Mental Health & Addictions Report 6th Try 4 12 · Come Together Report & Recommendations of the...

Come Together

Report & Recommendations of theMental Health and Addictions StrategyAdvisory Committee

March 2012

Table of Contents

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Solutions for Nova Scotia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

1 . Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 1.1SocialDeterminantsofHealth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 1.2Knowledge,EducationandAwareness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 1.3DiscriminationandStigma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 1.4HealthPromotionandEarlyIntervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

2 . Access and Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 2.1AccesstoServices—ResponseandWaitTimes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 2.2PeerSupport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 2.3DiversePopulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 2.4Incarcerated/JusticeInvolvedIndividuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 2.5MentalHealthInpatientCare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 2.6AddictionsServices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 2.7ContinuityofCare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

3 . A Collaborative and Coordinated Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 3.1CollaborationandCoordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 3.2Person-centredandFamilyInclusive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 3.3CollaborationbetweenMentalHealthandAddictions............................................. 45 3.4CollaborationwithPrimaryCare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 3.5PrivacyandConfidentiality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

4 . Sustainability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 4.1HumanResourceIssuesandCareProviderSupport. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

5 . Accountability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 5.1AccountabilityandEvaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Mental Health and Addictions Strategy Advisory Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Glossary and Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Appendix A: Terms of Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Appendix B: Ottawa Charter for Health Promotion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Appendix C: Selected Works Reviewed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Consultations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

5Report & Recommendations of the Mental Health and Addictions Strategy Advisory Committee

Foreword

A Call for System Improvement EvEry Nova ScotiaN haS thE right to ExpEctequitableopportunitytoaccessmentalhealthandaddictionservices.TheNovaScotiagovernmenthastheresponsibilitytoupholdthatrightthroughhealthandsocialpolicies.Despitethebesteffortsofhighlyqualifiedanddedicatedprofessionals,careandserviceproviders,andcommunitygroups,thecurrentsystemsofmentalhealthandaddictionsservicesarenotmeetingtheneedsofmanypeopleandfamiliesimpactedbymentalhealthand/oraddictionsissuesinNovaScotia.Asaresult,thehealthandwell-beingofindividuals,familiesandcommunitiesisatstakeandhasanegativeimpactonthesocialfabricandeconomicfoundationofthisprovince.

Thedevelopmentofservicedeliverystandardsinthementalhealthandaddictionsservicessystemsemergedfromthebroadertrendinhealthcaretoimprovequalityofservicestoclients,ensureconsistencyofcare,monitoroutcomesandmanageassociatedcosts.In2002,NovaScotiabecamethefirstprovinceinCanadatodevelopasetofstandardsforaddictionsservices.Thesestandardswereupdatedin2005.

In2003,NovaScotiawasagainfirst,thistimewithstandardsformentalhealthservices.Whileintendedtoguidesystemdevelopment,thementalhealthstandardshavenotbeenachieved.Despitededicatedeffortsandtargetstofundimplementationofthesestandards,spendingonmentalhealthandaddictionsservicesisnotsufficientorappropriatelyallocatedtomeetthestandardsortheneedsofmany.Indeed,spendingonmentalhealthandaddictionsasapercentageofoverallhealthspendinghasdecreasedsteadilyoverthepasttwodecades.

Thegovernmentelectedin2009understoodthescopeandseriousnessofthisproblem.IntheMarch2010ThroneSpeech,thenewgovernmentcommitteditselftoactionandannouncedthataMentalHealthandAddictionsStrategywouldbedeveloped.Whenimplemented,thestrategywouldbringabout“timelyaccesstoquality(mentalhealthandaddictions)services.”

InJune2010,NovaScotia’sAuditorGeneralreportedthatimplementationoftheProvincialStandardsforMentalHealthCarewaslaggingandcalledforgreateraccountability,transparency,andsystem-widemonitoring.Aspartofessentialsystemwidechange,theRossreviewofEmergencyCareinNovaScotia(2010)alsocalledforimprovementswithinthementalhealthsystem.

Otherreports,mediacoverageandpublicinquiriesintounfortunateandtragiceventsheightenedawarenessthat,withintheverysystemchargedwithservingavulnerableandstigmatizedpopulation,numerousinadequaciesandfragmentationwerecontributingtosufferingandevendeath. Mentalhealthworkersjoinedtheirvoiceswiththepublicinthesereviewstohighlighttheirconcerns,dissatisfactionandtheircommitmenttofindsolutions.

InSeptember2010,theMinisterofHealthandWellnessappointedtheMentalHealthandAddictionsStrategyAdvisoryCommittee(theAdvisoryCommittee)tostudythisissueandreportbackwithrecommendedsolutionstoaddresslocalandsystem-widechallengeswithinthecurrentNovaScotianmentalhealthandaddictionsservicessystems.(TermsofReferenceareincludedinAppendixA).

6 Report & Recommendations of the Mental Health and Addictions Strategy Advisory Committee

TheAdvisoryCommitteewasmadeupofrepresentativestakeholderswithexperienceandexpertiseinmentalhealthandaddictions.TheNovaScotiaHealthResearchFoundation(NSHRF)wasenlistedtogatherdatarequiredfortheAdvisoryCommittee’sworkandtofacilitateandoverseetheprocess.

How the Advisory Committee WorkedFromtheoutset,theAdvisoryCommitteeembarkedonaconsultativefact-findingmissiontobecomeacquaintedwiththecurrentstateofmentalhealthandaddictionsservicesinNovaScotia.Itsmembersparticipatedineducationandinformationgatheringsessions,consultedwithexpertsinthefield,participatedinaworkshoponmodelsforintegratedgovernanceofmentalhealthandaddictions,andreadaplethoraofresearchreportsandotherrelevantdocuments.CurrentmentalhealthandaddictionsservicesinNovaScotia,acrossCanadaandinothercountries—Australia,England,NewZealand,ScotlandandtheUnitedStates—andtheworkoftheMentalHealthCommissionofCanadawereexamined.

Earlyintheprocess,theAdvisoryCommitteeidentifiedthreecriticalgapsinknowledge.TheNSHRFcalledforproposalstogatherinformationintheseareas:

1. Currentdemographic,epidemiologicalinformationandthecurrentstateofservicedeliveryrelatedtomentalhealthandaddictionsservicesspecifictoNovaScotia.

2. Reviewoftreatmentapproaches,servicesandexistingmentalhealthandaddictionsystemsintheprovincerelatedtospecificpopulationsandaccesstoservices(ruralandurban).

3. Reviewofstrategies(local,national,international)toaddressmentalhealthandaddictionservicedeliverytovariouspopulationsacrossmultiplesettings.

ThesereportsinformedtheAdvisoryCommittee’sdeliberationsandareavailablefromtheNSHRF.

IssuesandchallengeswereexploredthroughaconsultationprocessthatinvitedtheperspectivesofmanyNovaScotians,including:

• Focusgroupswithtargetedpopulations;

• Consultationwiththegeneralpublic;

• Onlineandmail-inquestionnaires.

Morethanonehundredgroupswereconsulted.Theseincludedhealthprofessionals,mentalhealthclinicians,addictionscounsellors,psychiatrists,individualswholivewithmentalillnessand/oraddictions,othersaffectedbymentalhealthandaddictionsissues,non-governmentalorganizations(NGOs),FirstNations,AfricanNovaScotianandFrancophone/Acadiancommunities,DistrictHealthAuthorities(DHAs),theIWKHealthCentre,alliedcommunitiesworkingwithAfricanNovaScotians,forensicserviceproviders,chiefsofpolice,andmilitaryfamilies.Alistofparticipantsisincludedintheappendices.

TheAdvisoryCommitteemetregularlytodiscussthedata,andidentifiedthemesthatwouldformthefoundationofthisreport.ApopulationhealthapproachwasadoptedtoaddressissuesandmoveindividualmembersbeyondtheirspecialintereststoarriveatrecommendationsthatmeettheneedsofallNovaScotians.


CommunicationsAcomprehensiveplanwasdevelopedbytheNSHRFtosupporttheactivitiesoftheAdvisoryCommittee.Itincluded:

• Onlineavailabilityoflocationsforconsultationsandup-to-dateresults;AdvisoryCommitteemeetingminutes;anoverviewoftheAdvisoryCommitteeactivities;andnamesandcontactinformationofNSHRFstaffwhowereactivelysupportingtheAdvisoryCommitteeandwhocouldrespondtoquestionsfromthefield.

• ThedevelopmentofasummaryreportregardingthecurrentstateofmentalhealthandaddictionsservicesinNovaScotia.ThisreportremainsavailableontheNSHRFwebsiteandwasdistributedtokeystakeholdersintheDepartmentsofHealthandWellness,CommunityServices,Education,andJustice.ItwasreviewedforaccuracybyrepresentativesfromeachoftheDHAsandtheIWK,aswellasbymentalhealthandaddictionspersonnel.

• Themesthatemergedfromtheconsultationswerecontinuouslyupdatedtoensurerobustdialogueandaniterativeprocessforseekingandobtainingpublicinput.

• TheMinisterofHealthandWellnessandseniordepartmentstaffwereregularlyinformedabouttheworkandprogressoftheAdvisoryCommittee.

Report Presentation Thethemesthatemergedasaresultofstakeholderconsultations,reviewofacademicliterature,andreviewofprovincial,federalandinternationalreportsonmentalhealthandaddictionswereusedtoorganizetheAdvisoryCommittee’srecommendations.Findingsandconclusionsarepresentedinthefollowingformat:

1. Identificationofmajorissues,undertheheading:Whatweheard.

2. Objectivesforchange.

3. Expected(ordesired)outcomesasaresultofimplementationofchange.

4. Recommendations.

ManykeyreportsinformedtheAdvisoryCommittee’swork.Someshouldbenotedherebecausetheyprovedparticularlyhelpfulinthedevelopmentofourrecommendations.Thesereportsinclude:

• Fatality Inquiry into the Death of Howard HydebyHon.JudgeAnneDerrick(2010).

• Out of the Shadows at LastbyHon.SenatorMichaelKirby(2006).

• Spiralling Out of Control: Lessons Learned from a Boy in Trouble: Report of the Nunn Commission of InquirybyHon.D.MerlinNunn(2006).


• The Patient Journey Through Emergency Care in Nova Scotia: A Prescription for New MedicinebyDr.JohnRoss(2010).

• Report of the Auditor General,JacquesR.Lapointe(2010);and

• Toward Recovery & Well-being: a Framework for a Mental Health Strategy for Canada.MentalHealthCommissionofCanada(2009).

NumerousotherstudiesandreportshaveassistedtheAdvisoryCommitteeandarecitedintheappendices.

Despitetheserichsourcesofinformation,up-to-dateempiricaldataforNovaScotiaremaineddifficulttofind.Someinformationislesscurrentthanwouldbeidealbut,intheopinionoftheAdvisoryCommittee,retainsvaliditybecausetherehasbeenlittleornochangeinthehealthcareserviceconditionsthatgaverisetothedata.AsnotedintheAccountabilitysectionofthisreport,currentsystemstocollectdata,measureoutcomesandevaluateinterventionsareinadequate,particularlyformentalhealthservices.Effectivemanagement,well-guideddecisionsandhighqualityservicedeliveryrequireconsistent,validandreliablelongitudinaldatacollection.

TheAdvisoryCommitteehadaccesstoawealthofexperientialknowledgeofmentalhealthandaddictionsservices,issues,gapsandoutcomesthroughpublicconsultations,sitevisits,personalandprofessionalexperiences.Inouropinion,thisfirst-handexperienceaddedcriticalandrelevantinformationtothelimitedbankofempiricaldata.

Recommendationsareorganizedunderthefollowingthemes:

1. Wellness

2. AccessandIntervention

3. Collaboration

4. Sustainability

5. Accountability


Introduction

The High Price of InactionBy 2030, mENtal hEalth aNd addictioNS iSSuESwillbetheleadingcauseofdisabilityinCanada,yetCanada—includingNovaScotia—isalowspenderonmentalhealthservices.Thischronicunderfundingmayreflectandbeaformofstigmainitself.Thelowpriorityisreflectedintherelativelylowinvestmentofpublicdollarsintheseareasascomparedtospendingtoaddressothercommondiseases.

Thereismountingevidencethatthegrowingcosttosocietyofuntreatedorunder-treatedmentalhealthandaddictionissuesisnotsustainable.Indeed,thetotalcosttosocietycouldbecomegreaterthantheentirecostofthehealthcaresysteminCanada.

OneinfiveCanadianswillexperienceadiagnosablementalhealthissuethisyear.InNovaScotia,thatmeansnearly200,000peoplewillexperiencesymptomsrangingfromproblematicandchronictoacuteanddebilitating,mostofwhichcouldandshouldbetreatedandrelieved.Manywillnot.

Mentalhealthissuesandillnessesaretheleadingcauseofshortandlong-termdisabilityinCanada.Thenationaleconomicburdenofmentaldisorderswasestimatedat$51billionperyearin2002,withalmost$20billionofthatcomingfromwork-relatedlosses.

Nationally,oneinfourworkerswillexperienceamentalhealthprobleminthenext12months,and500,000Canadiansareabsentfromthejobeverydayforpsychiatricreasons.Mentalillnessisassociatedwithmorelostworkdaysthanmostchronicphysicalconditions.WhilethereisahighincidenceofmentalhealthproblemsamongworkingCanadians,between70and90percentofCanadianswithseriousmentalillnessareunemployed,unabletosupportfamilies,deniedopportunitiestomakeacontributiontotheeconomy,andthereforeplacepressureonsocialsafetynets.

Likewise,theoverallcostofsubstanceabuseinCanadain2002wasanestimated$39.8billion.Thisincludestheburdenonhealthcareandlawenforcementservices,andthelossofworkplaceproductivityasaresultofabsenteeism,disabilityandprematuredeath.

InNovaScotia,hundredsofdedicatedmentalhealthandaddictiontreatmentprofessionalsworkhardandtheireffortsaresupplementedandassistedbyabroadarrayofcommunityandnon-governmentalorganizations.Butitisnotenough.Fartoomanypeoplewhoneedtreatmentwaittoolong.Manyotherswhofearthestigmathatattachestotheirillnessdonotseektreatmentatall.

Healthcareprofessionals,andotherswhoprovidetreatmentandcareforthosewithmentalillnessandaddictions,workinasystemthatispoorlyorganized.Itlacksintegrationbecauseofbureaucraticdivisions,andithasbeenunder-fundedforgenerations.Itismisunderstoodbypeoplewithinandoutsidethehealthsystemandisunevenlyaccessibleorresponsive,oftenduetocultural,geographic,linguisticorracialfactors.

Addressingsuchmentalhealthandaddictionsissuesandthesocialconditionsthatcontributetothemiscomplex.TheWorldHealthOrganizationdefinesmentalhealthas“astateofwell-beinginwhichtheindividualrealizeshisorherownabilities,cancopewiththenormalstressesoflife,canworkproductivelyandfruitfully,andisabletomakeacontributiontohisorhercommunity.”Mentalhealthisessentialto


healthylivingandqualityoflife.Goodmentalhealthisassociatedwithbetterphysicalhealth,improvededucationalattainment,increasedeconomicparticipation,andrichsocialrelationships.

Ina2009report,theMentalHealthCommissionofCanadasaidgoodhealthisnotpossiblewithoutgoodmentalhealth.Whenindividualsexperiencementalhealthoraddictionissues,notonlyistheirqualityoflifethreatened,arippleeffectiscreatedoftenimpactingmanyothers,includingfamily,friends,co-workers,workplacesandcommunities.

Thetotaleconomiccostsofmentaldisordershavebeenshowntomatchtheeconomicimpactsofheartdisease,diabetesandhypertensioncombined.Ofthenon-communicablediseases,neuropsychiatricconditionscontributemoretotheoverallburdenofillnessthaneithercardiovasculardiseaseorcancer.

Substanceabuseandaddictionaddbillionsofdollarstotheoverallsocialandeconomicburden.OfthetotalcostsrelatedtosubstanceabuseinCanada,alcoholaccountedfor36.6percent,or$14.6billionin2002.InNovaScotia,therelativecostsofsubstanceabuseareconsistentwithnationalfigures.Socialandeconomiccostsofalcoholabusetotalled$419million(2002)or33.7percentofallsubstanceabusecostsintheprovince.Thissubstantiallyexceededtheannualprofits($158millionin2002)returnedtotheNovaScotiagovernmentfromalcoholsalesthroughtheNovaScotiaLiquorCorporation.Thecostsoftobaccouse,primarilytothehealthsystem,were$625million(50.3percentofallsubstanceabusecostsintheprovince);andillegaldrugcostswere$200million(16percentofsubstanceabusecostsintheprovince).

Addiction,asdefinedbytheAmericanSocietyofAddictionsMedicine,isaprimarychronicdiseaseofbrainreward,motivation,memory,andrelatedcircuitry.Dysfunctioninthesecircuitsleadstocharacteristicbiological,psychological,socialandspiritualcomplications,whichresultinapathologicalpursuitofrewardand/orreliefbysubstanceuseandotherbehaviours.

Addictionischaracterizedbyaninabilitytoconsistentlyabstainfromsuchsubstanceuse,impairmentinbehavioralcontrol,craving,diminishedrecognitionofsignificantproblemswithone’sbehaviorsandinterpersonalrelationships,andadysfunctionalemotionalresponse.Likeotherchronicdiseases,addictionofteninvolvescyclesofrelapseandremission.Withouttreatmentorengagementinrecoveryactivities,addictionisgenerallyprogressiveandresultsindisabilityorprematuredeath.

AddictionsservicesprovidedinNovaScotiaalsofocusonhealthpromotionandpreventionofsubstanceabuse.Therefore,forthepurposesofthisreport,addictionrequiresabroaddefinitionandincludesthespectrumofharmfulbehavioursrelatedtoproblematicsubstanceuseandgambling.

Earlyinterventionandeasily-accessed,effectivetreatmentsformentalhealthandaddictionissuesimprovebothshortandlong-termoutcomes,includingthepreventionormitigationofsymptomsofsomedisorders,reductionindisability,andenhancedcivicandeconomicparticipation.Outcomessuchasthesehavethepotentialtodramaticallydecreasetheoverallsocialandeconomicburdensoftheseillnesses.

Butourmentalhealthandaddictionservicessystemsrequiremorethanafocusonearly,effective,andeasilyaccessibletreatments.Publicawarenessandothereducationaleffortsareneededtoreducestigmaanddiscriminationassociatedwiththesedisorders.Healthpromotionplaysacriticalroleandeffectivecollaborationatandacrossalllevelsofservicedeliveryandprogramdecision-makingisvitaltoeffectivetreatment,servicesandpositiveoutcomes.

Allofthisrequiresstrongleadershiptocreatechangeandaccountabilitytoensureimprovedresults.Ifasocietywantsasustainable,highqualityoflifeforitscitizens,attentiontomentalhealthandaddictionissuesisnotoptional.Itisessential.


The1978WorldHealthOrganizationdeclarationofAlma-Atathathealthisafundamentalhumanright—astateofcompletephysical,mentalandsocialwell-being;notmerelytheabsenceofdiseaseorinfirmity—isamajormilestoneinthefieldofpublichealth.Theattainmentofthehighestpossiblelevelofhealthwasdeclaredanimportantglobalsocialgoalthatrequiresactiononthepartofmanysocialandeconomicsectors.ThereisnodoubtthatmanyNovaScotiansinneedoftreatmentformentalillnessoraddictionslackaccesstotreatmentandthereforearedeniedthishumanright.

Althoughmentalillnessandaddictionsoccurindependentlyofsocialorfinancialstatus,thesocialandeconomicdeterminants—andtheoutcomes—ofthesedisordersarepredictable:poverty,loweducationalattainment,familydistress,troublewiththelaw,isolationandincreasedriskofotherhealthproblems.

ThisreportcomesatatimewhentheGovernmentofNovaScotiaiswrestlingwithseriousfinancialissues.Thereisnodoubtthattheactionsandrecommendationsadvocatedherewillrequireadditionalspendingintheareasofmentalhealthandaddictionsservices.However,itisclearthatpreventivemeasures,promotion,earlyinterventionandtreatmentwillreducetheoverallsocialandeconomiccoststheprovincecurrentlybearsfromuntreatedandunder-treatedmentalillnessandaddictions.

NovaScotiansexpectthatgovernmentwillinvestwiselyandbringspendingundercontrolinordertoensuretheprovince’sdebtdoesnotoverwhelmusorourchildren.Astrongcasecanbemadeforinvestmentinmentalhealthservicesandaddictiontreatment.ThisinvestmentandmanagementofservicesisintendedtorelievethesufferingandfinancialtollthatthousandsofNovaScotians,theirfamiliesandcommunitiesfaceasaresultofmentalhealthandaddictionissues.

