A Study of Impact of Targeted Community Mental Health Funding on Utilization of Hospital and Corrections Services by Persons with Mental Illness the ‘Impact Study’

A Study of Impact of Targeted Community Mental Health Funding on Utilization of Hospital and Corrections Services by Persons with Mental Illness The ‘Impact Study’

Baseline Report, November 2006

Part 2

Profiles of LHINs and Local Systems

Study Team Janet Durbin Brian Rush Daryl Boshart Brendan Smith

Health Systems Research and Consulting Unit Centre for Addiction and Mental Health

Funded by Ontario Ministry of Health and Long Term Care 2

Table of Contents

RATIONALE FOR LOCAL SYSTEMS...... 3 METHOD FOR DEVELOPING LOCAL SYSTEM DEFINITIONS...... 3 RESULTS...... 4 NEXT STEPS...... 5 LOCAL SYSTEM IN RELATION TO THE LHINS...... 6 Table 1: Local Systems within LHINs...... 6 Figure 1: LHINs and local system boundaries - Ontario ...... 8 Figure 2: LHIN and Local System boundaries - by Ontario region...... 9 RESULTS: LHIN AND LOCAL SYSTEM PROFILES ...... 10 LHIN 1: Erie St. Clair ...... 10 LHIN 2: South West ...... 11 LHIN 3: Waterloo Wellington...... 12 LHIN 5: Central West ...... 14 LHIN 6: Mississauga Halton...... 15 LHIN 7: Toronto Central...... 16 LHIN 8: Central...... 18 LHIN 9: Central East ...... 19 LHIN 10: South East...... 20 LHIN 11: Champlain ...... 21 LHIN 12: North Simcoe Muskoka...... 22 LHIN 13: North East...... 23 LHIN 14: North West...... 24 Appendix 1: Data sources ...... 25 Appendix 2: LHIN boundaries...... 26 3

RATIONALE FOR LOCAL SYSTEMS

The main aim of the Impact study is to monitor changes in use of hospital and jail services by persons with mental illness as new community mental health funding enters the system. These new resources are being provided through two initiatives – the Federal Accord initiative to enhance home care supports and the inter-ministerial initiative for justice and mental health, targeted to individuals with mental illness who come in contact with the law. The primary aim of the Accord funding is to provide community- based, intensive individualized supports for persons with severe and persistent mental illness, thus reducing likelihood of decompensation and need for hospitalization. The primary aim of the justice (system enhancement or SE) funding is to provide a treatment alternative to incarceration, thereby reducing the criminalization of the mentally ill.

This report establishes baseline system performance. Part 1 reported results for 13 indicators of capacity and hospital/jail utilization across a range of areas where a change in performance is expected as a result of the new funding. These results are reported for the province overall and for 14 Local Health Integration Networks (LHINs), the current regional governance structure in the province for provision of health care.

While the LHINs hold ultimate accountability for health system performance, LHIN areas are large in terms of both population and geographic size, and include a multiplicity of health organizations. Efforts to provide integrated and responsive service delivery are likely to occur in smaller geographic areas or local systems. As a result, the relationship between system change (resources and organization) and consumer utilization of hospital and jail services may be stronger at the local system level than at the LHIN level, and the local system may be more informative for identifying system practices that help consumers stay of out hospital and jail. While local mental health systems are not formally defined in Ontario and do not have an accountability mandate, feedback from system decision makers early in the project suggested that local systems can be geographically identified and characterized for evaluation purposes.

During the spring and summer of 2006, the study team worked with CAMH system planners, Ministry regional staff and other stakeholders to define meaningful local systems of care. In total 32 were identified and geographic boundaries were defined. The next section outlines in more detail the process used to define the local systems. This is followed by the results, reported in 14 summary tables (local systems within LHINs).

METHOD FOR DEVELOPING LOCAL SYSTEM DEFINITIONS

The process of defining the local systems began with a presentation to regional leads at the Ministry of Health and Long-term Care (MOHLTC) in August of 2005. The feasibility and value of defining local systems was discussed and supported.

During the next months the study team worked with the CAMH system planners, MOHLTC regional consultants and other local stakeholders as needed to define the local systems. We suggested that areas be considered local systems if: • there was a system planning table with representation from most mental health agencies in the area; • the area was consistent with Ministry expectations for local system development; • most area residents were thought to obtain mental health care from programs in the area; • the area population exceeded 50,000 people, as estimates of service use would become very small and unstable for smaller populations. 4

In all, 32 local systems were defined that were consistent with these criteria.

The final stage involved creating geographic boundary definitions for the identified local systems. Most of the systems were defined by county boundaries (e.g., Essex, Kent, and Lambton make a local system). In some cases, local systems did not fall within county boundaries and the “census subdivision” unit was used. In Statistics Canada geography, census subdivisions are one classification smaller than the county unit of analysis.

