Mid-East Local Collaborative Priority Area: – Focus on Mental Health and Addictions

April 20, 2017 Contents

1. Moss Park map, background and methodology/considerations/limitations for this deep dive analysis 2. Key Highlights and Summary of all Findings 3. Homeless, under-housed, and street involved population in Toronto Central LHIN • Overall • Moss Park 4. Emergency Department Visits for Moss Park Residents • Overall • Focus on Mental Health 5. Adult Mental Health Admissions for Moss Park Residents 6. Use of Community Addictions services by Moss Park residents 7. Health Service Providers serving Moss Park residents 8. Toronto Community Housing High Needs Buildings in Moss Park 9. Appendix – ICD-10 codes used for mental health and addictions ED visits 2 Mid- Sub-Region - Oakridge Neighbourhood

3 Moss Park – Background Information

• Total population: 16,315 (20+: 14,535) (2011) • Poor economic conditions with high percentage of residents living below the low income measure, after tax (38.6%) • High number of residents who self-identify Indigenous • Anishnawbe Health Toronto on Queen St. East • 8 shelters (2 Family, 4 Men and 2 Women): Total 1,397 beds, including largest shelter (men) in Toronto – on George Street (562 beds) • High number of 'high urgency' and ‘low urgency’ ED visits in adults 20+yrs (high: 7,936, low: 2,174) (both higher among males) • High hospitalization for mental health conditions, 20+ (642 hospitalizations) • High count of ACSC hospitalizations, 2012/13-2013/14 (20-74 yrs: 246) • High number of ALC inpatient days, 2011-2012 (all ages: 22,058)

Comments from Providers • Need to coordinate services for housing, transportation and increasing outreach

4 Moss Park - Methodology/Considerations/Limitations

• Several Data Sources were used for this analysis:

1. Toronto Central LHIN utilization data on emergency department visits (NACRS) with a focus on mental health and addictions and mental health and addictions inpatient discharges (OMRHS). This data was based on identifying the number of ED visits and discharges from the postal codes of residents from Moss Park neighbourhood. A list of ICD-10 codes used for MHA ED visits can be found in the Appendix. 2. CBI data has been used to identify a small group of top HSPs in a neighbourhood, A list of top HSPs that serve 50% of the clients in a given neighbourhood is provided (this gives the top 4 to 6 CMHA HSPs and the top 1 or 2 CSS HSPs). However, it should be noted that most HSPs are serving small numbers in each neighbourhood, so this is just a fraction of the total HSPs involved in the neighbourhood.

3. Toronto Community Housing Data – Information is presented on socio-demographic characteristics of residents and building characteristics

4. DATIS data has been included on residents in Moss Park who are enrolled in at least one Ministry of Health and Long Term Care (MoHLTC) funded substance abuse or problem gambling program. Data includes individuals with the selected postal codes in Moss Park. Substance abuse and problem gambling programs provided by an agency and funded by the Ministry of Health and Long Term Care (MoHLTC) are mapped to one of the Functional Centres to permit the generation of statistics by Functional Centre and Functional Centres have been aggregated to Program Levels.

5 Key Highlights and Summary of all Findings

• Homeless, under-housed, and street involved population in City of Toronto and Toronto Central LHIN • There is an increasing prevalence of seniors homelessness since 2006. Seniors aged 61 and older increased from 5% to 10% between 2009 and 2013 • Respondents identifying as male represent almost two-thirds of the homeless population in Toronto (65%). • Moss Park has 8 shelters (2 Family, 4 Men and 2 Women) with a total of 1,397 beds

• MHA ED Visits, 2015/16: • There were 1,306 MHA visits by residents of Moss Park with a total of 582 unique patients (those who had a valid health card number) • Moss Park neighbourhood had the highest rate of ED visits for mental health and addictions conditions in Mid-East Toronto sub-region (99.5/1,000) and was 2.5 times the rate of Mid-East Toronto (40.1/1,000) • Overall there were more MHA ED visits by males (69%) with a large proportion being by patients aged 20-64 (92%) • Almost one quarter (24%) of the MHA ED visits were by patients living in homeless shelters in Moss Park with a large majority (85%) being by patients living in men’s shelters • Almost two thirds of visits to the ED for MHA conditions (63%) were by patients who had a family physician • A large proportion (84%) of the visits were for CTAS levels 2 & 3 indicating that residents are presenting to the ED when they are really sick • Three quarters (75%) of MHA ED visits were discharged home with no supports, with only 3% being discharged with supports and 13% being admitted • Majority of ED visits were for alcohol (36%), followed by Other mental health and behavioural disorders (23%) and Schizophrenia, Schizotypal And Delusional Disorders (22%) and residents presented most at St. Michael’s Hospital (29%), followed by CAMH (22%) • Over one-third (38%) of the visits were for 36 patients who presented 5+ times with the number of visits ranging from 5 to 138 6 Key Highlights and Summary of all Findings

• MHA Discharges for Adults 20 years and over, 2015/16: • There was a total of 183 MHA discharges in Moss Park during FY2015-16. 98% of these discharges were for patients with a valid health card number. • Overall there was a higher proportion of males (57%) with most discharges being for patients aged 20-64 (92%) • The rate of discharges for mental health & addictions per 1,000 population in Moss Park for FY2015/16 (12.6) is more than double the Toronto Central LHIN rate (5.6) • Half of the MHA discharges were for schizophrenia and other psychotic disorders (50%) followed by mood disorders (22%) and substance related disorders (15%) • A large majority (91%) of all discharges were planned and regular in nature • There were 137 Unique individuals from Moss Park discharged from adult mental health and addiction beds during FY 2015-16. A large majority of patients (96%) accessed services in one hospital only and most patients were admitted to CAMH (57%) and St. Michaels Hospital (16%) • Most individuals were admitted only once for inpatient mental health care in Moss Park during FY 2015-16. Of the 7 who had 3 or more discharges, the number of discharges ranged from 3 to 14.

