income Percent Visible Minority 1.1% 4.2% 16.2% Percentage of the 42.4% 44.7% 19.9% Population that live in Rural Areas Population Density (per km 2 ) Unemployment 14.4% 9.3% 8% Youth (under 20) as a proportion of the total population Table 3: Demographic comparison of Newfoundland and Labrador, Nova Scotia, and Canada as taken from Statistics Canada 2011 Health Profile Introduction to Mental Health and Addictions in Newfoundland and Labrador Mental Health and Addiction services are offered across Newfoundland by the regional health authorities. Newfoundland has four defined Regional Health Authorities: the Eastern Regional Health Authority which includes St John s, Rural Avalon, Bonavista, and Burin; the Central Regional Health Authority which includes Gander and Grand Falls-Windsor; the Western Regional Health Authority which includes Corner Brook and Stephenville; and the Labrador/Grenfell Regional Health Authority which includes St Anthony, Happy Valley-Goose Bay and Labrador City. 5

15 SUMMARY OF THE MENTAL HEALTH AND ADDICTION SERVICES IN NEWFOUNDLAND AND LABRADOR Health Promotion and Prevention o Mental Health Prevention and Promotion Services Mental Health Services along the Continuum of Care Community-Based Services o o o o o o o o Community Mental Health Support Services Mental Health Court Eating Disorder Programs Seniors Mental Health Services Case Management Program Assertive Community Treatment Team Trauma Program PREP Hospital Based / Inpatient Care o o o o Acute Inpatient Services Early Psychosis Program Supportive Housing Inpatient Unit at WMRH Table 3: Summary of the Mental Health Services available in Newfoundland and Labrador Addiction Services along the Continuum of Care Health Promotion and Prevention Services Community-Based Services Inpatient Services and Emergency Care Early Intervention and o RAFT o Mental Health Crisis Outreach for Youth o Get Up On It Line o Outpatient counselling o Adult Residential o Opioid Treatment Treatment Services Centre o Detoxification Centre Table 4: Summary of the Addiction Services available in Newfoundland and Labrador MENTAL HEALTH SERVICES IN NEWFOUNDLAND The Mental Health Services in Newfoundland are divided into Population-Specific Programs, Community-Based Services, and Hospital-Based Programs. Population-Specific Programs include those programs that serve one specific population. Community-Based Services support individuals living in the community and provide the least restrictive form of care possible. Hospital-Based Services include responsive services that provide immediate mental health care. These services typically operate in a hospital setting. 6

16 POPULATION SPECIFIC SERVICES The Janeway Hospital in St John s Newfoundland has a seven-bed Inpatient Unit for children and adolescents. This unit is designed to treat children and youth with serious acute mental difficulties, whose needs extend beyond the treatments available on an outpatient basis. The Mental Health Court is a specialized court for clients with mental health or addiction problems who have come in contact with the law. This primary purpose of the mental health court is to provide client assessments to determine the mental and emotional capacity of limitations the client. In addition to lawyers, the court employs social workers and practical nurses. Eating Disorder Programs are available across Newfoundland. The Centre of Hope is a day treatment program in St John s that targets the province s children and adults dealing with eating disorders. Services provided include: meal and weight management, medication, and counselling. A multidisciplinary treatment team provides these services. The Early Psychosis Program provides assessment, treatment, medication management, and long-term follow up to patients diagnosed with a major mental illness, such as schizophrenia or bipolar disorder, and their families. The purpose of this program is to minimize the long-term disability caused by severe mental illnesses. The program is available in the Eastern, Central and Western Health Authorities, and is staffed by nurses and physicians. The Trauma Program offers a wide range of services for survivors of child sexual assault, and to males who have a history of violent behaviour who suffer from a mental disease or addiction. COMMUNITY BASED SERVICES Community Mental Health Support Services are offered across the province to provide community based mental health services, including: family or individual counselling, and intervention services for children, youth and adults. Seniors Mental Health Services are provided in the Eastern Health Region through inpatient units, an assessment unit, a geriatric psychiatry day hospital, and community outreach services. Case Management is provided in all Health Regions across Newfoundland. This service is designed to ensure that individuals with severe and persistent mental illnesses receive the appropriate and integrated level of care, treatment and support. Front line mental health providers, primary nurses, and social workers deliver these services. These services target persons who experience functional disabilities as a result of mental illness and who require ongoing support in their daily lives. The Assertive Community Treatment Team provides intensive services for individuals with severe and persistent mental disease. Services are available 24 hours a day, seven days a week, and are provided on an on-call basis. This service is available in the Eastern, Central and Western health authorities. 7