Some local systems were relatively easy to define applying the above criteria. For example, four local systems were defined in the North East and three in Champlain that were relatively self contained in terms of agency collaboration and local population service use patterns. In other cases, local system definitions were not as clear, especially in the more densely populated areas where populations and services tend to be contiguous. For example, in the Halton and Peel region, it was uncertain whether services and consumers in Mississauga aligned more with the Burlington- Oakville local system or with Caledon-Brampton. The final decision, based on stakeholder input, was that Mississauga be included in the Burlington-Oakville local system, hence that local system crossed into LHINs 4 and 5. There were a number of situations where local system boundaries were based on pre-LHIN service use patterns, hence crossed the current LHIN boundaries.

Toronto-Central was particularly challenging to characterize. Because of the density of the services and the population, no naturally occurring separation of services and users into local systems could be made. After considerable feedback from stakeholders, a decision was made to keep Toronto intact as one local system, with boundaries consistent with its municipal boundaries prior to development of the LHINs. Only the Scarborough area was separated.

In total 32 local systems were defined. These are discussed in the next section.

RESULTS

Table 1 provides a brief summary of the local systems identified within each LHIN. For each local system the table indicates the population, main cities and relationship to LHIN boundaries. As indicated previously, many local systems cross LHIN boundaries. Local system population sizes are much smaller than the LHINs for the most part, although there are still several very large ones – e.g., Toronto and Mississauga-Oakville-Burlington. Local system population sizes range from 72,000 to 2 million. Within LHINS, the number of local systems ranges from one to five. Figures 1 and 2 provide visual representations (maps) of the local systems within LHINs. Appendix 2 provides a LHIN map.

The remainder of this document profiles the mental health service capacity in Ontario through a series of 14 tables, one for each LHIN, subdivided by local systems. Each community mental health organization in the province was mapped into to a local system, based on the location of their administrative/corporate office. Therefore, for each local system we list all MOHLTC funded community mental health agencies and indicate system per capita funding4. For each LHIN we list the schedule 1 hospitals and indicate physician capacity. A full listing of data sources used to produce these tables is provided in Appendix 1.

4 Agency addresses were obtained from Mental Health Service Information Ontario - CONNEX Ontario data base and agency funding was obtained from the MoHLTC Community Mental Health Budgets and Programs Inventory. 5

NEXT STEPS

The idea underlying the development of the local systems is that it is these areas that assume de facto responsibility for providing mental health care to local residents, hence are in a position to enhance community care with the new resources and reduce use of hospital services and contacts with the justice system by residents with mental health concerns. We can calculate the rate of hospital and jail use of persons residing in local systems, for all of the indicators reported in Part 1.

In our follow-up consultations with local stakeholders, the local system (LS) descriptions will be presented, along with local system indicator results, in order to: • determine if the LS boundaries make sense; • make any necessary corrections, e.g., re geographic locations of the agencies; • discuss whether the systems will be useful for understanding the impact of changing system practices in resources on client outcomes.

Both hospitals and community organizations were assigned to a system based on the location of their administrative/corporate office. This impact of this limitation, which reduces accuracy of capacity calculations, will also be discussed.

LOCAL SYSTEM IN RELATION TO THE LHINS

Table 1: Local Systems within LHINs

LHIN # local Major cities Local system names Relationship to Pop (pop) systms LHIN boundaries* #1 Erie St. Clair 1 Sarnia Essex/Kent/Lambton Within 640K (643K)

London London- Within 600K #2 South West 3 Middlesex/Elgin/Oxford (920K) Stratford Huron/Perth Within 140K Owen Sound Grey-Bruce Crosses into LHINs 160K 3 &12

#3 Waterloo/ 1 Kitchener Waterloo/Wellington/ W-W-D crosses into 720K Wellington (678K) Waterloo Dufferin LHIN #5

#4 Hamilton Niagara 3 Hamilton Hamilton Within 520K Haldimand Brant N. Falls Niagara Within 420K (1343K) Port Dover Haldimand-Norfolk & Crosses into LHIN 234K Brant #2

#5 Central West 1 Brampton Brampton-Caledon Within 410K (700K)

#6 Mississauga 2 Milton Halton Hills Within 86K Oakville (1008K) Mississauga Mississauga-Oakville- Crosses into LHINs 988K Burlington 4 & 5

#7 Toronto Central 1 Toronto, Toronto Crosses into LHINs 2.0 million (1151K) minus Scar. 5, 6, 8

#8 Central 1 Aurora York Within 813K (1505K)

Scbrgh Scarborough Within 587K #9 Central East 5 Oshawa Durham Within 546K (1437K) Peterboro Peterborough & Haliburton Within 147K Lindsay Kawartha Lakes Within 72K Cobourg Northumberland Within 82K

Brockville Lanark, Leeds and Crosses into LHIN 167K #10 South East 3 Grenville (entire) 11 (479K) Kingston Frontenac, Lennox and Within 186K Addington Bancroft Hastings and Prince Edward Within 157K

Ottawa Ottawa Within 821K #11 Champlain 3 Cornwall Stormont, Glengarry- Within 195K (1170K) Prescott, Dundas, Russell Petawawa Renfrew County Within 100K