• Use of Community Addiction Services, FY2015/16 & FY2016/17 • Majority of residents in Moss Park attended programs for Special Community Services, Special Inpatient Services & Residential Rehab Treatment and Case Management. • In both fiscal years, overall there were more males than females and majority of residents were in the 35-54 age group. • Case Management, Special Community Services and Outreach, Counselling & Treatment had the longest average length of stay • Majority of residents attended programs at St. Michael's Withdrawal Management Services, UHN , Street Haven at the Crossroads, Salvation Army Harbour Light Centre and Jean Tweed Treatment Centre • In both fiscal years for open and discharged admissions, majority of residents in Moss Park presented with problems related to alcohol, followed by crack, cannabis and tobacco. 7 1. Homeless, under-housed, and street involved population in City of Toronto Street Needs Assessment Results - 2013

8 Total Estimated Homeless Population in Toronto (2013) (based on respondents)

Year 2006 2009 2013 Surveyed Groups Count Share of Count Share of Count Share of Total Total Total Outdoors 735 15% 362 7% 447 9% City administered 3,649 73% 3,990 77% 3,970 76% shelters VAW shelters 171 3% 306 6% 356 7% Health & Treatment 275 6% 223 4% 236 4% Facilities Correctional Facilities 139 3% 288 6% 244 5% Total 4,649 100% 5,169 100% 5,253 100%

9 Source: City of Toronto, 2016, 2013 Street Needs Assessment Results Distribution of Respondents by Age Group (2013)

Survey groups Under 21 21-30 31-40 41-50 51-60 61-65 65+ There is an Outdoors 7% 22% 17% 29% 19% 1% 5% increasing City Administrated Shelters 7% 19% 18% 24% 21% 6% 5% prevalence of Family 8% 37% 28% 18% 8% 1% 1% seniors Youth 47% 52% 1% 0% 0% 0% 0% homelessness Mixed Adult 2% 12% 26% 28% 25% 4% 3% since 2006. Men 0% 8% 17% 30% 27% 9% 8% Women 3% 16% 20% 27% 24% 6% 5% Seniors aged 61 VAW Shelter 5% 36% 43% 12% 5% 0% 0% and older increased from Health and Treatment Facilities 1% 16% 22% 22% 22% 11% 5% 5% to Correctional Facilitiies 3% 26% 28% 33% 8% 1% 0% 10% between ALL RESPONDENTS 6% 20% 20% 24% 19% 5% 5% 2009 and 2013.

Also, respondents aged 51 and above increased to 29% from 20% four years ago.

10 Source: City of Toronto, 2016, 2013 Street Needs Assessment Results Self-Identified Gender of Respondents (2013)

Survey groups Female Male Transgender/Transsexual Other No Answer Outdoors 15% 85% 0% 0% 0% Respondents City Administrated Shelters 31% 68% 1% 0% 0% identifying as Family 75% 25% 0% 0% 1% male represent Youth 28% 69% 2% 1% 0% almost two-thirds Mixed Adult 31% 67% 2% 0% 0% of Men 0% 99% 1% 0% 0% Women 97% 0% 3% 0% 0% the homeless VAW Shelter 99% 0% 1% 0% 0% population in Health and Toronto (65%). Treatment Facilities 31% 69% 1% 0% 1% Correctional Individuals Facilitiies 5% 93% 2% 0% 0% ALL identifying as RESPONDENTS 33% 65% 1% 0% 0% female represent one third and transgender and transsexual identified individuals represent 1% of the homeless population.

11 Source: City of Toronto, 2016, 2013 Street Needs Assessment Results Emergency Department Visits for Homeless Population by Hospital of Visit (Toronto Central LHIN hospitals Only), FY 2014/15

Source: National Ambulatory Care Reporting System (NACRS), FY2014/15, MOHLTC, IntelliHealth (Extracted: 2016) Main Diagnosis for Homeless Population Attending Emergency Departments in Toronto Central LHIN (FY 2014/15)

ICD10-CA Main Problem Diagosis TOTAL % of Total Mental and behavioural disorders due to use of alcohol, acute intoxication 1965 13.2% Mental and behavioural disorders due to use of alcohol, harmful use 1009 6.8% Mental and behavioural disorders due to multiple drug use and use of psychoactive substances, harmful use 525 3.5% Issue of repeat prescription 387 2.6% Paranoid schizophrenia 262 1.8% Other symptoms and signs involving emotional state 246 1.6% Abdominal and pelvic pain 242 1.6% Chest pain, unspecified 235 1.6% Mental and behavioural disorders due to use of alcohol, withdrawal state 229 1.5% Anosmia (inability to perceive odor) 229 1.5% Unspecified Non-Organic Psychosis 202 1.4% Unspecific Injury of Head 171 1.1% Pain in Lower Limb 168 1.1% Mental and behavioural disorders due to use of alcohol, dependence syndrome 167 1.1% Cellulitis of Lower Limb 163 1.1% Malaise and Fatigue 147 1.0% Depressive episode, unspecified 146 1.0% Anxiety disorder, unspecified 139 0.9% Unspecific Convulsions 130 0.9% Adjustment disorders 127 0.9% Other 8041 53.9% TOTAL 14,930 100.0%

Source: National Ambulatory Care Reporting System (NACRS), FY2014/15, MOHLTC, IntelliHealth (Extracted: 2016) City of Toronto Shelters in Moss Park, 2016

