Systems, not symptoms: How do we address Mental Health and Wellbeing in Canada’s Downtowns?

Full Panel
Transcript

Note to readers: This video session was transcribed using auto-transcribing software.  Questions or concerns with the transcription can be directed to events@canurb.org with “transcription” in the subject line.

Mary W Rowe Hi everybody, it’s Mary Rowe from the Urban Institute. Thanks for joining us. It’s such an important topic that we’re tackling today, and I’m very appreciative of the people that have joined us on the panel, but also all of you in the House as they say in the audience that are going to participate. If you have never used a chat before please use it because lots and lots of questions are asked there and resources are posted – it’s a whole alternate universe on the CUI CityTalk chat, so I hope you’ll take advantage of it. I’m in Toronto today as it happens CUI is a national organization, we have people working in cities across the country. But today I’m in Toronto, which is the traditional territory covered by Treaty 13 and the Williams Treaty so it is ceded, and traditional, ancestral home of the Mississaugas of the Credit, the Anishnabeg, the Chippewa, the Wendat peoples, the Haudenosaunee. And we continue to come to terms with the legacy of exclusion that’s affected First Nations, Inuit and Métis peoples. And this topic is particularly relevant because there is a disproportionate presence of those communities, vulnerable communities, and other equity deserving communities in the … people, I was going to say populations, I’m trying to not use that term, people that are challenged by mental health and the kinds of challenges that we’re going to discuss today. You saw that we titled this “Systems Not Symptoms”, because we want to try to continue to pull back the curtain on what are all the aspects that are affecting what many of us experience every day. If you are present in, not only in an urban environment, I think even in smaller communities, but if you’re out and about you are continuing to see, visibly, people that need support and need some kind of intervention, and I think it leaves a lot of people feeling quite helpless, in some cases overwhelmed, and not really clear about what can be done and what isn’t happening that should be and why is it suddenly seeming to be so much worse? Why are we suddenly all seeing it, or did we just not see it? Is it another one of those situations that existed before Covid, Covid exacerbated it, and here we are now with these challenges. So the focus of CityTalk is always “what’s working, what’s not and what’s next?” We all in Canada seem to have sometimes great skill at admiring a problem and continuing to talk about it. And we’re hopeful with all of you that we can start to move to practical solutions and steps that need to be taken. Hence our comment here that this is about systems and it is affecting commercial life, it’s affecting community safety, it’s affecting people’s level of trust, it’s affecting their willingness to get on transit, go into public spaces, go to a local shop, get into an elevator, occupy public space … As we know it’s manifesting in all sorts of ways. So not just the people that are struggling with the mental health challenge of their own, it’s also affecting other people’s mental health. So with that said, I’m going to ask our folks to turn their cameras on. And I’m going to introduce first Andre Corbould, who is the former city manager of the city of Edmonton, with whom we’ve been working for several years through Covid. And he’s now in a new role. And in addition to his new role in the private sector outside of city government, and Andre’s had many hats, he’ll tell you, but he’s also just been appointed this morning, it was announced, our Fellow at CUI on mental health. So he is absolutely on the front lines of this, tackling it, trying to raise the profile of it. And then we have other folks coming in to join us, who are going to speak about their own particular experience of what they’re seeing and the approaches they’re taking to address it. So Andre, can you just get us started a little bit with the big picture and why this issue has seized you for the last several years, and just give people a bit of a glimpse of what you think what’s working, what’s not, and what needs to be next.
Andre Corbould Yeah. Thanks, Mary. Just delighted to be here today. And, you know, I think there are so many good things happening out there with all the efforts. And we do see some real commonalities, and people certainly understand how, you know, for example, having law enforcement, the social sector and health work together in a very collaborative way and one that gets the right resource to the right place at the right time is an example across the country that’s doing really well. You know, so we’ve been talking a lot about the symptoms, as you say, over the years. And I think, people are shifting more to solutions. And we’re seeing some very good solutions. I think some of it just needs to be efficiency and coordination. My experience is when things are not going well, you quickly realize that they have not been coordinated well. Everybody’s really trying hard. Everybody’s working really hard. Everybody’s doing a great effort. But it has not been coordinated. Every time that I’ve seen success, it’s a result of a coordination effort that brings all the entities together and, and, coordinates their activities in a very efficient way. So I think that’s one of the key things I think that has proven to be successful in the last few years. I think it’s one we need to double down on and make sure we’re creating coordinating entities. And, you know, I’ll give you an example – the Downtown Business Association can be a really amazing coordinating entity to help sort of rally people’s efforts through a place like downtown. I would also say that I think we need to do more focusing on the core root problem of mental health. We definitely have to deal with the symptoms. That’s something that has to happen every day. But we really need to put more effort into the core root mental health problem. And we also, I think, need to mobilize better as a country to deal with that. You know, we’ve seen very successful mobilizations of our country in the past 5 to 10 years, it can be done. And I think given the mental health crisis that the country is in, we need to do a better job of mobilizing. And what you get from mobilizing is resources in the right place. You get coordination efforts in the right place. And you know, we often mobilize for wildfires, but we’re not mobilizing for a mental health crisis, which, you know, arguably is causing more damage and suffering for people in our country. So maybe I’ll just leave it there Mary, happy to expand on any of those ideas …
Mary W Rowe Yeah, we’ll come back to you on this, you know, this notion of mobilization and which crisis are we mobilizing on? Toronto just went through its own, 48 hours where there had to be some kind of, you know, massive mobilization because it crippled transit routes and things like that. And each city and every city … I’m pushing people who are in the chat … If you are punching into the chat, can you make sure your settings are set to everyone. So, for instance, Sandra Severs, you’ve gone just to host and panels, just so you know, I can see them all, but go back … Anybody that’s posted, make sure you send it to everyone so everybody sees it. Otherwise only me and the gang see it and we’re happy to hear from you. But I think you want everybody to see what you’re saying. But I can appreciate on this call, we have people coming in from all across the country. We have people coming in from outside of Canada, and there’s probably not a city at the moment or a community that isn’t dealing with some kind of crisis. And that’s the moment that I think that we need to distill from this is – what kind of muscles do we have to mobilize, to coordinate, and what does it take to get that kind of focused investment? I’m going to go to Pam Tobin next. Pam, can we hear from you? You’re a mental health practitioner for many years in my hometown of London, but I know you’ve worked in other places. Tell us what perspective you’re taking. And then I’m going to go to the practitioners that are working in Ottawa and Pembroke to hear about their experience. But what are you seeing from the CMHA Thames Valley perspective?
