Towards a Northern Centre of Excellence for Addiction and Mental Health

Engagement Results for: THUNDER BAY DISTRICT (excluding the city of Thunder Bay)

Northwestern Ontario Engagement Nov 2017 - Mar 2018 Thunder Bay District Engagement Sessions (excluding the city of Thunder Bay)

NORTH WEST LHIN FACE-TO-FACE SESSIONS 2 Marathon and Longlac: Nov 2017

TELECONFERENCE SESSIONS 2 Rural and Remote First Nations: Nov 2017 Rural Communities: Feb 2018

VIDEOCONFERENCE SESSION Northwestern Ontario EAST: 1 Jan 2018

VIDEOCONFERENCE / TELECONFERENCE SESSION 1 Northwestern Ontario EAST 2: Mar 2018

PARTICIPANTS FROM 24 ORGANIZATIONS serving Marathon, Longlac, Greenstone, Nipigon, Manitouwadge, Terrace Bay, THUNDER BAY surrounding rural communities and 9 First Nations. DISTRICT 43 Of these, 20 participants were affiliated with Indigenous 17 661 people | 61 215 km2 organizations and organizations serving Indigenous people 44% rural 12% Francophone** * 30% Aboriginal Identity SECTORS ROLES 28% Youth 0-24 years Addiction, Mental Health, Front-line workers and Managers 5 Major towns, 9 First Nations Social Services, in Indigenous-specific and non-Indigenous Housing, Public Health, organizations, including Physicians, Nurses, Marathon to Thunder Bay: Primary Care, Hospital, Social Workers, Police, Counsellors, 3.5 hours drive Emergency Services, People with Lived Experience, (Source: Statistics Canada, 2016 Census) *“Aboriginal” is used to reflect census Justice, Peer Support Community Leaders, Outreach Workers 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 the Addiction and Mental Northwestern Ontario Thunder Bay District? Health help? look like? A Priority Mental Health & Addiction Issues --Thunder Bay District (excluding city of Thunder Bay)

1. EMERGING TRENDS 3. NO EMERGENCY SERVICES OR 5. WORKFORCE ISSUES AFTERCARE AVAILABLE LOCALLY • While there is a perception that • Burnout and compassion fatigue the opioid crisis is not as bad • Locally, people in a crisis cycle causes high turnover; social work as it was 5 years ago, cocaine, between hospital and police, and law enforcement graduates methamphetamine, fentanyl, and nowhere else to send them; no often not prepared for rural work cannabis problems are getting homeless shelters in communities worse • When workers change clients have a • People who require specialized care hard time trusting staff; it takes time • Increase in drug use linked to can wait up to 7 days before they to build rapport with someone: “Why increase in synthetic drugs arriving can access services in Thunder Bay, should I share my story with you?” along the highways; more drug- but no guarantee there will be a induced psychosis is being seen bed available • Accessing specialized addiction and mental health training is • Additional mental health needs • Few aftercare options for those expensive; sending a staff member related to shifting employment discharged after treatment; wait to Thunder Bay for a 3-day session patterns; families experiencing lists for counselling in every can cost over $3,000 more stress community and transportation to services is an issue • Children and youth using drugs at 6. MEETING NEEDS OF INDIGENOUS earlier ages AND FRANCOPHONE CLIENTS 4. POOR COORDINATION OF CARE • Intra-familial drug use and use of AND UNCLEAR CARE PATHWAYS • Many Indigenous people want multiple substances is common cultural help and benefit from • “Silo effect” means clients must healing programs that connect to access multiple organizations the land and traditions; however, 2. LIMITED LOCAL ADDICTION AND and fill out several consent forms few cultural supports off-reserve MENTAL HEALTH SERVICES to address addiction and mental health needs • First Nations are not all the • No detox centre east of Thunder Bay; same; cannot take a “one size long waitlists; up to 4 years for • Complex referral patterns increase fits all” approach to develop local government-funded treatment centres likelihood that clients will lose Indigenous addiction and mental connection to services; care health programs • Few Suboxone and methadone pathways that work in urban areas programs available in district; not a good fit for small towns, rural, • Although Thunder Bay District has clients are rarely weaned off these or remote communities a concentration of Francophone medications and programs don’t residents, getting French-speaking connect with counselling • Advocacy is necessary to help services is “next to impossible” clients navigate the system • Gap between mental health services • When Francophone clients are and addiction services; lack of transferred to city for crisis integrated programming causes care, wait times double while challenges for clients and providers interpreters are located

