Towards a Northern Centre of Excellence for Addiction and Mental Health

Engagement Results for: RAINY RIVER DISTRICT

Northwestern Ontario Engagement Nov 2017 - Mar 2018 Rainy River District Engagement Sessions

NORTH WEST LHIN FACE-TO-FACE SESSIONS 2 Fort Frances 1: Jan 2018 Fort Frances 2: Jan 2018

VIDEOCONFERENCE SESSIONS Northwestern Ontario WEST: 2 Jan 2018 Northwestern Ontario WEST 2: March 2018

PARTICIPANTS FROM 15 ORGANIZATIONS serving Fort Frances, Atikokan, Emo, Rainy River, surrounding rural communities, and 10 First Nations

RAINY RIVER 23 Of these, 5 participants were affiliated with Indigenous DISTRICT organizations and organizations serving Indigenous people 20 110 people | 15 474 km2

42% rural ** 2% Francophone SECTORS ROLES 27% Aboriginal* Identity 17% adults over age 65 Addiction, Mental Health, Front-line workers and Managers 30% children and youth 0-24 years Hospital, Emergency Medical in Indigenous-specific and non- Services, Primary Health Indigenous organizations, including 4 major towns, 10 First Nations Care, Public Health, Tribal Nurse, Paramedic, Policy Maker, Fort Frances to Thunder Bay: Health Authority, Social Social Worker, Counsellor, Volunteer 4 hours drive Services, Education, Health Coordinator, Superintendent, (Source: Statistics Canada, 2016 Census) Administration Director, People with Lived Experience *“Aboriginal” is used to reflect census terminology **inclusive definition

INSIDE: What are the mental How could a Northern What should a Centre health and addiction Centre of Excellence for of Excellence for priorities in Rainy River Addiction and Mental Northwestern Ontario District? Health help? look like? A Priority Mental Health & Addiction Issues -- Rainy River District

1. EMERGING TRENDS • Lack of childcare makes it difficult for they often get lost in the system clients with children to access treatment • Rainy River District has a history of • Staff may be unaware of available collaboration - among organizations, • Extremely long wait lists for services, so clients don’t get the and between Indigenous and non- treatment centres services they need Indigenous populations

• Local capacity for mental health and 3. LIMITED AFTERCARE AVAILABLE 6. LACK OF SERVICES FOR YOUTH LOCALLY addiction care has been increasing • More youth are seeking help for (e.g. the new detox beds just approved) • Because the only Assertive Community mental health and addiction issues, • Substances use trends are shifting: Treatment (ACT) Team is in Kenora and providers know that working with crystal methamphetamines use has and serves two districts, Rainy River youth at an early age can help break increased dramatically and being providers need to find other ways to the cycle of addiction, but there is combined with alcohol; Desomorphine support clients in the community nowhere to send them is becoming more common • Lack of local, regular psychiatric care: • Increasing number of suicidal youth, • Decreasing resources and increasing “OTN (Ontario Telemedicine Network) but no child/adolescent services to numbers of people who need them isn’t the answer. Technology is great, help them but not everyone can access it” • Lack of psychology and psychiatry • Available services for youth are supports across the province • Services need to be provided “close connected to Child and Family to home” so that clients do not Services (CAS), and parents are • Increase in long-term care need to leave their communities afraid their children will be taken if residents who are on methadone they seek help for them • Distances are a huge issue; even if • Increase in youth with anxiety; the services are available elsewhere, • Lack of safe spaces for children drugs becoming more common in clients have no way to get to them and youth schools; suicide is becoming more common among 12-13 year olds • Staff must travel long distances to serve district communities, and 7. WORKFORCE ISSUES constantly need to be creative to • Decreasing resources, increasing need 2. LIMITED LOCAL ADDICTION AND “make things work” MENTAL HEALTH SERVICES • Staff are “maxed” and do not have • People go to jail because that is the 4. MEETING THE NEEDS OF the time to give clients what they only way they can access treatment INDIGENOUS CLIENTS need; they cannot see clients as often as they would like • Overall lack of services means • A need to build capacity in Indigenous staff struggle with where to send organizations and communities to • Difficult to retain staff who come clients who are actively suicidal, deliver care to people living on and off from out of town psychotic e.g. Paramedics (EMS) have reserve: “We want to look after our • Need more educated and qualified nowhere to bring someone other own people” staff to fill positions; students than Emergency Room (ER), and that entering the workforce unprepared person is released the next day: “It’s 5. POOR COORDINATION OF CARE AND a hand off game – EMS hands that UNCLEAR CARE PATHWAYS • Staff need a deeper understanding of person off to a doctor, the doctor mental health and addiction issues hands them off to someone else, and • Issues weaning clients off (social determinants of health, past they do not get the help they need.” methadone/Suboxone; prescribing trauma) doctors have authority over Rigid criteria • for treatment dosages; service providers are • Severity of some cases are beyond programs make them inaccessible unable to help their clients taper off the resources that exist; need access for some e.g. CMHA is compliance- to specialists for supervision/ based, so non-compliant clients do • Following up with clients sent away consultation when practicing not get services they need for treatment is complicated and Priority Mental Health & Addiction Issues -- Rainy River District • Unqualified staff are expected • It is difficult to help hungry poor” as well as older adults still to provide specialized services clients address mental health and working who cannot afford the high because no one else available addiction issues; staff pay out of costs of rent pocket or bring food from home to • Front-line staff need support with feed clients • No supportive housing means stress and trauma they experience clients cannot leave situations of on the job: “there is a lot expected of • It is difficult to help homeless family violence and domestic abuse them and they go above and beyond to clients address mental health and because there is nowhere else to go try to meet the needs of their clients” addiction issues e.g. an address is needed to navigate the mental 10. FUNDING ISSUES 8. STIGMA OF MENTAL HEALTH AND health and addiction system • Decrease in funding to pay staff ADDICTION • A new gold mine in the area has affordable housing • Clients may be reluctant to seek sparked an • More funding needed to maintain crisis homeless shelter care due to stigma ; there is no programs and services for increasing numbers of “working • Some clients have not been believed or helped adequately in the past, so are reluctant to seek help again nowhere to send them access to specialists overworked staff training • Some harm reduction services in rigid criteria alcohol crystal methamphetamine place, but lack community support youth stigma youth anxiety Desomorphine 9. COMPLEX ISSUES funding collaboration wait lists travel distances • Many individuals have concurrent access parents are afraid addiction and mental health issues no supportive safe spaces housing limited aftercare for kids • Staff must be creative and “think lost in the hungry weaning off outside the box” to solve complex system Indigenous methadone/Suboxone issues for their clients no homeless shelter youth suicide