Pam Tobin Yeah. Thanks so much, Mary. And, I’d like to build on what Andre had said. I think it is all about coordinated care. There’s so many service providers in our community and in the surrounding area, and it’s so important to have that coordinated care. There’s a lot of people that are trying to provide services and supports and programs. But we can only do it if we’re all coordinated in our efforts. I think that there’s, also a need for financial support. So even though we do have poor funding, we need more for funding. The need for complex services is increasing. It increases every day, every week, every year. And the funding doesn’t match what that need is. So I think that it’s really important to make sure that we continue to advocate for funding and advocate as a community of community-based Mental Health and Addiction Services. So it’s not one or the other. I think we need a coordinated effort to increase funding to provide the services that we need to provide.
Mary W Rowe You know, I feel sometimes, like what’s the expression … Groundhog day? You know, I feel like at CUI we are always having the same conversation, but just in a different domain. So here you’re saying we need resources and we need coordination. We published a report 2 or 3 weeks ago, many of you will have seen it, talking about infrastructure investment around housing and how you can’t just build the unit, you’ve got to figure out all the other investments in infrastructure that need to be placed around it … Sewers and water and wastewater and all that stuff. And again, the same call that you just made – coordination and that it be community based, specific to the place. What is it, Pam? Why have we not been doing it this way?
Pam Tobin I ask myself the same thing all the time, you know.
Mary W Rowe I know you and I are awake at three in the morning. We could be calling each other. Yeah. What do you think? How can we don’t know? Why aren’t we doing what we know is the right thing to do?
Pam Tobin There’s so many … Where do I start? So, you know, I’ve been working in the field of health and wellness for more than 20 years. 20 years ago, I was advocating the same thing in different areas of health and wellness – that we need coordinated care, we need coordinated funding, we need everybody to work together. Right? It’s just common sense in my mind. Mental health is well behind some of the other areas of health and wellness. We look at cancer care. You look at diabetic care. You look at any of those other avenues of care. It’s quite different to mental health and addictions. There’s a lot of stigma.
Mary W Rowe I was going to say is that about stigma? [It is – very much so] … Wow.
Mary W Rowe Somehow cancer is … I mean, I don’t want us to compete, to have a competition of maladies here. But somehow, as you say, cancer is seen as a legitimate thing to invest in. Of course, we have a crisis in cancer, but somehow we still … And if you add on to mental health drug use, tons of stigma around that, right? I’m going to go, let’s go to the practitioners and then I’m going to bring you all into the room. So thanks Pam. We’ll circle back on those points. Paul, can we come to you next in Ottawa to talk about what you’re doing? And then I’d like to hear from Michael and Lori who are on the ground in Pembroke. Go ahead. Paul.
Paul Stam Yeah. Great. Thanks, Mary. Yeah. You know, I’ll again also build on what the previous panelists have said … In downtown Ottawa what we’re experiencing, as with cities right across the country, is this ongoing crisis between folks experiencing homelessness, experiencing, you know, untreated, mental health issues and, of course, the fentanyl crisis, which is really having an impact on many cities across the country and North America. So to me, all of these crises are really underlined by mental health. It really is mental health, at the heart of it. Ottawa police have seen a 55% increase in mental health calls for service over the last couple of years. So, you know, we can see that as a barometer of things are getting worse. And it’s really, you know, chewing up our mandate more and more. I think that, you know, the title of this webinar is very apt … “Systems, Not Symptoms”. We absolutely need more coordination, no doubt about it. And it’s the, you know, to your question, how do we how do we achieve that? It’s we need to bake these processes into the system. We don’t have it right now because we have individual champions who are working overtime to bring people together and do coordination that’s small scale, with these, you know, terrific individual initiatives and programs at a local level. But we need systems that have these processes built into them so that, you know, it’s automatic. And that’s what we’re starting to try to work towards here, in a very small way.
Mary W Rowe When you say baking it into the system, Paul, I want to … Actually I’ll come back to you. I’m going to get the others in and then we’ll all come back in. Because part of what I think the challenges that Pam flagged and that we wrestle with over here at CUI is which system, how many systems, how are we baking it into it, and how do we make sure that we’re being strategic about that? Because as I say, every conversation we have at CUI is this lack of coordination, lack of policy that’s community based … I mean you could lift out mental health and addiction and you could put in housing, you could put in mobility, you could put in equity … You know what I mean? So I’m going to come back to you on that. Let’s now go to Michael and Lori who are, in in Pembroke, as I say, where my sister lives. And I know Pembroke. And also just to say, how much I appreciate you two taking the time because you are on the front lines here. And, Lori, you have become a bit of a celebrity because of that extraordinary piece on the CBC, on the National. And I hope one of my staff will be able to put the link in. So if you haven’t seen this piece … It was on The National last week (trying to remember when it was. Yeah). It’s extraordinarily moving. I hope it’s motivating. I hope it motivates us to mobilize. But can I hear from Michael and Lori? Tell us about the Mesa program? Tell us how it came about. Tell us what you’re learning. Tell us what you think the rest of the country needs to hear about what’s going on for you in in the implementation of the compassionate approach you’re taking.