A Closer Look at Nova ScotiaInNovaScotia,self-reportedratesofoverallmentalhealthandsubstanceuse(cannabisandotherdrugs)arecomparablewithotherpartsofthecountry.However,theprevalenceofalcoholmisuse,bingedrinking,dailysmoking,andmoodandanxietydisordersaresignificantlyhigheramongadultNovaScotiansthanotherCanadians.Womenhavehigherratesofpoormentalhealthwhilesubstanceabuseratesarehigheramongmen.

Incidenceofmentalhealthandaddictionissuesisstronglyassociatedwithsocialdeterminantsofhealthsuchaslowincomes,beingolder,single,isolatedandunemployed.Theconverseisalsotrue.Positiveemotionalhealthisreportedbyyoungerpeople,whoareincommittedrelationships,educated,employedandhavehigherincomes.

Mostmentalhealthdisorders—anestimated70percent—beginpriortoage25.Theytendtobechronicandresultinsignificant,negativeoutcomesintheshortandlongterm.Theyleadtopooracademicandoccupationalsuccess,interpersonalandfamilydifficulties,increasedriskofphysicalillness,shorterlifeexpectancyandeconomicdependence.

Despitetheprevalenceofearlyonset,thosewhoreportpoormentalhealtharemorelikelytobewithinthe45–64agerange,unemployedandfromalow-incomebracket.The2002CanadaCommunityHealthSurvey(CCHS)found11.3percentofNovaScotiansaccessedsomeformofmentalhealthoraddictionsservicesthatyear,whileanadditionalfivepercentreportedthattheirmentalhealthcareneedswentunmet.

Justoverone-quarter(26percent)ofstudentsintheprovincescreenpositiveforelevatedriskofdepression,butbetween10and20percentofthosewhowantedhelpfortheirmentalhealthissuesdid


notreceiveit.Amongstudents,femalesreportedthehighestratesofdepression,asdidstudentswithlowerGradePointAverages,thosefromsingle-parenthouseholds,andthosewithlesseducatedmothers.

Comparedtotherestofthecountry,fewerNovaScotiansidentifythemselvesas“regulardrinkers”whilemorereport“occasionaldrinking.”However,theoverallrateofalcoholmisuseinNovaScotiaishigher.

SubstanceuseisfairlycommonamongstudentsinNovaScotia,withalmost70percentofhighschoolstudentsreportingalcoholuseinthepastyearandone-quarterofthemreportingbingedrinkinginthepastmonth.Eighteenpercentofyouthreportedtheuseofcannabiswithinthepast30days.

Theuseofpainkillersandillicitsubstancesotherthancannabisforrecreationalpurposesisequallywidespread.Thereisabundantanecdotalevidencethatabuseofprescriptionmedications,painkillersinparticular,isagrowingproblemwithsometimestragicoutcomes.

InNovaScotia,therelativecostsassociatedwithsubstanceabusearefairlyconsistentwithnationalcosts.HeavydrinkinginNovaScotiabeginstopeakinearlyadolescenceandusuallytapersoffthroughmiddleadulthood.Drinkingismoreoftenassociatedwithurbanmalesandmaybeassociatedwithunemployment,singlestatusandloweracademicgrades.Youth(18–24years),males,andsingleindividualsaremorelikelytoreportdruguseasarestudentswithlowerGradePointAverages,thosefromsingle-parentfamilies,andthosewithlesseducatedmothers.

Problemgamblingaccountsfor2.6percentofthecostsofprimaryaddictionstreatmentintheprovince,buttheconsequencesaresevereandcanleadtolossoffamily,bankruptcyandsometimessuicide.

Approximately23percentofNovaScotiansconsiderthemselvessmokers,withalmost19percentreportingdailytobaccouse—aratethatissignificantlyhigherthantherestofCanada.NovaScotiansareexposedtoahigherrateofsecond-handsmokecomingfromtheirhomeorvehiclesthanareotherCanadians.Individualswhoreportedwantinghelptostopsmokingsaidtheyhaddifficultyreceivingthissupport.

Thedevelopmentofprovincialconcurrentdisorderstandardsisunderway.Dataonconcurrentmentalhealthissuesandaddictionsislimitedanddifficulttoextractfromexistingdatasources.NovaScotianswereidentifiedasbeingbetweenoneandtwopercentmorelikelythanotherCanadianstoexperienceco-occurringalcoholordrugproblemsandmoodoranxietydisorders.

“MynameisKaren.IgrewupwithanalcoholicfatherwhowassavedbyatreatmentprogramwhenIwasyoung,andformanyyearsIwasactivelyinvolvedwithvariousfamilysupportgroups.Mydaughterisanalcoholicanddrugabuser.Thishasbeenongoingforsixyears.Shesoughttreatmentseveraltimesinthepastfouryears,butathree-to-fivedaydryoutisnottreatment.Shehasrepeatedlyaskeddoctors,detoxstaffandothersformentalhealthhelpbuthasreceivednone.Shehaslostseveralfriendstoaddictions-relateddeaths.”

Tobaccosmokingamongpatientswithmentalillnessiscommonandexposesthemtoincreasedriskofsmoking-relatedmorbidity,mortality,andtodetrimentalimpactsontheirqualityoflife.Theneurobiologicalandpsychosociallinkstosmokingappearstrongerincertainco-morbidities,notablydepressionandschizophrenia.

Individualswithmentalhealthandaddictionsproblemshavesignificantlypoorerphysicalhealththanthosewithout.Physicalhealthandmentalhealtharenotseparateentities.However,thereisoften


afailuretoprovideadequatephysicalcaretothosewithmentalhealthand/oraddictionsissues.Theinabilitytoseebeyondthesymptomsofmentalillnessandaddictions,inadequateunderstandingofmentalhealthandaddictionsissues,discriminationandstigmaallplayaroleinthisoversight.

TheAdvisoryCommitteewasdistressedtoheartheexperienceofanAboriginalwomanwithahistoryofmentalillnessandsubstanceabusewhopresentedatoneoftheprovince’shospitalEmergencyDepartments.ERstaffknewher,butwhattheydidn’tknowwasthatshealsosufferedfromdiabetes.Shewassober,butlowbloodsugarmadeherdisorientedanduncoordinated.Shewasdismissedwithoutexamination.Shehitchhikedhomeandwastreatedthenextdaybyherfamilydoctor.


Solutions for Nova ScotiaShaping an excellent system of care in Mental Health and Addictions

thE adviSory committEE dEvElopEd aNd adoptEdvision,beliefandmissionstatements,aswellasasetofclearprinciplestoguideitsworkandinformthedevelopmentofrecommendedactions.

Vision StatementAllNovaScotianswillhaveeffectiveaccesstoanexcellentsystemofcareinmentalhealthandaddictionstoimprovewell-being,addressinequities,eliminatestigmaanddiscrimination,andreducetheimpactofillness.Makinguseofinnovation,collaborativepractice,longitudinalevaluationandleadershipacrossHealthandWellness,Justice,EducationandCommunityServices,thissystemwillbeefficientlycoordinatedandsustainable.

Belief StatementThepresentsystemofmentalhealthandaddictionscarecanimprovebybecomingmoreaccessible,coordinated,collaborative,non-stigmatizingandrespectfulofindividuals,theirfamilymembersand/ortheirnetworkofsupport,aswellasbeingsensitivetolanguage,culture,race,ethnicity,sexualidentity,andgender.Thisrenewedsystemwillpromotewellnessthrougheducation,preventionandhealthpromotion,earlyandrecovery-focusedinterventions,rehabilitation,andsoundscientificresearch.

Mission StatementToprovidetheMinisterofHealthandWellnesswithareportandrecommendationsthatleadtoimprovementandongoingdevelopmentofmentalhealthandaddictionsservicesinNovaScotia.

Objective Tocreateamentalhealthandaddictionssystemthatisaccountabletothepublic,informedandguidedbyintegrated,reliableandvaliddatameasuredwithinaninformationsystemthatisstandardizedacrosstheprovinceandinwhichstaffareappropriatelytrainedandcompetent.Thereisconsistentandtimelyknowledgetransferandtranslationfromresearchtopracticeandthesepracticesarebasedonscientificevidenceorwherethisislacking,onwiseandpromisingpractices.

Peoplewithalivedexperienceofmentalhealthand/oraddictionsissuesactivelyparticipateinthedesign,implementationandevaluationofthecomprehensivementalhealthandaddictionssystem.


Core PrinciplesAsoutlinedbytheWorldHealthOrganization(seeappendices),awell-functioninghealthsystemrespondsinabalancedwaytoapopulation’sneedsandexpectationsby:

• improvingthehealthstatusofindividuals,familiesandcommunities;

• defendingthepopulationagainstwhatthreatensitshealth;

• protectingpeopleagainstthefinancialconsequencesofill-health;

• providingequitableaccesstopeople-centeredcare;

• makingitpossibleforpeopletoparticipateindecisionsaffectingtheirhealthandhealthsystem.

Inadditiontothese,theAdvisoryCommitteedevelopedprinciplesuponwhichtherecommendationsarebased.Theseare:

1. MeetthementalhealthandaddictionsservicesneedsofallpersonsinNovaScotia,includingthoseofjurisdictionallyandhistorically-marginalizedpopulationsandunder-servicedpopulations(suchasAboriginalandmilitaryfamilies),linguisticallyandculturallydiversepopulations,andpopulationswithspecificneeds.

2. Followperson-centered,familyandnaturalsupports-inclusiveapproachestomentalhealthandaddictionscareacrossthelifespanasappropriate,withattentiontovariedhealthliteracyneeds.

3. Useapopulationhealthapproachandincludesocialdeterminantsofhealth.

4. UseahealthpromotionapproachthatisconsistentwiththeOttawaCharterforHealthPromotion.

5. Ensurethataccesstocareistimelyandeasytonavigate.

6. Supportcommunication,collaborationandco-operationaswellascoordinationandintegrationofservicestodevelopseamlessandefficientcaredelivery.

7. Embedmentalwellnessandrecovery-basedapproacheswithinservices.

8. Ensurethathealthpromotion,prevention,earlyinterventionandanti-stigma/discriminationareessentialcomponentswithinservices.

9. Applyprovincialmentalhealthandaddictionsstandardstoservicedelivery.

10. Incorporatebestorwiseandevidence-basedpracticesandensureknowledgeexchangebetweenscientificresearchandpractice.Theterm“wisepractices”referstoactions,tools,principlesordecisionsthatcontributesignificantlytothedevelopmentof


sustainable,culturallyappropriateandequitablesocialconditionsanddevelopment.(AdaptedfromUNESCO,2000andWesley-Esquimaux&Calliou,2010).

11. Utilizeandincorporateculturally-competentandsafeapproachesconsistentwith Nova Scotia’s Provincial Cultural Competence GuidelinesaswellasThe Nova Scotia Cultural Competence and Health Literacy Guide.

12. Ensureaccountability.Utilizeframeworksthatevaluateserviceseffectivelyandlongitudinallytomonitorprogress.Thesemeasuresshouldbecomparableacrosstheprovinceforevaluation,accountability,qualityimprovementandsustainability.Engagestakeholdersinthedesign,implementationandevaluationofthesystem.

A Call for CollaborationRecommendationsareorganizedunderthethemesthatemergedfromasynthesisofstakeholderconsultations,academicliteraturereviews,provincial,federalandinternationalreports,andothermentalhealthandaddictionsstrategies.Toprovidecontextforeachrecommendation,itisframedbyabriefexaminationofwhatweheard,theobjectivesofthechangesweadvocateandtheexpectedordesiredoutcomes.TheAdvisoryCommitteeunderstandsthatimplementationofitsrecommendationswillchallengeNovaScotia’sfiscalresourcesandcallsforanon-partisancollaborativepartnershipofallpoliticalpartiestoworktogetherandengageinthisprocesstoleavealastinglegacyforthepeopleofNovaScotia.


1. Wellness

1.1 Social Determinants of Health

WHAT We HeARd:Theevidenceisclear:whilementalhealthandaddictionsissuesaffectpersonsofallsocioeconomicgroupsandallages,whenbasicneedsarenotadequatelymet,healthrisksincrease,theabilitytoaccesstreatmentisimpaired,andchancesofrecoveryarediminished.Unemployment,povertyandlackofeducationareamongthekeydeterminantsofpoormentalhealthandaddictionamongNovaScotians.

TheAdvisoryCommitteeheardfrommanyNovaScotiansconcerningthedebilitatingimpactofpovertyonthelivesofthosewithmentalillnessandaddictions.Povertyisclearlyadeterminantofthesedisordersaswellasafrequentoutcome.Positiveoutcomesfromtreatmentaresignificantlydiminishedamongpeoplelivinginpoverty.

Determinantsofpoorhealtharedisproportionatelyevidentamongcertaingroups,includingFirstNations,racial,ethnicandlinguisticminorities.Successincreatingmoreeffectivementalhealthandaddictionsservicesandinimprovingoutcomesfrominterventionwillbediminishedwithoutacommitmenttoaddresstheinequitiesinthesocialandeconomicfoundationsofgoodhealth.Income,employmentandeducationallformpartofthefoundationbutadequateandsafehousingisessential.

Fordecades,personswithmentalhealthandaddictionsissueshavebeenunabletoaccessappropriatehousingoptions.Crisis,transitionandrecoveryhousingarefrequentlyunavailableorinaccessibletothesepeople,resultinginrelapse,inappropriatehousingplacementsandcompromisedrecovery.Governments,workingingoodfaith,havebeenunsuccessfulinfindingsolutions,perhapsinpartbecauseofthedivisionofresponsibilitiesacrossvariousdepartments.Whilementalhealthandaddictiontreatmentisaresponsibilityofthehealthsystem,responsibilityformitigatingtheharmfulimpactofthedeterminantsofpoormentalhealthoraddictionmorefrequentlyfallstotheDepartmentofCommunityServices.TheJusticeDepartmentisalsofrequentlyinvolvedwhenpersonswiththeseissuesareinconflictwiththelaw.

Thehistoryofgovernmentdepartmentsworkingtogethersuggeststhattheywillstruggletocometogethereffectivelyinresponsetothecomplexmixofissuesandproblemsfacedbypersonswithmentalillnessandaddictioninneedofhousingoptions.

Adequate,safeandappropriatehousingisafirstvitalstepinrecovery.Researchindicatesthatprovisionofappropriatehousingoptionsisacost-effectiveresponse.AjointeffortofSimonFraserUniversity,theUniversityofBritishColumbiaandtheUniversityofCalgaryfoundthateachhomelesspersoninBritishColumbiacoststaxpayers$55,000ayearinhealth,correctionsandsocialservices.Thereportconcludesthatadequatehousingsupportscouldbeprovidedtothesepeoplefor$37,000ayear,resultingin$18,000inannualsavingsperpersonperyear.Thecostofincarceration—toooftentheunhappyresultwhenpeoplewithmentalhealthandaddictionsproblemsarelivingonthestreet,orareinadequatelyhoused—is$323aday,or$117,895ayear.

A“HousingFirst”modelisbeingexploredbytheMentalHealthCommissionofCanadawithamajorprojectlocatedinNewBrunswick.Theresearchistobecompletedin2013.Thisisapromisingapproach


toaddressinghomelessnessandhelpingpeoplegetbackintocommunitylife.Theconceptissound,inthatonceapersonhasaplacetoliveheorshecanthenconcentrateonotherpersonalissues.Withaplacetolive,thepersonisofferedarangeofhealthandsocialsupportservices,includinghelpwithroutinetaskslikeshoppingorgettingtoadoctor’sappointment,securingopportunitiesforeducation,volunteering,andemployment.ParticipantsintheHousingFirstmodelpayaportionoftheirrent,meetwithprogramstaffonceaweekandareencouragedtomakeuseofsupportservices.

Housingaloneisanincompleteresponse.Personswithsevereandpersistentmentalhealthissuesandaddictionsneedmeaningfuldailyengagementandemploymentopportunities,aswellasprogramstopromotewellness,preventrelapseandenhancerecovery.And,quitesimply,thesuccessofanyeffortstodealwithmentalhealthissuesandaddictionswillbelimitedwithoutdeterminedactiontoreducepoverty.

Peoplerecoveringfrommentalillnessandaddictionsneedsupportinaccessingeducationandemployment,orsimplyadjustingtoareturntoeverydaylife.The“Clubhouse”modelisanevidence-basedexampleofpsychosocialrehabilitation.MembersarepartnerswithstaffinallaspectsofrunningtheClubhouse,whereprogramsprovideopportunitiestoimproveskills,findemployment,takepartineducationopportunities,andmakefriends.Staffandmemberslinkwithcommunityorganizationstoencourageparticipationandinvolvement.TheInternationalCentreforClubhouseDevelopmenthasestablishedstandards,trainingandaccreditationprograms.ItisamodelthatdeserveswiderconsiderationinNovaScotia.

OBjeCTIve:Tomaximizetheeffectivenessofimprovementsinmentalhealthandaddictionstreatmentandservices,governmentwilladdressthesocialdeterminantsofhealth—specificallyandasapriority,thehousingandemployment/purposefulactivityneedsofpersonswiththesedisorders.Adequatecrisis,transitionalandrecoveryhousingappropriatetotherecoveryneedsofpeoplewithmentalhealthissues,illnessandaddictions(includingthosewhohavebeeninconflictwiththelaw)willbeavailableandaccessible.Governmentwillhaveorganizeditselfsothatthisobjectivecanbemetthroughasingleentrypointavoidingthepastproblemscreatedbyineffectivecross-departmentalefforts.AHousingFirstmodelwillbeeffectivelydeliveredthroughthissinglesource.

OuTCOMeS:Expectedanddesiredoutcomesfromthefollowingrecommendationsincludeimprovedhousingoptionsinadditiontoincreasedopportunitiesforemploymentandpurposefulactivities.Anoveralldecreaseinpovertyamongpersonswithmentalhealthandaddictionissuesoffersthemabetterchancetolivefullandmeaningfullives.

ReCOMMeNdATIONS:

1 .1-1 AdoptaHousingFirstmodelthatspanstheDepartmentsofHealthandWellness,JusticeandCommunityServices.Theclient-centredHousingFirstmodelshouldensureasingleentrypointforsupportivehousing.Inadditiontoexistinghousing,themodelshouldalsomeettheneedforcrisis,recoveryandtransitionalhousingforindividualswithmentalhealthandaddictionsissuesincommunitiesacrosstheprovince.


1 .1-2 Coordinatedeffortsarerequiredacrossgovernmenttoaddressandreducepovertyanditseffectsonpersonswithmentalhealthandaddictionsissues.Theprovincialpovertyreductionstrategyshouldbeactedupon.

1 .1-3 Increasemeaningfuldailyengagementopportunities,employmentopportunitiesandprograms (e.g.,work/educationtransition,volunteerismsupports,etc.)appropriateforindividualswithmentalhealthandaddictionsissuestopromotewellness,preventrelapseandenhancerecovery.IneachDHA,supportsforeducationandproductivitywithinvariousenvironmentsmustbeavailable,includingsupportiveprograms(suchasthosefollowingguidelinesofthe“Clubhouse”model).ThiscouldbepartiallyachievedbysupportingNGOstofostersocialenterpriseand/orbypartneringwiththeprivatesector.

1.2 Knowledge, Education and Awareness

WHAT We HeARd:Gapsinawarenessandknowledgeaboutidentificationandtreatmentofmentalhealthandaddictionissuesareevidentacrosssociety—inworkplaces,inschoolsandingovernment-providedservices.Increasedawarenessandknowledgecanresultinsignificantly-improvedoutcomes,throughareductioninstigmaanddiscrimination,andthroughearlyandmoreeffectiveinterventions.

Thereisalackofaccessibleinformationandeducation—bothphysicalaccessandaccesstoappropriateliteracylevels—onmentalhealthandaddictionissues.Individuals,families,othersupportersandcommunity-basedgroups,aswellashealthcareandserviceprovidersfromothergovernmentdepartmentsandagenciesneedtobebetterinformed.

Ignorancebreedsdiscriminationandaddstotheburdenofstigmaattachedtomentalhealthandaddictionproblems.Alackofknowledgepreventsthoseinapositiontoidentifyproblemsfromtakingactionthatwouldleadtoearlyintervention.

OBjeCTIveS:

• Topromoteawareness,knowledgeandeducationrelatedtomentalhealthandaddictionsacrossthespectrumwherethereisneedandwherecareisprovided.

• Toensurethatallhealthpractitionersandfront-lineserviceprovidersoftheDepartmentsofHealthandWellness,Education,CommunityServicesandJustice,aswellasDHAsandtheIWKhaveacoreunderstandingofmentalhealthandaddictionsissuesandreferralprocesses.

• Toensurethatpersonswithmentalhealthandaddictionsissues,theirfamiliesandthepublichaveeasyaccesstoinformationontheseissuesandtheresourcesavailableforintervention.