17 A variety of Mental Health Promotion and Prevention programs is available across Newfoundland. The Community Addictions Prevention and Mental Health Promotion Fund is a province wide initiative designed to support groups wishing to prevent addiction issues and promote mental health to community members. Any/all individuals, not-for-profit groups, and organizations with an interest in promoting mental wellness are eligible to apply. Supportive Housing is provided in the Eastern Health Region in the form of community care homes, family care homes, and ACCESS a transitional housing service for ten individuals. The PREP program offers career-planning services to individuals with mental difficulties and who require assistance in acquiring or maintaining a job. This program targets persons 18 years and older with mental health issues. HOSPITAL BASED SERVICES The Mental Health Crisis Line is available 24 hours a day, seven days a week for people who are experiencing a mental health problem or crisis. Acute Inpatient Services are offered in St. John s, Grand Falls Windsor, and Corner Brook. These services target adults who require a high level of immediate care. The Western Memorial Regional Hospital has a 23-bed acute inpatient care service addressing Mental Health needs. This unit serves as the only mental health unit in the Western Region. ADDICTION SERVICES IN NEWFOUNDLAND The four regional health authorities in Newfoundland provide Addiction Services in the same fashion as they provide the Mental Health Services. Addiction Services are separated into Community-Based Services, which provide support to individuals living in the community in the least restrictive fashion; and Hospital-Based/Residential Services, which include immediate care facilities or long-term inpatient programs. COMMUNITY BASED SERVICES The Recovering Addicts Fellowship Team (RAFT) is located in St. John s, and is a non-profit organization that helps individuals during their recovery by them teaching socialization skills and how to enjoy life in a healthy environment. RAFT uses educational, emotional and social supports for patients and their families. Another service offered in Newfoundland for people addicted to alcohol, drugs or gambling is the Get Up On It program, which provides educational and emotional supports for people trying to rid themselves of their addiction. 8

18 There are 26 outpatient offices that offer outpatient counselling in Newfoundland. Individual, group and family counselling is available. An initial assessment is completed prior to treatment in order to develop an individualized treatment plan. The Early Intervention and Outreach for Youth is a program delivered in all four regional health authorities, and targets at-risk youth before they develop serious addictions. The Mental Health Crisis line, described under the Mental Health Services in Newfoundland is also equipped to take substance abuse and gambling problems. A gambling hotline is also available across Newfoundland. HOSPITAL BASED/RESIDENTIAL SERVICES Adult Residential Treatment Services are offered at the Humberwood Treatment Centre in Corner Brook (Western Health Authority). The centre targets adults 19 years and older who are experiencing a severe substance use or gambling problem. A three-week inpatient treatment program is provided. Individuals must first be referred to the program by an addictions counsellor or other community professional. Individual and group counselling, relaxation and leisure therapy, and educational sessions are provided. Follow-up outpatient services are provided for patients who have completed the program. There is one Detoxification Centre in Newfoundland, and it is located at the St John s Recovery Centre and operated by Eastern Health. The centre serves adults 16 and older who are intoxicated or who are experiencing symptoms of alcohol or other drug withdrawal, or who need respite from a gambling problem. Clients of the centre have access to the inpatient and outpatient treatment services. Detoxification services are offered in the patient s home under a physician s care, or in hospital for those experiencing severe withdrawal symptoms. There is an Opioid Treatment Centre in St John s operated by Eastern Health. This centre provides a multidisciplinary approach to treatment, mainly through methadone maintenance. This service targets people who have a severe opioid addiction. BIBLIOGRAPHY Eastern Health. (2010, December 2). Mental Health & Addictions Services. Retrieved from Eastern Health Newfoundland and Labrador: Government of Newfoundland and Labrador. (2011, May 20). Addiction Services. Retrieved from Department of Health and Community Services: Government of Newfoundland and Labrador. (2011, May 20). Mental Health Programs. Retrieved from Department of Health and Community Services: 9