Michael Nolan Yeah. Thank you, Mary. And to the people that have taken the time out to be a part of this today, I’m sure they’re all well aware that there’s no community in Canada that’s immune from the challenges related to mental health, addictions and homelessness. What we’ve seen in Renfrew County or the Ottawa Valley is, is a significant explosion of issues over the last couple of years. So if you look back in terms of economic stability, there’s been, you know, pressures on that, there has been significant pressures, as Paul says, related to mental health and the addictions and homelessness are really just coming into light. They’ve been there for some time. And those of us in public safety and in health care are well aware that this is not a new problem. But the reality is that it’s now exceeded the capacity of the system to be able to adequately address it. When we think about Pembroke as a relatively small community of about 15,000 people – last year, Pembroke saw 40 opioid use disorder deaths, in that community alone. So that became part of our call to action, if you will, to think differently about the services. When you talk about resources coordination, I think collaboration. There are significant resources that exist within the health, the mental health, policing, as well as community based services. And I think that whether we add resources or we better utilize the resources that we have, I think we can make a dent in that. So what we’ve done here in Renfrew County through the Mesa program is a forced marriage, so to speak, between the Community Services Department, the paramedic service and the development of property, who are responsible for all of the social housing. And we’ve all put our shoulder to the wheel to find a different way to work together, to be able to engage in this problem. We’re not necessarily adding significant resources. We’re teaming up in a different kind of way through a collaborative approach. So what that looks like for us is, Lori, for example, as a community paramedic taking a community paramedic lens. We … 15 years ago took on community paramedicine, much like community policing, and tackled older adults with complex chronic disease. What we’ve seen is a significant reduction in their repeat 911 utilization, their repeat hospitalization. We’ve improved their quality of life, knowing that home and community care still exist, hospitals still exist, family doctor still exist. But there are stressors within those systems that needed a different kind of approach to be disruptive and to change the way that we engage in that population. That’s what Mesa has done, predominantly for younger adults with complex medical and social disease that we are tackling in a different way, with boots on the ground, on the street. And Lori can talk to you about her engagement with them, but doing that and being backstopped by community services who have Ontario Works, who have, you know, employment security programs as well as the Housing department, we’ve been able to change that conversation and provide new transitional housing and bridge housing with incredible support from Peter Emon, our warden, and the entire council to say, just do the right thing and do it now. And that’s what Mesa represents.
Mary W Rowe Lori, let’s hear a bit from you because you’re delivering this service. And then I want to come back, Michael, and ask you a few details, and then I’d like everybody on the screen for us to just have a big conversation. But, Lori, just tell us your perspective on the street, delivering in this new way.
Lori Shannon I think it’s exciting, actually, is one way to describe it. So there are many services available to everyone within a community that we can all access. But everyone’s running in sort of like parallel lanes, right? And nothing is really crossing. And I think that that’s, that’s some of the success that I’ve seen with this program is that we’re connected with community mental health, with addictions treatment services. We are connected with Ontario, Works, with ODSP, just very … All the people that are … or all the organizations that are trying to support this same group as well as the rest of the population. And, with homelessness, lack of a cell phone, lack of ability to contact, travel to, get to places and access the resources that are available to them, people end up falling through the cracks a little bit with that, and then falling away from, you know … It’s unfortunate … And in a lot of areas, I think there’s a lack of access to family physicians. So they’re falling through the cracks in that way as well. And even just sort of practical matters, people get their things stolen … ID this and that. They no longer have a health card, no longer have a license or verifiable I.D. How do they access their funds? So we’ve just sort of, by everyone teaming up together and with us going out and building trust with this vulnerable population, to get them sort of to approach us with some trust and to bring in the other parties to try and connect them to what they are entitled to for those that haven’t been able to access it and then introduce them to things that they didn’t realize were accessible to them. So it’s really sort of taking everything that’s running in lines and bringing it together like this to try and support these people better.
Mary W Rowe It’s interesting imagery that you’re all sort of in parallel lanes. And how do you actually get this to happen? Right. Michael, when did when did the Mesa program start?
Michael Nolan March
Mary W Rowe Oh, it’s fairly new. Okay.
Michael Nolan Yeah. It had been in development since this time last year. We worked through municipal timing on the advent of the program. So we leaned into it in January, and then really in March, we’ve had three, three and a half months of momentum that has been, I think captured well by CBC in their description. But we’re really taking a phased approach in that the first two quarters of the program are about connection. It’s about connecting with the individuals. So that’s where, Lori and the boots on the ground have taken a very deliberate approach. We’re not here to boil the ocean. We’re here to connect so that as new solutions and new pathways are built out for individuals, whether that be into addictions treatment, whether that be into sustainable housing, whether that be simply into mental health supports, that we’re able to do that in collaboration with our partners in policing and so on. But we’re not, as I said, burdening the frontline team with that. We’re simply saying, go out, leverage the trust that the community has with the community paramedics and the mental health workers and the social workers and the addictions workers that are buddied up with the community paramedics and do that in a way where it’s no pressure. But we’ve already seen people coming forward saying, you know, I want to hand my drugs over to you and I want to stop you know, this use. You’ve helped me work through that system. So there isn’t a week that goes by that Lori and the team aren’t taking people out of precarious living situations, mental health crises and addictions, and moving them more seamlessly through the system than we’ve seen before. Because as a system, we tend to expect people to come to us, but we don’t necessarily maintain the presence necessary and the connection necessary to make that possible or easy or timely. And I think timeliness is the biggest gap that I’m seeing in the system. It’s that lack of coordination, as was previously described, is actually creating barriers to access to care and access to success.