Barrie Simcoe Crosses into LHIN 410K #12 North Simcoe 2 #8 Muskoka (409K) Parry Sound Muskoka/ Parry Sound Parry Sound crosses 98K to LHIN13

The Soo Algoma District Within 120K #13 North East 4 Sudbury Sudbury/Manitoulin Within 196K (571K) North Bay Nippissing/Timiskiming Within 120K Timmins Cochrane District Within 85K

T-Bay Thunder Bay District Within 154K #14 North West 2 (243K) Keewatin Kenora/Rainy River District Crosses into LHIN 86K 13 Total 32

*Notes if local systems cross into other LHINs

Figure 1: LHINs and local system boundaries - Ontario

Figure 2: LHIN and Local System boundaries - by Ontario region

Southwestern and Central Ontario Northern Ontario

Eastern and Champlain Regions

• Black lines = LHIN boundaries • Shades of grey = Local Systems 10

RESULTS: LHIN AND LOCAL SYSTEM PROFILES

LHIN 1: Erie St. Clair

System Feature* LHIN Local Systems Name Erie St Clair Essex-Kent-Lambton

Population 643,205 (82) 643,205 (82) (density) Main Cities Windsor, Chatham, Sarnia Schedule 1 Acute: 17.4 Specialty: 2.6 beds/100K pop Schedule 1 Specialty hosp (0): No Specialty hospitals facilities ** Gen hosp (4): Bluewater Health, Hotel Dieu Grace Hospital – Hotel Dieu of St. Joseph’s Site, The Public General Hospital Society Of Chatham, Windsor Regional Hospital CMH funding $27.34/pc (FY 03) $27.65/pc (FY 03) $30.96/pc (FY 04) $31.30/pc (FY 04) CMH - Bluewater Health agencies** - Bulimia Anorexia Nervosa Association (BANA) - CMHA Chatham-Kent Branch - CMHA Lambton County Branch - CMHA Windsor-Essex Branch - Chatham-Kent Consumer/Survivor network Inc. - Chatham-Kent Health Alliance - Family Counselling Centre - The Hospice of Windsor and Essex County - Mental Health Connections - Mental Health Consumer/Survivor Employment Association of Essex County - Religious Hospitallers of the Hotel-Dieu of St Joseph of the Diocese of London - Sexual Assault Crisis Centre of Essex County - Windsor Regional Hospital MD capacity Psy: 4.5 FTEs FPs: 64.5 FTEs N/A * See Appendix 1for data source information. ** Organizations were assigned to a LHIN or local system based on the location of their administrative/corporate office. 11

LHIN 2: South West

System Feature* LHIN Local Systems Name South West Huron-Perth Grey-Bruce Middlesex-Elgin-Oxford

Population 919,962 (42) 139,354 (23) 160,111(18) 613,093 (80) (density) Main Cities London, St. Thomas, Woodstock

Schedule 1 Acute: 17.8 Specialty: 63.2 beds/100K pop Schedule 1 Specialty hosp (1): St. Joseph's Health Care, London facilities ** Gen Hosp (4): Alexandra Marine And General Hospital, Grey Bruce Health Services Owen Sound, London Health Sciences Centre, Woodstock General Hospital CMH funding $34.49/pc (FY03) $34.80/pc (FY 03) $36.90/pc (FY 03) $34.21/pc (FY 03) $39.41/pc (FY04) $36.79/pc (FY 04) $41.93/pc (FY 04) $39.71/pc (FY 04) CMH - Alexandra Marine and General - CMHA Grey Bruce Branch - CMHA Elgin Branch agencies** Hospital - Grey Bruce Community - CMHA London/Middlesex Branch - CMHA Huron-Perth Branch Health Corp - CMHA Oxford County Branch - Phoenix Survivors Perth County - Grey Bruce Health Services - Can-Voice Consumer/Survivor Community Mental Health Peer Support Support Services, Centre - Crest Centre (Meadowcrest) Inc. - Stratford General Hospital - Family Service London/Thames Valley - Women's Shelter, Second Stage - London Health Sciences Centre Housing and Counselling - Mission Services of London Services of Huron - Oxford Self-Help Network - Psychiatric Survivors Network of Elgin - Search CMH Services - St. Joseph's Health Care London - Violence Against Women Services Elgin County - Western Ontario Therapeutic Community Hostel (WOTCH) - Women's Emergency Centre Oxford - Women's Mental Health Resources - Woodstock General Hospital MD capacity Psy: 11.3 FTEs FPs: 73.6 FTEs * See Appendix 1 for data source information. ** Organizations were assigned to a LHIN or local system based on the location of their administrative/corporate office. 12

LHIN 3: Waterloo Wellington

System Feature* LHIN Local Systems Name Waterloo Wellington Waterloo-Wellington-Dufferin