19 Western Health. (2011, January 20). Programs and Services. Retrieved from Western Health Newfoundland: 10

20 PRINCE EDWARD ISLAND Prince Edward Island (PEI) is Canada s smallest province, both in population and landmass. According to the 2009 Canadian Alcohol and Drug Use Monitoring Survey (CADUMS), PEI has the second lowest reported lifetime use of illicit drugs (after Newfoundland), and has the third lowest reported lifetime use of alcohol. Prince Edward Island Nova Scotia Canada Total Population 142, , , 108, 752 Patients with repeat 13.1% 10.8% 11% hospitalization for mental illness Perceived Mental Health 75.0% 73.6% 73.9% to be very good or excellent Percent Aboriginal 1.3% 2.7% 3.8% Percent Heavy Drinker 19.7% 20.5% 17.3% Percent living off a low 11.0% 13.8% 15.3% income Percent Visible Minority 1.4% 4.2% 16.2% Percentage of the 55.3% 44.7% 19.9% Population that lives in Rural Areas Population Density (per km 2 ) Unemployment 11.3% 9.3% 8% Youth (under 20) as a proportion of the total population Table 5: Demographic comparison of Prince Edward Island, Nova Scotia, and Canada as taken from Statistics Canada 2011 Health Profile 11

21 SUMMARY OF THE MENTAL HEALTH AND ADDICTION SERVICES IN PRINCE EDWARD ISLAND Mental Health Services along the Continuum of Care Health Promotion & Prevention Community Care Emergency and Inpatient Care o I m Thumbody Program o Children s Mental Health Program o Prince County Hospital o Consumer and Family Support Program o Directory of Self-Help and Community o Queen Elizabeth Hospital o Resource Library Resources o Hillsborough Hospital o Changing Minds o With Hope in Mind and Special Care o PEI Helping Tree o McGill Community Centre o Provincial Suicide Mental Health Centre o Crisis Response Prevention Committee o ASIST Team o Supports for Survivors of Suicide Table 6: Summary of the Mental Health Services available in Prince Edward Island o o o Addiction Services along the Continuum of Care Health Promotion & Prevention Community Care Emergency and Inpatient Care Student Assistance o Adolescent o In-patient Mental Program Rehabilitation Health Units 10-Hour Pathway o Family Programs o Acute Psychiatric Smoking Cessation o Community Outreach Units and needle exchange o Hillsborough Hospital o Outpatient and Special Care Detoxification Centre o Adult Rehabilitation o Specialized inpatient o Women Specific detoxification services Program o After Care o Extended Care o Methadone Maintenance Treatment Program Table 7: Summary of the Addiction Services available in Prince Edward Island 12