Mary W Rowe Can I ask everybody to put their cameras on? And can I ask Wendy, the producer, to put us in Gallery View so I can see everybody and we can all see each other? I’m interested again in the larger lessons here. And one of the things that I’m conscious of, for instance, is we often talk at CUI that every community needs minders or watchers, I call them … City watchers or community minders. And we do a lot of work around downtowns and main streets, where mental health is very present as a challenge. And we find that everybody basically has to become a community minder or a community watcher, right? That’s the dilemma. We did a report last year on libraries, and we know that librarians also have this kind of triage role. And Lori, when I hear you talking, it feels to me like you are doing triage, you’re a caseworker, you’re a trusted friend, you’re a neutral resource. Right? And it’s all about trust. I’m hearing. I think.
Lori Shannon Yeah, 100%. Yes. Absolutely. Trust. It’s a population of people that don’t trust easily. Trust doesn’t come easily for them. And it’s justified. And it’s also a group of people that … We talk about stigma, but there’s also a reverse in that … I find that some of the clients that I interact with, they expect to be treated poorly because they have been historically. So that is their expectation. So there’s this level of being sort of hyper reactive to any sort of perceived slight or potential for misunderstanding that can really sort of spiral very quickly. And this is where the trust piece comes in, is getting to know people as individuals, not who they are identified by their addiction, but as just a person just like everyone else. And then having conversations spring forth from that. And yeah, so you do wear several different hats and figure out what one works for that person.
Mary W Rowe You do for sure. We watched it on the television. I’m interested in our chat, for instance, if we have people from business improvement areas, I know they have staff that are called navigators, and it feels to me like they are playing a very similar role where they maybe got a job thinking they were doing business development, but actually what they’re doing is triaging, as you’re suggesting, and I’m interested, Paul, we know that the police force don’t always have the highest degree of trust in communities. Tell me how you’re starting to think about how that gets … How do we overcome that? And then, Pam, I want to hear a little bit from you about training. How do we actually train all sorts of people to be able to be equipped? So Paul first, then Pam, then I’m going to come back to you Andre. Go ahead. Paul.
Paul Stam Thanks. Yeah. Especially in the last few years. Certainly, trust and support for the police has taken a hit in Canada and across the world. So, you know, when we talk about trust for police, we’re really talking about legitimacy. And how legitimate do the public see the police to be, and to me, that’s the cash value of anything that we do in policing. You know, we can be as effective as we want at solving crime. But if we don’t have the trust and support of the public, it really gets back to that original notion of policing and that policing by consent, we police at the consent of the people that we serve. So how do we get back to that? It’s really about … It’s not necessarily about effectiveness. It’s about being seen to be fair, neutral, proportional and respectful. Are we giving people a voice? Are we following those principles of procedural justice when we’re interacting with them? A lot of that comes down to training for individual officers, but also how, you know, the police service as a whole develops its strategic goals. And, you know, in the realm of mental health much has been said recently about the police taking a step back out of that role of dealing with folks who are dealing with mental health issues. That’s a complex issue to disentangle. And, you know, I don’t think there’s any way we’re ever going to get policing out of that space.
Mary W Rowe But I’m interested in this collectively, if we can talk as a group about it because we can see, Lori, when you use that description of, people in parallel lanes and can we get them to do more of this [weaves fingers together]? I think there are people in certain lanes that are resentful that they can’t just do what they thought their job was. And so what do we do about that? How do we deal with the resistance that might exist in the system? We see that in some of the other domains where people just want to get back to doing what they thought their job was. So Pam and then Andre, thoughts on this about … It’s like who has to administer a naloxone kit? Like we all have to. We all have to. But how do we get people to feel confident about that and understand that’s an appropriate thing to expect of your fellow community member. Pam first, then Andre.
Pam Tobin Thanks, Mary. I think when I think about training, it goes well beyond the naloxone kits and that sort of thing. When we first started the discussion about training, I’d like to break it down into two different avenues. One is called the train, of the service provider. So when we think about the Truth and Reconciliation Commission’s calls to action, there’s very distinct calls to action about health and wellness. And I think that we need to do a much better job in providing culturally appropriate care to clients. And that’s right across the board. And I think that, I mean, the TRC report came out in 2015. And if there is an evaluation done of that now, I think you’d see very little movement in addressing those calls to action. So there needs to be culturally appropriate care provided, and it’s not just training. You can have whatever training want, you have to apply it. So that’s one aspect of training. And then, we have a strong team of experts at CMHA and we work really well with police, with EMS, with all other service providers, and we provide strong training to the police and to the EMS about working with clients with mental health and addiction issues. And I think we just, we need more of that and we need to do it on a consistent basis. So we have strong relationships, but it takes a long time to build a relationship in order get trusting and shared learning if you will, because we also learn from the police and the EMS and how they deliver services. So it’s all about relationship building and it’s about timeliness and building those long term relationships and putting the time in to do that work. And I think that’s critical to deliver the care that we need to provide.
Mary W Rowe And Pam, you’re talking about trusting relationships between service providers, not just with the client or the community member. Yeah, right. That’s what I … and Paul, when I heard you, you know, sort of advocating for what has to happen within the police force, I think this is the dilemma that we’ve got is, each of your lanes have a culture, have a particular approach, and trying to soften the edges of those cultures. Andre, you come from a military culture. So you’ve got experience with how do you actually blur these lines and get that kind of collaboration amongst different lines of service? So what’s your perspective of this then?
Andre Corbould Yeah. In terms of coordinating effort and sort of leading the charge. Like I would say, you’ve got to get the right leaders in the right room. So one of the things the City of Edmonton did, you know, for the last two years on things like transit safety and some of the work was … Created, essentially a tri-party authority, if you will, between the chief of police, the city manager and the Bent Arrow Healing Society, so that we had, you know, law enforcement administration and the social sector working together and making decisions together. So it wasn’t anybody working for anybody. It was three leaders who were charged with making the decisions together. And we wouldn’t make big decisions unless we all agreed first. So that’s helpful …
Mary W Rowe Who were they charged by Andre?
