breaking down barriers breaking down barriers for better success in changing times community in...
Post on 21-Jan-2016
217 Views
Preview:
TRANSCRIPT
Breaking Down Barriers
for better success in changing times
Community in Concert: We CAN Work it Out
Elizabeth White
October 28, 2011
Canadian Criminal Justice Association Congress
Quebec City, Quebec
1
Background Shelter and Access Towards an Integrated Network Community Connections CAROW initiative
◦ Ontario Projects
What’s NewWhat’s Next
Introduction
2
“Violence and mental disorder is a small part of the overall picture of interpersonal violence but one where there is a significant possibility of reducing the levels of violence by improved risk assessment and treatment intervention.”
Bradford, JM
Canadian Journal of Psychiatry
Vol. 53 No. 10 October, 2008. Canada
Why It Matters
3
St. Leonard’s Society of Canada is a membership based, charitable organization founded in 1967.
Our mission is to provide a humane and informed justice policy and responsible leadership to foster safe communities.
SLSC addresses the needs of the community and its members by promoting socially responsible conduct throughout the justice system in an effective and ethical manner.
Endorse evidence based approaches to criminal and social justice
Conduct research and develop policy
Support its member affiliates
Advance collaborative relationships and communication among individuals and organizations dedicated to social justice
Who We Are and What We Do
4
Deinstitutionalization intended to reduce in-patient service in favour of community-based outpatient services
Essential redistribution of funds did not happen Community-based programs overburdened and
under-trained
The Background
Deinstitutionalization has led to approximately 90% less beds in psychiatric
facilities
By default, individuals end up in the criminal
justice system
End Result: Criminalization of people
with mental illnesses
5
Stigma and Discrimination
Inadequate community health services
Inadequate training for service providers
Inadequate Funding Eligibility criteria
A Web of Complexities
6
Ontario: Since 2004, the total number of mentally disordered inmates increased by 5.7%
Just over 18 % of the 8,948 inmates had a psychiatric disorder. (June 2010)
31% of the 575 female offenders 30% of the jail population is developmentally
delayed, psychiatric disorder, and serious drug and alcohol
Quebec: People with schizophrenic disorders @4 times, people with major depression @3.5 times
Both groups equally overrepresented in homelessness
7
Current Statistics
Newfoundland & Labrador 2008 - @ 25% male and @60% female inmates had mental disorder diagnosis on admission.
@90% have mental health issues when substance abuse and antisocial personality included.
Federal 13% male and 29% female admissions present mental health “problems”.
Roughly doubled since 1996/97. International: Population increasing 5-10%
each year in prison and hospital.8
Current Statistics
Issue: reducing the criminalization of individuals with mental health problems
Need to close gaps in services to the population
Issue: Many service providers find themselves ill-equipped to deal with individuals who suffer from mental health & social problemsLack of effective collaboration and partnerships between systems has had a huge impact on available services
The Challenges
9
10
Mental Disorder
Shelter Criminalization
Connecting the Issues
Canada Health Act S.3: “protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.”
We must strive to achieve compliance with the legislative framework.
11
Why A Strategy is Essential
Focus on a Perspective of Change
Encourage Initiatives
that focus on Reducing
Stigma and Discriminatio
n
Develop Community
Capacity
Promote a Continuum of
Care
Develop tangible protocols
Build on values of dignity and respect
Promote sustainable communities
Improve Availability and Accessibility
Generate flexible and adaptable strategies
Focus on the individual
Identify shared goals and objectives
Incorporate the social determinants of health
Include community demographics
Promote and support advocacy
Develop an action plan
Develop a holistic approach
12
Creating a National Mental Health Strategy:Models to Consider
The Corrections and Conditional Release Act S.86 states that CSC shall provide inmates (not ‘offenders’) “essential health care and reasonable access to non-essential mental health care that will contribute to their rehabilitation in the community”.
Once term of incarceration is complete, offenders become eligible for health services under the Canada Health Act
13
Canadian Legislation
Too many years of closed doors and revolving doors in and out of hospitals, shelters and prisons
Duty of care for CBRFs?◦ no direct case law: this does not mean that one
does not exist“Although the state’s responsibility and ability to
protect against troubling incidents is reduced outside the walls of institutions, the phenomena of recidivism and reincarceration or relapse and rehospitalization display a continuity of state interest in these situations of diminished liberty” Kaiser, A. 2010
14
Turning Revolving Doors into Doors of Opportunity
Development of a Strategy focused on Mental Health, “a state of well-being”, rather than Mental Illness
Goal of Equitable and Timely Access◦ Seamless integration of services
Recovery: Living well with disease Gap: Little mention then of corrections
Now: CSC co-chairs the FPT Correctional working group on mental health: MHCC participates.
At Home:Chez Soi – CSC participates
Mental Health Commission of Canada: Toward Recovery and Well-Being
15
Community Awareness Increased Exchange of Knowledge on Effective
Interventions Promote Cross-Sectoral Understanding and
Collaboration Enhanced Capacity for Staff in
Residential Programs and Training Contribute to a National Strategy
16
Community Connections:Project Goals and Outcomes
Increased awareness of service providers Communities are better informed about
the criminalization of citizens with mental health issues.