B Considering a Northern Centre of Excellence for Addiction and Mental Health

1. WHAT COULD A NORTHERN • Facilitate collaboration and • Provide a space for people with lived CENTRE OF EXCELLENCE DO? consultation among service providers, experience to share their knowledge organizations and schools in the north and “provide healing and wellness to • Help drive grassroots initiatives and people in despair” keep them going, write proposals, • Coordinate problem-solving between collect data, and provide training; communities, eg. “Fort Frances • Advocate for staff, providing training and overworked staff do not have energy works on X, Kenora works on Y, etc.” support so they can better manage the or time to put into these much- trauma of the job, e.g. dealing with suicide needed activities that will improve • Allow front-line workers to “be the service provision experts”, and share best practices with • Provide training to front-line others across [Northwestern Ontario]: workers to strengthen local capacity • Document local knowledge and “learn about what people are doing expertise, and provide a place to across [Northwestern Ontario] to help • Educate workers about culturally house that knowledge address the issues we’re all facing” safe and sensitive practices, opioid use in pregnancy, mental health • Bring people together from a variety • Share northern-based research that promotion and literacy, etc. of service areas so that what is respects Indigenous knowledge and available can be known to all methodologies • Facilitate access to specialist support for front-line staff 2. WHAT SHOULD A NORTHERN CENTRE OF EXCELLENCE LOOK LIKE? FACE-TO-FACE, VIRTUAL, OR BLENDED?

• Must be inclusive of First Nations • The virtual component is important people and respect Indigenous to bridge distances; needs to be knowledge accessible and easy to navigate (have a local representative who • A blended model would be the most can coordinate resources and sustainable in NWO; because the needs) internet is not reliable it cannot be completely virtual; face-to-face engagement is important, with a partner site in each community

ce R ien es er ea xp rc E h d an ve d i E L v th a i lu w a BLENDED MODEL e t l io p n o e Research, Training, & P Evaluation Services

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Northwestern Ontario Engagement: Overall Results

NO - 5% 35% city of Thunder Bay SUPPORT 216 Do you support the participants from towns, rural areas, development of a YES 5 engagement areas 65% and First Nations Northern Centre of Excellence for Addiction 95% participants were affiliated with Indigenous and Mental Health? 65 organizations and First Nations

Teleconference and Videoconference Face-to-Face Engagement Sessions 14 12 Engagement Sessions

For further information contact Cynthia Olsen, Coordinator - Thunder Bay Drug Strategy 807-625-2942 | [email protected]