Andre Corbould By city council at the time.
Mary W Rowe By city council …
Andre Corbould Yeah. And it was part of the plan that was approved by city council. And that, you know, the city of Edmonton had pushed that in several venues that were very effective, because it got the right leaders to get their folks in the right mind frame and resource. Quite frankly. I think some of the other things is, there are barriers to frontline staff. I mean, I encountered many barriers in different organizations where frontline staff wanted to do the right thing. They wanted to do something. But because there was a policy in place or something, they were not able to, you know, we had lots of bus drivers in the city of Edmonton who really wanted to help. But, you know, were constrained from doing that in certain circumstances.
Mary W Rowe And what do you do with that?
Andre Corbould Well, you got to remove the barriers. You got to listen to people. You’ve got to listen to staff, you’ve got to listen to the frontline social people, the health people that are on the front lines. And you’ve got to ask them what is the barrier and what can we remove. And that that can make very big changes. And then if I could just comment on the trust thing, trust comes in my opinion from relationships, yes. And connections. But also from results. And so three examples I can think of where trust was really helpful, recently here in the city of Edmonton was, you know, with … The province established a navigation center to help provide a resource, a coordinating effort, if you will, that coordinated everybody. But we made, you know, they made sure that there was an elder and several elders at that coordination center. So if you were from a First Nations community, the first thing you would see when you arrived at the navigation center was an elder who could be trusted because they were from that nation. And then I think, you know, results. There are lots of ways to unlock things. And I would say one of the most powerful, quick, easy results to unlock a whole bunch of resources is getting identification to people. So, again, in the navigation center there was an identification machine on site. So people … The first thing that would happen, they would get their identification back, which then … and we found people that had $35,000 in the bank, but just couldn’t access it because they didn’t have any I.D.. So I, you know, I think that’s a good example of a combination of a trust and a relationship bit and then demonstrating quick success on somebody who walked into that place and then got other supports as well. So, it’s not super complicated. Sometimes something as simple as getting an ID can unlock a person’s, you know, life and open up all sorts of possibilities.
Mary W Rowe I’m interested in those little, you know, when you said frontline staff are being inhibited from doing something, so you remove the barrier and then you’re saying municipal ID, that might be a critical thing. We try to write takeaways at the end of this. (AI helps us … Those of you that are using AI) … To see if we can distill, you know, doable things. I want to go back to Michael and Lori – in terms of … you’re in that triage environment, what is happening when you need to make a referral. What happens if there’s no one to refer to or the program you’re referring to is struggling? What do you do then?
Michael Nolan So one of the things we did in building out the original program design is that the three main agencies that would be the refer-to agencies are now under contract to Mesa. So we’ve provided them funding so that they have both boots on the ground. So when Lori comes to work and goes in an emergency response vehicle or paramedic vehicle sitting right next to her, is someone from either our addictions facility or our mental health, crisis work facility. So not only has that built and literally paid for a relationship, but it now gives us direct access into those organizations that 90% of the people that we’re managing on a day to day basis, are in need of. So it’s actually paved that way contractually, but it’s also given them a heightened level of awareness in terms of the need in the community. And that way we can also pre-assess people for eligibility into those services. And it’s significantly broken down barriers to access that would otherwise have been, you know, just some other organization somewhere else with their own culture and their own challenges. We’re seeing a synthesis of their culture, our culture, and what’s really emerging as a new culture, which is a way of doing business in the Mesa program. Maybe if I could, Mary, could I ask Lori to just speak to that transitional piece? Because I think she would speak well to it.
Lori Shannon So I’ve noticed a big difference from the time that I started and just going out and meeting people, getting to know faces, names and, you know, getting people to come and talk to me about just purely their health concerns, wounds and that kind of thing. And once we onboarded mental health crisis workers or like, addiction treatment service workers that just … that opened the door significantly for us because I was limited primarily to medical care, which is needed and provided but there was just so much more that that was needed as well that I, I didn’t have that direct access to or not enough knowledge with it, not being my particular lane or area of expertise. So instead, I have these people riding along with me. We tag team situations all the time now that we we’re sort of getting into a rhythm of things and stuff like that, where I could be dealing with something medical, trying to make certain arrangements on my end where I have more direct access and more knowledge, and my counterpart, whoever that might be for the day, is on their phone. We’re sort of working together to, to, you know, create a solution for that person for that day, week or month or whatever their goal is at that time.
Mary W Rowe And it’s very it’s very human centered. That’s the other thing. We’re always advocating for place-based local policy and local investment. And you’re taking it even further. Family centered, individual centered. I’m hoping there are people on the chat from the housing advocacy community, because I’m interested for them to chime in as I always encourage people … Check the chat. If you’re aware, in chat, of other programs, we’re doing a proper brief on this at CUI about approaches to mental health, “systems, not symptoms”. And we’re keen to hear all the examples. So if you’ve got one, you’re aware of one, please put it into the chat. I want to go back to the accountability piece that you just mentioned, Michael. I’m interested that you set this up. You got the funding and then these partners … There’s some accountability because you’re actually providing some resources as opposed to “do me a favor”. Right? Is that a key thing? And Paul, how does that sit with you? Could there be an application of this in the Ottawa environment where the law enforcement was in tandem with these other services and it was a sort of collective thing.
Paul Stam I’ll go ahead and let Michael speak.
Mary W Rowe Go ahead Michael …
Michael Nolan I would say, you know, we think about social determinants. I think a lot about structural determinants. So how do we lay out that foundation, as the chief of the paramedic services, as Andre was saying, my job is to remove barriers. One of those barriers structurally, in this environment is personal health information privacy. Just, information sharing is a broken wheel in this sector. So we’ve tried to take a bit of a health lens and define our circle of care so that we can share information, whether it be for quality assurance, for research or for the individual. When we think about how we do that now by having our partners in the Mesa program, they no longer see us as another agency or another 1-800 number. They know how to pick up the phone or more importantly, that things are being done just in time, which is what builds the trust, builds the connection with this community because they’re not bureaucratized. My job is to de-bureaucratize the program and to align services as quickly as possible. And our partners have been fantastic.
