Cheques and Balances
By Nicole Zahradnik
Network, Fall 2007
“I never knew when my next meal was coming,” says Kathy Eliese. “Often I would have to go without food for days, as I could not manage my money. I would move from rooming house to rooming house. I had no stability and no place to call home.” “Me too,” adds Monique Joncas; “I never had any money left after the first couple of days of the month.” And Tony Theriault notes, “When I left North Bay Psychiatric Hospital I had no home except the odd rooming house and boarding home run by slum landlords with unclean living conditions.”
How can you make progress or enjoy your life if you’re [capable, but] not in control of the money you have, no matter what that amount might be? At Bridges, our clients get the support they need to look at their priorities and set spending plans in motion to achieve them.”
— Georges Kristolaitis, executive director of CMHA, Nipissing Regional Branch
Theriault, Joncas and Eliese have a serious mental illness and have had difficulties managing their money and maintaining stable housing. They are not alone. According to a recent Senate report, at least 140,000 Canadians with mental illness do not have adequate housing. Moreover, people with a serious mental illness are disproportionately affected by homelessness, and are often released from hospitals and jails without proper community supports in place for them. But today the lives of Eliese, Joncas and Theriault are more independent and secure, thanks in part to the Bridges Voluntary Trusteeship Service.
Bridges was created by CMHA, Nipissing Regional Branch to help clients manage their finances and keep their housing. The program operates in the district of Nipissing and the northeast quadrant of Parry Sound. Georges Kristolaitis, the executive director of the branch, notes that since the Ministry of Health and Long-Term Care began funding the program in 1987, “Bridges has continued to evolve in response to the needs of its clients and the growth of the mental health system. Today, 96 people have chosen Bridges to help them support their decision-making and make their independence real.”
Prior to the creation of the program, CMHA, Nipissing Regional Branch opened Bridges to Community Living, a storefront operation designed to help people with mental illness find housing and support for their daily living needs. This program was created out of a growing need for community supports for people discharged from the North Bay Psychiatric Hospital. Many had been patients of the hospital for decades and lacked daily living skills and the ability to manage their finances. Today, one-third of Bridges clients are former residents of the North Bay Psychiatric Hospital.
Before Bridges, the Office of the Public Guardian and Trustee was the only option available for financial trusteeship for Ontarians with mental illness. However, the office has absolute control and makes all financial decisions and transactions on behalf of the people it serves, so it is not appropriate for anyone who has the capacity to understand their finances.
As Kristolaitis comments, “How can you make progress or enjoy your life if you’re [capable, but] not in control of the money you have, no matter what that amount might be? At Bridges, our clients get the support they need to look at their priorities and set spending plans in motion to achieve them.”
Bridges is part of a common referral process for all community supports within the Nipissing region. When someone requests the trusteeship service, a Bridges case manager will contact the individual to confirm their interest in the service and assess whether they meet the program’s criteria. To be eligible, one must have a serious mental illness and the capacity to learn to eventually manage one’s own finances. If the applicant meets the criteria, they are added to a wait list that now stands at 40. As Cheryl Brotherston, a case manager, says, “The program does not work for everyone. Some clients will do incredibly well and graduate with a full and comprehensive understanding of how to budget. Others will think it is an open pocket book.”
Agencies in the area that refer applicants to Bridges are on a numbered list. When Bridges can accept a new client, the program coordinator will call the next agency on the list. It is the agency that determines who will become a client of Bridges, usually based on how long potential clients have been waiting, but also on who most needs the service at the time.
Once the new client has been decided upon, Bridges arranges to meet with them and their case worker. During this time, both case workers and the client create a trusteeship service plan which clearly outlines for the client what the case workers will do. At this time, the Bridges worker will also thoroughly review the client’s current finances, including debts, rent, utilities, basic needs and spending habits. If a debt is too substantial, the Bridges case worker will negotiate for lower payments with the creditor. If the debts were incurred while the client was ill — if they were experiencing delusions, for example — Bridges staff will try to void the debt.
“We work really hard to make sure our clients are not victimized or taken advantage of,” says Rhea Funnell, the program coordinator for Bridges. “Almost one third of our clients [have paranoid schizophrenia]. It is often during a psychotic episode that a client will incur a significant debt, not knowing what they have just purchased or said yes to. In at least 70 percent of the cases, we are able to reduce the debt payments significantly. We strongly advocate on behalf of the clients to ensure that their rights are protected at all times. It is also a perfect opportunity for us to educate the various agencies and creditors about mental illness and its cyclical nature.”