OuTCOMeS: Thefollowingrecommendationswillfosterimprovedmentalhealthandaddictions-relatedhealthoutcomes,includingmentalwellness,empowermentofindividualswithmentalillnessandtheirfamilies,reductioninstigmaanddiscrimination,earlyandappropriateinterventions,improvedphysicalhealthandanimprovedqualityofthepatient’sjourneytorecovery.Increaseduseofharmandriskreductionstrategiesandrecovery-focusedinterventionsinmentalhealthandaddictionsservicesacrossallsectorsisalsoexpected.Recoveryandwellnessistheultimateanswertostigma.

ReCOMMeNdATIONS:

1 .2-1 Makementalhealthandaddictionsawarenessandknowledgeacorecompetencyforhealthprofessionalsatallservicelevelsandforappropriatestaffofothergovernmentservices.Programstoenhancethecompetenciesofstaffinlong-termcarefacilitiesshouldalsobeimplemented.

Thismaybeachievedthroughcollaborationwithuniversityandcollegehealthcaretrainingprogramstodevelopmentalhealthandaddictionscurriculaofferedearlyinthetrainingofmedicalstudents,nurses,occupationaltherapists,socialworkers,psychologists,teachers,childcareworkersandotherswhocomeincontactwithindividualswithmentalhealthandaddictionsissues.

Evidenceandbestpractice-basedapproachesshouldbeusedinmentalhealthandaddictionsbasictrainingandsensitivityawarenessforprovincialandDHA/IWKadministrators,policy-makersandemployeesintheDepartmentsofHealthandWellness,Education,CommunityServicesandJustice.Trainingmustincludecurrentinformationaboutcommunityresourcesandsupportsforpersonswithmentalhealthandaddictionissues,basichumanrightsprinciples,empathy,anti-stigmaawareness,communications,andlisteningskills.

1 .2-2 Educationsupportsmustbeavailabletoindividualswithamentalhealthissueorillnessand/oraddiction,aswellastotheirfamilyandidentifiedcircleofcaresothattheyunderstandtheillness,itstreatmentandhowtheycanbuildtheircapacitytocontributetoitsmanagement.

1.3 Discrimination and Stigma

WHAT We HeARd:Stigmaanddiscriminationmarginalizepersonswithmentalhealthandaddictionsissuesandillnesses.Theyarecontributingfactorsinmaintainingthesocialandeconomicdisadvantagesthatareanimpedimenttoseekingservices,supportsandrecovery.Notonlyarepeoplesufferingfrommentalhealthandaddictionissuesaffected,sotooaretheirfamiliesandserviceproviders.

Lackofknowledgeaboutmentalillnessandaddictionsisattherootofmanyformsofstigma,whichincludeinternalandexternalstigma,self-stigma,stigmabyassociationandstigmaacrossthelifespanoftheaffectedindividual.Stigmaisrealbehaviour,notmerelyanattitude.Thatbehaviourisorganizedthroughculturalandsocialroutinesandthepoliciesthatkeeppeoplewithmentalhealthandaddictionsissuesonthemargins.


Stigmaanddiscriminationexperiencedbythosewithmentalillnessaredistinctfromthatexperiencedbythosewithaddictions.Stigmatowardalcoholaddictionisdistinctfromdrugaddiction.Stigmaoccursinmanyenvironmentsincludingworkplaces,educationalfacilities,healthcaresettingsandinthemedia.Stakeholdersintheconsultationsidentifiedtheneedforgreatereducationinallmentalhealthandaddictionssettingstoaddressandreducestigma.

Under-fundingthementalhealthandaddictionsservicesis,initself,aformofdiscrimination.Itaddstothestigmaattachedtotheseissues.

Anti-stigmainitiativesmustbeconsistentwiththeinitiativesoftheMentalHealthCommissionofCanada,andbestpracticesmustbeidentifiedanddevelopedintoaprovincialanti-stigmacampaign.

TheProvinceshouldsupportcommunityinitiativesandprogramsthatpromoteananti-stigmamessageorengageinpositivestigma-reductionactivities.Effectiveexistingprovincialinitiativesshouldbeincorporated.Anti-stigmainitiativeswill:

• Drawattentiontothedifferencesinhowstigmaisunderstoodandexperiencedspecifictoaddictions,mentalhealthissuesandillnessandconcurrentdisorders.

• TargettheDepartmentofHealthandWellnessandDHA/IWKadministratorsandpolicymakers,healthcareprofessionals,policeandjusticesystempersonnel,DepartmentsofCommunityServicesandEducationpersonnel,otherserviceprovidersandthegeneralpublic.

• Developinterventionsthatareculturally-relevantandaccessibletomarginalizedgroupsandhigh-riskpopulations(e.g.,seniors,children,youth,AboriginalPeople,AfricanNovaScotians,Francophone/Acadians,immigrantpopulations,disabledpersons,andstreetinvolvedpersons).

• Developandusehealthpromotion,healthliteracyandprevention-focusedapproachesinsupportofevidence-basedanti-stigmacampaignsdirectedtowardaddressingstigmaamongyouth.

• Incorporatemessagesthatareinformedand/ordeliveredbypersonswithlivedexperienceofmentalhealthissuesandillnessand/oraddictionsandtheirfamilies.

• Usesocialmarketingtechniquesfordisseminationofknowledgetopromoteawarenessandtakeactionagainststigmaanddiscrimination.

• Supporttheadoptionacrossgovernmentdepartmentsandinthemediaofrespectfullanguagethatisappropriateinidentifyingpersonslivingwithamentalillnessand/oraddiction.

OBjeCTIve: ToeliminatediscriminationcausedbythestigmaassociatedwithmentalhealthandaddictionsissuesinNovaScotiathrougheducation,advocacyandbyenforcingtheprincipleswithintheCharterofRightsandFreedomsandprovinciallegislation,suchastheHumanRightsAct.


OuTCOMeS: Tobeginaprocesswherebypeoplearetreatedwithequityandwithoutdiscriminationwithinfamiliesandcommunities,aswellasinthehealthcare,education,justiceandcommunityservicesystems.Reductioninthestigmaattachedtomentalillnessandaddictionswillleadtoincreasedself-identification,earlyandtimelyinterventionandharmreduction.

Education,healthpromotionandknowledgetransferwilloccurincommunity-basedinitiatives.Thesewillberelatedtotopicslikesuicide,mentalhealthandaddictionsissuesandwilloccurinallcommunitiesincludingthosethataremarginalized.

ReCOMMeNdATION:

1 .3-1 Theprovincialgovernmentshouldcommittoamulti-year,collaborativeandinclusivestigmareductioninitiative.Bypubliclycommittingtothis,thegovernmentwilldemonstrateleadershipinaddressingdiscrimination,inequitiesandstigmaassociatedwithmentalhealthandaddictionsissues.

1.4 Health Promotion and Early Intervention

WHAT We HeARd:Healthpromotionandearlyinterventioninmentalhealthandaddictionissuesarecriticaltoacomprehensivestrategy.Opportunitiesaretoooftenmissedforearlyidentificationofandinterventioninmentalhealthandaddictionsissues.Thereisaneedtoenhanceeffortsamongyouthinschools,andamongadultsinworkplaces.Ahealthpromotionapproachusesastrengths-basedframeworktobuildresilienceamongyoungpeopleandbuildstrongsupportnetworksamongadults.

Kevin’soddbehaviourinandoutofschoolwasmarkinghimasasocialoutcastfromaveryearlyage.Childrenoftenrecognizedifferencesinthebehaviourofotherchildrenthatadultsmissorshrugoff.

Kevinwasfortunate.Heattendedschoolwhereamulti-agency,evidence-basedprogramcalledBEST(BehaviourEducationSupportTreatment)offeredhelpforelementaryschoolchildrenwithbehaviourandsocialchallenges.

Brightandcurious,Kevintookandhoardedinhisdeskatschoolandhisroomathomethingsthatclearlyweren’thisandsomethathefound,orbelongedinthegarbage.Inhisdeskatschoolwerehisclassmates’erasersandusedsnackwrappers.Athome,hismotherfoundastashoftrash.Shewasevenmoreworried,however,byKevin’ssevereagitationwhenshetookitaway.Kevinalsohummedincessantlyinschoolandhisteacherworriedaboutthesocialisolationhisbehaviourwascausing.

KevinwasreferredtotheBESTProgramwhenhewasinprimary.Assessment,consultationandtherapeuticinterventionsfromthelocalMentalHealthServiceschildpsychiatristandtheBESTteam,includingtheSchoolPsychologistwerearranged.Thesecliniciansconsultedwitheachother,Kevin’smotherandschoolstafftoplanandcoordinateKevin’scare.


GuidelinesweredevelopedregardingtheitemsKevinwasallowedtocollect.HismothercheckedhisbackpackeachnightandKevinhadtoreturnanythingthatwasnothis.Hewassupervisedmorecloselyatschoolandwasgivenastressballtokeepanduseintheclassroomashechose.

TwoyearsafterhisentryintheBESTProgram,Kevinwassuccessfullyusinganumberofthestrategieshelearnedtodealwithhiscompulsivebehaviour.Hissocialisolationwasbeingreversed;hewasbeinginvitedtobirthdaypartiesagainandappearedtobefittinginwithhispeers.Hismotherfeltcomfortablewithherson’sprogress.Thesedays,thesupportbothsheandKevinreceiveisonan“asneeded”basisonly.

Fosteringcollaborationamongdiversehealthcaredisciplinesandacrossthepublicsectorwillhelpimproveearlydetectionofmentalhealthandaddictionissues,andincreasetreatmenteffectiveness.Earlyidentificationandinterventionreducestheburdenofillnessandtheimpactontheindividual,familyandcommunity.Itreducescoststosocietyoverthelong-term.Giventhatupto70percentofmentalillnessesbegininchildhoodoradolescence,theDepartmentofEducationhasacriticalroletoplayinearlyidentification.

Researchsuggeststhatthestrongestreturnoninvestmentinhealthpromotioneffortsisforprogramsfocussingonchildrenandadolescents.Theseprogramsmightincludeincreasingparentingskills,andprimaryhealthcarescreeningfordepressionandalcoholmisuse.Healthpromotionprogramsinschoolsmightbeaimedatreducingconductdisordersanddepression,promotinganti-bullyingandanti-stigma,andincreasingsuicideawarenessandprevention.NovaScotiahasevidence-basedexamplesthatcanserveasmodels.

Returnsfrommentalhealthpromotionandaddictionspreventionshowupindifferentsectorsfromtheoneinwhichtheinvestmentsaremade.A“mentalhealthinallpolicies”approachshouldbeconsidered.ItshouldbenotedMentalHealthServicesandAddictionsServicesmusttakedifferentapproacheswhenaddressinghealthpromotion,illnesspreventionandearlyintervention.

Aformallinkbetweenreproductivementalhealthprogramsandthementalhealthandaddictionsservicessystemsshouldbeestablished.Thiscouldbeaccomplishedviaaspecialtynetworktolink DHA-basedprogramswiththeprovincialIWKprogram,andthroughdistance-basedinterventions.

OBjeCTIveS:

• Toenhancehealthpromotionandearlyinterventioninitiativesinallsettings,withspecificattentiononhealthcarefacilitiesandservices,workplaces,andeducationalinstitutions.

• Touseapopulationhealthapproachtoaddressmentalhealthandaddictionissues.

OuTCOMeS: Theexpectedordesiredoutcomesofimplementationofthefollowingrecommendationsare:

• Morementalhealthissueswillbeidentifiedearlysothattreatmentismoreeffectiveandtheconsequencesofillnessarenotassevere.Fewerpeopledevelopaddictionsandbeginusingsubstancesinappropriately,high-riskuseisreducedand,furtheralong


thecontinuum,aharmreductionapproachistakentominimizehealthandsocialconsequencesofaddiction.ThehealthofNovaScotiansisimproved.

• Aholisticapproachtomentalhealthandphysicalhealthassessmentisutilized.

• Employeesareprotectedfrompsychologicalharmandpsychologicalwell-beingisactivelypromotedintheworkplace.

• Employersexperienceenhancedorganizationaleffectivenessastheresultofreducedabsenteeism/presenteeism;lowerdisabilitycosts;reducedcostsassociatedwithhighturnoverandrecruitment;higherlevelsofemployeeengagementandproductivity,creativityandinnovation;lowerratesoferrorandphysicalinjuries;greatermarketabilityasan“employerofchoice”;anenhancedreputationasagoodplacetowork;andareducedriskoflegalissuesrelatedtopsychologicalharmtoemployees.(Presenteeismisattendanceatworkwhenillandgenerallynon-productive.)

ReCOMMeNdATIONS:

1 .4-1 Designaprovince-widehealthpromotionandearlyidentificationandinterventionapproachthat:

• Alignswithotherstrategies(district,provincial,otherjurisdictions,national);

• Targetsthegeneralpopulationaswellasspecificpopulationgroupsatrisk;

• Addressesthespecificneedsofyouthandyoungadults,includingjuniorandseniorhighschoolandcollege/universitystudents;

• Addressesthespecificneedsofseniors;

• Providesresourcingforprovince-wide,distance-basedearlyinterventionandself-managementprogramsaddressingmildtomoderatementalhealthissues;

• Recognizesandincorporatesthedifferentapproachestopreventionandpromotionrequiredformentalhealthandaddictioninitiatives;

• Collaborateswithemployersandunionstodevelopandimplementworkplacesupports,opportunitiesforearlyidentificationofproblemsandlinkagestoappropriateinterventions;

• Expandsthereachandrangeofharm-reductionservicesthatpreventandreducethehealth,socialandfiscalimpactsofproblematicsubstanceuseandproblemgambling;

• Includesinformationonaccesstolocally-availableresourcesincludingalternativestoconventionaltreatment.

1 .4-2 Integratescreeningandinterventionformentalhealthandaddictionproblemsacrossthelifespanintoprimaryhealthcaresettings,ensuringeffectiveandtimelyreferralandfollow-upprocesses.


• Includeanassessmentoffamilysupportsandwell-beinginscreening.

• Ensuretrainingofhealthpractitioners(e.g.,primarycarephysicians,emergencyphysiciansandEmergencyDepartmentstaff,nursepractitioners,continuingcarecoordinators,homecare,andlongtermcarestaff)inscreening,identification,earlyinterventionandreferral.

• Ensurethatthephysical/medicalassessmentneedsforpersonswithsevereandpersistentmentalillnessandaddictionsareaddressedinprimarycaresettings.

• Enhancescreeningforreproductivementalhealth,prenatalperiod,maternaladdictionsandmaternal-newbornattachmentissues.

• Integratescreeningforearlychildhooddevelopmental,behavioralandlearningdisorders,andfamilywell-beingintoaprovince-widescreeningprogramandensureeffectivereferralandfollowupprocesses.

• Supportevidence-basedinterventionstoenhanceearlydetectionandmanagementofillnessforyouth,adultsandtheirfamilies,takingintoaccounttheimpactoneducationandemployment,transitionintoschoolortheworkplace,andsupportforpharmacologicalandbehavioralmanagement.

• CreateapartnershipbetweentheDepartmentsofHealthandWellness,Education,JusticeandCommunityServicestocoordinateacomprehensiveapproachtoarangeofparentingsupportforfamiliesinNovaScotiadealingwithmentalhealthandaddictionissues.

1 .4-3 AdvancepsychologicallysafeworkplacesinNovaScotia(considerthestandardsunderdevelopmentbytheMHCC).Publicly-fundedworkplacesshouldhaveevidence-basedstrategiesandbeamodelforallworkplacesinassessingandaddressingriskstomentalhealthandproblematicsubstanceusewithintheemploymentsituation.

1 .4-4 Usethefindingsandevaluationsofyouthhealthandwellnessmodelsestablishedinsomeschoolsintheprovincetoinformhowbroaderaccesstothesemodelscouldstrengthenmentalhealthandaddictionsservices.

1 .4-5 AlcoholmisuseisamajorhealthissueinNovaScotia,withabroadimpactfeltwellbeyondthosewhoarealcoholdependent.Evidence-informedpopulation-basedpoliciesshouldbeexaminedaswaystofurtherreducealcohol-relatedharms.


2. Access and Intervention

2.1 Access to Services — Response and Wait Times

WHAT We HeARd:Virtuallyallstakeholdersidentifiedaccessingmentalhealthandaddictionsservicesasachallenge.Waittimesforoutpatientservices,majordifficultiesinaccessinginpatientservice,andlackofafter-hoursserviceswereallcitedasproblematic.Longwaittimesforchildrenandyouthwithsymptomsofmentalillnesswasaparticularconcern.Navigationofthesystemisdifficult.Therearedisparitiesinservicesformarginalizedpopulationsandacrossregionsordistricts.

NovaScotianswhoparticipatedinconsultationstoldustheywantasystemwhichcanproviderapidandeffectiveassistancetothosewithmentalhealthandaddictionsissues—onewhere“everydooristherightdoor”leadingtoeasynavigationandaccess.Today,accessforvarioussub-populationsisunevenatbest.Thesegroupsincludechildrenandyouth,diverse(indigenousandimmigrant)communities,incarceratedindividuals,seniors,militaryfamiliesandindividualswithsevereandpersistentmentalillness.

Tele-healthserviceisavailableineveryhospitalintheprovincebutisnotusedtocapacity.Itwasseenasapotentialsolutiontosomecommunityaccessproblems.Technologycouldprovideameasureofequalityofaccess,especiallyforruralpopulations,andcouldofferincreasedaccesstospecializedmentalhealthandaddictionsservices.Itisareasonablealternativetotravellinglongdistances,whichisabarrierformany.

NovaScotiahasbeenaleaderintheresearchontechnology-aidedinterventions.Evidencesuggeststheseinterventionscanprovidetimelyaccesstoassessmentandearlyinterventionformildtomoderatementalhealthissues.Thiswouldpermitthemoretraditionaldeliverysystemtofocusonthosewithmoresevereorcomplexmentalillnesses.

Areviewisrequiredofthefeasibilityofmobilecrisisteamsoron-callsystemstomeettheprovincialMentalHealthStandard:“Acrisisandemergencyresponseservice(CRS)isavailableinatimelymannerinthemostappropriateenvironmentineachdistrictandincludesaplanfor24-hourservice,sevendaysperweek.”Ultimately,however,governmentmustensurethatcrisis/earlyresponseserviceineachDHAisadequatetomeettheneedsofthepopulation.

Tele-healthandotherformsofinformationtechnologyandhealthinformaticsbasedapproachesshouldbeexaminedtodeterminetheirfeasibilitytoprovideservicesandenhancecollaborativecare.TheMobileCrisisTeam(basedintheHalifaxRegionalMunicipality)couldbesupportedtoprovidetelephonecrisisadvicetoallNovaScotiansfrom5:00p.m.to9:00a.m.andonweekends,withlinkagestocommunity/districtcrisisservices,emergencydepartmentsandinpatientunits.Thistypeofservicemightbeaccessedthrough811HealthLinkand211InformationandReferralService,onceoperatorsaretrained.Trainingfor911operatorsanddispatchersisunderwayandshouldcontinuesothattheycanidentifycallswithmentalhealthoraddictionsaspectssomembersofthemobileorothercrisisteamsand/orpoliceofficerswithcrisisinterventiontrainingcanrespond.

Trainingisanissueacrossthespectrumofserviceproviderswhocanencounterpersonswithmentalhealthandaddictionsproblems.TheDepartmentofCommunityServices,forexample,shouldreviewstafftrainingandbehavioralconsultationsupportsinthefacilitiesitfunds.Nursepractitionersin


collaborativecarepracticesshouldbetrainedtoenhancetheirroleinscreeningandbasicinterventionsformentalhealthandaddictionsissues.

Toexpandservices,theprovinceshouldevaluatethefeasibilityofwalk-inassessmentandbriefinterventionservicesintheDHAsand,basedonpopulationandneed,providementalhealthandaddictionsconsultationsinatimelymannerinEmergencyDepartmentsettings.

Seniorscanbeaparticularlyvulnerablepopulationduetodifficultdiagnosticcriteriaformentalillnessandaddictions,complexco-morbiddiseases,frailty,difficultambulation,livingarrangementsandlackofpeersupport.

Individualswithaddictionsormentalhealthconcernswhosebehaviourisdeemedtobeofconcernareoftennotofferedaccesstohomecare.Thepresentsystemofhomecaredoesnothavesufficientfundingandeducationforproviderstoensurehomecareisavailableforallpersonswithmentalhealthand/oraddictionsissueswhorequireit.

Communicationsandsystemnavigationisapersistentproblem.Atthecommunityordistrictlevel,anavigator/advocatesystemcouldbeusefulandrelevant,particularlyforspecificandminoritypopulations.Theseservicesmaybeabletoaddressmultiplehealthservicesbeyondmentalhealthandaddictionsservicesinsomedistricts.