Population (density) 677,887 (134) 724,643 (124) Main Cities Waterloo, Kitchener, Cambridge, Guelph Schedule 1 beds/100K pop Acute: 21.5 Specialty: 26.8 Schedule 1 facilities ** Specialty hosp (1): Homewood Health Centre Gen hosp (1): Grand River Hospital Corporation CMH funding $18.09/pc (FY 03) $17.01/pc (FY 03) $23.96/pc (FY 04) $23.96/pc (FY 04) CMH agencies** - Cambridge Active Self Help (CASH) - Cambridge Memorial Hospital - CMHA Waterloo Regional Branch - CMHA Wellington - Dufferin Branch - Catholic Family Counselling Centre (Region of Waterloo) - Community Mental Health Clinic – Guelph - Family Counselling and Support Services for Guelph- Wellington - Grand River Hospital Corporation - Homewood Health Centre Inc. - Torchlight Services - Waterloo Regional Homes for Mental Health Inc. - Waterloo Regional Self Help (WRSH) - Welling-Dufferin Homes for Psychiatric Rehabilitation

CMH agencies located in LHIN 5: - Family Transition Place

MD capacity Psy: 7.1 FTEs FPs: 68.2 FTEs * See Appendix 1 for data source information. ** Organizations were assigned to a LHIN or local system based on the location of their administrative/corporate office. 13

LHIN 4: Hamilton Niagara Haldimand Brant

System Feature* LHIN Local Systems Name Hamilton Niagara Hamilton Brant-Haldimand-Norfolk Niagara Haldimand Brant Population 1,343,403 (194) 518,558 (429) 234,481 (55) 428,491 (215) (density) Main Cities Hamilton, Stoney Creek Brantford Burlington (in LHIN 6 local St. Catharines, Welland, system) Niagara Falls

Schedule 1 Acute: 14.7 Specialty: 12.1 beds/100K pop Schedule 1 Specialty hosp (1): St. Joseph's Healthcare (Hamilton) facilities ** Gen hosp (6): The Brantford General Hospital; Hamilton Health Sciences Corporation, Joseph Brant Memorial Hospital**; Niagara Health System - Greater Niagara General Hospital site, St. Catharines General site and Welland County General Hospital site CMH funding $18.82/pc (FY 03) $21.72/pc (FY 03) $23.10/pc (FY 03) $11.25/pc (FY 03) $23.59/pc (FY 04) $28.07/pc (FY 04) $25.86/pc (FY 04) $11.92/pc (FY 04) CMH agencies*** - CMHA Hamilton Branch - Adult Mental Health Services - CMHA Niagara Branch - City of Hamilton of Haldimand-Norfolk - Consumer/ Survivor Initiative - Good Shepherd Non-Profit - Brant Community Healthcare of Niagara Homes Inc. System - Gateway Residential and - Hamilton Health - CMHA Brant County Branch Community Support Services Sciences Corporation - Erie’s North Shore Housing of Niagara - Hamilton Program for Inc. - Niagara Health System Schizophrenia - Haldimand- Norfolk Women’s - Oak Centre Alternative - Mental Health Rights Coalition Services Community Support of Hamilton - Haldimand Norfolk Work - Region Municipality of - St. Joseph’s Healthcare Group of Simcoe (HNWGS) Niagara Hamilton (SJHH) - St. Leonard’s - West Lincoln Memorial -Wellington Psychiatric Outreach Community Services - True Hospital Program Experience Supportive Housing and Community Work Program MD capacity Psy: 8.5 FTEs FPs: 69.0 FTEs * See Appendix 1 for data source information. ** Hospital is located in Burlington-Oakville-Mississauga Local System (see LHIN 6 table) *** Organizations were assigned to a LHIN or local system based on the location of their administrative/corporate office.

LHIN 5: Central West

System Feature* LHIN Local Systems Name Central West Brampton-Caledon

Population (density) 699,631 (256) 410,580 (407) Main Cities Brampton Brampton

Schedule 1 beds/100K Acute: 12.4 Specialty: 0 pop Schedule 1 facilities * Specialty hosp (0): No specialty hospitals Gen hosp (2): William Osler Health Centre - Brampton Hospital Campus, William Osler Health Centre – Etobicoke Hospital Campus CMH funding $15.02/pc (FY 03) $10.64/pc (FY 03) $19.83/pc (FY 04) $16.53/pc (FY 04) CMH agencies** (4) - CMHA Peel Branch - Friends & Advocates Peel - Peace Ranch - William Osler Health Centre MD capacity Psy: 5.3 FTEs FPs: 61.5 FTEs

* See Appendix 1 for data source information. ** Organizations were assigned to a LHIN or local system based on the location of their administrative/corporate office.