Type of Shelter Shelter Name Number of Beds

Family Shelter Robertson House 90 • Moss Park has 8 shelters (2 Sojourn House 149 Family, 4 Men Total 239 and 2 Women) Men's Shelter Dixon Hall - Schoolhouse 44 with a total of 1,397 beds, Salvation Army - Gateway 120 including the Salvation Army - Maxwell Meighen 345 largest men’s shelter in Seaton House 562 Toronto – Seaton Total 1,071 House on Women’s Shelter Fred Victor Transitional George Street Women at Dundas 37 which has 562 Street Haven 50 beds Total 87 Moss Park Total 1,397

14 Source: City of Toronto, October 2016 Emergency Department Visits for Moss Park Residents NACRS FY2015-16

15 Emergency Department Visits in Moss Park, FY2015-16

• There were a total of 9,803 ED visits for all ages by residents of Moss Park in FY2015/16 • There were 8,834 ED visits for ages 20+ by residents of Moss Park in FY2015-16 • Of those visits, 1,306 (14.8%) were for mental health and addictions conditions • 36 visits were for patients who did not have a valid health card number • There are 1,270 visits for patients who had a valid health card number, with a total of 582 unique patients • The analysis includes all 1,306 MHA visits by residents of Moss Park

Note: It is important to consider other conditions beyond mental health and addictions for this population as only 14.8% of ED visits for ages 20+ had a most responsible mental health and addictions condition. 16 Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) MHA ED Visits in Mid-East Toronto neighbourhoods, Ages 20+, FY2015-16

Neighbourhood MHA ED visits, Ages 20+ Population 2011, Ages 20+ Rate per 1,000 Rosedale-Moore Park 270 17,120 15.8 -Bennington 28 1,650 17.0 Rates of MHA Waterfront Communities-The Island 398 15,695 25.4 ED visits ranged South Riverdale 534 15,305 34.9 from 15.8 in Church-Yonge Corridor 1,007 26,415 38.1 North St. James Town 578 14,835 39.0 Rosedale-Moore 259 6,205 41.7 Park to 99.5 in Cabbagetown-South St. James Town 445 10,100 44.1 Moss Park Moss Park 1,306 13,130 99.5 Mid-East Toronto Sub-Region 4,825 120,455 40.1

Rate of ED visits for mental health and addictions conditions, Ages 20+, FY2015/16 Moss Park had 120.0 99.5 the highest rate 100.0 of ED visits for 80.0 mental health 60.0 41.7 44.1 34.9 38.1 39.0 and addictions 40.0 25.4 15.8 17.0 conditions in Mid- 20.0 Mid- East Toronto Rate: 40.1 East Toronto

Rate Rate per1,000 population 0.0 sub-region (99.5) which was 2.5 times the rate of Mid-East Toronto (40.1) 17 Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) Demographics of Patients with MHA ED Visits, FY2015-16

n= 1,306 n= 1,306

• Almost one quarter (24%) of the MHA ED visits were by patients • Overall there were more MHA ED visits by males (69%) than by living in homeless shelters in Moss Park with a large majority (85%) females (31%) being by patients living in the following men’s shelters – 1)Dixon • A large proportion of MHA ED visits were by patients aged 20-64 Hall – Schoolhouse, 2) Seaton house and 3) Salvation Army – which accounted for 92% of all visits Maxwell Meighen. Only 5% of visits were by patients who did not have a valid health card number.

Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 18 CTAS Level and Primary Care Provider for MHA ED Visits, Ages 20+, FY2015-16

>5%

>5%

n= 1,306 n= 1,306

• Almost two thirds of visits to the ED for MHA conditions (63%) were • More than half (56%) of the MHA ED visits were categorized as by patients who had a family physician CTAS level 3 – Urgent and Potentially Serious, followed by CTAS • Of the 21% of visits which who did not have a family physician, only level 2 – Emergent and Potentially Life Threatening (28%) indicating 6% of visits (15 visits) were for patients who did not have a valid that residents are presenting to the ED when they are really sick. health card number

Note: The category called “Unknown to Patient” means that the patient indicated a provider name, however the corresponding physician name was not found in the CPSO. Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 19 Time of Day/Day of Week for MHA ED Visits, Ages 20+, FY2015- 16

Day of Week/Time of Morning (6:00 - Afternoon Evening (18:00 Late night (0:00 Day 11:59) (12:00 - 17:59) - 23:59) - 5:59) Total % # of Visits Sunday 2% 4% 5% 4% 14% 187 Monday 2% 5% 4% 3% 14% 178 Tuesday 2% 5% 5% 3% 14% 178 Wednesday 2% 5% 4% 2% 14% 180 Thursday 3% 5% 5% 3% 16% 211 Friday 2% 5% 5% 2% 13% 170 Saturday 2% 5% 5% 4% 15% 202 Total % 14% 33% 33% 20% 100% # of Visits 186 428 430 262 1,306

• There were slightly more MHA ED visits on Thursday, followed by Saturday with all other days having a similar proportion • Majority of the MHA ED visits were in the afternoon and evening

20 Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) Ambulance Arrival for MHA ED Visits, Ages 20+, FY2015-16

Percent of MHA ED Visits by Ambulance Arrival , Ages 20+, Percent of MHA ED Visits Amublance Arrival by CTAS Level , Ages FY2015-16 20+, FY2015-16 100%

90% CTAS Level 5

80% CTAS Level 4 6% 70% 56%

60% CTAS Level 3 55%

50% CTAS Level 2 36%

40% Percentage(%)

30% CTAS Level 1 >5% 20% 44% 0% 10% 20% 30% 40% 50% 60% 10% Percentage (%) 0%

Ambulance Other n= 1,306 n= 580

• Less than half of the MHA ED visits arrived through • Of the MHA ED visits that arrived through ambulance, more than half Ambulance were for CTAS Level 3 – Urgent and Potentially Serious (55%)