Inaddition,effectiveandefficientcommunicationpathwayswithprimaryhealthcare,communityagenciesandotherreferralsourcesshouldbeestablishedtoensureupdatedinformationonmentalhealthandaddictionsservicesandreferralroutesiswidelyavailable.

Throughoutitswork,theAdvisoryCommitteelearnedofanarrayofspecificissuesrelatedtomentalhealthandaddictionsthatarecreatinggapsinaccesstoserviceandservicedelivery,particularlyforspecificsegmentsofthepopulation.Toooften,duetofinancialreasons,medicationsarenotavailabletothoseinneed.Peoplewithseriousorseverementalillnessfallthroughthecrackssimplybecausetheydonotactivelyseektreatment.

Understandingthepatientjourneyduringillnesscanshedlightonwhythosewithsevereillnessdonotseekservices.TheProvinceshouldexplorewaysofreachingpeoplewho,duetoseverementalillness,donotseekservices.Thesemightincludetheuseofpeersupportprograms,assertiveoutreachteams,andenhancedpublicandhealthcareproviderunderstandingoftheInvoluntaryPsychiatricTreatmentAct.

Community-levelsupportsarevitalinorderforrecoveredandrecoveringindividualstoreintegrateintotheworkforceandtheircommunities.Thesetypesofsupportsareunevenintheirdistributionandavailabilityacrosstheprovince.

TheAdvisoryCommitteeheardconcernaboutunevenaccesstoprovincialservices.Patientswholiveincloseproximitytotheprogramsseemtoaccessthemwithmoreeasethanthosefartheraway.Theprovinceneedstoevaluatetheutilizationofprovincialprogramstodeterminethattheyareequallyaccessibletopeopleinallareas.

Untreatedandunder-treatedmentalhealthissuesandillnessoraddictionscancontributetobehaviourthatleadstoself-harmandharmtoothers(e.g.,threatenedandcompletedsuicide,drinkinganddriving,assault,beingbullied).Theserequireinterventionthroughcrisisresponse,acutecareandcommunity-basedservicestohelpindividuals,familiesandcommunities.Interventionrequirescross-jurisdictionalcollaborationandinvolvesmanyelements,suchasthejusticesystem,involuntaryhospitalization,communitytreatmentorders,revokinglicensestodriveoralicensetoownfirearms,andprivacyand


confidentialityissuesinordertoeffectivelyintervene,prevent,postventandmanageriskofself-harmandharmtoothers.

OBjeCTIveS:

• Todevelopamentalhealthandaddictionssystemthatconnectspeoplewiththeservicestheyneedinaseamless,timelyandsimpleway.

• Toimprovetreatmentofseverely-illpatientsthroughaplannedandmanagedapproachtourgentcareandhospitalization.

• Toemploytechnologiesandemergingbestpracticestoimproveaccess.

OuTCOMeS: Expectedanddesiredoutcomesfromtherecommendationsinthissectionare:

• Mentalhealthandaddictionsstandardsrelatedtowaittimesareachieved.

• Earlyidentificationandinterventionthatwillleadtobetterhealthoutcomesandpatientsatisfaction,improvedpractitionersatisfactionandqualityofworklifeforserviceproviders.

ReCOMMeNdATIONS: General Access

2 .1-1 MentalHealthandAddictionsStandardsshouldberevisedtoincludeastandardrelatedtotheurgencyofaddressingmoderatetoseverementalillnessand/oraddictionsinapersonwhoisaparentorguardianofchildrenoryouth,giventhepotentialnegativeimpactonchildren’sdevelopmentandwell-being.Thetriagecategorymustbeadjustedtoreflectthisstatus.

2 .1-2 Resourcesneedtobesufficienttomeetthecurrentmentalhealthandaddictionsstandards.Stepsshouldbetakentofurtherreducewaittimesforchildrenandyouth.Thefollowingaresuggestedobjectives:

• urgent level of priority .AddictionsServicesStandardsforchildrenandyouthmustalignwithexistingMentalHealthStandards.Urgentreferralsshouldbeofferedanappointmentforassessmentwithinsevencalendardaysofthedateofreferral(achangefrom“10businessdays”incurrentAddictionsStandards).

• Semi-urgent .Semi-urgentreferralsofchildrenandyouthshouldbeofferedanappointmenttobeseenwithin14calendardaysofthedateforthereferral(achangefrom28daysintheexistingMentalHealthStandards).

• “Regular” or “general” referrals .MentalHealthStandardsshouldberevisedtoalignwithexistingAddictionsStandards.Regular/generalreferralsofchildrenandyouthshouldbeofferedanappointmentwithin21calendardaysofcase


assignment(achangefrom90daysinMentalHealthStandardsandconsistentwithAddictionStandardof15businessdays).

2 .1-3 Telephonecrisisinterventionservicesshouldbeexpandedandofferedprovince-wide,withtrainedstaffavailabletorespond.

2 .1-4 EnsurethatineachDHAthereisaccesstoaSeniorsMentalHealth/Addictionsprogramwithtrainedcliniciansandconsultingpsychiatryforspecialtyservicetoseniorswithlate-onsetmentalillnessormentalillnesscomplicatedbytheagingprocess,addictionsandmulti-dimensionalfactors.SupportandcontinuingprofessionaleducationforthesecliniciansshouldbeavailablethroughparticipationintheprovincialSeniorsSpecialtyNetwork.

2 .1-5 Assessmentandserviceforseniorsshouldbeavailablewithinthehome,residentialandlongtermcaresettingsandduringtransitionbetweensettings.Collaborationwithcommunityagenciesandservices,alongwithDHAinitiatives,shouldensurethat“arangeofpracticalandsocialsupportservicescanbedeliveredintheirhomestoseniorslivingwithmentalillness”andthat“thereisalevelofsupporttoseniorslivingwithmentalillnessthatis,ataminimum,equivalenttothelevelofsupportavailabletoseniorswithphysicalailments,regardlessofwheretheyreside.”(Kirby)SenatorKirbyalsorecommendedthatconsultationbeavailabletolongtermcarefacilitiestodeliverpsycho-educationforclientsandcaretakers.TheAdvisoryCommitteesupportsthatrecommendation.

2 .1-6 Thereshouldbeoneormore“stabilizationunits”withintheprovinceforpatientswithdementiawhoareexhibitingdifficultordangerousbehaviour.Dementiacarespecialistsworkingintheseunitscouldassessandtreatsuchpeopleoveralimitedtime,beforereturningthemtolong-termcarefacilitiesclosertotheirhomeswithspecifictreatmentplans.

2 .1-7 Fundhomecareprogramsthatspecializeinmanagingpeoplewithmentalhealthandaddictionsissues,especiallythoseperceivedtobe“highrisk”andthosewithsevereandpersistentmentalillness.

2 .1-8 Ensurethatthehealthcareneedsofpersonswithsevereandpersistentmentalillness(i.e.:schizophrenia,bi-polardisorder,andotherpsychoticdisorders)andconcurrentdisordersareaddressedthroughacomprehensivecontinuumofcare.Whilethismaybeacomparativelysmallpatientpopulation,ithasextremelyhighneedformanycomplexservices.IneachDHA,aformofintensivecommunitysupportservice(e.g.,AssertiveCommunityTreatment)mustbeavailableforthispopulation,reflectiveofdemographicsandneed.

2 .1-9 Navigators/advocatesshouldbemadeavailabletohelpindividualsandtheirfamilieseasilyfindtheirwaytotheappropriateserviceinthementalhealthandaddictionssystems.

2 .1-10 Ensurethatprogramsandserviceswithaprovincialmandateareclearlydesignatedassuch,andevaluatetheuseoftheseprogramstoensureequitableaccessforpersonsfromallpartsoftheprovince.

2 .1-11 Developcriteriaforandfundaccesstopharmacologicaltreatmentsformentalhealthandaddictionsforindividualswhodemonstratefinancialneed.


2.2 Peer Support

WHAT We HeARd:TheMentalHealthCommissionofCanadadefinespeersupportasanyorganizedsupportprovidedbyandforpeoplewithmentalhealthproblems.Peersupportissometimesknownasself-help,mutualaid,co-counsellingormutualsupport.Peersupportalsoappliestoaddictionsissues.Agreatdealofinformationonthebenefitsofpeersupportandadvocacyisavailable,butqualitativeandquantitativeresearchdataisgenerallylackingacrossCanada.

InApril2010,theMentalHealthCommissionofCanada(MHCC)launchedthenationwidePeerProjecttosupportthedevelopmentofStandardsofPracticeandresearchthevalueofpeersupportandadvocacy.InarecentMHCCstudy,peoplewhohadbenefitedfrompeersupportreportedbettercopingskills,betterunderstandingofmentalhealthissuesandservices,lessisolation,betterengagementatworkandintheircommunity,greaterabilitytoreachlifegoalsandexperienceasenseofaccomplishment,increasedqualityoflife,andfewercrisesandhospitalizations.Withpeersupport,peoplewithmentalhealthproblemsandillnessesandaddictions,serviceproviders,familycaregiversandothersbecomepartnersinthehealingjourney.

ThethreekeyobjectivesoftheMHCCprojectaretoproduce:

1. Nationalstandardsofpracticeforpeersupport;

2. Atrainingcurriculumandacertificationprocesstoprovidepeersupportworkerswithnationally-recognizedcredentials(voluntary);and

3. Researchtoevaluatetheefficacyofpeersupportprograms.

ReCOMMeNdATIONS:

2 .2-1 EstablishapartnershipwiththeMentalHealthCommissionofCanada(MHCC)andits“PeerProject”tocollaborateinestablishingnationalstandardsofpracticeforpeersupport.Developatrainingcurriculumandacertificationprocesstoprovideprovincial/localpeersupportworkerswithnationallyrecognizedcredentials,andresearchandevaluatetheefficacyoftheseprograms.

2 .2-2 ReviewthevarietyofwayspeersupportandpeeradvocacyisbeingdeliverednowinNovaScotiaasitrelatestomentalhealthandaddictions,reportingonthecurrentstateofpeersupportservicedeliverywithrecommendationsforproceedingundertheMHCCPeerProjectmodel.


2.3 Diverse Populations

WHAT We HeARd: MentalhealthandaddictionsservicesmustbeabletomeettheneedsofdiversepopulationsinNovaScotia.Manyinthesepopulationshavebeenunder-servedornotservedbytheexistingsystemforgenerations.Diversepopulationsexperiencebarrierstoserviceresultinginahigherburdenofillnessandgreaterriskformentalhealthandaddictionsproblems.

Programscurrentlyinplaceoftenarenotculturallyspecific,safeorrelevant,andarenotlinguisticallyinclusiveorresponsivetothehealthliteracyneedsofdiversepopulations.

“ItookmydaughtertothelocalEmergencyDepartmenttoseethepsychiatristbecauseshewashavingthoughtsofkillingherself.Whenwegotthereastaffmemberinthementalhealthsectionmadeacommentthathedidn’tthinkBlackpeopletriedtokillthemselves.AsmembersoftheBlackcommunitywhohavea200+yearhistoryoflivingintheprovince,Iwouldthinkthatpeoplewhoworkwithmentalhealthpatientswouldhaveabetterawarenessofprovidingsupporttonon-whitepeople.TheracialcommentsmadetomyfamilyspeaktowhyBlackpeopledonottrustthesystemtohelpus.Mydaughterwaitedalmostthreeweekstoseeatherapist.Thatpersonwasnobetterandmadeassumptionsaboutwhereshelived.Inshort,sheendedupnotgoingtocounsellingtherebecauseofthelackofculturalawarenessandpoortreatmentforhermentalhealthcrisis.WeendedupcontactingaBlacksocialworkerandgettingheraprivatetherapistwhounderstoodherculturalandmentalhealthneeds.Inshortthepresentsystem,asfarasIcansee,doesn’tworkforBlackpeople.”

Mentalhealthandaddictionsserviceprovidersrequireeducationaboutco-morbidity,concurrentdisorders,anduniqueriskfactorsforthediversepopulationstheyserve.Thereisagrowingbodyofknowledgethatindicatesthatunlesssenioradministratorsareconsistentlyanddeliberatelyeducatedaboutdiversityandsocialinclusion/exclusion,thelikelihoodoflongitudinaluptakeinagenciesandinstitutionsismarginalatbest.

Amongourdiversepopulations,therearegroupsthatwarrantparticularattentiontoensurethattheirmentalhealthandaddictionsserviceneedscanbeaddressedeffectively.Evidence-basedandculturallyspecificpreventionandhealthpromotionprogramstomeettheuniqueneedsofFirstNationsandAboriginalNovaScotians,AfricanNovaScotians,Francophone/Acadians,ImmigrantandLesbian,Gay,Bi-Sexual,TransgenderandIntersex(LGBTI)communitiesshouldbedeveloped.Whenworkingwithindiversepopulations,theDepartmentofHealthandWellnessshouldensurethatacollaborative,community,participant-drivenapproachispracticed.

MentalhealthandaddictionsneedshavebeenconsistentlyidentifiedasthehighestprioritybyFirstNationscommunitiesandAboriginalorganizations.Aboriginalindividuals,familiesandcommunitiessufferasignificantburdenofillnessintheseareas.

TheAdvisoryCommitteewasdistressedtoheartheexperienceofanAboriginalwomanwithahistoryofmentalillnessandsubstanceabusewhopresentedatoneoftheprovince’shospitalEmergencyDepartments.ERstaffknewher,butwhattheydidn’tknowwasthatshealsosuffered


fromdiabetes.Shewassober,butlowbloodsugarmadeherdisorientedanduncoordinated.Shewasdismissedwithoutexamination.Shehitchhikedhomeandwastreatedthenextdaybyherfamilydoctor.

Theprofoundimpactofculturalandhistoricalintergenerationaltraumamustbeconsideredwhenplanninganddeliveringservicestothispopulation.Itiscriticalthatservicesareculturallyappropriateandculturallysafe.

OBjeCTIve: TodevelopmentalhealthandaddictionsservicesthatmeettheneedsofallNovaScotians,includingdiversepopulationsandcommunities.Thesystemwillbeculturallyandlinguisticallyinclusive,healthliteracy-based,culturallysafeandaccessibletoallNovaScotians.

OuTCOMeS: Expectedanddesiredoutcomesfromtherecommendationsbelowinclude:

• Increasedculturalcompetencyamongcareproviders;

• Increasedculturalsafetywithinallmentalhealthandaddictionsservices;

• Increasedaccesstoservicesfordiversepopulations;

• Timelyaccesstointerpretersandgreaterengagementofdiversepopulationsasserviceprovidersandasclientsofthesystem;

• Providerteamsthatreflectandunderstandculturaldiversitiesofthecommunitiesinwhichtheypractice;

• Increasedrecruitmentandretentionofculturallyandlinguisticallydiversepractitioners.

ReCOMMeNdATIONS:

2 .3-1 Workcollaborativelywithmembersofdiversepopulationsandcommunities,includingimmigrantcommunities,toeliminatebarriersandsupportinitiativesthathavebeendemonstratedtoreducehealthdisparities,consistentwiththeProvincialCultural Competence Guidelines.

2 .3-2 Identifybest/wiseandevidence-basedpracticestomeettheneedsofspecificdiversepopulations.Identificationofsuchpracticesmusttakeplaceincollaborationwithidentifiedcommunitygroups.EstablishaDHAsandIWKProvincialNetworkforServicestoDiverseCommunitiestosupportthisprocessandtheworkofproviders.

2 .3-3 Provideinterpreterandtranslationservices(includingsignlanguage)asrequiredinclinicalsettings.


2 .3-4 Implementcommunity-basedmentalhealthandaddictionsservicesforAboriginalpopulationsthatareculturallycompetentandappropriate,supportcapacitydevelopmentandstrengthenrelationshipsparticularlybetweenFirstNationscommunitiesandDHAs/IWKmentalhealthandaddictionsprograms.SupportinitiativesaimedatincreasingAboriginalmentalhealthandaddictionserviceproviders.

2 .3-5 TheDHAsandtheIWKmustdevelopmeaningfulpartnershipswithkeystakeholderswithintheAfricanNovaScotiancommunitytodevelopcollaborativeclinically-competentapproachestomeetthementalhealthandaddictionsneedsofthecommunityacrossthelife-span.TheDHAsandIWKneedtorecruit,retainandpromoteAfricanNovaScotianhealthcareproviders.TheDepartmentofHealthandWellnessmustcontinuetoworkwiththeOfficeofAfricanNovaScotianAffairsandotherdepartmentstoaddressasystem-wideapproachtomeettheconcurrentneedsoftheAfricanNovaScotiancommunity.

2 .3-6 AcadiansandtheFrancophonepopulationmusthavetimelyaccesstoarangeoflinguistically-competentservices.TheprovinceshouldbesupportiveofinitiativesaimedatincreasingFrench-speakingmentalhealthandaddictionsserviceproviders.Inaddition,English-speakingserviceprovidersneedtobemadeawareoftheavailabilityofFrenchserviceprovidersandFrenchlanguageresourcestoaddressmentalhealthandaddictionsissues.Ultimately,serviceprovidersneedthenecessarytrainingtoprovidetherelevantmentalhealthserviceslinguistically.Furtherresearchisnecessarytodetermineifthereareculturally-specifictreatmentsrequiredtomeettheneedsofthispopulation.

2.4 Incarcerated/Justice Involved Individuals

WHAT We HeARd: Approximately50percentofprovincialinmatessufferfrommentalillness,and77percentreportsubstanceabuseproblems.Thereareconcernsthatadequatementalhealthandaddictionsservices,aswellasadequately-trainedstaff,arenotavailabletotreatindividualsinjail.Thereisalsoconcernthatsomepeoplemaycommitcrimesbelievingtheywillhaveaccesstomentalhealthandaddictionsserviceswhileincarcerated.TheAdvisoryCommitteesupportsrecommendationsintheDerrickreportthataddressgapsinservicesforthispopulation.

Moreworkisrequiredtoresearch,developandimplementevidence-basedapproachestomentalhealthandaddictionissuesspecifictoindividualswhoareincarceratedorbeforethecourts.Particularemphasisshouldbeonyoungpeoplewithmentalhealthand/oraddictionsissueswhoareintroublewiththelaw.Allapproachesshouldbegender,ethno-racial,culturalandlinguisticallysupportive.

Therearespecialchallengesinsupportingindividualsastheytransitionfromprovincialcorrectionalfacilityservicestocommunity-basedmentalhealthandaddictionsservices.Protocolsshouldbeestablishedtoensuregapsintreatmentareeliminated.

TheAdvisoryCommitteesupportstherecommendationofJudgeDerricktoexpandtheRestorativeJusticeprogramtoincludeadultswithlowseveritymentalhealthandaddictionsissuestoensuretheyreceivetimelytreatmentinterventions.Aswell,theAdvisoryCommitteesupportstheDerrick


recommendationthattheDepartmentsofHealthandWellness,Justice,Education,andCommunityServicescollaboratetoprovidementalhealthandaddictionsservicestoaccusedpersonsappearingincriminalcourts.

TheapparentsuccessoftheMentalHealthCourtnowsittinginHalifaxsuggestsanexpansionshouldbeconsidered.TheprovinceshoulddetermineifthereisaneedforaMentalHealthCourtinSydney,anddeterminethepossibilitiesforextendingaccesstotheexistingMentalHealthCourt,oranacceptablealternative,topersonsresidingoutsidetheMetroregion.

Specificguidelinesareneededtohelppoliceofficersdealwithsomeoneintheircustodysuspectedofhavingamentalhealthand/oraddictionsissue.Ifamentalhealthoraddictionsissueisdiagnosed(inanEmergencyDepartmentorbysomeothermeans),measuresmustbetakentoensurefollow-upwhenthepersonisreleasedbackintopolicecustodyormovesthroughthecriminaljusticesystem.Thisisparticularlyimportantforpeoplewhomaybeonpsychotropicmedicationandwhomaynothaveaccesstotheirprescriptionswhileincustody.Thelackofmedicationtocontroltheirsymptomsorwithdrawalfrompsychoactivedrugscanbeathreattotheperson’shealth,andwouldalsolikelyhaveanimpactontheoutcomeofanycriminalproceedingsagainstthem.

Policepointoutthatguidelinesarealsoneededtoassistwithpersonswithsuspectedordiagnosedashavingmentalhealthand/oraddictionsissues,whoarenotintheircustodyforcriminaloffencesbuthavenohousingornaturalsupports.TheyarebroughtbypolicetoEmergencyDepartmentsandsubsequentlydischarged.

Specificguidelinesshouldalsobedevelopedtoensurepersonssuspectedordiagnosedwithmentalhealthand/oraddictionsissueshavethoseissuesaddressedwhentakenintocustodybythepolice.

OBjeCTIve: Toensurethatmentalhealthandaddictionsservicesareeasilyaccessibleinaseamlessmannertoindividualswhoareincarceratedorinvolvedwiththejusticesystem,aswellastotheirfamilies.