Mary W Rowe You’re giving us all sorts of good sound bites … The structural determinants of health I love, and de-bureaucratize … Who’s not going to love an approach to de-bureaucratizing? Andre, I saw you nodding your head as somebody who’s been trying to de-bureaucratize in every role you’ve been in. Thoughts on this particular model? And then, Paul, I’ll come back to you. Go ahead. Andre.
Andre Corbould Yeah, I would just say I call it de-complicating the system. And there are, you know, great examples of how you can de-complicate the system. I use the ID example … I know, for example, in Veterans Affairs, you can immediately within 24 hours get mental health supports without being diagnosed just by reporting in. That’s a great example of how they have de-complicated the system, where within 24 hours you’re getting 100%, you know, mental health supports, prior to diagnosis. So that, you know, we need to do more things like that. And again, I think a lot of it has to do with listening to the frontline folks who know where the complications are and then getting them out of the way.
Mary W Rowe Thank you to the people in the chat who are throwing in all sorts of examples from different communities, different health care communities, different approaches, different kinds of vulnerable population responses. So please, as we say in in the movies, keep your cards and letters coming in. Please put those in the chat because we will turn them all up. Paul, go ahead, comments for you in terms of what you’re trying to do in the city of Ottawa. And then Pam, I’m going to talk to you about London. Go ahead Paul.
Paul Stam Sure. Yeah. So I as we said at the topic, it’s all about coordination. And, you know, I think Andre makes some great points about, the front line and folks on the ground doing that. And that’s exactly what we’re doing. So, you know, we created a situation table in Ottawa. We were one of the only cities in the province who didn’t have one. So that was really a grassroots initiative. That was folks working on the front line, tired of seeing so-called people fall through the cracks, saying, let’s collaborate our collective resources to focus acutely on one individual at a time. From the front side of things, we’ve just opened up a new neighborhood operation center in the Byward Market. And that’s a collaborative space. And we’ve created a new front line task force that involves the police, our community, social services, community engagement teams, the paramedics, our OC Transpo special constable unit, bylaw, anyone who’s working on the front line and in a real time capacity, we’ll be meeting there once a week, having weekly briefings. And, you know, these folks who are actually working on the ground out there, having a weekly briefing and then going out immediately after and addressing those problems together, collectively, as one unit. So, you know, and there’s numerous examples of these sort of integrated teams across the province, across the country. Hurt teams and coast teams, so it is being done in many different ways. The question is, it’s all isolated and you know that …
Mary W Rowe You mean isolated from each other.
Paul Stam Exactly.
Mary W Rowe How do we establish best practice, right? If I hadn’t watched that program on the National, how would I know what Pembroke was doing? The Mesa program.
Paul Stam Exactly. And that’s an amazing program. It’s fantastic. And thanks, you know, to CBC for making that known so widely. But how do we build that in from the top so that … oftentimes what you’ll see with these programs, these pilot programs is you have some passionate champions, which Michael and Lori obviously are, and they’re able to carry programs forward. When we try to expand that at scale and systematize it, it doesn’t always work because you don’t have those passionate champions who are driving it forward. Yeah. So that’s what I mean when we need to systematize this so that the system isn’t working in parallel tracks in these silos so that it is one system, because we can talk about the criminal justice system. We can talk about the mental health system or the public health system. It is one system. It’s all inter … We can’t completely disentangle ourselves.
Mary W Rowe Well, no. Although the situation in Kamloops or in Whitehorse or in Antigonish is going to be different than it is in Pembroke. So, whatever the Mesa-like program is has to be adapted. Pam, do you have a thought on how individuals can … We’ve got a question in the chat, which I totally appreciate around when you’re an individual and you are witnessing something, it’s very difficult to know what to do other than get off the subway car or something. And I’m just curious what in the mental health community, what is your current sort of approach to this around creating a kind of where regular folks somehow are involved in the process too? Thoughts over there?
Pam Tobin Yeah, that’s, that’s a really difficult question to answer. I don’t think I’d be comfortable answering that other than you don’t want to escalate people. And people who are in mental distress are often escalated easily. But I mean, every scenario is quite different.
Mary W Rowe Yeah. You know, I, I have this little personal preoccupation with what are called pinnies. I always ask people, do you know what a pinny is. Andre? Do you know what a penny is?
Andre Corbould I do not.
Mary W Rowe I think it must be a term that only people of a certain age in Ontario know. It’s a little jacket-y thing that you wear that identifies you as being some kind of an official. And occasionally you see cops wear them. Sometimes transit workers wear them. But the thing about it is it has this effect where you suddenly think, “oh, there’s someone I can go to”, you know? It’s like when I was a kid, we had the good the Block Parent Program. You knew you could go to that house. I keep wanting to have more eyes on the street to be able … So if you see an incident, you can you at least have someone to go to and say “there’s a person in distress two blocks over”. And I don’t know how we set that up, but … Because we can’t have everybody wearing pinnies. Andre, thoughts from you in terms of the kind of systematic, how do we bridge the need for a system-wide transformation, but also very local, locally specific challenges?