LHIN 6: Mississauga Halton

System Feature* LHIN Local Systems Name Mississauga Halton Burlington-Oakville-Mississauga Halton Hills-Milton

Population (density) 1,008,121 (906) 988,265 (1524) 86,322 (127)

Main Cities Mississauga

Schedule 1 beds/100K pop Acute: 8.6 Specialty: 1.0

Schedule 1 facilities** Specialty hosp(0): No specialty hospitals Gen hosp (3): Credit Valley Hospital, Halton Healthcare Services Corporation -Trafalgar Memorial Hospital, Trillium Health Centre CMH funding $8.43/pc (FY 03) $14.10/pc (FY 03) $17.64/pc (FY 03) $9.89/pc (FY 04) $15.24/pc (FY 04) $31.19/pc (FY 04) CMH agencies** - The Credit Valley Hospital - CMHA Halton Region Branch - Grace House Inc. - Region of Halton Health Department, Community - Halton Healthcare Service Corporation Health Services - Support and Housing – Halton (SHH) - Supported Training and Rehabilitation in Diverse - Trillium Health Centre Environments (STRIDE)

CMH agencies located in LHIN 4: - Joseph brant Memorial Hospital Corporation - Summit House & Outreach Programs

CMH agencies located in LHIN 5: - Supportive Housing in Peel MD capacity Psy: 7.5 FTEs FPs: 72.6 FTEs

* See Appendix 1 for data source information. ** Organizations were assigned to a LHIN or local system based on the location of their administrative/corporate office.

LHIN 7: Toronto Central

System Feature* LHIN Local Systems Name Toronto Central Toronto

Population (density) 1,150,938 (5663) 2,006,384 (4221) Main Cities Toronto Schedule 1 Acute: 21.1 Specialty: 50.6 beds/100K pop Schedule 1 Specialty hosp (1): Centre for Addiction and Mental Health (4 sites) facilities** Gen hosp(7): Baycrest Hospital, Mount Sinai Hospital, St. Michael's Hospital, St. Joseph's Health Centre, Sunnybrook And Women's College Health Sciences Centre, Toronto East General Hospital, University Health Network CMH funding $76.05/pc (FY 03) $55.56/pc (FY 03) $84.42/pc (FY 04) $62.70/pc (FY 04) CMH agencies** - Accommodation, Information and Support Inc - St. Christopher House - A-way Express Courier Service - St. Joseph's Health Centre - The Barbara Schlifer Commemorative Clinic - St. Jude Community Homes - Baycrest Centre for Geriatric Care - St. Michael's Hospital - Boundless Adventures - St. Stephen's Community House - Breakaway Survivors Inc. - The Street Haven at the Crossroads - The Canadian Hearing Society - Street Health Community Nursing - CMHA Ontario Division Foundation - Central Toronto Youth Services - Sunnybrook Health Science Centre - Centre for Addiction and Mental Health (CAMH) - The Toronto East General - Community Housing Support Service of Toronto - Trinity Square Enterprises - Community Resource Connections of Toronto (CRCT) - University Health Network - Consumer/Survivor Information Resource Centre of - West Park Healthcare Centre Toronto - Women's Counselling Referral and Education - Cross Toronto Community Development Corporation Centre (WCREC) - East York Mental Health Counselling Services Agency - Woodgreen Community Services - Eden Community Homes - YWCA Toronto - Family Association for Mental Health Everywhere (FAME) CMH agencies located in LHIN 5: - Friends and Advocates Centre - Friends of the Shopping Bag Ladies - Reconnect Mental Health Services - George Brown College - George Herman House CMH agencies located in LHIN 8: - Gerstein Crisis Centre - Habitat Services (Mental Health Program Services of - Across Boundaries: An Ethnocultural Mental 17

Metropolitan Toronto) Health Centre - Homes First Society - Bayview Community Services Inc - Homeward Mental Health Projects of Metropolitan - CMHA Metropolitan Toronto Region Branch Toronto - Cota Health - The Hospital for Sick Children - Humber River Regional Hospital - Houselink Community Homes - Jane Finch Community and Family Services - Lakeshore Area Multi-Service Project Inc. (LAMP) - North York General Hospital - Loft Community Services - Ontario Federation of Community Mental - Madison Avenue Housing and Support Health and Addictions Programs - Mainstay Housing - Seneca College - Margaret Frazer House Toronto North Support Services - Mood Disorders Association of Ontario - Mount Sinai Hospital - My Brother's Place - The Ontario College of Family Physicians - Ontario Council of Alternative Businesses - The Ontario Mental Health Foundation - Ontario Peer Development Initiative - Opportunity for Advancement - The Parkdale Activity - Recreation Centre (PARC) - Pilot Place Society - Progress Place - Regeneration Housing and Support Services - Schizophrenia Society of Ontario - Sherbourne Health Centre - Sistering - A Women's Place - Sound Times Support Services of Metropolitan Toronto MD capacity Psy: 54.0 FTEs FPs: 120.9 FTEs * See Appendix 1 for data source information. ** Organizations were assigned to a LHIN or local system based on the location of their administrative/corporate office. 18

LHIN 8: Central

System Feature* LHIN Local Systems Name Central York

Population (density) 1,504,817 (469) 813,928 (371)