OuTCOMeS: Lawenforcementofficialswillhavetheknowledgeandskillstorecognize,interveneandcopeeffectivelywiththeuniqueneedsofindividualsinvolvedinthejusticesystemand/orincarceratedindividualsinneedofmentalhealthandaddictionsservices.Theseindividualswillexperienceseamlesscontinuityofcareandtimelyaccesstomentalhealthandaddictionsservices.

ReCOMMeNdATIONS:

2 .4-1 Provideadditionalmentalhealthandaddictionsservicestoensuretimelyaccessandtomeettheneedforservicewithinprovincialcorrectionalservices.Reviewthespacerequirementsforsuchenhancementsandensuresufficientandappropriatetreatmentspaceisavailablewithincorrectionalfacilities.

2 .4-2 Providebestpracticeanti-stigmaeducationtohealthcareproviders,EmergencyDepartmentstaff,policeandcorrectionsworkerstoestablishagreaterlevelofcomfortandskillindealingwithindividualswhohavementalhealthand/oraddictionsissues,andareorhavebeeninconflictwiththelaw.


2.5 Mental Health Inpatient Care

WHAT We HeARd: Inpatientbedsarethe“criticalcare”endofthementalillnessandaddictionscontinuum.Here,acutelyillpatientswhoneedstabilizationandwhosecrisescannotbesafelymanagedinthecommunityaretreated.Theaimofacuteinpatientcareistorelieveproblemssafelyandrapidlyinastructuredenvironmentthatprovidessupportandinvolvementwithanemphasisontreatment,stabilizationandtransitionbacktothecommunity.Thestabilizedpatientisexpectedtoaccesscommunityprograms.Withoutaccesstoinpatientservices,communityprogramsandsupportivehousingcanbeoverwhelmedbytheneedsofseverely-illpatients.

Theconsequencesofashortageofbeds,especiallywhencombinedwithinadequatesupportivehousingandcommunitysupports,include:increasedhomelessness,theincarcerationofmentallyillindividuals,overburdenedEmergencyDepartments,andincreasedviolentcrime.Therightbalancemustbeachievedbetweentreatmentwithincommunity-basedservicesandinpatientservices.

CurrentlyinNovaScotia,thereare20psychiatricinpatientbedsper100,000people.Thisnumberislowcomparedtootherjurisdictions.Unevenbeddistributionacrosstheprovincecreatesbarrierstoaccessandfrustratingsearchesforavailablebeds.Theshortageofsupportivehousingoptions,andthetendencytoadmitpeoplewithbehaviouralproblemslinkedtodementiatopsychiatricunits,hasreducedthecapacityforinpatientcareofseverely-illpatients.

Overthepastdecadeormore,theExecutiveDirectorofMentalHealth,Children’sServicesandAddictionTreatmentoftheDepartmentofHealthandWellness,DHAVicePresidentsofCommunityHealth,ChiefsofPsychiatry,MentalHealthDirectorsandPsychiatricUnitManagersfromtheDHAshavefrequentlyreviewedtheseriouschallengesofaccesstoinpatientpsychiatriccare.Thereisagreementthatthecurrentsystemdoesnotprovideeffectiveandtimelyaccess.

Whenreconfiguringtheadultinpatientpsychiatricsystem,considerationshouldbegiventotheshortstayinpatientneedsforyouthandchildren.Itisimportanttocontinuetohousetheyouthforensicpopulationseparatelyfromthegeneralyouthinpatientservices.

Anumberofchallengesrelatedtoinpatientpsychiatriccareareidentifiedbelow:

1. Smallunitsaredifficulttosustaindueto:

• Chronicshortagesofpsychiatricandnursingresources;

• Smallcomplementofstaffwithlimitedsupportforprovidingservices;

• Inadequatecomplementofpsychiatricservicesfor24/7coverageofunitsespeciallyinnon-urbansettings;

• Inadequateaccesstoadmissiontomeet24/7requirementofservices;e.g.closuretoadmissionsasearlyas3:00p.m.onweekdaysandnoononweekendsinnon-urbanunits;

• Partialshutdownofunitsduringholidayperiods;


• Lackoffullcontinuumofcarefromshort-staycrisisstabilizationtomediumstaypsychiatricrehabilitationandsubspecialtyservices;and

• Crowdedenvironments.

2. Pressureonunitstoadmitpatientspresentingfornon-psychiatricdisorders,suchasbraininjury,dementia,orwhoaredifficulttomanageonothermedicalunits.

3. Utilizationofbedsbyotherpatients,suchasthosewaitingforplacementinlongtermcarefacilities.

4. Insufficientdevelopmentofintensivecommunitysupportswhichinturnplacespressureontheinpatientsystem.

Thesechallengeshaveledto:

• Chronicshortagesofinpatientpsychiatricservicesandbeds;

• SignificantdifficultiesforEmergencyDepartmentstafffindingbedswhenhospitalizationisessentialformentalillnessmanagement;

• LackofavailableinpatientresourcestoacceptandmanagepatientscertifiedundertheInvoluntaryPsychiatricTreatmentAct;

• Patientswithseverepsychiatricillnessbeingheldinunsafe,inappropriateandnon-therapeuticsettings,whichexposesthemtoincreasedriskandsetsdangerousprecedentsforstaffandDHAmanagers;and

• Frequentout-of-districtandout-of-provincetransferswithadditionalcostsandfragmentedpatientcare.

ReCOMMeNdATIONS:

2 .5-1 Implementaprovincialsystemofinpatientpsychiatricbedmanagementwhichincludesconsistentandclearadmissioncriteriaandpolicy.Aprovincialbedcoordinatormayfacilitateaccesstoinpatientbedsacrosstheprovince.

2 .5-2 Provideadultinpatientpsychiatriccareinfewer,largerunitsstrategicallyplacedacrosstheprovince.Eachunitshouldprovideafullrangeofservicestopatientsandfamiliesfromallareasandensuresuccessintherecruitmentandretentionofstaff.TheIWKshouldcontinuetohouseachildandyouthinpatientunit.ThenumbersofbedsintheprovincemustnotbereducedsinceNovaScotiaisalreadyworkingwithasmallnumberofbedspercapita.Servicesshouldincludeshortstaycrisisstabilizationtomediumandlongerstaypsychiatricrehabilitationandsubspecialtyservices(whicharecurrentlyunavailableinsmallerinpatientunits).AllNovaScotiansshouldhaveequitableaccesstotheseunits.

2 .5-3 Establishaprovincial/multi-DHA/IWKMentalHealthInpatientServicesCommitteetowhichallinpatientserviceswouldbeaccountable,toensureappropriateutilizationandaccessibility.


2 .5-4 Reviewtheeffectivenessofexistingmodelsofobservationbedsinpsychiatricunitsthatareaccessibledirectlybyemergencyphysiciansorfamilyphysicianson-calltodetermineifimplementationacrossallDHAsshouldbecomestandarduntilsuchtimeas2 .5-1and2 .5-2arefullyimplemented.

“Modelsofobservationbedsinpsychiatricunitsthatwereaccessibledirectlybyemergencyphysiciansorfamilyphysicianson-callwerenotedtobeeffectiveinsomedistricts.Somereportedthat24to48hourmanagementofmanyofthesecrisesoutsideoftheemergencydepartmentandinanappropriatementalhealthunitoftenledtoresolutionofproblemsbeforepsychiatrybecameinvolved.”(Gass)

2 .5-5 Ensurethatshortstay,crisismentalhealthandaddictionsservicecapabilitiesexistwithinthecontinuumofinpatientservicesforchildrenandyouth.Itisvitalthatpatientsandtheirfamilieshaveaccesstotheseservicesregardlessofwheretheyliveacrosstheprovince.

2 .5-6 EstablishoneortwosecureroomswithinEmergencysettingstomeettheneedforshorttermstaysandemergenciesinDHAswithoutin-patientservices.

2 .5-7 Examinetheneedforspecialized,tertiary-levelpsychiatricbedsandservicesforcomplexillnesses(e.g.,psychogeriatrics,eatingdisorders,etc.).Thesearedistinctfromacutecarepsychiatricunits.

2.6 Addictions Services

WHAT We HeARd:Currently,accesstoaddictionsservicesisvoluntary,respectingthefacttheindividualmustrecognizeaneedfortreatment.Whilethisapproachworksformanypeople,itisdifficultforfamily,friendsandthecommunitywhentheindividualdoesnotagreetotreatment.Morecanbedonetoprovidesupportandengageineffortstoencouragethosewhoneedtreatmenttoreceivetreatment.

Accesstoopiatesubstitutiontreatmentshouldbebroadened.Thoseonevidence-basedsubstitutiontreatmentregimesshouldalsohaveaccesstomedical,pharmaceutical,andpsychosocialsupports.Thealarmingprevalenceofopiateuse,particularlyamongyoungNovaScotians,suggeststhattheappropriateinfrastructuretosupporttreatment(generallymethadone)programsshouldbeavailableprovincially.Thiswillrequirethedevelopmentofstandards,laboratorytestingofurines,recruitmentandtrainingincorecompetenciesforhealthpractitionersinprimarycaresotheycanundertakeprescribing,managingandongoingcareofindividualsthathavebeenstabilizedinsupportedprograms.

Thefollowingchallengesspecifictoaddictionsservicesaccessandinterventionhavebeenidentified:

• Chronicshortageofwithdrawalmanagementservices;

• Shortageofintensiveresidentialandinpatientrehabilitationprograms;

• Lackofsupportivehousingusingarecoverymodel;


• Highrecidivismtowithdrawalmanagement;and

• Limitedaccesstomethadonetreatmentduetolownumbersofpractitionerscompetentinmethadonemanagement,lackofinfrastructuretomanageandmonitoradherencetotreatment,lackofcommunity-basedtreatmentandlackoffunding.

Thesechallengeshaveresultedinthefollowingproblems:

• Withoutappropriateaccesstowithdrawalmanagementandrecoverycare,individualshavelostfamily,housing,employment,andfreedomduetoincarceration.Theyhaveexperienceddeteriorationinphysicalhealth.Thisallhasadetrimentalimpactonthewell-beingofcommunities.Theeconomiccosttohealthcareprograms,andthesocialcosttocommunitiesandindividualsareincreasedwhenindividualsareunabletobefinanciallyindependentorareincarcerated.

• Withoutaccesstomethadonetreatmentthereisahigherchanceofoverdoseanddeath.Whenpeoplearestableonmethadone,otherhealthissueslikeHepatitisCcanbetreatedinatimelymanner,avoidingsubsequentseriousmedicalconsequences.

ReCOMMeNdATIONS:

2 .6-1 Reconfigureaddictionsinpatientbedsforwithdrawalmanagement,opiatestabilizationandstructuredtreatmentaccordingtoevidenceandbestpractice,utilizingalternativecommunity-basedapproacheswherepossible.

2 .6-2 Ensurethatwithdrawalmanagementservicesforyouthareavailableformanagementofaddictionsandconcurrent(mentalhealthandaddictions)disorders.Ensureseparateadultaccesstotreatmentforconcurrentdisorders.

2 .6-3 Supportthedevelopmentofcommunity-basedsupportivecareformentalhealthandaddictionswithinspecificculturalcommunitiesintheprovince,andofferon-sitecaretopopulationsthatcannot,foravarietyofreasons,accessthatcareinclinicalsettings.

2 .6-4 Increaseaccesstoevidence-basedopiatesubstitutiontreatment.


2.7 Continuity of Care

WHAT We HeARd: Intimesoftransitionbetweenservices,therisksofgapsinservicewherepeoplemay“fallbetweenthecracks”aresignificant.Thiscanhappenwhenyouthtransfertoadultservices,whenpersonswithconcurrentdisorderstransferbetweenmentalhealthandaddictionsservices,andwhenpatientsaredischargedfrominpatienttreatmentprogramstocommunity-basedoroutpatientservices.

Theservicesreceivingthenewpatientsmaynotreceiveinformationinatimelyway,orengagementoffamilyorothersupportsmaybelacking.Similarly,whenpersonsaredischargedfromformalmentalhealthandaddictionsservicestocommunitysupports,transitionanddischargeplanningcouldbeimprovedtoensurecontinuityofcare.Thiscanalsobeanissuewhenincarceratedindividualswithmentalhealthandaddictionsissuesaredischargedtoreceivementalhealthoraddictionsservicesinthecommunity.

Theliaisonsbetweenchildandyouthandadult-focusedmentalhealthandaddictionsservicesshouldbestrengthenedtoprovideatimelyandseamlesstransitionforyoungpeople,theirparents,guardiansorcaregivers.Thiswillrequirecollaborativeconsultationandcarepractices.Circumstancessuchasdifferencesintheageatwhichvariousgovernmentdepartmentsdefinechildrenoryouthservices,versusadultservices,cancausesignificantgapsanddisruptioninservicetoanindividual.

Effortsareneededtoensureseniorswithmentalhealthand/oraddictionsissuesarecaredforintheappropriatesettings.Forexample,theyshouldbetransitionedfromacutecaretolong-termcarefacilities,orotherappropriatehousing,whenitisclinicallyappropriatetodoso.AsrecommendedbySenatorKirby,alternativestohospitalizationshouldbemorewidelyavailablebycreatingaffordableandsupportivehousingunitsforseniorslivingwithmentalhealthand/oraddictionsissues.

AsDr.Rossrecommended,longtermcarefacilitiesshouldhavespecialcareunitswithdifferentstaffratiossotheycantakeandcareforhigher-careresidents,includingthosewithmentalhealthandaddictionsissues.Thisflexibilitywillfreeupacutecarebedssoonerandkeepat-riskpatientsfromEmergencyDepartments.

Essentialsupportsneedtobeputinplaceforpersonsdischargedfromcriminaljusticeprogramsandfacilitiesbacktothecommunity.Theseshouldincludesupportiveshort-termhousing,adequatelongertermhousing,homecare,readyandregularaccesstoappropriatementalhealthandaddictionsservices,communityoutreachandintensivecommunitysupport(includingpeersupport)andmedicationsasneeded.

OBjeCTIve: Tocreateaseamlesscontinuityofcarewithadequatetransitionsupportforpersonsastheymovebetweenprogramsandservicesandastheyaredischargedfromservices.Continuityofcareisavailableinsystemsutilizingcollaborativementalhealthcaremodels.

OuTCOMeS: Personswithmentalhealthand/oraddictionsissuesandtheirfamiliesareappropriatelysupportedduringtransitionsbetweenservicesandwhendischargedfromtreatment,leadingtoenhancedcontinuityofcare,harmreductionandenhancedrecovery.


ReCOMMeNdATIONS:

2 .7-1 Implementeffectiveplansfortimelyandseamlesscontinuityofcarebetweenservicesandacrossthelife-span(e.g.,fromyouthtoadultservicesorfromadulttospecializedseniorservices;frominpatienttocommunity-basedcare).Plansforsuchtransitionsshouldincludewrittendischargeplans,briefingthosewhowillprovidecareinthenextstepoftreatment(familyandotherserviceprovidersincludingsheltersandtransitionhouses),caseconferencingandothercoordinatingtasksasrequired.

2 .7-2 Aligntheageoftransitionfromyouthtoadultserviceacrossgovernmentdepartments,especiallyDHWandDCS.

2 .7-3 EnsurethesafetransitionofpatientswhoaremedicallyclearedanddischargedfromEmergencyDepartmentsbackintothecommunity,whenpolicehavebeeninvolved,orwhenthereisalackofhousingandfamilyornaturalsupportsfortheperson.


3. A Collaborative and Coordinated Approach

3.1 Collaboration and Coordination

WHAT We HeARd: Thesystemneedstoworkmoreeffectivelyacrossdepartments,careteams,betweenjurisdictionsandamongacademicsandcliniciansthatdeliver,plan,researchorfundsomeaspectofmentalhealthandaddictionstreatmentorsupport.Therearetoomanysilos.Thelackofcoordinationmakesitchallengingforprovidersofmentalhealthandaddictionsservicestryingtoensuretheyareofferingthebestcare.Somesilosareduetothewayprofessionalsaretrainedandtheirscopeofpractice.Someareduetothewayresourcesareadministered,eventhoughinefficienciesareperpetuated.Othersareduetothefactthatawiderangeofagencies,sectorsandjurisdictionsareinvolvedinthelivesofpeoplewhoneedmentalhealthandaddictionsservices—andtheissuestheydealwitharecomplex.

AcrossNovaScotia,thereareexamplesofexcellenceincollaborativecarefromwhichthesystemcanlearn.Theseincludecollaborativecarebetweenmentalhealth/addictionsandprimarycarepractices,betweenMentalHealthServicesandAddictionsServices,andbetweenMentalHealthandAddictionsServicesandotheragencies.

Havingclearrolesandaccountabilities,guidedbypoliciesthatmakesenseandprogramsthatreflectthemisfundamental.InthecaseofFirstNationspeoplelivingonReserves,thejurisdictionalmazeisespeciallyconfusing.Federally-fundedmentalhealthserviceson-reservearefocusedonprevention,promotion,educationandshort-termcrisisintervention,anddonotparallelorduplicateprovincialmentalhealthoraddictionsservices.Thisleadstosignificantgapsinservicedeliverybetweenhospitalandhome,andmissedopportunitiestoimproveaccess,qualityandthepatientexperience. Itiscriticalthattheprovincialandfederalgovernmentsandserviceprovidersareclearonwhoisresponsibleforprovidingwhatmentalhealthandaddictionsservices,sothatFirstNationsindividualsneedingcareandsupportareabletogetit.Militaryfamiliescanfindthemselvesinasimilarsituation,deniedservicesduetojurisdictionalconfusionoverresponsibilities.Thesebarrierstocareneedtoberemoved.

Stakeholderswantincreaseduseofsharedcareandcollaborativecaretoimproveoutcomesforindividualswithmentalhealthandaddictionissues.Acollaborativeapproachtoconcurrentmentalhealthandaddictionsdisordersisalsorequired.

Issuesidentifiedincludeinefficienciesandinadequatecareresultingfrompoorcommunicationandco-ordinationbetweenandamong:

1. Governmentdepartments;

2. DHAsandtheIWK;

3. Varioushealthcareservices;

4. Thementalhealthandaddictionsservicessystems;

5. Teamsandcliniciansprovidingservices;


6. Theformalsystem;and

7. Servicesinthecommunity.

Effectiveandefficientteamscouldmaximizetreatmentandprogrameffectivenessandultimatelyenrichtheworkenvironmentforpractitioners.StaffteamsinDistrict/IWKMentalHealthServicesandAddictionsServiceswillaffordopportunitiesforcaseconferencing,casemanagement,specialtyconsultation,interdisciplinaryeducation/professionaldevelopment,programplanning,evaluationandqualityassurance.

Interagency,interdisciplinarycasemanagementapproachestoaddresstheserviceneedsofchildrenandyouthwithseriousbehaviouralandsocialchallenges,aswellasfortheirfamilies,andalsoforpersonswithcomplexandmultipleneedswillbridgethegapswheretoomanyofthesepeoplefall.

OBjeCTIve: Improvedcommunication,co-operationandcontinuityofservicesacrosssectorsresultinacollaborativeapproachtomentalhealthandaddictionsservices.

OuTCOMeS: Collaborative,sharedcareapproachestomentalhealthandaddictionsservicesareevidentwithineachDHAandtheIWK,andinvolvehealthcareproviders,government(DepartmentsofHealthandWellness,Justice,CommunityServices,Education)andnon-governmentservices.

ReCOMMeNdATIONS:

3 .1-1 DevelopandimplementDHAandIWKapprovedguidelinesforacollaborativeapproachtoinformationsharingamongteamsofmentalhealthandaddictionserviceproviders,aswellasindividualsidentifiedbypatientsassupportingthemintheirrecovery,withoutcompromisingthepatient’srighttoprivacyandconfidentiality.

3 .1-2 EnsurethatMentalHealthandAddictionsServicesacrosstheprovinceworkcollaborativelywiththeDepartmentsofCommunityServices,Education,JusticeandHealthandWellnesstocreatemodelsofcarethatidentifyandsupportchildrenandfamiliesatrisk.

3 .1-3 DevelopaMemorandumofUnderstandingbetweenDHAsandFirstNationcommunitiestoclarifytheresponsibilitiesoftheprovincialgovernmentandfederalgovernmentinordertohaveseamlessaccesstonecessarymentalhealthandaddictionsservicesforFirstNationscommunities.StrengthenrelationshipsbetweenDHAs/IWKandFirstNationcommunitiestobuildasharedunderstandingofmentalhealthandaddictionsneedsandhowtoaddressthemmosteffectively.

3 .1-4 Resolveconfusionoverfederalandprovincialhealthcaremandatestoensureappropriateandtimelymentalhealthandaddictionsservicesareavailabletomilitaryfamilies.