21 Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) Discharge Disposition Status for MHA ED Visits, Ages 20+, FY2015-16

Percent of MHA ED visits by Disposition Status, Ages 20+, FY2015/16 80% 75%

70%

60%

50%

40%

Percentage(%) 30%

20% 13%

10% 5% 3% 4% 0% 0% n= 1,306 Discharged Home - no Discharged to Place of Admitted Left Death (On And After Transfer (intra facility, supports Residence/Institution Arrival) another acute or non- (with supports) acute care facility)

• Three quarters (75%) of MHA ED visits were discharged home with no supports, with only 3% being discharged with supports and 13% being admitted 22 Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) Most Responsible Diagnosis Category and Hospitals visited for MHA ED Visits, Ages 20+, FY2015-16

n= 1,306 n= 1,306

• Majority of ED visits were for alcohol (36%), followed by Other • Majority of patients visited St. Michael’s Hospital (29%), followed mental health and behavioural disorders (23%) and by CAMH (22%), Sinai Health System (11%) and UHN – TGH Schizophrenia, Schizotypal And Delusional Disorders (22%) (11%)

Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 23 Frequency of visits for MHA ED Visits, Ages 20+, FY2015-16

Frequency of MHA ED visits, Ages 20+, FY2015-16 450 • 487 ED visits in total (38%) 395 (395 visits) 400 • Majority of patients were males (78%) 350 • More than half are in the 45- 64 age group (52%) 300 • More than half of ED visits 250 were for diagnosis category alcohol (53%), followed by 200 Schizophrenia, Schizotypal

UniquePatients And Delusional Disorders 150 (14%) (176 visits) 100 88

40 (120 visits) 36 50 23 (92 visits)

0 1 2 3 4 5+ Frequency of MHA ED visits

• More than two thirds of patients only visited the ED once for MHA related conditions (68%) • Of the 36 patients who had 5 or more MHA ED visits, the number of visits ranged from 5 to 138

24 Source: National Ambulatory Care Reporting System (NACRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) Adult Mental Health and Addictions Admissions for Moss Park Residents OMHRS FY2015/16

25 Number of Adult (20+) Mental Health & Addictions Discharges For Moss Park Residents 2015-16

• 183 - the total number of discharges in Moss Park in 2015-16 • 98% of these discharges were for patients with a health card • Overall there were 104 discharged for men and 82 for women • Most discharges were for individuals aged 20-64 (92%)

26 Source: Mental Health Reporting System (OMHRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) Adult (20+) Mental Health & Addictions Discharge Rates in Moss Park and Toronto Central in 2015-16

2014/15 2015/16 # of Population Rate/1,000 # of Population Rate/1,000 Discharge 20+ (2011) 20+ Discharge 20+ (2011) 20+

Moss Park 204 14,535 14.0 183 14,535 12.6

Toronto Central LHIN 5,518 929,625 5.9 5,217 929,625 5.6

• The rate of discharges for mental health & addictions per 1,000 population in Moss Park is more than double the Toronto Central LHIN rate

27 Source: Ontario Mental Health Reporting System (OMHRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) Diagnosis Distribution for Moss Park Residents Discharges for Adult Mental Health & Addictions in 2015/16

• Schizophrenia and other psychotic disorders were the most diagnosed conditions (50%) followed by mood disorders (22%) and substance related disorders (15%)

Source: Ontario Mental Health Reporting System (OMHRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 28 Discharge Disposition for Mental Health & Addictions Discharges in Moss Park, FY 2015-16

• 91% of all discharges were planned and regular in nature

29 Source: Ontario Mental Health Reporting System (OMHRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) Distribution of 2015-16 Moss Park Resident Discharges by Hospital

No. of Hospitals Number of Unique Patients 1 131 2 6

Hospital Number of Unique Patients # of Discharged Admissions Average number of Discharges CENTRE FOR ADDICTION & MENTAL HEALTH 78 103 1.32 ST MICHAEL'S HOSPITAL 22 22 1.00 MICHAEL GARRON HOSPITAL 5 13 2.60 SUNNYBROOK HEALTH SCIENCES CENTRE 4 6 1.50 SINAI HEALTH SYSTEM-MOUNT SINAI SITE 6 6 1.00 ST JOSEPH'S HEALTH CENTRE <5 5 1.25 NORTH YORK GENERAL HOSPITAL 5 5 1.00 ROUGE VALLEY HEALTH SYSTEM-CENTENARY <5 <5 <5 ONTARIO SHORES CTR FOR MENTAL HLTH SCIEN <5 <5 <5 WILLIAM OSLER HEALTH SYSTEM-ETOBICOKE <5 <5 <5 WAYPOINT CTR FOR MENTAL HLTH CARE-PROVIN <5 <5 <5 HUMBER RIVER REGIONAL HOSP-NORTHWESTERN <5 <5 <5 NIAGARA HEALTH SYSTEM-ST CATHARINES GEN <5 <5 <5 OTTAWA HOSPITAL ( THE )-GENERAL SITE <5 <5 <5 UNIVERSITY HEALTH NETWORK <5 <5 <5 WAYPOINT CTR FOR MENTAL HLTH CARE-REGION <5 <5 <5 MACKENZIE HEALTH <5 <5 <5 ST.JOSEPH'S HEALTH CARE,LONDON-ST THOMAS <5 <5 <5 ROYAL VICTORIA REGIONAL HEALTH CENTRE <5 <5 <5 Total 137 180 1.31