Main Cities Vaughan

Schedule 1 beds/100K pop Acute: 10.0 Specialty: 1.1

Schedule 1 facilities** Specialty hosp (0): No specialty hospitals Gen hosp (4): Humber River Regional Hospital, Markham-Stouffville Hospital, North York General Hospital, Southlake Regional Health Centre CMH funding $19.21/pc (FY 03) $30.20/pc (FY 03) $23.71/pc (FY 04) $34.81/pc (FY 04) CMH agencies** - CMHA York Region Branch - The Chai-Tikvah Foundation - Lance Krasman Memorial Centre for Community Mental Health - Markham-Stouffville Hospital - Southlake Regional Health Centre (SRHC) - York Central Hospital - York Region Abuse Program - York Support Services Network MD capacity Psy: 9.2 FTEs FPs: 77.4 FTEs

* See Appendix 1 for data source information. ** Organizations were assigned to a LHIN or local system based on the location of their administrative/corporate office. 19

LHIN 9: Central East

System Feature* LHIN Local Systems Name Central East Durham Kawartha Lakes Peterborough- Northumberland Scarborough Haliburton Population (density) 1,436,769 (82) 546,161 (199) 72,757 (21) 147,417 (16) 82,135 (39) 587,417 (3102)

Main Cities Oshawa Peterborough

Schedule 1 beds/100K Acute: 12.7 Specialty: 18.4 pop Schedule 1 Specialty hosp (1): Whitby Mental Health Centre facilities** Gen hosp (6): Rouge Valley Health System (Ajax and Pickering), Lakeridge Health Corporation (Oshawa), Peterborough Regional Health Centre, Ross Memorial Hospital, Rouge Valley Health System (Toronto), The Scarborough Hospital CMH funding $14.83/pc (FY 03) $11.90/pc (FY 03) $23.31/pc (FY 03) $23.46/pc (FY 03) $15.70/pc (FY 03) $14.24/pc (FY 03) $17.70/pc (FY 04) $15.37/pc (FY 04) $24.94/pc (FY 04) $34.09/pc (FY 04) $18.72/pc (FY 04) $14.67/pc (FY 04) CMH agencies** - Alzheimer Society of – CMHA Victoria - CMHA - Campbellford - The Governing Durham Region County Branch Peterborough Memorial Council of the - CMHA Durham - The Ross Branch hospital, Salvation Army in Branch Memorial - Haliburton - Northumberland Canada - Community Care Hospital Highlands Health Hills Hospital - Hong Fook Mental Durham - Survivors Services Health Association - Durham Mental Psychiatric Corporation - Rouge Valley Health Health Services Advocacy - Peterborough System - Lakeridge Health Network Regional Health - Scarborough Hospital Corporation Centre - United Survivors Support Centre - Victorian Order of Nurses (VON) Canada – Ontario Branch - Whitby Mental Health Centre MD capacity Psy: 6.0 FTEs FPs: 69.7 FTEs

* See Appendix 1 for data source information. ** Organizations were assigned to a LHIN or local system based on the location of their administrative/corporate office.

LHIN 10: South East

System Feature* LHIN Local Systems Name South East Prince Edward-Hastings Frontenac-Lennox-Addington Lanark-Leeds-Grenville

Population (density) 478,892 (24) 157,806 (20) 186,674 (25) 167,688 (24)

Main Cities Belleville Kingston

Schedule 1 Acute: 18.0 Specialty: 84.4 beds/100K pop Schedule 1 Specialty hosp (2): Providence Continuing Care Centre Mental Health Services (former Kingston Psychiatric Hospital), Royal Ottawa facilities** Health Care Group (Brockville) Gen hosp (4): Brockville General Hospital, Hotel Dieu Hospital (Kingston), Kingston General Hospital, Quinte Healthcare Corporation CMH funding $46.55/pc (FY 03) $31.21/pc (FY 03) $62.63/pc (FY 03) $35.62/pc (FY 03) $52.28/pc (FY 04) $33.41/pc (FY 04) $73.59/pc (FY 04) $37.41/pc (FY 04) CMH agencies** - Addictions Centre - Frontenac Community Mental - Brockville and Area Centre for (Hastings/Prince Edward Health Services (FCMHS) Developmentally Handicapped Counties) Inc. - Kingston General Hospital Persons - Mental Health Services Hastings - Lennox and Addington - CMHA) Leeds-Grenville Branch Prince Edward Corporation Addiction Services Inc. - Leeds & Grenville Rehabilitation - Mental Health Support Network - Lennox and Addington and Counselling Services Hastings Prince Edward Community Mental Health - Perth and Smiths Falls District Corporation Services Hospital - Quinte Health Care - Peer Support of Kingston Inc. - Tricounty Addictions Program - Sexual Assault Centre for - Providence Continuing Care Quinte and District Centre (PCCC) CMH agencies located in LHIN 11: - Youth Habilitation (Quinte) Inc. - Religious Hospitallers of Saint - Lanark County Interval House Joseph of the Hotel Dieu of - Lanark Health and Community Kingston Services - Sexual Assault Centre Kingston MD capacity Psy: 13.2 FTEs FPs: 86.9 FTEs