Andre Corbould Yeah. Well, I would say, one thing is to use what you have. So we were, you know, a little concerned, previously when I was at the city of a coordinating efforts but, you know, we have an emergency management office sitting there that was not engaged at the time. So we, you know, were able to engage that office to do some of the coordinating efforts. we’ve talked about stovepipes and things like that. I think you got to break those down a bit, make sure you have, you’re using what you have in your resources. There’s lots of coordinating bodies that can do those kinds of things. So I think that’s a really important piece. I also think, you know, we’ve talked about some of the people we should listen to, but haven’t mentioned all the people we should listen to. So I just maybe want to put into my acknowledgment that there is, I think, certain groups that are vulnerable that that, you know, really need to have special supports for them. One is, you know, we’re seeing more and more youth, you know, fall into these difficult situations. And so I think, you know, you have to take a particular angle for youth. And then, of course, you know, the Indigenous, populations. I mean, we have to listen to Indigenous leaders on how best to help Indigenous people. So quite often, you know, some of the people I listened to were, you know, Grand Chief, Willie Little Child and Grand Chief Cody Thomas and Grand Chief Billy Moran at the time, and, you know, got some really … They know what’s going on and, you know, understanding what they need from a coordinating effort, what they need done is, I think, crucial to success as well.
Mary W Rowe You know, with the time we have left … And again, thank you to everybody in the chat. You never disappoint us. But can I also ask some of you to go back and look at your comments? Make sure they’re posted to everyone. Sarah Middleton, yours are going only to host and panelist … just out of the corner of my eye. Go repost everybody make sure you’re posting to everyone. These resources are really valuable. With the time that we’ve got left, can we talk about resources? Who pays for this? How? If we’re talking about creating it, we’re talking about getting beyond symptoms and patchwork to actually, as you’re suggesting, Paul, big system change. What was it that you said Michael? … Structural determinants of health and you want to de-bureaucratize the system. Where should the money be coming from?
Paul Stam Can I touch on that real quick?
Mary W Rowe Yeah. Go for it. How do we get the level of investment we need?
Paul Stam I mean, it always comes down to resources. And money is nice but we also need the people to do the work, which is often the problem for us right now. In 2021, OPS commissioned “Help Secret Technologies”, which is an indigenous startup tech company actually. They did a social impact audit where they looked at all the government money that’s coming into the city. They did this for Toronto and Vancouver as well, and they found that about $507 million was coming into Ottawa every year from government funds, public funds, specifically for addictions and mental health. And here we are in 2024. And the problem is worse than ever. So, money is there for sure. I mean … And that’s aside from the police budget and everything else. Right? So that’s just for mental health and addiction. We also have a $400 million police budget. So it could go towards some of this. So there is a lot of money coming in, we just got a grant from the provincial government. It comes back to what we said at the start. How is that money being used in a coordinated way? Do we have 50 people who are all very well intentioned and hardworking doing 50 things, or do we have them all pulling in the same direction, working together, so that we’re accomplishing these bigger goals from a systems lens? To me, I think, you know, the resources can be there. The dedication, the passion is there. How do we bring it together?
Mary W Rowe So there’s the reallocation of existing money. There’s this accountability piece that Michael signaled that he actually gets some resources. And then there’s some accountability. Other thoughts on resourcing … where … because remember we always want accountability and resourcing to go hand in hand, I get it. Thoughts from the Pembroke folks, from London and then back to Edmonton. Go ahead.
Michael Nolan Okay. I think as Canadians, when we think about health care, we think of that as a provincial responsibility that’s backstopped federally from a funding perspective.
Mary W Rowe Okay.
Michael Nolan Much of what we’re talking about is people, and how do we support people? In many respects, it is a health lens that we are taking in the Mesa program as well as a social security lens. And then lastly, and maybe should be firstly, a housing related issue. I think both the provincial and federal governments need to be aligned in terms of this is a priority, but this also as an economic priority for Canadians. We know in the absence of these programs, it’s significantly more expensive to have homelessness, to have the levels of unemployment, to have the complexity and the chaos associated with addictions and mental health, than it is to fund them adequately. I think municipalities are well situated to be able to deliver services, but those programs need to be supported, both provincially and federally. And then I also think from the plural sector perspective, this isn’t all about money. It’s about how do we leverage our relationships with the business community, with the faith based communities. And there’s a lot of chat in the chat box here about, you know, peer support and volunteerism. I absolutely support that. How do we take lived experience survivors who have faced this precariousness and raise them so that their voices can be heard, and in fact, they can continue to take this challenge on at low to no cost to the system, but allow the legitimacy of their experiences to drive the next steps in these programs.
Mary W Rowe It’s kind of a both/and answer. I appreciate what you’re saying, Michael. Pam.
Pam Tobin I think that it’s so much more cost effective to fund community based mental health and addictions programs than it is to fund other areas in health care. And that’s a piece that often gets missed with our crisis center, for example. The amount of clients that we divert from the emergency department at the hospital is very significant when compared to looking at hospital stays, and you do a comparison of the two, you can’t compare. It’s just such a huge cost savings to provide the community based services that we do. At the same time, the funding is provided either in short term or it’s piecemeal and it’s not a coordinated approach. So you’re constantly chasing money at different departments, whether it be provincial or federal or different areas. And it needs to be coordinated. It needs to be long term and sustainable.
Mary W Rowe Yeah, I think the sustainability piece and this idea that, you know, The Hunger Games … you’re all madly looking for this grant pool and that grant pool. Andre, what’s your view? I mean, I know you and I have had this conversation in other in other contexts for the last few years. How do we get more money to actually be collected and stay in the local system?