• 137 Unique individuals from Moss Park were discharged from adult mental health and addiction beds during fiscal 2015-16 • Most patients (96%) accessed services in one hospital only • Most patients were admitted to CAMH (57%) and St. Michaels (16%) Hospital

Source: Ontario Mental Health Reporting System (OMHRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) 30 Frequency of Discharges in Moss Park, FY2015-16

• 36 discharges in total (20%) • All 7 are within the 20-64 age category • Females accounted for ¾ of all discharges • Majority of the discharges were for patients diagnosed with Schizophrenia and other psychotic disorders (61%)

• Most individuals were admitted only once for inpatient mental health care in Moss Park during 2015-16 • Of the 7 who had 3 or more discharges, the number of discharges ranged from 3 to 14

31 Source: Ontario Mental Health Reporting System (OMHRS), FY2015-16, MOHLTC, IntelliHealth (Extracted: 2017) Use of Community Addictions services by Moss Park residents DATIS FY2015/16 & FY2016/17

32 Health Service Providers Serving Moss Park Residents All HSP List CBI – 2016/17

33 Number of Open Individuals in Moss Park by Program Level, Gender and Age Group, FY15/16-FY16/17

Gender Age Group Program Level – FY15/16 Males Females Other Total <16 16-24 25-34 35-44 45-54 55-64 65+ Total CMH/A Centralized Access --- … 0 8 0 … … … … … 0 8 Case Management 22 37 0 59 0 … 10 17 15 8 6 59 Outreach, Counselling & Treatment 0 … 0 … 0 0 0 … 0 0 0 … Special Community Services 57 53 0 110 … 7 26 28 23 16 --- 110 Special Inpatient Services & Residential Rehab Treatment 81 14 0 95 0 … 27 31 26 8 … 96

Gender Age Group Program Level – FY16/17 Males Females Other Total <16 16-24 25-34 35-44 45-54 55-64 65+ Total CMH/A Centralized Access --- … 0 8 0 0 … … 0 … … 8 Case Management 16 38 … 55 0 … 13 16 11 9 … 55 Outreach, Counselling & Treatment 0 … 0 … 0 0 … … 0 0 0 … Special Community Services 55 48 0 103 … 8 20 23 28 16 --- 104 Special Inpatient Services & Residential Rehab Treatment 87 20 0 107 0 … 25 26 30 21 … 107

• In FY15/16, majority of residents in Moss Park attended Special Community Services, followed by Special Inpatient Services & Residential Rehab Treatment and Case Management. • In FY16/17, majority of residents in Moss Park attended Special Inpatient Services & Residential Rehab Treatment, followed by Special Community Services and Case Management. • In both fiscal years, overall there were more males than females and majority of residents were in the 35-54 age group.

Note: To protect client anonymity, cells with values less than 6 are redacted and replaced with "...". '---' indicates a value equal to or greater than 6 that was masked to prevent another masked value from being calculated from a column total. Source: Drug and Alcohol Treatment Information System, FY15/16 – FY16/17 34 Length of Stay (LOS) for Clients in Addiction Treatment Programs in Moss Park by Program Level, FY15/16-FY16/17

Average LOS Median LOS Terminated Program Individuals with Terminated Program Level – FY2015/16 (Days) (Days) Registrations Program Registrations CMH/A Centralized Access 1 1 8 8 Case Management 333 174 40 36 Special Community Services 93.8 28 129 84 Special Inpatient Services & Residential Rehab Treatment 15.6 4 187 82

Average LOS Median LOS Terminated Program Individuals with Terminated Program Level – FY2016/17 (Days) (Days) Registrations Program Registrations CMH/A Centralized Access 1 1 8 8 Case Management 248.1 150 46 41 Outreach, Counselling & Treatment 296 296 2 2 Special Community Services 106.4 49 98 72 Special Inpatient Services & Residential Rehab Treatment 19 3 187 92

• In FY2015/16, Case Management had the longest average length of stay, followed by Special Community Services. • In FY2016/17, Outreach, Counselling & Treatment had the longest average length of stay, followed by Case Management and Special Community. • Majority of individuals with terminated program registrations were enrolled in Special Community Services and Special Inpatient Services & Residential Rehab Treatment

Notes: • LOS calculations are based on program registrations that were terminated during the fiscal year. Length of Stay (LOS) = (Program Registration End Date - Program Registration Start Date) + 1 • Terminated Program Registrations: Includes all program registrations terminated during the fiscal year. If an individual had two or more terminated program registrations, all registrations are counted under the Program Level. • Individuals with Terminated Program Registrations: If an individual had two or more terminated program registrations during the fiscal year, the individual is counted once only under the Program Level. Source: Drug and Alcohol Treatment Information System, FY15/16 – FY16/17 35 Number of Open Individuals in Moss Park by LHIN and Addiction Treatment Agency, FY15/16