* See Appendix 1 for data source information. ** Organizations were assigned to a LHIN or local system based on the location of their administrative/corporate office. 21

LHIN 11: Champlain

System Feature* LHIN Local Systems Name Champlain Ottawa Stormont, Dundas, Renfrew Glengarry- Prescott-Russell Population (density) 1,170,172 (61) 821,348 (275) 195,226 (35) 98,766 (12)

Main Cities Kanata, Nepean, Ottawa Cornwall

Schedule 1 Acute: 26.8 Specialty: 4.2 beds/100K pop Schedule 1 Specialty hosp (2): Royal Ottawa Health Care Group – Regional Children’s Centre and Royal Ottawa Hospital; Children's Hospital facilities** Of Eastern Ontario Gen hosp(4):Cornwall Community Hospital/Hopital communautaire de Cornwall, Hôpital Montfort, Queensway-Carleton Hospital, The Ottawa Hospital / L'Hôpital D'Ottawa CMH funding $30.09/pc (FY 03) $31.83/pc (FY 03) $24.21/pc (FY 03) $40.89/pc (FY 03) $33.40/pc (FY 04) $35.20/pc (FY 04) $27.18/pc (FY 04) $44.29/pc (FY 04) CMH agencies** - A Post Psychiatric Leisure Experience - CMHA SD& - Pembroke Regional Hospital, - CMHA Ottawa Branch G/Prescott- Community Mental Health - Carlington Community and Health Services Russell Branch Services - Causeway Work Centre - Cornwall - Children’s Hospital of Eastern Ont-CHEO Community - Family Services a la Famille Ottawa Hospital - Geriatric Psychiatry Community Services of - Hopital General Ottawa de Hawkesbury - Hopital Montfort Hospital and District - Horizons Renaissance Inc. General - The Ottawa Hospital Hospital Inc - Ottawa Salus Corporation - Maison Baldwin - Project Upstream Inc. House - Psychiatric Survivors of Ottawa (PSO) - Queensway Carleton Hospital - Royal Ottawa Health Care Group/Services Des Sante Royal Ottawa - Service Catholique Familial D’Ottawa/ Catholic Family Service Ottawa - Shepherds of Good Hope MD capacity Psy: 21.5 FTEs FPs: 83.4 FTEs * See Appendix 1 for data source information. ** Organizations were assigned to a LHIN or local system based on the location of their admin/corporate office. 22

LHIN 12: North Simcoe Muskoka

System Feature* LHIN Local Systems Name North Simcoe Muskoka Simcoe Muskoka-Parry Sound

Population (density) 408,731 (42) 410,498 (74) 98,048 (6.5) Main Cities Barrie

Schedule 1 beds/100K Acute: 15.6 Specialty: 56.5 pop Schedule 1 Specialty hosp (1): Penetanguishene Mental Health Centre facilities** Gen hosp (2): Orillia Soldiers' Memorial Hospital, Royal Victoria Hospital CMH funding $25.36/pc (FY 03) $15.30/pc (FY 03) $49.18/pc (FY 03) $32.16/pc (FY 04) $21.87/pc (FY 04) $51.77/pc (FY 04) CMH agencies** - Barrie Area Native Advisory Circle - Muskoka – Parry Sound Community Mental - CMHA Barrie- Simcoe Branch Health Service - Collingwood General and marine Hospital CMH agencies located in LHIN 13: - Huronia Transition Homes - Muskoka/ Parry Sound Sexual Assault Services - Mental Health Consumer/Survivor - Parry Sound District Social Services Project for Simcoe County Administration Board - Orillia Soldiers’ Memorial Hospital - The Royal Victoria Hospital of Barrie - Wendat Community Psychiatric

CMH agencies located in LHIN 8:

- Stevenson Memorial Hospital MD capacity Psy: 7.1 FTEs FPs: 83.4 FTEs

* See Appendix 1 for data source information. ** Organizations were assigned to a LHIN or local system based on the location of their administrative/corporate office.