• Important to be able to refer clients to “the right person at the right time”, but not often possible

• Clients become “fed up” having to wait a long time for appointments

• Very little “after hours” support available for clients locally

• Lack of services specifically for youth Priority Mental Health & Addiction Issues --Thunder Bay District (excluding city of Thunder Bay) 7. RELUCTANCE TO SEEK ADDICTION 8. COMPLEX NEEDS 9. FUNDING ISSUES AND MENTAL HEALTH SERVICES • When clients have to wait for • Several participants stated that • There was widespread agreement services, local agencies have current Thunder Bay District that people are reluctant to seek trouble meeting basic needs for sub-region funding allocations are help due to the stigma around food and shelter; whole families insufficient to meet demands for care addiction and mental health need to be supported • Some staff felt under-resourced • Trauma and hopelessness are seen • Safe housing for those with services meant they could not as underlying causes of mental health addiction or mental health issues deliver adequate care: they were problems and addiction; “Addiction is is a priority; no homeless shelters “putting out fires instead of running just a symptom of the trauma” and rent is extremely expensive effective programs”

• People leave for treatment but • Lack of public transportation is an • Inflexible provincial and federal return to the same environment; issue; because space in medical funding criteria also restricted their without support, they relapse; vans is limited, people must use ability to “think outside the box” those who start using again have costly taxis or find private vehicles and customize programs to meet high risk of death to get to appointments local needs

• Suicide rates are high and timely crisis cycle Suboxone and intervention is necessary safe housing trauma methadone tapering • In small communities, people often confidentiality cocaine fentanyl methamphetamine are reluctant to share problems due multisubstance use suicide to confidentiality concerns; some transportation aftercare prefer going elsewhere for care gaps economic stress no detox centre on families • Parents can be reluctant to seek drug induced psychosis care for addiction and mental trust wait times expensive health for fear their children will be relapse silo effect taken away Francophone food and shelter Indigenous high turnover stigma virtual

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

1. WHAT COULD A NORTHERN • Determine limits of local addiction staff on compassion fatigue, safety, CENTRE OF EXCELLENCE DO? programs, identify what is working self-care, trauma and debriefing or not, and survey clients about what • Assess local client needs through is needed to improve quality of care • Identify gaps in knowledge about surveys on barriers, harm reduction, services and offer service provider and basic issues; results could • Encourage collaboration between and client education in navigating be used to develop strategies to partner sites to solve coordination the system improve access to care of care problems and inform clients about the circle of support locally • Promote local education and • Build local capacity by connecting awareness programs, including service providers, community partners, • Engage people with lived experience school-based programs for youth and clients to facilitate sharing to create videos to share their at risk of addiction or mental health experiences and best practices stories; such videos could reduce challenges stigma and improve provider • Conduct analysis of mental health awareness • Support community-based healing and addiction funding and assist and treatment centres that address organizations with funding proposals • Deliver supportive online and face- First Nations clients’ need for to improve equity in access to care to-face workshops for front-line cultural care 2. WHAT SHOULD A NORTHERN CENTRE OF EXCELLENCE LOOK LIKE? FACE-TO-FACE, VIRTUAL, OR BLENDED?

• Blended model preferred; face-to- • Centre of Excellence should face and human connection is very be accessible to people with important and virtual component lived experience, families, and (telephone and internet) necessary community members to bridge distances • Virtual information and peer • Ideally, centre in Thunder Bay with supports could work well for rural outreach workers and offices in and remote communities partner sites located in small towns across Northwestern Ontario

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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]