3.2 Person-centred and Family Inclusive

WHAT We HeARd:Personswithmentalhealthandaddictionsissuesmustbeempoweredandsupportedtobeactivelyengagedintheirownjourneytowell-being.Bydefinition,therecoveryprocessisself-directedbytheindividualtowardhisorherowngoals.

“Iwasdiagnosedwithschizophreniainmysecondyearofuniversity.Anhonoursstudentwithhopesofamedicalcareer,Iwassuddenlydefinedbymyillness.Iwasnotofferedmuchhopeorhelpfromtheprovincialhealthcaresystem.InsteadIwasofferedareferraltocommunityservicesforincomeassistanceandasmall,lessthandesirableapartment.Mylifewastobereducedtooneofisolation,poverty,discriminationandillness.

“Thehealthcaresystemwassatisfiedtosendmebacktomyfamily,whoknewnothingaboutschizophrenia,withoutsupportoradischargeplaninplace.RehabilitationandrecoverywereneverdiscussedandIwasreadytoacceptmynewreality.Iwastoosicktofightformyself.

“Myfamilyhoweverhaddifferentplansandsteppedintoeducatethemselves,advocateandsupportmeinmyjourneytorecovery.Theyfirmlybelievedinrecoveryandcouldalwaysseemenotjustmyillness.TogetmylifebackontrackbecameapriorityforthemandwiththeirhelpIgotthemedicalcareIneededandhavenowcompletedmyeducation.Ihaveawonderfulfull-timejob,abrightfutureandgoodmentalhealthdespitehavingamentalillness.

“Inaperfectworldeveryonediagnosedwithaseriousmentalillnesswillreceiveearlyintervention,treatmentandrehabilitationandbegivensupportandhope.Icannotunderstatetheimportanceofmyfamilyandtheneedforfamilytobesupportedintheirefforts.”

Stakeholdersreportedthatwithintheformalsystemofhealthcare,familymembersaresometimespreventedfromplayingaroleinthecareofpersonswithmentalillnessand/oraddictionsissues.Thedefinitionof“family”isbasedonthepatient’sconceptoffamily.

Stakeholderssupportedanapproachthatincludesfamilyandnaturalsupports.Itshouldbeacknowledged,however,thatinsomecircumstancesthisiseitherimpossibleorinappropriate.

Stakeholdersalsoidentifiedtheimportanceofrespitecarebeingavailabletosupportcaregivers.Caregiverstakeonanenormousburdenandoftenputthemselvesatgreaterriskfordevelopinghealthconcernsrelatedtothestressofdoingso.Providingmoresupportforcaregiverscouldreducethestress-relatedissuestheyoftenexperience,andtherebyreducetheburdenonthehealthcaresystem.

Thenon-profitandvolunteersectorssupportthementalhealthandaddictionssystemandhelpbuildcapacityinacost-effectiveway.They,inturn,requirethesupportofgovernmentandthecommunity.Volunteergroupscouldhelpprovidepeersupportinitiatives,educationprograms,familygroupinitiativesandself-helpprograms.Qualityassurancecouldcomethroughthedevelopmentofcertificationandaccreditationprocessesforself-helpandpeersupportprograms.


Casemanagementoffersaperson-centredapproachwhentheindividual’sneedsencompassmanyservicesandcrossmanyagencies.Acasemanagercoordinatesservicesformentalhealth/addictions/justiceclients,andisresponsiblefortheassessmentofneedandimplementationofcareplans.

Casemanagementisacollaborativeprocessofassessment,planning,facilitationandadvocacyforoptionsandservicestomeetanindividual’sholisticneeds.Itisimplementedforindividualswhorequiresupportinareassuchashousing,mentalhealth,justice,addictions,employment,socialrelationships,andcommunityparticipation.

Careplansaredevelopedincollaborationwithclientsandreflecttheirchoicesandpreferences.Thegoalistoempowertheclientandensuresheorheisinvolvedinallaspectsoftheplanningandservicearrangements.

Thecasemanagementapproachassumesthatclientswithcomplexandmultipleneedswillaccessservicesseamlesslyfromarangeofserviceproviders.Casemanagementisdescribedasaboundaryspanningprocesstoensureserviceprovisionisclientratherthanorganizationallydriven.

OBjeCTIve: Aperson-centredsystemofcarethatrespectstheprivacyandconfidentialityoftheindividualwithmentalhealthand/oraddictionsissues,andwhichtakesintoaccounttherolesoffamilymembersandnaturalsupportsincaringforindividuals.

OuTCOMeS:Acommonunderstandingofperson-centeredandfamily-inclusivecareamongproviders,individualsandfamiliesshouldresultin:

• Increasedengagementofthepersonintreatment,increasedself-empowermentandself-care.

• Flexibleservicemodelsthatintegratefamiliesandidentifiedsupportsintocareanddevelopmentofcommunitiesasintegraltowellness.

ReCOMMeNdATION:

3 .2-1 Developandimplementprovince-wideperson-centeredandfamily-inclusiveapproachestomentalhealthandaddictionservices.


3.3 Collaboration between Mental Health and Addictions

WHAT We HeARd: Foranumberofyears,therehavebeenclaimsthattheincidenceandprevalenceofco-occurringdisordersisveryhigh.Thisclaimhasbecomewidelyacceptedandhascontributed,atleastinpart,toapushforintegrationofMentalHealthServicesandAddictionsServices.Evidenceinthesupportingdocument“EpidemiologicalandDemographicAnalysis”(p.28)presentsaslightlydifferentperspective. (Note: Supporting documents are available from the Nova Scotia Health Research Foundation.)

Asimportantastheepidemiologicdataarefordrawingattentiontotheoverlapbetweenmentaldisordersandsubstanceusedisordersinthegeneralpopulation,itshouldalsoberecognizedthatmostpeoplewithsubstanceuseproblemsdonothaveco-occurringmentaldisorders,andviceversa.Thesignificant,butnotoverwhelming,degreeofoverlapcautionsustomaintainafocus,asappropriate,onthelargemajorityofpeoplepresentingwithsingledisorders.

Itisalsoimportanttonotethattheratesofoverlapinsomesubgroupsareindeedsubstantial.Forexample,closetoone-thirdoffemaleillicitdrugusersmetcriteriaforaco-occurringmoodoranxietydisorder.Butoverallratesofco-occurringdisordersinthegeneralpopulationaremuchlowerthanwhathasbeenobservedinclinicalpopulations.

Itisessentialtoensurethatindividualsimpactedbyconcurrentmentalhealthandaddictionsdisordersandtheirfamilieshavetimelyaccesstoqualitycollaborativecarealongacontinuumofservicesandsupportsthatbestmatchtheirneeds.

TheDepartmentofHealthandWellnessiscurrentlydevelopingstandardsofcareforconcurrentdisordersandtheseshouldbeimplemented.

ReCOMMeNdATIONS:

3 .3-1 PriortoproceedingwithanyamalgamationofMentalHealthServicesandAddictionsServices,aninterdepartmentalteamshouldidentifyandcriticallyappraiseevidencepertainingtotheneedforintegrationatboththeserviceandsystemlevel.

3 .3-2 Promotethephysicalco-locationofMentalHealthandAddictionsServiceswherefeasible.Jointcollaborativeapproachestocareshouldbeundertaken.

3 .3-3 Developsharedprotocolsandpoliciesaimedatcoordinatingmentalhealthandaddictionsservices.Theseprotocolsshouldconsiderthefollowing:

• Asingleaccesspointforinformationonmentalhealthandaddictionsforserviceprovidersandthegeneralpublic;

• Acoordinatedintakeandassessmentprocessthatusescommontools;


• Commondatabaseand/ortheabilitytoshareinformationaboutpatientsacrossserviceproviders;

• Boundaryspanningpositions(e.g.,navigators,formalliaisons,casemanagers);

• Aframeworkforevaluationthatusesserviceindicatorsthatmeasuresuccessofcollaborativeinterventionsforconcurrentdisorders;

• Manageconcurrentdisordersbyearlyidentificationanduseofinterventionsthatintegratementalhealthandaddictioncare;

• Developexpertiseinmanagementofconcurrentdisordersandensureavailabilityofsuchservicesacrosstheprovince;

• Cross-trainmentalhealthandaddictionsservicesclinicianstopromoteacommonunderstandingofbothaddictionsandmentalhealth;

• Ensureallclientsarescreenedformentalhealthandaddictionsissues;and

• SupportcapacitybuildingacrosstheprovincewithaConcurrentDisordersNetwork.

3.4 Collaboration with Primary Care

WHAT We HeARd:Collaborativementalhealthcareandsharedmentalhealthcaremodelshavebeendeveloped,studiedanddocumentedinjointreportsoftheCanadianPsychiatricAssociationandtheCollegeofFamilyPhysiciansofCanada.ThismodelofcareisarequiredexperienceforpsychiatryresidencytrainingprogramsaccreditedbytheRoyalCollegeofPhysiciansandSurgeonsofCanada.SomeNovaScotiacommunitiesapproximatethisdegreeofcollaborationinsomeaspectsofmentalhealthcare.Itappearstobeanexcellentmodeltostrengthentiesbetweenprimarycare,mentalhealthandaddictionsservices.

Thecollaborativementalhealthandaddictionsprimaryhealthcaremodelshouldinclude:

• Adoptionoftheprinciplesofcollaborativecareasoutlinedintheliterature.

• Effectivemethodsforongoingcommunicationamongprovidersandservicerecipients.

• Consultationbasedincollaborativementalhealthcareapproacheswhereby:

a) psychiatristsandothermentalhealth/addictionsprofessionalsprovideadvice,guidanceandfollow-uptoprimarycareproviderstosupportcareofindividualsandfamilieswhilesharingongoingresponsibilityforcare,and

b) familyphysiciansprovideadviceonthemanagementofmedicalconditionsinindividualswithmentalhealthand/oraddictionproblems.

• Coordinationofcareplans(includingdischargeplans)andclinicalactivities.


• Accesstobriefpsychologicaltherapiesincludingmotivationalinterviewing.

• Inter-professionaleducationalprogramsincludingskillenhancementprogramsforprimarycareproviders.

• Definedcompetencies(roleclarity)andprotocols.

Whenscreeningformentalhealthissuesandillnessbecomesaroutinepracticeinprimaryhealthcare,earlyinterventionandimprovedoutcomescanbeexpectedtofollow.Routinescreeningisparticularlyimportantforpeopleathighrisk,suchasthosewithchronicphysicalillnessesandphysicaldisabilities.Toputthisinpractice,educationalinitiativesforprimarycarephysiciansandotherprimarycareproviderswillbeneeded.

Stronginterdepartmentalcollaborationbetweentheacademicandpractitionercommunitiesisawaytoenhanceandsupportclinicalactivities,enrichteachingprogramsandgeneratecollaborativeresearchprojects.Thiscouldincludeengagingacademicdepartmentstofindwaysofinitiatingandsupportingoutreachactivitiesbypsychiatriststoprimarycareprovidersandunderservedcommunities(ashasbeenthecasebyChild/YouthPsychiatrythroughDalhousieUniversity).

Familyandemergencyphysiciansplaykeyrolesinthemanagementofmentalhealth,physicalhealthandaddictionsissuesincommunity-basedandinstitutionalsettings.Otherprovidersofprimaryhealthcare(e.g.:pharmacists,nursepractitioners,andfamilypracticenurses),socialworkers,counsellors,psychologists,dentists,dentalhygienists,lawenforcementofficials,firstresponders,legalaidprovidersandcommunitybasedgroupsthatdealwiththepubliccontributetothemanagementofissuesrelatedtomentalhealthandaddictions,andwouldbenefitfromcollaborativelinkageswithinthesystemofhealthcare.

OBjeCTIve:Tocreateacollaborativecaresystemwheretheappropriatecareisgivenbytheappropriatepersonattheappropriateplaceandtime.

ReCOMMeNdATION:

3 .4-1 Encouragegreateruptakeofthesharedcaremodelofcollaborativementalhealthandaddictionscare.ThiscouldbesupportedbytheestablishmentofaprovincialCollaborativeCareNetworktoshareexperiencesaroundexistingsuccessfulmodelsinurbanandruralenvironments,tosupportknowledgeexchangeandtopartnerwithuniversitiesforevaluationofprojects.


3.5 Privacy and Confidentiality

WHAT We HeARd: Greaterclarityregardingtheapplicationofprivacyandconfidentialityinhealthcareisurgentlyneededasitrelatestocollaborationandinformationsharing.Clearunderstandingisessentialtoensureopportunitiesforco-operation,collaboration,andcoordinationofappropriateservicescanoccurwithinthecontextofthePersonalHealthInformationActandthedevelopmentofelectronichealthrecords.

TheProvinceshouldtaketheleadinpubliceducationthatensurespersonswithmentalillnessandtheirfamiliesunderstandtheyhavetheabilitytoappointsubstitutedecisionmakersandmakeadvancedirectives.

Thedevelopmentofstandardized,transparentprocedurestoallowinformation-sharingbetweengovernmentdepartments(DepartmentsofHealthandWellness,Education,Justice,andCommunityServices)shouldalsobeactivelypursued.

OBjeCTIve: Tobalancetherighttoprivacyandconfidentialitywithincollaborativecarepracticesbyaddressingbarrierstotheeffectivecommunicationofhealthinformationincludinglegalandlegislatedprotections.

OuTCOMeS: Effectiveinformationexchangeamongcareproviders,individualsandfamiliesthatenhanceaperson-centered,family-inclusiveapproachtomentalhealthandaddictionscare,whilemaintainingandrespectingtheindividual’srighttoprivacyandconfidentiality.

ReCOMMeNdATION:

3 .5-1 DevelopandimplementastandardAuthorizationforReleaseofConfidentialInformationforuseacrosstheprovinceformentalhealthandaddictionsservices.Clarifyitsappropriateuseforallstaff(clinical,supportandclerical)toensureitisuniversallyacceptedandconsistentlyappliedacrossallDHAsandtheIWK.Inaddition,developaprovincialpolicythataccommodatesprivacyandconfidentialityoftheindividualwithinfamily-based,collaborative/sharedcareapproaches.Thisshouldincludecleardirectionforinformationsharingandexceptions.Alsoclarifytheprivacyandconfidentialityguidelinesastheyrelatetospecificpopulationssuchasyouthandseniors.

InstandardizingtheAuthorizationforReleaseofConfidentialInformation,considerationmustbegiventothefollowing:

• Adoptconsistentrulesandguidelines,terminologyandunderstandingofconsentandliability,toaddressliabilityconcernsamongsomeprofessionalsandprofessionalorganizationsandgoverningbodies;

• Ensurethereisclarityforindividualsaboutwhatwillbedonewiththeirinformation;


• Avoidduplicationofassessmentservices(wherethesamequestionsareaskedrepeatedly);

• Incorporateexistingprivacyandconfidentialityguidelines.Foranexample,refertothenewguidelinesestablishedinCapitalDistrictHealthAuthority(CDHA);

• Provideeducationandtrainingaboutprivacyandconfidentialityforthepublic,healthcareserviceproviders,andpersonswithmentalhealthandaddictionsissues.Educationandtrainingshouldincludeclearandspecificexamplestousersregardingsituationswheninformationcanandcannotbereleasedandtowhom;

• Explorehowprivacyandconfidentialitypoliciesimpactcollaborativecareandsharedcareinitiatives;

• Reviewandreviserelevantlegislationtofacilitateinformationsharingandstandardizationofformats;e.g.,inclusionofthedefinitionsofCircleofCareandcollaborativecare(seeCDHAmodel)andprovisiontoincludealliedprofessionalsfromothergovernmentdepartmentsintheCircleofCare.(CircleofCareincludesindividualswhoareidentifiedbythepersonlivingwithmentalillnessand/oraddictionstoprovidepractical,caring,andemotionalsupport,andincludesparents/guardiansofchildren).


4. Sustainability

4.1 Human Resource Issues and Care Provider Support

WHAT We HeARd: Thehealthcaresystemingeneral,andthementalhealthandaddictionssystemsinparticular,areonlyasstrongasthepeoplewhoworkinit.Theyneedtobesupported,theirhealthandsafetymustbeassuredandtheyshouldbeprovidedwithaccesstoongoingtrainingandeducation.

Inordertohaveasustainablementalhealthandaddictionssystem,recruitmentofnewstaffaswellaseducationandsupportsforcurrentstaffisessential.Creative,neweffortsarenecessarytoattractandretaincareprovidersacrosstheprovince,toanticipateandplanforfutureattritionamongserviceproviders,andtoattractpeoplefromdiverseandunder-representedgroupsintothementalhealthcareandaddictionstreatmentsectors.

Currentdataandinformationareinsufficienttosupportadequatehumanresourceplanningformentalhealthandaddictionsservices.Thereappearstobeaperceptionoflackoftransparencyinhumanresourceplanning.Ruralareasexperiencechallengesinrecruitmentofhealthprofessionals.

OBjeCTIveS:

• Tocreateasufficientlyresourcedandrepresentativementalhealthandaddictionssystemwithahumanresourceplanthatensuresserviceneedscanbemetthroughouttheprovince.

• Toensurethesystemissupportiveofserviceprovidersandthathealthhumanresourcesaresufficientforprovincialmentalhealthandaddictionsstandardstobemet.

OuTCOMeS: Theexpectedanddesiredoutcomesare:

• Morestudentsinthehealthprofessions(includingnurses,socialworkers,primarycareworkers,psychologistsandpsychiatrists)willbeencouragedtoseekplacementsinruralareasandhaveexperienceservingdiverseandmarginalizedcommunities.

• Sufficientnumbersofwell-qualifiedprofessionalswillbeemployedwithinthementalhealthandaddictionssystemsinruralandurbanareastomeetMentalHealthandAddictionstandards.


• Well-qualifiedprofessionalsandsupportstaffwillberetainedwithinallareasoftheprovince.

• Thenumbersofcareprovidersandprofessionalsfromdiversegroupswillincrease.

ReCOMMeNdATION:

4 .1-1 Focuseffortsonrecruitmentofmentalhealthandaddictionsprofessionalsfromdiversecommunitiesandforworkinruralareas.


5. Accountability

5.1 Accountability and Evaluation

WHAT We HeARd:Accountabilityforservicesandsupportsdelivered,andforfundingreceived,isakeycomponentinthementalhealthandaddictionssystems.Accountablepartiesmustknowtheirrolesandresponsibilities,setperformanceexpectationsandachievetheirstatedandmeasuredoutcomes.Organizationsandprofessionalsmustbeaccountablefortheservicesandsupportstheyprovide.Theremustbetransparentwaysforallstakeholderstoidentifyandaddresschallengesandproblemsinthesystem.

Knowinghowwellthesystemisperforming,andhowitcanbeimproved,requiresaccesstotherightinformation.NovaScotia’shealthcaresystemisbehindthetimeswhenitcomestotheefficient,reliableandtimelycollectionandsharingofinformation.Thecurrentinformationsystemsinplacetocollectdata,measureoutcomes,andevaluateinterventionsareinadequateformentalhealthandaddictionsservicesusesadifferentsystemaltogether.Thiscompromisesthequalityofpolicydevelopment,programplanningandservicedeliverytoclients.Itcanresultinmissedopportunitiesforsystemimprovements,losttimeandwastedmoney.Therecanbebreakdownincommunicationsthatdisruptscareandsometimespreventspeoplefromgettingservicesatall.

Healthinformatics-basedapproacheswillensurethatservicesaremeetingtheneedsofallNovaScotians.Thecollectionofexpandeddemographic,socialandethnicdataonprovincialhealthrecordsisnecessarytoensurethateffortstoreformandimprovethesystemareworkingtoreducehealthinequitiesanddiscriminationwheretheyexist.Linkagestopopulationepidemiologichealthdataandadministrativehealthrecordsthroughindividualhealthcards(whererespondentshavegivenpermission)mayofferarichsourceofdataonthepopulation.

Knowledgetransferandtranslationfromscientificresearchtopracticeisofteninconsistentanddelayed.Expansionofcapacityandopportunitiesforappliedclinicalresearchinaddictionsandmentalhealthwouldbeappropriate.Involvementinclinicalresearchincreasesanorganization’scapacityforknowledgetranslation(e.g.,identifyingknowledgebestsuitedtoone’sowncontextandforadaptingevidencetoone’sowncontext).

Serviceproviderexpertiseinsomeareasofpracticeisinconsistentandcorecompetencystandardsdonotexist.Professionaldevelopmentandclinicalsupervisionandmentoringareinconsistentlysupported.Theutilizationofbest/wiseandevidence-basedpracticesmustbeensured,whilesupportingtheuseofpromising,newpractices.

Scientificresearch,knowledgeexchangeandevaluationneedtobeintegratedintopracticetocreateaculturewhereresearchandevaluationbecomeanintegralaspectofservicedelivery.Thecapacityandopportunitiesforappliedclinicalresearchinaddictionsandmentalhealthshouldbeexpanded.Researchpartnershipsshouldbecreatedwithuniversities,academics,andstakeholders.