LHIN 13: North East

System Feature* LHIN Local Systems Name North East Nipissing-Timiskaming Sudbury-Manitoulin- Algoma Cochrane Sudbury District Population 570,777 (1) 119,820 (3.5) 196,959 (3.8) 120,392 (2.3) 85,971 (0.6) (density) Main Cities North Bay Sudbury Sault Ste. Marie Timmins Schedule 1 Acute: 28.0 Specialty: 46.4 beds/100K pop Schedule 1 Specialty hosp (2): Northeast Mental Health Centre, North Bay Psychiatric Hospital facilities** Gen hosp (2): L'Hôpital Regional de Sudbury Regional Hospital, Sault Area Hospital (Sault Ste. Marie) CMH funding $58.44/pc (FY 03) $48.95/pc (FY 03) $59.19/pc (FY 03) $46.22/pc (FY 03) $125.77/pc (FY 03) $65.44/pc (FY 04) $55.96/pc (FY 04) $64.65/pc (FY 04) $56.99/pc (FY 04) $65.44/pc (FY 04) CMH agencies** - CMHA Nipissing - CMHA Sudbury - Board of Health - Alemotaeta: James Bay Regional Branch Branch for the Algoma Community Mental Health - Community Counselling - Hopital Regional de Health Unit - CMHA Cochrane Timiskaming Centre of Nipissing Sudbury Regional - CMHA Sault Ste Branch - Nipissing Mental Health Hospital Marie Branch - Minto Counselling Centre Housing and Support - Manitoulin Family - Elliot Lake Family - Services de Counselling de Hearst Services Resources Life Centre Kapuskasing and Smooth Rock - North Bay General Incorporated - Lady Dunn Health Falls Counselling Services Hospital - The Northeast Centre - Timmins and District Hospital - North Bay Mental Health Mental Health - North Shore - Timmins Consumer Survivor Services Inc. Centre Community Network Inc (TCSN) - Pavilion Family - Peer Support of Support Services - Timmins Family Counselling Resource Centre Sudbury Inc. Inc. Centre Inc/ Centre Counselling - People for Equal - Services de Sante de - Phoenix Rising Familial de Timmins Inc. Partnership in Mental Chapleau Health Women’s Centre Health (PEP) Services and Non-Profit - Timiskaming Health Homes Inc. Unit - Sault Area - The West Nipissing Hospital General Hospital - Women in Crisis Algoma Inc MD capacity Psy: 7.0 FTEs FPs: 82.5 FTEs * See appendix 1 for data source information. ** Organizations were assigned to a LHIN/local system based on the location of their admin/corporate office. 24

. LHIN 14: North West

System Feature* LHIN Local Systems Name North West Kenora-Rainy River Thunder Bay

Population (density) 243,340 (0.5) 86,072 (0.2) 154,224 (1.3)

Main Cities Thunder Bay

Schedule 1 Acute: 28.8 beds/100K pop Specialty: 37.8 Schedule 1 Specialty hosp (1): St. Joseph's Care Group, Lakehead Psychiatric Hospital Site facilities** Gen hosp 2): Lake of the Woods District Hospital, Thunder Bay Regional Health Sciences Centre CMH funding $84.26/pc (FY 03) $111.78/pc (FY 03) $70.57/pc (FY 03) $93.26/pc (FY 04) $120.59/pc (FY 04) $80.11/pc (FY 04) CMH agencies** - Anishinabeg Community Counselling Services - Alpha Court Non-Profit Housing Inc. (ACCS) - CMHA Thunder Bay Branch - Atikokan General Hospital - Dilico Ojibway Child and Family Services - CMHA Fort Frances Branch - Lakehead University Centre for Education and Research on - Dryden Regional Health Centre Aging and Health - Kenora Association for Community Living - People Advocating for Change Through Empowerment - Kenora Chiefs Advisory Inc. (PACE) Inc. - Kenora Sexual Assault Centre - Red Lake Margaret Cochenour Memorial Hospital - Lake of the Woods District Hospital Corporation - New Directions Counselling Centre - St. Joseph's Care Group - North of Superior Programs - Thunder Bay Regional Health Sciences Centre - Riverside Health Care Facilities, Inc. - Thunder Bay Sexual Assault Assault/Sexual Abuse - Sioux Lookout Meno-Ya-Win Health Centre Counselling and Crisis Centre - Sunset Country Psychiatric Survivors - Wesway

MD capacity Psy: 7.0FTEs, FPs: 81.0 FTEs

* See Appendix 1 for data source information. ** Organizations were assigned to a LHIN or local system based on the location of their administrative/corporate office. Appendix 1: Data sources

System Feature LHIN Local Systems

Population Pop: 2003 Population of Ontario: Discharge Pop: Statistics Canada,1996 to 2004, and (density) Abstract Database (DAD) projections of Ontario Ministry of Finance Geographic Areas: GIS Filter, Statistics Canada Geographic Areas: GIS Filter, Statistics Canada Main Cities Cities with a population >30,000 (GIS Filter, Statistics Canada)

Schedule 1 MOHLTC Daily Census Summary (MOHLTC) beds/100K pop Schedule 1 Specialty hosp: Hospital Report 2004, Mental Health website: http://www.hospitalreport.ca/ facilities Gen hosp: MOHLTC website, http://www.health.gov.on.ca/english/public/contact/psych/designated.html CMH funding MoHLTC Community Mental Health Budgets and Programs Inventory

CMH agencies Mental Health Service Information Ontario (CONNEXOntario database)

MD capacity Physicians in Ontario By FTE Workload N/A Activity, ONT Physician Workforce DB

Appendix 2: LHIN boundaries

1 Erie St. Clair 8 Central 2 South West 9 Central East 3 Waterloo Wellington 10 South East 4 Hamilton Niagara Haldimand Brant 11 Champlain 5 Central West 12 North Simcoe Muskoka 6 Mississauga Oakville 13 North-East 7 Toronto Central 14 North-West