No Place Like Home
Network, Spring/Summer 2005
The Canadian Mental Health Association provides community-based mental health support services across Ontario through a network of 33 local branches. Following are only a few examples of the many CMHA programs that help people who are homeless or have a mental illness to find stable housing and connect with other community resources.
When ‘Steven’ arrived in Sarnia in the fall of 2004, all he had was a place to stay. But soon after his arrival, it became clear he wouldn’t even have that for long. His living situation was not working out. ‘Here’s a person from four provinces away who came with nothing, to a community he’s never been to before,’ explains Amy Churchman, team leader for crisis and short-term services at the Canadian Mental Health Association, Lambton County Branch. ‘And there’s so much involved in setting up a home when you have nothing.’
Fortunately, Steven did have Chuck Lutz, the branch’s outreach and team support worker. Chuck conducts the assertive outreach housing program, part of the branch’s crisis and short-term services department. The outreach program complements the rent supplement program, which helps CMHA clients bridge the gap between what they can afford to pay for rent and the rent itself. ‘Chuck helped Steven manoeuvre through a community he’d never been to before,’ says Amy. ‘He will help people get clothing, furniture, whatever they need.’
Chuck’s role is more complicated than simply helping people meet their basic needs. All of the program’s clients have been diagnosed with a serious mental illness, or there is reason to believe that mental illness is a major factor in their situation. But the outreach emergency housing response is geared to people who are otherwise not involved with the mental health system, generally because the symptoms of their illness make it difficult for them to go through the traditional intake process. Chuck will try to encourage them to get support from other CMHA services, such as case management, when their housing situation is stabilized. With a stable housing situation, Steven, who is diagnosed with schizophrenia, was able to begin to address his mental health.
Chuck’s role is about ‘making linkages.’ He connects with landlords, caseworkers for Ontario Works (OW) and the Ontario Disability Support Program (ODSP), community agencies, hospital staff and many others. His ability to develop and nurture his relationships with these contacts pays off for his clients.
Education and outreach to the landlords is a key component of the work, and the landlords, in return, will call CMHA to let them know if they have a unit available, or if they see that someone might be experiencing a crisis.
Most important to the program are the relationships Chuck fosters with his clients. As Amy explains, ‘Sometimes he’s the only person from the mental health system that the consumers are accessing, so it’s important to take care of that relationship, particularly if he’s assessing capacity and trying to decide if hospitalization is necessary, if that person poses a risk to themselves or the community, or if their housing needs stem from an inability to care for themselves.’
Chuck can support his clients and earn their trust in ways that are unique to a program like this one. ‘When an individual’s being discharged from hospital, the hospital can help them apply for OW and look for housing options, but they can’t physically go with them. Chuck can do that. He’ll take them around and show them what apartments are available. He can connect with people before they’re discharged.’
Chuck spends a great deal of time with clients, showing them around the neighbourhood. He knows what’s available to rent in the community and which neighbourhoods are safe. He shows them where the food bank is and where they can cash a cheque. He makes sure that apartments are clean and in good condition. Basically, he’s working to ensure that an individual is stable and receiving everything they need to allow them to begin to address their mental health needs.
The program has its challenges. For many in the community with a mental illness, there are few options because there is no emergency shelter or residential mental health facility. Another challenge is the program’s capacity. Chuck is the only staff member, and outreach does not make up his full-time position. ‘He has to wear several hats,’ says Amy. ‘He helps the case managers to find housing for their clients, does referrals to our single point of access, and covers the crisis line regularly. We could use six more of him in our department.’
Services Across the Recovery Spectrum
When ‘Margaret’ first came into contact with CMHA Sudbury’s housing programs, her mental and physical illness had almost entirely confined her to bed. She wasn’t able to take care of her apartment or her own physical needs. She was completely isolated and struggled with discrimination from her neighbours.
‘She had no supports in her building and had deteriorated to such a point that she couldn’t take care of herself and had no idea how to get resources to help her do that,’ says Jane Pagnutti, a community mental health worker in CMHA Sudbury’s housing department. ‘We got her a rent supplement, got the Community Care Access Centre in, we hooked her up with a doctor to get her pain management and a diagnosis, and now she’s in case management.’
Margaret still struggles with anger and depression, but her living situation has greatly improved and her housing is stabilized. ‘When we can attach our rent supplement program, the case manager can start working on the many different issues,’ adds Nick Mancini, team leader for housing.
CMHA Sudbury’s housing services provide supports across a whole spectrum of needs, with the rent supplement program at the most independent end of the continuum. Funded through the provincial Homelessness Initiative Phase 2, rent supplements help individuals and families in 84 different units across the city pay their rent each month. While many who receive the supplement have experienced a mental illness, it is not a requirement to qualify for the program.
The next step towards more intensive support is the branch’s supportive housing program, which includes a 24-unit building as well as units throughout the community. The support is provided mostly on a monthly or weekly basis, and each individual is connected to a case manager.
Then there is the shared living home, an eight-bedroom building with daily staff support in activities including cooking and housekeeping, attending doctor’s appointments and case management. Both the supportive housing and shared living home hold regular tenants’ meetings which are attended by staff but facilitated by tenants. The meetings allow clients to express concerns, organize social events, and share successes. Plus, the skills the consumers learn by running the meetings themselves support their recovery.