22 MENTAL HEALTH SERVICES IN PRINCE EDWARD ISLAND Mental Health Services in Prince Edward Island are divided into Child and Youth Services, Community Based Services, Suicide Prevention Services, and Emergency Services. Child and Youth Services target individuals under the age of 18, Community Based Services support individuals living in the community and provide the least restrictive form of care possible. Suicide Prevention services focus specifically on reducing the incidence of and harm associated with suicide. Emergency Services include responsive services, typically in a hospital setting. CHILD AND YOUTH SERVICES The Children s Mental Health program is a comprehensive, multi-disciplinary program that provides a range of services for children living on the Island with mental health concerns and their families; and is located at the Community Mental Health Centres across the province. The I m Thumbody Program is a self-esteem strengthening program for children in grade 3 designed to: Build healthy self-concepts Stimulate the development of self confidence Instil feelings of self-worth, individuality and responsibility Develop an understanding of each person's unique skills and interests and the value of their differences, strengths and individuality Enhance self-awareness This program is delivered in all public elementary schools across PEI. The objective of this program is to increase the skills that promote personal development and successful relationships in children. COMMUNITY BASED SERVICES The Consumer and Family Support Program operates under the direction of a volunteer management committee. The Consumer and Family Support Program and the With Hope in Mind Program are delivered in partnership with the Prince Edward Island Department of Health. The Consumer and Family Support Program can (as taken from the website): Assist in locating self-help groups, professionally led groups and other community resources; Offer support in creating self-help groups and provide support to existing groups; Provide a meeting place for self-help group or help a group find a meeting space; Provide an avenue to promote a group or service by including your information in the Directory of Self Help Groups and Community Resources in Prince Edward Island, an annual publication of the Consumer and Family Support Program, or by listing your group in the weekly Self-Help Column in local newspapers; 13

23 Provide a wide variety of educational resources through resource libraries; Set up and deliver, through a network of trained family educators (with professional support), With Hope in Mind education courses in many locations across the Island... these courses are designed to educate family members about the major mental illnesses and Provide presentations to your business/community organization covering mental illness/health issues and promoting mental health. The Directory of Self-Help and Community Resources on Prince Edward Island is updated annually and has information on groups and organizations dealing with: Addictions and Compulsions (Alcoholism, Drug Abuse, Gambling, Overeating, Smoking) Bereavement and Loss (Death of a Child, Grief Self-Help) Disabilities (Blindness, Head Injuries, Deafness, Learning Disabilities, Developmental Disabilities, Physical Disabilities) Health (Aids, Cancer, Alzheimer's, Parkinson's, Arthritis, Diabetes, Epilepsy, Bulimia, Infertility, Multiple Sclerosis, Ostomy, Spina Bifida, etc.) Mental Health (Bipolar Disorder/Manic Depression, Depression, Schizophrenia, Emotions Anonymous, Recovery) Parenting and Family (Single Parenting, Adolescents, Resources in the Community) Information on Seniors, Multiculturalism, Physical and Sexual Abuse, Family Violence Listings on Community Resources, Groups Run by Professionals, Service Clubs and other Associations, Help and Information Lines and PEI Schools and Churches. PEI s Resource Libraries located in Charlottetown, Summerside and Alberton, contain information on mental health issues in the form of pamphlets, books, audiotapes and videos. Material can be taken from the libraries and borrowed. This service is provided by the CMHA. With Hope in Mind is a program designed to educate and support the family members of someone with a mental illness. It is a provincial, family-to-family, education and support program delivered by trained family member volunteers, and is supported by the Consumer and Family Support Program. Courses are scheduled throughout the year, typically occurring for one hour per week for eight weeks. Information on Schizophrenia, Schizo-affective Disorder, Obsessive Compulsive Disorder, Depression, Anxiety, Bipolar Disorder and Additional Disorders is presented. Problem Management, Self Care, and Coping Skills also are discussed. The Clubhouse Project gives people with mental or emotional difficulties a place to volunteer and feel needed, wanted and expected. There are three projects across PEI. The 4 Guarantees of Clubhouse The right to a place to come The right to meaningful work The right to meaningful relationships The right to a place to return 14