Toguidecurriculumdevelopmentinrelateduniversityandcollege-basedprograms,coretherapeuticevidence-basedapproachescommonlyusedinpreventionandtreatmentofmentalhealthandaddictions


shouldbeidentified.Incollaborationwithuniversitiesandthecommunitycollege,corecompetencytrainingshouldbeincludedinallrelevantprograms.Overtime,thiswilldecreasetheneedforprovincially-organizedtraining.

Specialtyservicenetworksprovideanavenueforprovince-widecollaboration,knowledgeandbest/wisepracticestransfer.SufficientresourcesarerequiredtoensureparticipationbyeachDHAandIWKinspecialtyservicesnetworksincluding,butnotlimitedto:

• AutisticSpectrumDisorder(ASD)

• EatingDisorders

• EarlyPsychosis

• SeniorsMentalHealthandAddictions

• SexuallyAggressiveYouth

• Neuro-developmentalDisorders

• Concurrentdisorders

• Diversepopulations

• Addictions

• Collaborativecare

• ReproductiveMentalHealth.

Importantly,personswithlivedexperienceofmentalhealthand/oraddictionsissueshavemuchtoofferasactiveparticipantsinthedesign,implementationandevaluationofcomprehensivementalhealthandaddictionssystems.TheinclusionofthesepersonsonthisAdvisoryCommitteeandonpreviousplanningcommitteesisapplauded.

OBjeCTIve: Tocreateamentalhealthandaddictionssystemthatisaccountabletothepublic,informedandguidedbyintegrated,reliableandvaliddatameasuredwithinaninformationsystemthatisstandardizedacrosstheprovinceandinwhichstaffareappropriatelytrainedandcompetent.Thereisconsistentandtimelyknowledgetransferandtranslationfromresearchtopracticeandthesepracticesarebasedonscientificevidenceorwherethisislacking,onbestpracticeorwiseandpromisingpractices.

Peoplewithalivedexperienceofmentalhealthand/oraddictionsissuesactivelyparticipateinthedesign,implementationandevaluationofthecomprehensivementalhealthandaddictionssystem.


OuTCOMeS: Thereis:

• Province-wideuseofastandardizedinformationsystemthatisreliable,valid,consistentlyapplied,andappropriatelysupportedtocollectdata,measureoutcomes,andqualityofcareindicatorsinmentalhealthandaddictionsservices.Thereisconsistentuseandevaluationofreliabledatatomonitorcompliancewithmentalhealthandaddictionsstandards.

• Useofhealthinformaticstofacilitatelinkagesbetweenserviceprovision,administrativeandmanagementsystems,financialdecision-makingandepidemiologicdatasystemsthatinformpolicy.

• Anaccountablesystemwithwell-trainedandsupportedserviceproviders,includingprovidersfromdiversecommunities,utilizinginterventionsbasedonscientificevidenceandbestpractices,andinformedbypersonswithlivedexperience.

• Aninterdepartmentalaccountabilitysystemtoevaluatetheintegrationandcoordinationofmentalhealthandaddictionsserviceswithhousing,employmentsupport,communityandsocialservices,transportationandotherrequiredservices.

ReCOMMeNdATIONS:

5 .1-1 Developaconsistentsystemtomonitorcompliancewithmentalhealthandaddictionsstandards,andforregularevaluationoftheeffectivenessofmentalhealthandaddictionprogramsandservices.

5 .1-2 ImplementstandardizedinformationsystemsacrossallDHAsandtheIWK.Thesesystems—orsystem—shouldcapturedataonclinicalactivitiesandhealthoutcomes,improvelinkagesbetweenhealthservicesdataandfinancialmanagementinformation,andcollectdataonkeyindicatorssuchasrecovery,wellness,andqualityoflife.

5 .1-3 Expandandintegrateresearchandknowledgeexchangeandevaluation,ensuringutilizationofwise/bestpracticesandscientificevidence-basedtherapeuticapproachesacrossthesystem.

5 .1-4 Developcorecompetencystandards,alongwithprovince-wide,mandatory,targetedandfundedprofessionaleducationforexistingandnewmentalhealthandaddictionsservicesclinicians.Anenvironmentofcontinuouslearningshouldbecreatedbystrengtheningtheroleofeducation,clinicalsupervisionandfundingofprofessionaldevelopment.


Conclusion

thiS rEport aNd rEcommENdatioNS rEflEctwhattheAdvisoryCommitteeheardandlearnedthroughconsultationandbyconsideringthebestevidenceavailable.Ourreportanditsrecommendationswillnotbeuniversallyembracedorapplauded.Itisunderstoodthatthosewhocontributetothesekindsoffact-findingmissionshave,inmanycases,experiencedtheweaknessesofthesystem.Fewcomeforwardtolauditsstrengthsorgivecreditfortheexcellentworkthatgoesoninthesystemnow.Thereportandrecommendationsarefaithfultothosewhocameforwardtotelloftheirexperiences.Itisbasedontheevidenceofwhatapproachesaremostlikelytobesuccessful,andbuildsonsignificantareasofworkthatareunderway—someofwhichbeganwhileourAdvisoryCommitteewasstilldeliberating.

ThisreportcomesatatimewhenthegovernmentofNovaScotia—asisthecasewithmostgovernmentsinthischallengingeconomicclimate—iswrestlingwithseriousfinancialissues.NovaScotiansexpectthatgovernmentwillinvestwiselyandbringspendingundercontrolinordertoensuretheprovince’sdebtdoesnotoverwhelmusorourchildren.Astrongcasecanbemadeforinvestmentinmentalhealthservicesandaddictiontreatment.ThisinvestmentandmanagementofservicesisintendedtorelievethesufferingandfinancialtollthatthousandsofNovaScotians,theirfamiliesandcommunitiesfaceasaresultofmentalillnessandaddiction.

Somethingsthatwerecommendwillcertainlyrequiremoremoney.Otherschallengeustoworkindifferentways.Bettercommunication,moreeffectivecoordination,breakingdownsilos,streamliningprocessesandusingdistance-basedtechnologiesareafewexamples.

Healthpromotion,earlyinterventionandtreatmentwillreducetheoverallsocialandeconomiccoststheprovincecurrentlybearsfromuntreatedandunder-treatedmentalillnessandaddictions.

Weendourreportwithacaution:NovaScotiacannotaffordthecostofnotactingonourrecommendations.Thecurrentandfuturewell-beingofallNovaScotiansandourcommunitiesisatstake.


Mental Health and Addictions Strategy Advisory Committee

Co-ChairsMichael ungar, Phd (Halifax),hasbeenasocialworkerandfamilytherapistformorethan25years,workingwithchildrenandfamiliesinchildwelfare,mentalhealth,educationalandcorrectionalsettings.AsaprofessorattheSchoolofSocialWorkatDalhousieUniversityinHalifax,heleadsaninternationalteamofresilienceresearchersthatspansmorethanadozencountriesonsixcontinents.Inadditiontohisresearchandwritinginterests,hemaintainsasmallfamilytherapypracticeandparticipatesinacommitteeworkingonanationalmentalhealthstrategy.

joyce Mcdonald (Truro) workedfortheColchesterEastHantsbranchoftheCanadianMentalHealthAssociationfor24years,includingasExecutiveDirector.ShehasabackgroundinpsychiatricnursingandisworkingaspatientrightsadvisorfortheEmpowermentConnection.Shehasdevelopedsupportivehousingprograms,socialandrecreationalprograms,employmentprogramsandpeerledgroups.

MembersAjantha jayabarathan, Md, FCFP (Halifax), hasaninnovativefamilymedicinepracticeinHalifax,NovaScotia.SheisanAssistantProfessorintheFacultyofMedicineatDalhousieUniversity.Shehasbeenafrequentcontributortolocalandnationalmediaonhealthcareissues.Shealsoco-leadstheadvocacycoalition,Healthynovascotians.com

Chief Frank Beazley (Halifax) wasappointedtothepositionofChiefofPoliceforHalifaxRegionalPolicein2003.ChiefBeazleyjoinedtheHalifaxPoliceDepartmentin1970andhasworkedinmanydivisionsandsectionsduringhispolicingcareer.HeisarecipientofthePoliceExemplaryServiceMedalandQueen’sGoldenJubileeMedal.HeisanactivememberoftheNovaScotiaChiefsofPoliceAssociationandtheCanadianAssociationofChiefsofPolice(CACP).

dr . Simon Brooks, MA, MB, ChB, FRCPsych, FRCPC (Bridgewater),isaspecialistinPsychiatryandhasFellowshipqualificationsfromboththeCanadianRoyalCollegeofPhysiciansandSurgeonsandtheUKRoyalCollegeofPsychiatrists.HehasbeenactivelyinvolvedintheCanadianPsychiatricAssociationandhaspublishedarticlesonmedicalethics,mentalhealthlegislationandinanumberofotherareas.Currently,Dr.BrooksisChiefofPsychiatryattheSouthShoreDistrictHealthAuthorityandhasasmallprivatepracticeinBedford.HeisalsoanexternalconsultanttotheDepartmentofHealthandWellness,andaclinicalassistantprofessorinDalhousie’sDepartmentofPsychiatry.

Andy Cox (Halifax) istheMentalHealthAdvocatewiththeMentalHealthandAddictionsProgramattheIWKHealthCentre.Hisroleconsistsofindividualadvocacy,systemicadvocacy,navigationofsystemsandcommunityresources.AndycreatedthepositionandstartedinJanuary2004.BeforetheIWK,Andyworkedprimarilyinthecommunityeducatingstudentsinschoolsaroundmentalhealthandmentalillness.Healsowasanemploymentcounselorforyouthwithmentalhealthdisorders.HesitsonvariousboardsandcommitteesdealingwiththeissuesofmentalhealthandmentalillnessincludingtheboardofTheMentalHealthCommissionofCanada(MHCC).


Paul d’entremont, BA, Bed, deS (West Pubnico),hasbeeninvolvedinimprovingFrenchlanguagehealthservicesfortheAcadianandFrancophonepopulationofNovaScotiasince2002.HeisafoundingmemberofRéseauSanté—Nouvelle-Écosse,andhasbeenitsExecutiveDirectorsince2003.HeworkedasaneducatorandineducationaladministrationinthepublicschoolsysteminNovaScotiafor30years.HecollaboratedonmanyAtlanticeducationalprojectsandinitiatives,especiallyinthefieldofsocialsciences.HehasbeeninvolvedinAcadiantourismproductandculturaldevelopmentinitiativesthroughouthiscareerinhislocalcommunity,provinciallyandattheAtlanticregionallevel.

daphne Hutt-MacLeod (eskasoni, Cape Breton) istheDirectorofEskasoniMentalHealthServicesandtheCoordinatoroftheTui’knPartnershipsCaseManagementandMentalWellnessTeams.ShehasbeenworkingwithCapeBretonFirstNationscommunitiesfor22yearsasaPsychologist,ClinicalTherapist,CaseManager,DirectorofMentalHealth,andDirectorofHealth&Wellness.AsoneoffivemembersofthewellknownTui’knInitiative/PartnershipwiththeotherfourCapeBretonUnama’kiBands,sheparticipatedinprojectsandcommitteesrelatedtotheimplementationofprogramstoaddressFetalAlcoholSpectrumDisorder,SuicideIntervention,andMentalHealth.

jessica Inkpen (Halifax) isayoungwomanwhohasstruggledwithanorexiaformanyyears.In2006shewasacceptedattheNovaScotiaCollegeofArtandDesign,butdeferredheracceptanceinordertoseektreatmentforherillness.Herexperiencewiththementalhealthsystemhasgivenherinsightintomanyproblemsinthesystemandobstaclestotreatment.

Lana MacLean, MSW, RSW (Halifax),isamemberoftheAfricanNovaScotiancommunityandisacommunityleaderintheareaofhealth.SheisaHalifax-basedsocialworkclinicianwhoprovidescomprehensivementalhealthandaddictioncounselingtoindividuals,youthandfamilies.SheusesherclinicalandadvocacyskillstoaddressculturallyspecifichealthneedsoftheAfricanNovaScotiancommunity.

Cecilia McRae (Merigomish, Pictou County) isPresidentoftheSchizophreniaSocietyofNovaScotia.Since2004,shehasbeenamemberoftheCreativeWellnessProjectandFriendshipCornerinAntigonish.Shehasbeencaregiverofafamilymemberwithamentalillnesssince1999.

Patti Melanson, RN (Halifax),isacommunityhealthnursewhohasspenthercareerworkingwithmarginalizedgroupsinHalifax.SheiscurrentlycoordinatoroftheNorthEndClinic’sMobileOutreachStreetHealthProgram,whichbringshealthservicestohomelessandstreet-involvedpersons.Previously,shewasHealthServicesCoordinatoratthePhoenixYouthPrograminHalifax.

Kathleen Thompson (Halifax) isretiredfromacareerincivilservicewiththeProvinceofNovaScotia.Sheisthemotherofayoungwomanwhoselifeisonholdasshebattlesaneatingdisorder.Herfamily’sinvolvementwithNovaScotia’smentalhealthsystemgoesbackmorethan13years.

Catherine M . Thurston, MA (Tidnish Bridge, Cumberland County),isaChildPsychologist.ShewasDirectorofMentalHealthServicesfortheCumberlandHealthAuthoritypriortoherretirementin2009.Earlierinhercareer,shewasDirectorofMentalHealthServicesinCumberland,Colchester/EastHants&PictoudistrictsundertheNorthernRegionalHealthBoard,andwasPsychologyDepartmentSupervisorfortheAtlanticProvincesResourceCentrefortheHearingHandicapped(APSEA)inAmherst.Shehaspublishedinthefieldsofattentiondeficithyperactivitydisorderandtreatmentofchildbehaviordisorders,andisCo-InvestigatorforCIHR-fundedpartnershipwithIWK/DalhousieUniversityStrongestFamiliesProgram,adistance-basedearlyinterventionprogramforchildrenwithmildtomoderatementalhealthdisordersandtheirfamiliesandforwomenwithpost-partumdepression.


Glossary and TermsThe following is a partial list of terms and words frequently referred to in the deliberations of the Mental Health and Addictions Strategy and Advisory Committee. Many of the terms have more than one definition depending on the source. For the purpose of this report the definitions are offered as a lens to assist the reader in understanding the Advisory Committee’s frames of reference formulating their recommendations.

Access:Theeasewithwhichindividualscanconnectwithaserviceinordertoobtainassistance.

Accountability:Theobligationofserviceprovidersand/ortheirorganizationstoacceptresponsibilityfortheiractions.

Acute Care:AsakeycomponentofthecontinuumofhealthservicesinCanada,acutecareinahospitalbasedsettingprovidesnecessarytreatmentforadiseaseorsevereepisodeofillnessforashortperiodoftime,withthegoalofdischargingpatientsassoonastheyaredeemedhealthyandstable.

Addiction:Arecurringcompulsionbyanindividualtoengageinsomespecificactivity,despiteharmfulconsequencestothatindividual’shealth,mentalstateorsociallife.Thetermisoftenreservedfordrugoralcoholaddictionsbutissometimesap-pliedtoothercompulsions,suchasproblemgambling,impulsebuyingorshopping,andcompulsiveovereating.Manyfactorsaresuggestedascausesofaddictionincludinggenetic,biologi-cal/pharmacologicalandsocialfactors.

Advocacy:Theactofhelpingpeoplereceiveavailableservicesandinfluencingproviderstoimproveexistingservicesandprovidenewonesastheneedsarise.

Assertive Community Treatment:AssertiveCommunityTreatment(ACT)isaclient-centered,recovery-orientedmentalhealthserviceintendedtofacilitatepsychosocialrehabilita-tionforpersonswhohavethemostseriousmentalillnessesandhavenotbenefitedfromtraditionalprograms(CanadianMentalHealthAssociationofOntario).

Assessment:Acomprehensive,systematic,andfrequentlyinter-disciplinaryexaminationofallaspectsofaperson’slifeincludingphysical,medical,psychological,emotional,financial,educational,vocational,social,housingneedsinordertodetermineatreatmentplanofcare.Additionalinformationisgatheredwithparticularemphasisontheperson’sindividualstrengths,areasofdeficiencies,andtheirculturalandhealth-relatedvaluesandbeliefs.

Alzheimer’s disease:Adisorderofthebrainthatcausesadeclineincognitivefunctioningresultinginprogressivelossofintellectualandsocialskills.

Alternative Medicine:Anyhealingpracticethatdoesnotfallwithintherealmofconventionalmedicineandisbasedonhistoricalorculturaltraditionsratherthanscientificevidence(retrievedfromtheinternethttp://en.wikipedia.org/wiki/Medicine).

Best Practice:Asuperiormethodorinnovativepracticethatcontributestotheimprovedperformanceofanindividual

ororganizationthatisusuallyrecognizedas“best”bypeergroupsororganizations.Itimpliesaccumulatingandapplyingknowledgeaboutwhatisandwhatisnotworkingindifferentsituationsandcontexts.Itrequiresthecontinuingprocessoflearning,feedback,reflection,andanalysis.

Capacity Building:Asupportive,educationalprocessthatpro-motesindividual,community,andserviceprovider(stakehold-er)managementofsustainablecapabilitiesandcompetencies.

Caregivers:Abroadrangeofindividualswhoprovidecareandsupporttofamilyandfriendsrequiringassistanceduetochron-icphysical,mentalorcognitivedisabilities.Caregiversrangeinagefromchildrentoseniors(asdefinedbyCaregiversNS).

Case Management:Withthegoalofassistingthepersontoachieveaccessibleandsuccessfulcommunityliving,aprocessofassessment,planning,implementation,evaluation,andadvocacyiscoordinatedamongandassignedtospecificserviceproviderstomeettheindividualandfamily’scomprehensivementalhealthand/oraddictionsservicerequirements.

Clinical Nurse Specialist:Aregisterednursewithaminimumofmaster’slevelpreparationwithahighproficiencyininter-personalskills,thenursingprocess,andasoundknowledgeofpsychological,somatic,pharmacological,andmilieutherapies.

Community:Asocial,religious,occupational,orothergroupsharingcommoncharacteristicsorinterestsandperceivedorperceivingitselfasdistinctinsomerespectfromthelargersocietywithinwhich itexists.

Community Based or Community Support Systems:Serviceorganizationsdevelopedbycommunitiestoreachthoseinneedandascloseaspossibletowherepeoplelive.Theyincludebutarenotrestrictedtomentalhealthcenters,governmentandnon-governmentagencies,private,voluntary,andoutreachservicesspecializinginmentalhealth.Examplesincludecrisis-responseteams,rehabilitationservices,housing,protection,andadvocacy.

Circle of Support:Individualswhoareidentifiedbytheper-sonlivingwithmentalillnessand/oraddictions(oraguardianofchildren/youthoradultsformallydeclaredincompetent),toprovidepractical,caring,andemotionalsupport.

Cognitive Behavior Therapy (CBT):Anevidence-basedpsychologicalapproachtotherapy,practicedbyarangeofpro-fessionalsthatisproblemfocusedandgoaloriented,dealingwithissuesinthehereandnow.CBThelpsclientstoanalyzetheirpatternsofthinking,emotionalreactions,andbehaviorswiththegoalofassistingthemtoattemptnewapproachestochangeexistingpatterns(Sheldon,Brian,1995and2011).


Collaboration:Anapproachtoworkingwithotherstowardpatientcenteredsharedgoals,usingaprocessthatincorpo-ratesplanning,decision-making,problemsolving,withanas-sumptionofaccountabilityandresponsibilityforactionsthatsupporttheclient/patient’sneeds.

Collaborative Mental Health Care:Boundbyasharedvisionforthefuture,mentalhealthandaddictionprimarycarepractitioners,togetherwiththepersonandtheirself-definednetworkoffamilysupportworktogethertoensurearesponsive,seamless,andtimelyaccesstotheindividualpatient/clientserviceneeds.Successfulcollaborationutilizeslocalresources,services,andsolutionsandisgroundedinpersonalandprofessionalrelationshipbuiltonmutualrespectandtrust,evidencedinformedpracticesandtheabilitytorespondtothechangingneedsofthepatient/client.Thefivecomponentsofcollaborativecareareeffectivecommunication,consultation,coordination,co-location,andintegration.

Community Outreach:Servicesthatactively“reachout”andprovidehelptothosewhowouldnototherwiselookforsup-portinthecommunity.

Concurrent diagnosis:Referstotheco-existenceofsubstanceabuseandmentalhealthdisorderswithinthesameperson.

Core Program Standards:Coreprogramsdeliveringcompre-hensivementalhealthandaddictionsservicesarecharacter-izedbythefollowingstandardaspectsofcare:promotion,preventionandadvocacy;outpatientandoutreachservices;communitysupports;inpatientservices;andspecialtyservices.