LHIN CONNEX # Agency Name Open Individuals Central 10233 Humber River Hospital … Central 10321 Addiction Services For York Region (ASYR) … Central East 10097 Pinewood Centre of Lakeridge Health … Central East 10386A Salvation Army Homestead … • In FY15/16, the Central East 10386B Salvation Army Harbour Light Centre 20 Central West 10087 Salvation Army Hope Acres Rehabilitation Centre … top 5 agencies Central West 11115 William Osler Health Centre … residents in Hamilton Niagara Haldimand Brant 10136 Wayside House of Hamilton … Moss Park Hamilton Niagara Haldimand Brant 10183 New Port Centre … Hamilton Niagara Haldimand Brant 10240 Alcohol, Drug and Gambling Services … attended were Mississauga Halton 10079 Hope Place Centres … 1) St. Michael's North East 10221 St. Joseph's General Hospital Elliot Lake … South East 10067 Hotel Dieu Hospital Withdrawal Management Centre … Withdrawal South East 10111 Salvation Army Kingston Harbour Light … Management South East 10176 Lanark, Leeds and Grenville Addictions and Mental Health (LLG AMH) … Services, 2) South West 10022 Grey Bruce Health Services … Toronto Central 10116 St. Joseph's Health Centre Withdrawal Management Services - Toronto 7 Toronto East Toronto Central 10120 Toronto East Health Network 28 Health Network, Toronto Central 10124 Street Haven at the Crossroads 21 Toronto Central 10128 St. Michael's Withdrawal Management Services 39 3) UHN, 4) Street Haven at Toronto Central 10145 Hospital for Sick Children, Substance Abuse Program … Toronto Central 10182 Breakaway Addiction Services 8 the Crossroads Toronto Central 10270 St. Michael's Homes 7 and 5) Toronto Central 10319 Jean Tweed Treatment Centre 17 Toronto Central 10576 Centre for Addiction & Mental Health (CAMH) - Problem Gambling Service … Salvation Army Toronto Central 10576A Centre for Addiction & Mental Health (CAMH) - Substance Abuse Programs (Including MAARS) 8 Harbour Light Toronto Central 10576B CAMH - Substance Abuse Programs … Centre. Four of Toronto Central 10931 416 Community Support for Women - Addiction Services 14 Toronto Central 11084 Corner, A Community Drop-In Centre (The) … the five Toronto Central 11125 Renascent Centres (The) 9 agencies are in Toronto Central 11158 LOFT Community Services - Ingles House … Toronto Central Toronto Central 11671 University Health Network / Toronto Western Hospital, Mental Health and Addictions 24 Toronto Central 50058 Good Shepherd Non-Profit Homes Toronto … LHIN. Toronto Central 50071 Reconnect Community Health Services 9 Toronto Central 50930 Fred Victor … Toronto Central 51016 Good Shepherd Refuge Social Ministries … Waterloo Wellington 10193 Waterloo Regional Withdrawal Management Centre … Total 253 Notes: • Open Individual counts are calculated as follows: • If an individual had two or more admissions to the same agency during the fiscal year, the individual is counted once only under the agency. • If an individual had at least one admission to more than one agency during the fiscal year, the individual is counted once under each agency. • To protect client anonymity, cells with values less than 6 are redacted and replaced with "...". 36 Source: Drug and Alcohol Treatment Information System, FY15/16 – FY16/17 Number of Open Individuals in Moss Park by LHIN and Addiction Treatment Agency, FY16/17

LHIN CONNEX # Agency Name Open Individuals Central 10233 Humber River Hospital 6 Central 10321 Addiction Services For York Region (ASYR) … Central East 10097 Pinewood Centre of Lakeridge Health … Central East 10386B Salvation Army Harbour Light Centre 26 • In FY16/17, the Central West 10087 Salvation Army Hope Acres Rehabilitation Centre … top 5 agencies Champlain 10236 Vesta Recovery Program for Women … Erie St. Clair 50100A Hotel-Dieu Grace Healthcare … residents in Hamilton Niagara Haldimand Brant 10136 Wayside House of Hamilton … Moss Park Hamilton Niagara Haldimand Brant 10183 New Port Centre … attended were Hamilton Niagara Haldimand Brant 10240 Alcohol, Drug and Gambling Services … 1) St. Michael's North East 10304 Monarch Recovery Services … North East 10378 Health Sciences North/Horizon Santé-Nord … Withdrawal South East 10067 Hotel Dieu Hospital Withdrawal Management Centre … Management South East 10111 Salvation Army Kingston Harbour Light … Services, 2) South West 10092 Choices for Change, Alcohol, Drug and Gambling Counselling Centre … Toronto Central 10116 St. Joseph's Health Centre Withdrawal Management Services - Toronto 9 UHN , 3) Street Toronto Central 10120 Toronto East Health Network 14 Haven at the Toronto Central 10124 Street Haven at the Crossroads 27 Crossroads, 4) Toronto Central 10128 St. Michael's Withdrawal Management Services 38 Salvation Army Toronto Central 10145 Hospital for Sick Children, Substance Abuse Program … Toronto Central 10182 Breakaway Addiction Services 6 Harbour Light Toronto Central 10270 St. Michael's Homes 14 Centre and 5) Toronto Central 10319 Jean Tweed Treatment Centre 17 Jean Tweed Toronto Central 10576 Centre for Addiction & Mental Health (CAMH) - Problem Gambling Service 6 Toronto Central 10576A Centre for Addiction & Mental Health (CAMH) - Substance Abuse Programs (Including MAARS) 8 Treatment Toronto Central 10576B CAMH - Substance Abuse Programs … Centre. Four of Toronto Central 10931 416 Community Support for Women - Addiction Services 8 the five Toronto Central 11084 Corner, A Community Drop-In Centre (The) 7 agencies are in Toronto Central 11125 Renascent Centres (The) 9 Toronto Central 11158 LOFT Community Services - Ingles House … Toronto Central Toronto Central 11671 University Health Network / Toronto Western Hospital, Mental Health and Addictions 30 LHIN. Toronto Central 50071 Reconnect Community Health Services 8 Toronto Central 50930 Fred Victor … Toronto Central 51016 Good Shepherd Refuge Social Ministries … Waterloo Wellington 10085 House of Friendship, Addiction Services … Total 262 Notes: • Open Individual counts are calculated as follows: • If an individual had two or more admissions to the same agency during the fiscal year, the individual is counted once only under the agency. • If an individual had at least one admission to more than one agency during the fiscal year, the individual is counted once under each agency. • To protect client anonymity, cells with values less than 6 are redacted and replaced with "...". 37 Source: Drug and Alcohol Treatment Information System, FY15/16 – FY16/17 Number of Open Individuals in Moss Park by Presenting Problem Substances, FY15/16 -FY16/17