24 The Clubhouse project is available to individuals who: Have a history of mental or emotional illness Are over 18 years of age, and under 65, when applying Are not abusing alcohol or drugs Are willing and able to become involved in one or more of the clubhouse units Are free from acute symptoms of illness Are living in the community, or if in the hospital, have a definite discharge plan The clubhouse model originated in the 1940 s with the establishment of the Fountain House in New York City. The model was introduced in Canada in 1983 and there are currently 400 affiliated clubhouses operating worldwide providing membership to more than people with mental illness. Changing Minds is a multi-use, mental illness education program. It was created to address a community need for mental health education, stigma reduction and to provide a better understanding of mental health and mental illness. Changing Minds is divided into eight distinct modules and delivered over a two-day period. This program is designed for organizations and people that come in contact with people experiencing mental illness on a daily basis in their occupation. The program helps them relate to the clients on a more personal level and gives them insight into their way of thinking. Mental Health Works is a full-day workshop, delivered by CMHA-certified trainers, that enables managers to deal with the complex issues of: Discussing mental illness with employees Separating performance issues from health issue Creating accommodation strategies that work Avoiding discrimination and human rights violations A practical and interactive multi-media presentation Intended Outcomes: Improve early detection rates Identify challenges to addressing mental illness in your workplace Clarify procedures and identify available resources Understand what affects employee motivation and performance Develop accommodations that work Review and reduce mental health risk factors Reduce likelihood of human rights violations and discrimination complaints McGill Community Mental Health Centre in Charlottetown offers a variety of services for individuals with serious and persistent mental illness who require intensive levels of outpatient and ambulatory mental health services. Specific services include: psycho-educational groups, outreach, individual therapy, medication distribution, and psychiatric consultation. The centre is located in Charlottetown, and is fully governed and funded by the government. 15

25 Richmond Centre in Charlottetown provides a variety of community-based mental health services to individuals, families and communities. Mental Health Teams are established under a multi-disciplinary model with input from nurses, psychologists, social workers and psychiatrists. SUICIDE PREVENTION SERVICES Signals of Suicide is a school-based suicide prevention program, in which a trained facilitator explores the topic of suicide with Grade 9 students across the province. The purpose of the program is to make students aware of the services available for individuals thinking of suicide. The lecture combines interactive learning techniques, open discussion, and a short video. The Applied Suicide Intervention Skills Training (ASIST) program is offered twice annually, and consists of a two-day suicide intervention workshop presented by certified trainers. The purpose of the ASIST program is to make caregivers more knowledgeable, comfortable, and confident when responding to a person at risk of committing suicide. The program was developed by LivingWorks Education. The PEI Helping Tree is an information-based newsletter distributed across PEI, designed to inform residents of the resources available for persons suffering through a mental or emotional crisis. The letter identifies the risk factors commonly associated with distress or suicide, and directs users through a number of support options, listing contact numbers of agencies that provide assistance and support. This resource is updated regularly and is funded through the Campbell Webster Foundation. Roughly copies of the PEI Helping Tree are mailed to households across the province. The Provincial Suicide Prevention Committee monitors suicide related information as well as various suicide prevention options and strategies in order to reduce suicide rates in PEI. The committee consists of stakeholders from across the province. A range of Supports for Survivors of Suicide are offered to survivors after a completed suicide, and include an information kit, and access to a survivors of suicide self-help group. These services target the families and friends of the deceased. EMERGENCY SERVICES The Prince County Hospital (PCH) is the provinces second largest acute care hospital, and is equipped to treat mental health emergencies. The PCH is located at 65 Roy Boates Ave in Summerside. The Queen Elizabeth Hospital (QEH) acts as PEI s referral centre for specialized hospital services. Both community services and specialized provincial services are offered in inpatient and outpatient format. The QEH is located at 60 Riverside Drive in Charlottetown. The Hillsborough Hospital and Special Care Centre is PEI s designated inpatient psychiatric facility. 75 beds are available for persons suffering from an acute or chronic mental illness. The Hillsborough Hospital is located at 115 Murchison Lane in Charlottetown. 16

