Researching Health in Ontario Communities (RHOC) Findings from our First Communities: Port Colborne and Welland Andrea Flynn, PhD Samantha Wells, PhD Kathryn Graham, PhD Paul F. Tremblay, PhD RHOC Researching Health in Ontario Communities Centre for Addiction and Mental Health, 100 Collip Circle, Suite 200, London, Ontario, Canada, N6G 4X8 © 2013 Table of Contents Executive Summary ......................................................................................................................... i Acknowledgements ........................................................................................................................ iv RHOC Principal Investigators ........................................................................................................ v RHOC Co-Investigators ................................................................................................................. vi RHOC Project Coordinator ............................................................................................................ vi Chapter 1: Introduction ................................................................................................................... 1 Chapter 2: Consumer Journey Study .............................................................................................. 7 Chapter 3: Intimate Partner Conflict and Communication (IPCC) Study .................................... 30 Chapter 4: Stress and Mental Health Study (“Random-Walk” Study) ......................................... 57 Chapter 5: Service Utilization and Unmet Need ........................................................................... 69 Appendix A: Evaluation of Health States Study ........................................................................... 79 Appendix B: Core Questionnaire Data - Port Colborne ............................................................... 80 Appendix C: Core Questionnaire Data - Welland ........................................................................ 85 Executive Summary Mental health, substance use, and violence problems are important public health concerns that impose considerable economic, health and social costs on individuals, families, communities, and societies. In order to improve understanding, prevention and treatment of mental health, substance use and violence problems in Ontario, a multi-disciplinary team of researchers from the Centre for Addiction and Mental Health (CAMH) developed the research program, Researching Health in Ontario Communities (RHOC). Working closely with community and provincial partners, RHOC uses a mobile research laboratory to bring research to diverse Ontario communities, including rural, remote, Northern, urban, and First Nations communities. The project is funded by the Canadian Institutes of Health Research (CIHR). In the spring of 2011, RHOC investigators launched the research project in Port Colborne and Welland. Following Welland, research was completed in Windsor and Leamington. As of the fall of 2012, the project is ongoing at Kettle and Stoney Point First Nation, and it will be starting in the Sudbury area in 2013. This is the first community report from the project. In it we describe the findings from the research conducted in Port Colborne and Welland. In Port Colborne and Welland, we conducted four pilot studies to examine mental health, substance use, and/or violence problems: 1. Consumer Journey Study 2. Intimate Partner Communication and Conflict Study 3. Stress and Mental Health Study 4. Evaluation of Health States Study. In addition to completing a pilot study, all participants were asked to complete a computerized questionnaire which included standard questions regarding service utilization, stress, mental health, substance use and experiences of violence. Participants in the four pilot studies were also asked to provide biological samples – hair, to examine stress cortisol, and saliva, to examine genetic vulnerabilities to mental health and substance use problems. This report provides a description of the overall RHOC project (Chapter 1) and outlines methods and results for the Consumer Journey Study (Chapter 2), the Intimate Partner Communication and Conflict Study (Chapter 3), and the Stress and Mental Health Study (Chapter 4). The report also describes service utilization patterns and unmet need for all study participants, with comparisons drawn across studies (Chapter 5). Because the Evaluation of Health States Study was designed mainly for statistical purposes (i.e., the improvement of measures of population health), we do not devote a chapter to this study in the present report. Methods for this study are outlined in Appendix A. Detailed results from the questionnaire data for the four pilot studies are presented in Appendices B (Port Colborne) and C (Welland), respectively. Analyses of biological samples are still underway and are not presented in this report. Consumer Journey Study The Consumer Journey Study involved interviews with individuals who currently have or previously had mental health and/or substance use problems and who have sought help for these problems (“consumers”). Family members of consumers were also interviewed. The goal of this study was to document individuals’ experiences seeking and receiving care and to identify the major barriers and facilitators associated with consumers’ journeys through the local system. As described in Chapter 2, participants in the Consumer Journey study in both Port Colborne and Welland had complex stories to tell that shed light on the strengths and weaknesses of local services. Participants commonly felt that their problems with mental health originated in childhood and that substance abuse was a coping mechanism used to deal with either childhood trauma or stressors associated with their mental health problems. Most individuals experienced co-occurring problems and Researching Health in Ontario Communities (RHOC): Findings for Port Colborne and Welland i had struggled to find care that adequately addressed the complexity of their needs. Participants felt that the Niagara region was underserved in terms of both primary and specialized care for mental health and addictions. Transportation and financial barriers were identified as major impediments to accessing needed care. Lack of affordable counselling was also a major concern, as were long waitlists and stigma. Participants also indicated that physicians and psychiatrists who do not show empathy and/or do not spend sufficient time with them was a key barrier to improvement. Many participants had experienced elements of success in their journey, and felt that certain local services (especially Port Cares, Hope Centre, and methadone services) were especially helpful. In addition, family members served a very important supportive role and often helped consumers obtain care. Participants’ recommendations for improving services included: more local services and more local health care professionals (including family physicians, more local specialized care for mental health and addictions, and care for concurrent disorders), more affordable counselling, assistance with transportation, and more help navigating the system. Intimate Partner Communication and Conflict Study This study (described in Chapter 3) sought to better understand intimate partner violence among young adults by examining a broad range of aggressive incidents, including physical and non-physical aggression. Because general population studies have been limited by the difficulty of recruiting young adults, especially men, the first focus of the study was to test new approaches to participant recruitment. We found that Respondent Driven Sampling was effective for recruiting women in Port Colborne but not men. Therefore, we tried a different approach in Welland involving recruiting people in the appropriate age group from the mall for immediate participation. This method proved more effective but in neither community was it possible to recruit a fully representative sample of young adults. The study also sought to develop a measure of perceived contributing factors to incidents of aggression and violence. Such information can provide critical insight for developing effective preventive and remedial interventions for partner aggression and violence among youth. The final version of the measure contained about 160 questions grouped under 16 themes (e.g., communication, stress). An important finding was that participants saw different factors contributing to their partner’s aggression compared to their own aggression. In particular, they saw their partner’s aggression as being influenced by their aggressive or controlling personality and a desire to make the participant feel bad, whereas they saw their own aggression as being a reaction to feeling disrespected and an attempt to end the fight. Although the Respondent Driven Sampling recruitment method did not result in representative samples, the diverse participants recruited in the two communities provided rich and detailed descriptions of aggressive incidents and the factors that were perceived to have influenced these incidents. Based on these descriptions, we were able to extend previous distinctions of intimate partner violence, which divides aggression into “intimate terrorism” and “situational violence,” to include a third category – aggression related to a troubled or unhealthy relationship. Troubled/unhealthy relationships were commonly related to: mental health problems of one or both