2015/16 2016/17 Presenting Problem Substances Open Admissions Discharged Admissions Open Admissions Discharged Admissions None … … 9 … Alcohol 207 169 212 162 Cocaine 54 41 54 42 Amphet. & other stimulants exc. methamphetamines 12 11 10 7 Cannabis 114 99 93 76 Benzodiazepines 10 9 7 7 Barbiturates … … … … Heroin/Opium 28 24 17 14 Prescription opioids 25 22 18 15 Over-the-counter codeine preparations … … … … Hallucinogens 6 6 … … Glue & other inhalants … … … … Tobacco 100 80 114 94 Other psychoactive drugs … … … … Crack 115 94 106 95 Ecstasy … … … … Methamphetamines (crystal meth.) 28 24 28 20 Unknown … … … … Missing … … … …

• In both fiscal years for open and discharged admissions, majority of residents in Moss Park presented with problems related to alcohol, followed by crack, cannabis and tobacco.

Notes: • Up to five Presenting Problem Substances can be reported in an admission. • To protect client anonymity, cells with values less than 6 are redacted and replaced with "...".

Source: Drug and Alcohol Treatment Information System, FY15/16 – FY16/17 38 Top CMHA and CSS Providers that Serve at least 50% of Clients in Moss Park

CMHA Providers Sound Times Support Services 22% Progress Place Rehabilitation Centre (Metropolitan Toronto) Inc. 13% Community Resource Connections of Toronto 9% St. Michael's Hospital 8% + 40 other HSPs CSS Providers Dixon Hall 48% Canadian National Institute for The Blind 10% + 17 other HSPs

• Moss Park is served by at least 44 CMHA providers and 19 CSS providers

39 Source: Community Business Intelligence, extracted Feb. 22, 2017 Mid- East Sub-Region Health Service Providers by Neighbourhood, 2017

Neighborhood Community Health Family Health Hospital Long Term Care Community Support Community Health and Addiction Shelter Center Team Service Moss Park -Anishnawbe Health -Sherbourne Health -The Rekai Centre -Dixon Hall -416 Community Support for Women/416 -Robertson House Toronto- Queen Site Centre at Sherbourne -The Neighborhood Drop-in Centre -Dixon Hall - Schoolhouse -Anishnawbe Health Place Group -Anishnawbe Health Toronto -Seaton House – Annex Toronto- Gerrard -Toronto People With -George Brown College of Applied Arts -Seaton House - Long Term Program Site AIDS Foundation and Technology -Seaton House - O'Neill -Sherbourne Health Centre -Sojourn House -Sound Times Support Services -Street Haven -St. Jude Community Homes -Sojourn House Transitional Housing -St. Michael's Homes -Salvation Army - Maxwell Meighen -Street Haven at the Crossroads PSU -Street Health Community Nursing -Salvation Army - Maxwell Meighen Foundation Transition to Housing -Fred Victor Transitional Women at Dundas -Salvation Army - Maxwell Meighen -Salvation Army - Gateway Cabbagetown-South St. -Regent Park -Fudger House James Community Health Centre, Pathways to Education Program Church-Yonge Corridor -Women's Health in -St. Michael's -St. Michael's -Fred Victor Centre -Central Toronto Youth Services -Covenant House - Rights of Passage Women's Hands Hospital Academic Hospital -Hospice Palliative Care -Gerstein Crisis Centre -Covenant House - Safe Beds FHT Ontario -Homes First Society, Savards -Covenant House Residence -LOFT Community -LOFT Community Services -Fred Victor Women's Hostel Services -Pilot Place Society -SVDP - Mary's Home -NABORS - Neighbors -Progress Place Rehabilitation Centre -Turning Point Allied for Better (Metropolitan Toronto Inc.) -FVC Church Site at Granby Opportunities in -Renascent Fellowship Residential Support -Society of St. Vincent de Paul, Toronto -The Good Neighbors' Central Council (Ozanam House) Club -The Governing Council for the Salvation Army in , on behalf of Toronto Harbour Lights Ministries -Toronto Public Health, City of Toronto Leaside- Bennington *

Note*: Leaside Bennington, Waterfront Communities-The Island and South Riverdale neighborhoods are split between sub-regions. Please note that some HSPs provide services to other neighbourhoods as well as provide different services in different neighborhood  40 Mid- East Sub-Region Health Service Providers by Neighbourhood, 2017

Neighborhood Community Health Family Health Team Hospital Long Term Care Community Support Community Health Shelter Center Service and Addiction North St. James Town -Casey House The Rekai Centre at -Centre for -Fife House – Hospice Wellesley Central Independent Living in Sherbourne Place Toronto (CILT) Inc. -St. Simon's -Fife House Foundation Inc. Regent Park -Regent Park -Good Shepherd -Mainstay Housing -Good Shepherd - Community Health Refuge Social -Good Shepherd Non- Barrett House Centre Ministries Profit Homes Inc. -Good Shepherd -Regent Park -COTA Health D.A.R.E. Community Health -Good Shepherd Centre,Parents for Centre Better Beginnings Rosedale- Moore Park -Yorkminster Park -Pine River Institute -YWCA - First Stop Meals on Wheels Woodlawn -YWCA - First Stop Woodlawn South Riverdale* -South Riverdale -The Heritage Nursing -Philip Aziz Centre for -Margaret's Housing -Red Door - Family Community Health Home Hospice Care and Community Shelter Centre Support Services Inc. -SVDP - Amelie House -Nellie's Women Shelter Waterfront -2 Spirit People of the Communities- The 1st Nations Island* -Les Centres d'Accueil Heritage -New Visions Toronto