26 The Crisis Response team provides immediate services for individuals who are suffering from a mental health related crisis or emergency. The purpose of this program is to reduce the burden of on Emergency Rooms in PEI. The Crisis Response Team consists of specialized nurses who are trained to deliver immediate mental health related care, and is based out of the QEH and PCH. ADDICTION SERVICES IN PRINCE EDWARD ISLAND Addiction Services in Prince Edward Island are divided into Child and Youth Services, Community Based Services, Hospital Based Services. Child and Youth Services target individuals under the age of 18, Community Based Services support individuals living in the community and provide the least restrictive form of care possible, and Hospital Based Services typically include emergency and crisis response services, and are located in a hospital setting. CHILD AND YOUTH SERVICES Student Assistance Program is an education-based program offered to high-school students in 80-minute sessions. Students enrol themselves independently, with a maximum of 14 students participating per class. There are two streams offered in this program. The first targets students who are involved with alcohol or other drugs, and is called the Harmfully Involved Group. The second is for students who are living or affected by alcohol or drug use, and is called the Friendship Group. Adolescent Rehabilitation is an education-based program designed to help students avoid substance abuse and encourage them to lead a healthy lifestyle, free of addiction. Topics covered include substance abuse education and consequences, peer pressure, and coping with daily stressors. This program is offered twice a week for 12 weeks. Family Programs provide specialized services to the friends and families of a person with a substance abuse problem. The purpose of the program is to provide support and education to people who are indirectly affected by substance abuse. These services include: individual counselling, the friendship program, parents support program, and strength program (below). Individual Counselling Individual counselling is available for youth requiring one-to-one assistance. The Friendship Program is a group for children ages 6-12 who have been affected by addiction in their family. This group runs in conjunction with the Family Program and the sessions are held once weekly. Through activities, videos, and discussions, children learn about addiction and how to cope with it. The Parent's Support Program provides support in the form of counselling and group sessions for parents whose children are abusing alcohol and other drugs. 17

27 The Strength Program offers a range of supports for youth and families who are dealing with substance abuse, addiction and related issues. This program is appropriate for those requiring more focused intensive treatment than what is offered through local community addiction services. COMMUNITY BASED SERVICES Community Outreach and Needle Exchange is designed to prevent the spread of HIV in PEI and to create a positive environment for individuals who are affected by HIV/AIDS. This program is non-profit, community based, volunteer driven, and operates in Charlottetown. 10-Hour Pathways is an education based program intended to educate adults, who may or may not be addicted to a substance, in order to deter them from re-using. The program targets adults who have suffered a severe consequence of their substance abuse (including an impaired driving conviction, an act of violence, or a parole violation). Outpatient Detoxification is designed to help individuals with an addiction that does not require inpatient detoxification. These individuals are expected to experience minimal withdrawal symptoms. Patients are admitted to the program after comprehensive screening to determine whether they meet the criteria to be safely detoxed as an outpatient. Once the patient is through the most acute stage of withdrawal, they are offered an education program. Patients may receive follow-up calls and contacts post-withdrawal to assist in recovery. This program allows patients to remain in their own homes during the withdrawal and recovery phase, and is implemented by trained addiction nurses. The Adult Rehabilitation Program is a 3-week program that provides education, motivation and counselling in order to enable clients to understand how drugs and substance abuse affects them and their lives. This program can be used in conjunction with Recovery Programs and Relapse Prevention Programs. Families are included in this service, and programs are available to help them understand how substance abuse has affected them. This program targets individuals who have experienced an addiction, but are currently drug-free. The Women-Specific Program is a 4-week program that addresses the unique needs and issues of chemically dependent women and their families. This program can be offered on an inpatient or outpatient basis depending on the needs of the patient. This program is primarily located out of the Mount Herbert Hospital, but is a mobile clinic, and as such can be moved and implemented at any community health centre in the province. The After Care program is an education-based program designed to help individuals reintegrate into society without returning to their substance dependency. The program consists of weekly classes for six months. Topics include: anger and resentment, pressure to use, and coping with daily stressors. This program targets individuals who have completed a rehabilitation program. The Extended Care program is available for clients who have finished a rehabilitation program, but still require assistance reintegrating into daily life without returning to their substance 18