Andre Corbould Yeah, I would say that. Yeah. I mean, I guess I would say I’m not convinced there’s not enough money in the system. I definitely think it needs to be better coordinated. And there’s so much inefficiency. I mean, you’re you know, you’re absolutely right. People are going from one grant to the next. And the problem that creates from a people perspective is that, you know, people are moving around for jobs. They don’t know if they’re going to have a job three weeks down the road because the grant hasn’t come in. And I see all these executive directors doing great work chasing this down, losing staff because they can’t guarantee them a job. These are very difficult jobs. I also think we’re probably not paying them enough, but I’m just simply not convinced that when the totality of the different systems don’t have enough resources in them. I think, again, another reason why the money needs to be coordinated, the efforts need to be coordinated so that you’re not jumping from sort of grant to grant, and you’ve got sustainable programs in all these areas. And I think, you know, Mesa is a great example. Like I’m not sure when your funding ends, but, you know, there’s going to be a time where you’re probably worried about when that ends – that needs to be so crystal clear that it’s long term, it’s sustainable. And then that creates that faith in the system. So I just think again, it gets down to the coordination effort. I don’t think it’s money. I mean, the taxpayers paying for all of it anyways. So I don’t think it’s necessarily not enough money. It needs to be coordinated in a way. And I think what we don’t need is … I think the lines are clear in terms of municipal, provincial and federal responsibilities. I think largely those orders of government are doing what they should. But I hear more arguing about it than I actually hear about getting the job done. Right? More of getting to the job with the lanes we’re in. And I think those lanes are pretty clear. And, you know, we see the funding reflect that generally. But it needs to be better organized for sure.
Mary W Rowe Yeah. I mean, it’s back to – let’s not spend too much more time admiring our problem. Last words to each of you, as we round the hour out here, in terms of this diverse listenership that you’ve had, that have been keen and who have populated the chat with all sorts of examples. And as I say, we’ll produce a proper report that’s going to talk about the case for exactly what you said, Pam. Early intervention. Why investing in mental health supports at the community level pays. What does it really produce right? So last words from each of you in terms of what you think we should be watching and paying attention to over the next couple of months as things continue to unfold in our communities. Paul, you first and then I’ll go to Pembroke. I’ll swing around that way and finish with you Andre. Go ahead, Paul.
Paul Stam This has been great and I’ve just been keeping an eye on the chat. You know, some great comments in there. And, you know, we don’t have much time so I just want to say thanks to my fellow panelists and then for introducing the rest of us to some of these great initiatives.
Mary W Rowe We’re going to watch carefully and see how that center in Rideau works. What are you calling it?
Paul Stam It’s a neighborhood operation center. That’s right. Yeah.
Mary W Rowe Operation center. Yeah, because we hear about that. And be interesting to see if that actual putting some eyes on the street, literally in a mall, in Rideau center is going to pay off … Whether or not that delivers … one of the things I hope is that we’re finding ways to actually record what’s working. So Michael and Lori, if you didn’t have the CBC coming to town, how could you be able to show other places how this is working? How are you documenting it?
Michael Nolan So from the documentation perspective, and I put it in the chat the link. So we put in our program design there. And I think to Andre’s point originally, we built this to scope it and scale it. We’ve had some success with our community paramedic programs which are now right across Canada, and as well our VTac program, which is a primary care program which allows everyone in Renfrew County to have same day access to a family physician. So the province has been partnering with us on those programs to go, scope, spread scale and the Mesa programs design. You know, we’re small or mighty. And we also have the ability to be able to do it in a programmatic, systematic way. So we have worked with the Ottawa Paramedic Service. We are working with jurisdictions across the country. So the documentation is in a number of ways. One is inviting media, as we have. The second one is inviting our community partners. We’ve also done qualitative evaluation, video interviews with our clients in terms of their needs and program impact. And then we have a quality framework that is tracking the impact of reductions in 911 calls to police and paramedics … Reductions …
Mary W Rowe So you’re documenting all that?
Michael Nolan Yeah. So that’s all being documented with peer review in mind so that we can publish that in peer reviewed journals.
Mary W Rowe We’re running out of time. So I want to get a word from Lori, then Pam. And then Andre. Word from you, Lori.
Lori Shannon I’m keeping it a little bit more simple on street level. So thanks to everyone and it was a pleasure to talk with everyone. I’m just looking forward to the next phase of what we’re doing, within Mesa. So we’ve built trust, we’ve built the relationships, and, you know, we’re making the move towards transitional housing on either end of treatment for the addicted population. So I’m excited.
Mary W Rowe That’s your next step. we look forward to continuing to learn with you as you move to that next step. Pam, and then last word, Andre. Quick word from you, Pam.
Pam Tobin Yeah, I think keep an eye on increased core funding. And conversations will be happening provincially and nationally at that level. Data is so important to tell the story about the impact of community based programs and services, and also keeping an eye on those best practices that we can scale and spread.
Mary W Rowe Yep. Andre, last word to you.
Andre Corbould Yeah. Very quickly, I just want to make a point. I think there’s a house housing crisis in the country. There’s a mental health crisis in the country. They are going to help each other a bit, but one is not going to solve the other. 53% of houseless people are likely to have a traumatic brain injury. So it doesn’t matter … Yes, we need to get them into housing. Absolutely. But we if we don’t provide the mental health supports the housing alone will not solve the problem. I just want to say people care in our communities and I see it everywhere we go. The business community cares. The social community cares. People care and people are willing to stand up, volunteer and help. And then lastly, I worry mostly about youth, and we have to think about the next generation and try to find a way to do things differently so the next generation doesn’t go through what this current generation is going through, in a different way.
Mary W Rowe All right. Listen, thank you very, very much. We have another CityTalk a week from today on the 25th. It will be about cultural infrastructure and what’s happening to the cultural space. Also part of, I hope, the response to mental health. But lots of other things as well. That’s … watch your inboxes, you’ll hear about it, it’s a week from today. Thank you for joining us for this really, really important conversation. As we always say, “this isn’t the end, it’s just the beginning of what’s working, what’s not and what’s next” – on addressing systems, not just symptoms. So Paul thank you. Nice to see you. Michael and Lori, really great to have a chance to have an interaction with you directly. Pam, always great to see you. And thank you. Fellow Andre. New CUI Fellow for your leadership. And we’ll see where this goes next. We are not letting the topic drop. And thanks everybody in the chat. So much great content there. Thanks everybody. Have a great day.