Bridges also provides full support services to its clients if necessary, including assistance with daily living, such as buying groceries. Eighteen of the 96 trusteeship clients have case managers in place to assist with these types of activities.
Because the program is voluntary and client-directed, clients are involved in all aspects of the handling of their finances, including developing budgets and allocating bill payments. Trusteeship service plans are adjusted as clients’ needs or abilities change. The service provides for a range of clients. Some clients have very little understanding of their finances, may require frequent encouragement and receive daily cheques in small amounts. Others may need help only with bill payments and financial advocacy, and receive the balance of their funds in one cheque at the beginning of each month.
Ronda Taylor (not her real name), a client of the Bridges program for over two years, says, “Having a monthly budget is much better than trying to live week by week. Every Monday I get $15 dollars for disposable spending which has to last me until Thursday. Then again on Thursday I get $75 dollars; $50 of this is for groceries and $25 is for the weekend. I have two kids and I get one each weekend. I now have the luxury of being able to take my kid to the movies on the weekend. Having control over my money and learning how to budget is great.” Kerry Waddell, a Bridges case manager, adds, “The goal of Bridges is to help clients achieve and maintain their highest level of financial independence and security.”
In fact, recovery is an important part of Bridges’ approach to financial management services. Mental health workers expect that their clients will grow and learn within the service, and someday will no longer require it, but there is no official time limit as to when a client must exit from the program. As Funnell states, “You cannot apply a time limit to when a person will graduate from the service. It is not fair to assume that an individual no longer requires the service. [That] is not recovery. Some clients have been with us for almost 18 years, while others only stay with us for six months. It all depends on the individual and their circumstances.”
When a client is ready to graduate from the program, the process is staged over three months. A case worker will work with the client to ensure that the transition is as smooth as possible, setting up a bank account and working with appropriate agencies and creditors as needed. Similarly, clients may leave the program because they have relocated. These clients are monitored for three months and linked to the appropriate mental health services in their new area. Often a program like Bridges is not available, in which case the staff work hard to set up a bank account and coordinate with the local Ontario Disability Support Program or Ontario Works office.
Some Bridges clients are serviced by other mental health agencies within the community and receive no other support services from CMHA, Nipissing Regional Branch. Claudette Lamothe, program manager of North East Mental Health Community Programs, says, “As a collaborative partner with Bridges, we have found that our Assertive Community Treatment (ACT) programs can stay focused on being therapeutic, as the trusteeship service will assist clients only with managing their money. Sometimes when you mix treatment and money it can create barriers. But this [collaboration] gives clients choice, and opportunities to have some independence with more natural support. Our ACT teams know that CMHA is client-centred and will advocate for clients. Bridges will go that extra mile to assist clients to make decisions that will [improve] their quality of life.”
Collaborating with other programs has many advantages, including the ability to monitor clients’ mental health status. As Waddell comments, “We often receive calls from other agencies asking if we have seen or heard from one of their clients. If there is a stack of the person’s cheques piling up on my desk then we can assume that something has changed in the individual’s circumstances and they might not be well. There are other times when we might respond, ‘Yes, I have seen this person every day of the week.’ We work together to best serve our clients.”
Another advantage of Bridges is that all clients maintain stable housing as the program reliably pays clients’ rent on the first of each month. Funnell adds, “I receive on average two calls a week from landlords in the region asking if we have any clients looking for an apartment to rent. Landlords in the area trust the program as the rent is paid on time and they have a place to call if anything goes wrong. Thirty-seven different landlords house our clients in the area.”
Bridges prides itself on having a very high success rate. As Kristolaitis remarks, “When you know your rent is paid up front each month and you’ve figured out a detailed plan to buy groceries, that would reduce anyone’s stress and increase your feeling of being in control. It’s all good for your mental health.” Many clients report having a savings account for the first time. Eliese, a client of Bridges for seven years, exclaims, “Bridges is probably one of the best things that ever happened to me. I now have savings, something I never had before. I no longer have problems budgeting my money.” Likewise, Stuart Buxton, a Bridges client for three years, adds, “I would be lost without the program. I now live in a three-bedroom house and am saving for a trip to Toronto in August.”
Says Lamothe, “We need more programs [like] Bridges. This program empowers individuals to make decisions, and they are not judged if they make decisions that have normal consequences. They simply learn from them…. You can see the difference the support makes.”
Nicole Zahradnik is a community mental health analyst with CMHA, Ontario.
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