Consumers decide which level of support would work best for them, and their application is reviewed by a selection committee made up of representatives from CMHA’s various community partnerships. The committee serves as the entry point for all three types of housing program CMHA Sudbury offers.
A recovery philosophy is what guides all the components of the housing program. According to Nicole King, acting team leader of property management, ‘Recovery is a process that endures a personal challenge on a path to self-actualization.’ As part of that journey, those in supportive housing are encouraged to take part in the Wellness Recovery Action Plan program through the branch’s rehabilitation department. ‘We want to ensure that people are working towards wellness and taking responsibility for that goal,’ says Jane. ‘We want to ensure that there’s a big picture in place and the case manager helps them along the road towards recovery.’
Two other important components of the housing department are the housing outreach program, which is funded by the City of Sudbury, and the landlord outreach program. The housing outreach program provides short-term support and links to affordable housing for people who are homeless or at risk of becoming homeless. The landlord outreach program works to create partnerships with landlords both in Sudbury and on Manitoulin Island, where the branch has two staff working out of a local medical clinic. Landlords involved in the program will inform the branch of available units and connect with CMHA staff if a tenant is experiencing a crisis. The branch provides regular education sessions and open houses. According to Patty MacDonald, manager of operations at the branch, ‘A lot of the landlords have had exposure to mental health issues in their buildings, and some have had the experience in their own families.’
Nicole says, ‘You just have connections with the landlords that go beyond what’s expected. They’ll call the case manager and say, ‘I haven’t seen this person lately,’ or ‘This person’s behaviour has changed.’ Landlords can become a key part of the circle of care.’
Each staff member working in the housing department realizes that housing means more than simply having a roof over your head. Margaret’s story is an example of the importance of reaching beyond the individual’s basic needs. ‘We’re looking at what’s important in her life and going from there,’ Nick explains. ‘We’re working together with her to find a place that’s good for her mentally, physically and emotionally.’
Complex Needs, Complex Systems
‘John’ has cerebral palsy, which has affected his cognitive development. He has also been diagnosed with a mental illness, and is bereaved by the recent loss of a parent. It doesn’t surprise Colleen Ashmore that John’s behaviour has recently changed for the worse. Colleen is the program manager for case management services, dual diagnosis and mental health, at CMHA Peterborough Branch.
However, it’s hard to be certain about the root of John’s problem. ‘Is it behavioural, due to his grieving, or is it psychosis, or is it neurological and related to the developmental disability? You have to constantly try to figure out what’s going on,’ says Colleen, who also runs the branch’s dual diagnosis housing program.
The term ‘dual diagnosis’ is applied when someone has both an intellectual disability and a mental illness or serious mental health issues. The dually diagnosed are a population whose complex needs are often overlooked. Conservatively, approximately 30 to 40 percent of adults with intellectual disabilities experience dual diagnosis. CMHA Peterborough has 37 clients in the program. Five live in a multiplex residence with access to support 24 hours a day, seven days a week. The other clients live in the community, with regular access to supports. Because of the unique needs of the people in the program, this support goes beyond traditional mental health care to include more personal attention and medical help.
‘The program is unique,’ says Colleen, ‘and it has shown that there’s a need for an ‘in-between,’ between living totally independently and a group home. Those are two extremes, and there’s a need to provide some support before you say, ‘Okay, it’s time for a nursing home, or it’s time for a group home.”
The program can’t meet the needs of every individual. When behavioural issues become very demanding, more intense support is required. However, many group homes for people with developmental disabilities lack resources to address the mental health issues, and most mental health programs do not have the expertise to provide the complex personal or life skills support needed by people with intellectual disabilities.
‘Our program had a client whose considerable behavioural issues meant that we could no longer support him,’ says Colleen. ‘He was on the waiting list for a group home but there was no space to match his needs. He was evicted from a nursing home because of behavioural issues.’
‘He’s been in a hospital psychiatric ward since the end of October 2004. He’s stuck in a system that doesn’t have the resources to support him.’ And he’s not alone. According to Colleen, ‘Many people are in hospital because they have no place else to go to get the support they need.’
Colleen feels that many of these gaps are caused by the complexity of responding to two bureaucracies, the Ministry of Community and Social Services (MCSS) and the Ministry of Health and Long-Term Care, who have demonstrated no real effort to work collaboratively to plan for and fund resources to support this population. ‘When you’ve got two separate funders,’ says Colleen, ‘never the twain shall meet.’
Colleen also has concerns about how the development of the Ministry of Health’s Local Health Integration Networks will affect her program’s services. ‘A significant piece of the Central East region for developmental services under MCSS does not overlap with the Ministry of Health’s Central East region. When you’re talking about specialized care, how do you ensure that the resource planning is minimizing duplication when the regions don’t even match?’
The CMHA program is connected to a committee of professionals from both sectors who are ‘wonderful people, willing to meet the challenges, but have yet to see the policy or support to make it happen,’ says Colleen. ‘We have clients in the program who were told they could never live independently, and they are. But this population puts the most pressure on the system, and we’re really struggling.’
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