Cross-sectoral understanding Improved training for correctional and
residential service providers
Project Outcomes
17
From the survey data 7 CBRF locations participated in site studies and roundtables with local mental health service providers in New Westminster B.C., London ON, Toronto ON, Joliette QC, Halifax NS
All participating CBRFs worked with individuals who have mental health disorders
Most predominant disorders included: PTSD, schizophrenia, bipolar disorder, depression, generalized anxiety, FASD
All expressed a difficulty with connecting clients to appropriate services in the community
18
Key Findings: Community Connections Site Studies
Resistance on the part of mental health agencies to work with CBRF clients due to criminal histories, especially if they involve violence
Networking is predominant method of being made aware of services in the community*
Privacy laws/policies are the greatest obstacles to information sharing among services and limit the disclosure of care plans
Majority of CBRFs do not have a mental health worker on staff
Respondents were split on whether their discharge planning practices were successful – early planning appears to be the key to successfully connecting residents to community services
Key Findings: Community Connections Survey
19
Assessing Needs Accessible mental health care Identifying what works Building Bridges
Community Connections:What is needed
20
Community Connections: Key Principles
• Having accurate diagnoses pre-release and creating treatment plans to be carried out by CBRF staffAccuracy
• Between CBRF and individual pre-release• Between CBRF, the resident, and
community mental health agenciesPartnerships
• Establish a support system that is accessible post-warrant expiryDischarge
Planning
21
Circles of Support and Accountability (CoSA) Reintegration for high risk sex offenders Restorative Justice principles Circle concept – Wrap-around Potential circles for other populations
Community-Based Residential Facilities Integrate into community-based mental health
services
22
Promising Practices: Accept - Circles and Conditional Release
Create choice - Give voice Connections Clubhouse relies on mental health
clients to design and deliver community supports - Clients gain responsibility and confidence
Recovery has been defined as “living well in the presence or absence of one’s mental illness” Patient centred Beyond silos
Promising Practices:Empowerment and Recovery
23
In facilities/residences 24 hour one on one support Wrap around services
Trusting relationships with staff CSC
Improving mental health services within institutions Implementing community mental health strategies Risk of suspension and revocation in the group who
received Community Mental Health Specialist Service was 34% and 59% lower, respectively, than the comparison group (CMHI Evaluation)
24
Community Connections:Promising Practices and Progress
Work in Coalition Cleaning Coalition: No one owns it, everyone is
invested in it Meet People at their Point of Need
Intensive second stage residential program Open the Doors
Welcome the community in, go out into the community
25
WCommunity Connections:Promising Practices and Progress
Macro level change in legislation is needed to create formalized interagency structures
Policy allowing for transitional housing to be adequately funded, and ensure mental health services are available for offenders on conditional release
Encourage support from local municipalities
Mental health housing with staging/graduated systems
Streamline application processes for housing, ID cards
Increase inter-agency communication
Community Connections:Suggested Solutions
26
Stigma and Discrimination from the community, direct service providers, and the media
Not enough training for community corrections service providers
Never Enough Funding Eligibility Criteria
Community ConnectionsThe Complexities of
Connecting
27
Positive Outcomes for Participants:
Establishing connections to potential funders
Tours of CBRFs have been requested by community corrections personnel and health service providers
CBRF execs have gone on tours of second stage housing initiatives in hopes of gaining new ideas and approaches to creating their own
Community ConnectionsThe Benefits of Connecting
28
Spring 2011: Implement a Strategy using awareness of service provision excellence and destigmatization to achieve access
Provincial, Federal and Local
Pulling the Pieces Together
Forum
CAROW Collaboration
29
30
Connect
Share Ideas
Create Opportunities
Boost your Benefits!
Communication Collaboration Agreement on success
indicators Broad-based
evaluations Overarching principles
What can be done?A Web of Solutions
31
For Everyone: Have a plan Human rights focus Programs and policy to be evidence-based Shelter The Individual is the centre
What the Strategy Needs to Succeed
32
The Message
Quote from CBRF staff, Community Connections Survey:
“I suppose the key point is that we are a community based program and are willing to
partner with any stakeholders to ensure appropriate services are available and
accessible.”
(Re: survey question What are some key points that mental health services need to know about your facility and the work that you do?)
33
“It starts with having a place to stay, having support, and then trying to find the balance to make sure they don’t fall through the cracks.”
- British Columbia Case Study Interviewee.
The Way Forward
34
Their deaths must lead us to better solutions.
Reyal Jensen Jardine-Douglas
35
They Mattered
Ashley Smith Edmond YuReyal Jensen
Jardine-Douglas
Timothy Mclean
36
St. Leonard’s Society of Canada208-211 Bronson AvenueOttawa ON K1R 6H5613.223.5170 slsc@on.aibn.com www.stleonards.ca
“People, even more than things, have to be restored, renewed, revived, reclaimed and redeemed; never throw out anyone.” - Audrey Hepburn
Conclusion
37
top related