Note*: Leaside Bennington, Waterfront Communities-The Island and South Riverdale neighborhoods are split between sub-regions. Please note that some HSPs provide services to other neighbourhoods as well as provide different services in different neighborhood  41 Toronto Community Housing Buildings in Moss Park TCH data ED and OMHRS data

42 Toronto Community Housing – High Needs Buildings in Moss Park, 2016

Total No. of Units % of One % of Bachelors Rent Geared to Development Name Building Address Classification (Rentable & non Bed in in Building Income (%) Rentable) Building

275 Shuter (formerly Moss Park) 275 Shuter Highrise 301 21.6% 51.8% 99.0% 285 Shuter St (formerly Moss Park) 285 Shuter Highrise 301 21.5% 51.8% 99.0% 295 Shuter St (formerly Moss Park) 295 Shuter Highrise 301 21.6% 51.8% 99.0% 251,279,283,285,241 Dan Harrison Complex Sherbourne Townhome 376 48.9% 33.0% 99.5% George St. (291) 291 George Highrise 132 100.0% 0.0% 100.0% Pembroke Mews 200 Sherbourne Highrise 199 58.3% 13.6% 96.5% Sherbourne Shuter 155 Sherbourne Highrise 301 40.2% 59.5% 99.3% South St. Jamestown 1 111/2 Aberdeen Ave Highrise 6 0.0% 16.7% 100.0% South St. Jamestown 2 26 Prospect Highrise 2 0.0% 0.0% 100.0% William Dennison Apartments 310 Dundas Seniors 166 79.5% 20.5% 100.0%

• Buildings range in size from 2 units in South St. Jamestown 2 to 376 units in Dan Harrison Complex • George St. is a 100% bachelor building with all residents having 100% rent geared to income • William Dennison Apartments is a seniors buildings with residents have 100% rent geared to income 43 Source: Toronto Community Housing Data, 2016 Toronto Community Housing – Demographics of High Needs Buildings in Moss Park, 2016

Total < 13 years 13-24 years 25-58 years 59-69 years Top 5 Languages Spoken Other Development Name Male (%)Female (%) 70+ years (%) Residents (% ) (%) (%) (%) Than English

275 Shuter (formerly Moss Somali, Amharic, French, Park) 458 53.7% 46.3% 17.7% 10.4% 52.8% 11.3% 7.7% Spanish, Vietnamese 285 Shuter St (formerly Moss Chinese, Amharic, Vietnamese, Park) 463 48.2% 51.8% 15.9% 10.8% 51.6% 14.2% 7.4% Somali, Mandarin 295 Shuter St (formerly Moss Somali, Vietnamese, Cantonese, Park) 497 51.4% 48.6% 13.7% 15.7% 49.6% 14.7% 6.3% Spanish, Amharic Dan Harrison Complex 197 75.1% 24.9% 0.0% 0.5% 66.0% 26.9% 6.6% Arabic, Somali, Cantonese,, Philippino, Tamil, Russian, George St. (291) 132 86.4% 13.6% 0.0% 2.3% 72.7% 23.5% 1.5% Chinese, Cantonese Amharic, Philippino, French, Pembroke Mews 220 60.0% 40.0% 13.6% 10.5% 55.5% 15.5% 5.0% Cantonese, Vietnamese Vietnamese, Cantonese, Sherbourne Shuter 314 58.9% 41.1% 3.2% 2.5% 58.0% 24.5% 11.8% Portuguese, Spanish, Chinese South St. Jamestown 1 0 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Data not ready South St. Jamestown 2 10 40.0% 60.0% 40.0% 20.0% 40.0% 0.0% 0.0% Data not ready Chinese, Cantonese, Vietnamese, William Dennison Apartments 165 53.3% 46.7% 0.0% 0.6% 1.2% 36.4% 61.8% Mandarin, Philippino

• The developments on Shuter St. (275 Shuter, 285 Shuter & 295 Shuter) have the highest number of residents • 291 George St. has the highest proportion of males and adults ages 25-58, while South St. Jamestown 2 and 285 Shuter have the highest proportion of females • William Dennison Apartments has the highest proportion of seniors 59+ • Residents in all buildings are multicultural and speak a variety of languages 44 Source: Toronto Community Housing Data, 2016 Appendix

45 ICD 10 Codes used for Mental Health and Addictions Conditions

• Data Inclusions: • Ontario residents • ED visits − unscheduled visits to hospital emergency departments or urgent care centres (AM case type = EMG) • ICD10 codes: the following ICD−10 codes reported for the main problem diagnosis (MPDx) for the ED visit: • Mental and Behavioral Disorders: F03,F04,F059,F067,F068,F072,F09,F100,F101,F102,F103,F108,F109,F110,F111,F112,F113,F119,F121,F122,F12 5,F131,F140,F141,F142,F145,F150,F151,F152,F153,F155,F158,F160,F161,F163,F181,F190,F191,F192,F193,F1 95,F198,F199,F200,F201,F202,F203,F205,F208,F209,F220,F229,F239,F251,F258,F259,F29,F300,F309,F311,F3 12,F313,F314,F315,F316,F318,F319,F321,F322,F323,F328,F329,F330,F331,F332,F333,F339,F341,F39,F400,F4 10,F411,F412,F418,F419,F430,F431,F432,F439,F449,F458,F459,F55,F600,F602,F603,F605,F608,F609,F61,F69, F709,F719,F849,F900,F99 • Injury and Poisoning and Certain Other Consequences of External Causes: T401, T402, T403, T406, T510, T512 • Factors Influencing Health Status and Contacts with Health Services: Z502, Z503, Z722

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