Cross-jurisdictional:Activitiesthatcrosstheboundariesofauthority,particularlybetweenprovincial,federalandmunici-palgovernments.

Cultural Competence and Safety:AnevolvingandlargelycomplementaryframeworkthataddressesthediversementalhealthneedsofpeoplelivinginCanada.Serviceprovidersregardlessoftheirculturalbackgroundareencouragedtocom-municateandpracticeinwaysthatrespectandtakeintoac-countthecultural,social,political,linguisticandspiritualreali-tiesofthepeoplewithwhomtheyareworking.Culturalsafetyhasitsoriginsintheindigenousexperienceofcolonization,anddrawsattentiontoissuesofpoweranddiscrimination,aswellastostructuralbarriersthatcanlimitaccesstoappropri-atecareforpeoplefromdiversebackgrounds.Approachesthatbuildonculturalcompetenceemphasizethenecessityandurgencyofaddressingthesevitalaspectsofserviceprovision.

Culturally diverse Populations:Likeallpeople,individu-alsfromculturallydiversepopulationshavedifferingskills,knowledge,andvalues.Itisimportanttounderstandpeopleasindividualswithinthecontextofculturalcompetence.

Whileculturallydiversepopulationsoftenexperiencebarriersinaccessingprimaryhealthcareorfeelingsofexclusioningen-eral,itcannotbeassumedthatallpeoplewithinthesegroupsexperiencethesamereality.Theformofexclusionexperiencedmaynotbethesameacrossgroupsofpeople(GovernmentofNovaScotia).

Culturally Safe Practice:Anapproachthatreflectstherecognitionthathealth,illness,andthemeaningstheyholdforpeopleareshapedbytheirsocial,cultural,family,community,

historicalandgeographicalcontexts,andgender,age,abilityandotherpersonalfactors.Allethno-culturalbackgroundsarerespected,empowered,andsafeenoughthatthepersonisabletocommunicatetheiruniquerealitiesoftheirsituationandactivelycollaboratesinthemanagementallaspectsoftheirhealthandwell-being(GovernmentofManitoba).

dementia:Dementiaisaclinicalstateofwhichthereare70to80differenttypesandcharacterizedbylossoffunctioninmul-tiplecognitivedomains.ThemostcommonlyusedcriteriafordiagnosesofdementiaistheDSM-IV(Diagnostic and Statistical Manual for Mental Disorders,AmericanPsychiatricAssociation).Diagnosticfeaturesinclude:memoryimpairmentandatleastoneofthefollowing:aphasia,apraxia,agnosia,disturbancesinexecutivefunctioning.Inaddition,thecognitiveimpairmentsmustbesevereenoughtocauseimpairmentinapreviouslyhigherleveloffunctioningincludingsocialandoccupational.

determinants of Health:Theinteractionsbetweensocialandeconomicfactors,thephysicalenvironmentandindividualbehavioursthatimpactthequalityofhealth,well-being,andcommunityliving.Theseinclude:incomeandsocialstatus,socialenvironment,educationandliteracy,employment,personalhealth,healthservices,gender,culture,geneticandbiologicalfactors(NewBrunswickStrategy).

diversity and diverse Needs:Diversityanddiverseneedsrefertothevarietyofethnicity,backgrounds,experiences,andneedsofanindividualorcirclesofsupportthathasabearingontheperson’sengagementwithanindividual,system,ororganizationandthequalityandeffectivenessofthecareorservicetheyreceive.

dependence (Psychological):Psychologicaldependenceoccurswhenapersonfeelsheorsheneedsthedrugtofunc-tionorfeelcomfortable(e.g.,needingtodrinkalcoholtofeelrelaxedinsocialsituations,orneedingtobehightoenjoysex).Somepeoplecometofeeltheyneedasubstancejusttobeabletocopewithdailylife.

dependence (Physical):Physicaldependenceoccurswhenaperson’sbodyhasadaptedtothepresenceofadrug.Toler-ancehasdeveloped,whichmeansthatthepersonneedstousemoreofthedrugtogetthesameeffect.Whendrugusestops,symptomsofwithdrawaloccur.

disabilities:‘Disabilities’isanumbrellaterm,coveringimpairmentsorlimitationinphysical,cognitive,mental,sensory,emotional,developmental,oracombinationofthesereflectinganinteractionbetweenfeaturesofaperson’sbodyandfeaturesofthesocietyinwhichheorshelives(WorldHealthOrganization).

early Intervention:Earlyinterventionreferstospecificmeasuresundertakenforpopulationsidentifiedasbeingatriskfororalreadyengagedinharmfulbehaviorsorpractices.Earlyinterventionservicesidentifyandassessearlysignsandsymptomsofmentalillness,provideearlyinterventiontopreventprogressiontoadiagnosableillness,referdiagnosedmetalillnessesfortreatmentandsupport,reducetheimpactofmentalillness,andfosterhopeforfuturewell-being.

empowerment:Consumershavetheauthoritytochoosefromarangeofoptionsandtoparticipateinalldecisions—includ-ingtheallocationofresources—thatwillaffecttheirlives,and


areeducatedandsupportedinsodoing.Theyhavetheabilitytojoinwithotherconsumerstocollectivelyandeffectivelyspeakforthemselvesabouttheirneeds,wants,desires,andas-pirations.Throughempowerment,anindividualgainscontrolofhisorherowndestinyandinfluencestheorganizationalandsocietalstructuresinhisorherlife.

evidence Based:Informationbasedonthebestavailablescientificevidence.

Families:TheMentalHealthCommissionofCanadastatesthatfamiliescanbemadeupofrelatives,suchasspouses,parentsandsiblings,orpeopledrawnfromaperson’sbroadercircleofsupport,whichmayincludeextendedfamily,closefriends,healthcareprofessionals,peersupportworkers,andotherconcernedindividuals.

Family Inclusive:Referstothecircleofindividualswhomthepatient/clientdefinesas“family”andconsentstotheirpartici-pationinthetreatmentandrecoveryprocess.

Follow-up:Themaintenanceofcontactwithorre-exami-nationofaperson(asapatient/client)usuallyatprescribedintervalsfollowingdiagnosisortreatment.

Forensic Psychiatry:Referstosub-specialtyofpsychiatryandanauxiliaryscienceofcriminology.Itencompassestheinterfacebetweenlawandpsychiatry.Aforensicpsychiatristprovidesservicessuchasdeterminationofcompetencytostandtrialtoacourtoflawtofacilitatetheadjudicativepro-cess.Forensicpsychiatristsevaluateanindividual’scompetencytostandtrialwheredefensesarebasedonmentaldiseasesordefects(e.g.,the“insanity”defense)andsentencingrecom-mendations.ThetwomajorareasofcriminalevaluationsinforensicpsychiatryincludeCompetencytoStandTrial(CST)andMentalStateattheTimeoftheOffence(MSO).

Framework:Abroadoverview,outline,orskeletonofinterlinkeditemswhichsupportsaparticularapproachtoaspecificobjective,andservesasaguidethatcanbemodifiedasrequiredbyaddingordeletingitems.

Health Human Resources:Addressescompetency,training,andresourcegapsintheprovisionofhealthservicedelivery.

Health Promotion and Illness Prevention:MentalhealthpromotionaimstofostermentalhealthinapositivewayforallpeopleinCanada,regardlessofwhethertheyarelivingwithamentalhealthproblemorillness.Preventionfocusestothegreatestextentpossible,onmeasurestopreventmentalhealthproblemsandillnesses.Promotionandpreventioneffortscanbothbedirectedatthepopulationasawholetopreventthedevelopmentofmentalhealthproblemsandillnesses.Itfocusesonpeopleandcommunitiesatrisk,vulnerablepopula-tions,andthosewithemergingproblemsinordertoincreaseopportunitiesforearlyintervention,preventtheprogressionofamentalhealthproblemorillness,andimproverecovery.Effortsareadditionallydirectedtowardpeoplelivingwithmentalhealthproblemsandillnessescontributingtotheirabil-itytoachievetheirfullpotential(MentalHealthCommissionofCanada).

Holistic:Anapproachthatincorporatesmind,body,andspiritinplanningandimplementingindividualizedcareofanindividual,systemorcommunity.

Holistic Recovery:Embracesallaspectsoflifesuchashous-ing,employment,education,mentalhealth,healthcaretreat-ment,andservices;complementaryandnaturalisticservices;addictionstreatment,spirituality,creativity,socialnetworks,communityparticipation,andfamilysupportsasdeterminedbytheperson.

Hope:Recoveryprovidestheessentialandmotivatingmessageofabetterfuturewherepeoplecananddoovercomethebar-riersandobstaclesthatconfrontthem.Hopeisinternalized;butcanbefosteredbypeers,families,friends,providers,andothers.Hopeisthecatalystoftherecoveryprocess(SubstanceAbuseandMentalHealthServicesAdministration,SAMHSA).

Housing First Approach:Referstoaclientcenteredapproachwhichholdstothebeliefthatbeforesomeonecanbreakthecycleofhomelessnessasafeandsecurehome,isnecessary,withsupportservicesreadilyavailable.

Human Resources:Atermusedtodescribetheindividualswhomakeuptheworkforceofanorganization.

Human Rights:Humanrightsare“basicrightsandfreedomsthatallpeopleareentitledtoregardlessofnationality,sex,na-tionalorethnicorigin,race,religion,language,orotherstatus.”Humanrightsareconceivedasuniversalandegalitarian,withallpeoplehavingequalrightsbyvirtueofbeinghuman.Theserightsmayexistasnaturalrightsoraslegalrights,inbothnationalandinternationallaw(Wikipedia).

Individualized Care:Carethatisplannedtomeetthepar-ticularneedsofanindividualpatient/client,asopposedtoaroutineappliedtoallpatients/clientssufferingexperiencinganillnessorhealthproblem.

Individuals/Persons with disabilities:Apersonwhomayhaveaphysical,cognitive,mental,sensory,emotional,develop-mentalorsomecombinationofthese.

Informal Services:Ineconomicterms,informalservicesreferto,“Anyexchangeofgoodsorservicesinvolvingeco-nomic value betweenpeopleoutsidethescopeof‘normalandformal‘business.Withreferencetohealthcare,carethatisperformedoutsideoftheformalsystemororganizationmaydifferfromtheprescribed,official,orstandardwayandistypicallyprovidedbyfamilyand/orfriends.Informalservicesasrelatedtomentalhealthandaddictionscouldrefertoanysupportsinvolvingvaluetothepersonwithmentalillness/ad-dictions.Thistypeofinformalcarecanincludetransportation,education,peersupport,orfamily/friendsengagedinacircleofcollaborativecare.

Informed Consent:Alegalproceduretoensurethatapatientorclientknowsalloftherisksandcostsinvolvedinatreatment.Theprocessofinformedconsentincludesinformingtheclientofthenatureofthetreatment,possiblealternativetreatments,andthepotentialrisksandbenefitsofthetreatment.Inorderforinformedconsenttobeconsideredvalid,theclientmustbecompetentandtheconsentshouldbegivenvoluntarily.

Involuntary Treatment:Thedeliveryofclinicaltreatment,usuallyinthecontextofamentalillness,towhichthepatienthasnotgivenconsent.


Integration System/Service:Theprocessofopeningagroup,community,place,ororganizationtoall,regardlessofrace,ethnicity,religion,gender,orsocialclass.

Interdisciplinary and Intersectoral:Anactivitythatincor-poratesallrelevantdisciplinesandsectorsofsociety.

Intervention:Theactionorprocessofintervening;withinhealthcareinterventionreferstoactiontakentoimproveamedicaldisorder.

Involuntary Psychiatric Treatment Act of Nova Scotia (IPTA), 2005:Accordingtothelegislationdefinesthecondi-tionsunderwhichapersonmaybedetained,assessed,andwhereindicatedtreatedformentalhealthissueswithouttheirconsent.

Knowledge exchange:Theactofclosingthegapbetweenresearchoutcomesandinformationandthosewhousethere-searchtoinformpolicy,professionalpractice,decision-making,researchers,consumers,andserviceproviders.

Memorandum of understanding (MOu):Anagreementtocollaboratebetweentwoorganizationsthatstipulatetheexpectationsofeachparticipant.

Mental Health:Astateofwell-beinginwhichtheindividualrealizeshisorherownpotential,cancopewiththenormalstressesoflife,canworkproductivelyandfruitfully,andisabletomakeacontributiontoherorhisowncommunity(WorldHealthOrganization,WHO).

Mental Health First Aid:Thehelpprovidedtoapersondevelopingamentalhealthproblemorexperiencingamentalhealthcrisis.ForoverfouryearstheprogramhastaughtCana-dianshowtorespondtomentalhealthemergencies,enablingthemtobettermanagepotentialordevelopingmentalhealthproblemsinthemselves,afamilymember,afriendorcolleague(MentalHealthCommissionofCanada).

Mental Health Promotion:Buildingthecapacityofindi-vidualsandcommunitiestoimprovetheirmentalhealthbycollaboratingwithmanysectorsofsociety.

Mental Illness:Clinicallysignificantpatternsofbehaviororemotionsthatareassociatedwithsomelevelofdistress,suffer-ingorimpairmentinoneormoreareassuchasschool,work,socialandfamilyinteractionsortheabilitytoliveindepen-dently.ExamplesofmentalillnessincludeMajorDepressiveDisorder,BipolarDisorder,Schizophrenia,andEatingDisorders(MentalHealthCommissionofCanada,Toward Recovery and Well-being: A Framework for a Mental Health Strategy for Canada).

Mental Health Commission Of Canada:Acatalystfortrans-formativechangewhosemissionistoworkwithstakeholderstochangetheattitudesofCanadianstowardmentalhealthproblemsandtoimproveservicesandsupport.Theirgoalistopromotementalhealthandassistancetothosepeoplewholivewithmentalhealthproblemsorillnesssothattheymayleadmeaningfulandproductivelives.

Mental Health Court:Avoluntaryoffender-basedprogramforadults(persons18yearsofageandover)whohavebeenchargedwithacriminaloffenceandhaveamentaldisorderbutarecompetenttoparticipateinthecriminaljusticesystem.

Methadone Treatment Program:Abestpracticetreatmentforopiateaddictionwheremethadoneisprescribedandmoni-toredbyaphysician.

Natural Support:Anindividual,familymember,friend,clergyoranyotherpersonorgroupwhoplaysasignificantroleinofferingsupporttoanindividuallivingwithmentalhealthproblemsormentalillness.Anaturalsupportisnotnecessar-ilyapartoftheformalcaresystemandisnotpaidforofferingthissupport.

Navigation:Aprocessbywhichanindividual(theNavigator)guidespersonsseekingassistancethroughandaroundbarriersinthehealthcaresystemtohelpensuretimelyassessmentandtreatment.Barrierstoqualitycarefallintoanumberofcategoriesthatinclude:financialandeconomic;languageandcultural;systemcomplexities;communication;transportation;andfear.

Navigationhelpsensurethatpersonreceivesculturallycompe-tentcarethatisalso:confidential,respectful,compassionate,andmindfulofthepatient’ssafety(OncolIssues,2004andFreeman,2001).

Non-Linear Recovery:Anaspectoftherecoveryprocessthatinvolvescontinualgrowth,occasionalsetbacks,andlearningfromexperience.Itbeginswhenanindividualbecomesawarethatpositivechangeispossibleandfullyengagesintheworkofrecovery.

Non-Traditional Services:Individualizedservicesprovidedtomeettheneedsofeachclientandfamilyandincludesavarietyofresourcesincludingmentoring,traditionalhealers,alternativemedicine/practices(s),sports/recreation/art/performingarts,faithand/orculture-basedinitiatives/programs.Thesenon-tra-ditionalservicesmaybeadministeredoutsideofthetraditionalclinicalsetting,incommunity-basedplacessuchasschools.

Person-Centered Care:“Asystemwherepatientscanmovefreelyalongacarepathwaywithoutregardtowhichphysi-cian,otherhealth-careprovider,institutionorcommunityresourcetheyneedatthatmomentintime.Thissystemisonethatwouldconsidertheindividualneedsofpatientsandtreatthemwithrespectanddignity”(Rossreport).Characteristicsofperson-centeredcareincluderespectforpatients’values,preferencesandexpressedneeds;coordinationandintegra-tionofcare;andInformation,communication,andeducation.Foundationaltotheprovisionofperson-centeredcareisphysi-calcomfort;emotionalsupport,involvementoffamilyandfriendsanddeliverysystemsthatprovideforcaringtransitionsbetweendifferentprovidersandthephasesofcare.

Participatory Process:Aconsultativeprocessthatseeksinputfromidentifiedstakeholderindividualsandgroupsinordertocollectdataandinformapotentialstrategytoaddressaparticularissueorconcern.

Patient Confidentiality:Therightofanindividualpatienttohavepersonalandidentifiablemedicalinformationkeptpri-vate;suchinformationshouldbeavailableonlytothephysicianofrecordandotherhealthcareprovidersandwillnotbedis-closedtoothersunlessthepatienthasgiveninformedconsent.

Person- and Family-centered Care:Person-andfamily-centeredcareisanapproachtotheplanning,delivery,and


evaluationofhealthcarethatisgroundedinmutuallybenefi-cialpartnershipsamonghealthcareproviders,patients,andfamilies(TheInstituteforPatient-andFamily-centeredCare).

Peer:Apeerisdefinedasapersonofequalstanding.Inthecontextofprovidingpeersupport,thewordpeerisusedinabroadersensetorefertopeoplewhoshareincommonamutuallivedexperience.Inthefieldofmentalhealtheducationpeerisdefinedas“someonewhoiseitheraco-workerorpersonwhoworksinasimilarorganizationalbackground,orsomeoneofthesamegenerationorculturalbackgroundwhohassufferedtheeffectsofmentalillness.”Thismoreprecisedefinitiontakesintoaccountthesignificanceofa“powerdifferential”inarelationshipinattemptingtoachievetheemotionalresonancerequiredtosuccessfullytransmittheunderstandingthatpeoplesufferingfrommentalillnessesare“justlikeyouandme.”

Peer Support:Peersupportisasystemofgivingandreceivinghelpfoundedonkeyprinciplesofrespect,sharedresponsibil-ity,andmutualagreementofwhatishelpful.Peersupportisnotbasedonpsychiatricmodelsanddiagnosticcriteria.Itisaboutunderstandinganother’ssituationempathicallythroughthesharedexperienceofemotionalandpsychologicalpain.Whenpeoplefindaffiliationwithotherstheyfeelare‘like’them,theyfeelaconnection. Thisconnection,oraffiliation,isadeep,holisticunderstandingbasedonmutualexperiencewherepeopleareableto‘be’witheachotherwithouttheconstraintsoftraditional(expert/patient)relationships(Mead,2001).

Peer Based Services:Informalpeersupporthasalwaysbeenprovidedbyfriends,familyandpeers.Formalpeersupportserviceshavebeenprovidedbygrassrootscommunityorgani-zationsandgroupsinVictoriaformorethan30years.Overthelast10years,however,thesharingoflivedexperiencehasbeenincreasinglyrecognizedasanintegral,complementarypartoftherecoveryjourneyinmentalhealth.Formalrecognitionhasledtoincreasingnumbersofpaidpeersupportrolesandadiverserangeofterminology,services,activities,practices,protocols,researchandresources.Thesehavebeendevelopedbyindividuals,communityandspecialinterestgroups,healthprofessionals,governmentdepartmentsandsupportagencies,allaimingtoharnessthepowerofpeersupportforconsum-ersofmentalhealthservicesandtheirfamilies/carers.Peersupportservicescanbeprovidedinavarietyofwaysincluding:One-on-oneorinagroup;byvolunteersorpaidemployees;peer-ledorfacilitatedbyahealthprofessional(forexample,apsychologistorpsychotherapist);inperson,onthephoneorviatheinternet;throughworkshopsorsocialactivities;andinadhocorongoingformats.

Person with Lived experience:Anyonewholives,orhaslivedwithamentalhealthproblemoramentalillness.

Population Health Approach:Thehealthofapopulationasmeasuredbyhealthstatusindicatorsandasinfluencedbysocial,economicandphysicalenvironments,personalhealthpractices,individualcapacityandcopingskills,humanbiol-ogy,earlychildhooddevelopment,andhealthservices.Asanapproach,populationhealthfocusesontheinterrelatedcondi-tionsandfactorsthatinfluencethehealthofpopulationsoverthelifecourse,identifiessystematicvariationsintheirpatternsofoccurrence,andappliestheresultingknowledgetodevelopandimplementpoliciesandactionstoimprovethehealthandwell-beingofthosepopulations(Federal,ProvincialandTerrito-rialAdvisoryCommitteeonPopulationHealth(ACPH),1997).

Primary Health Care:Isbasedonpractical,scientificallysound,andsociallyacceptablemethodandtechnology;uni-versallyaccessibletoallinthecommunitythroughtheirfullparticipation;atanaffordablecost;andgearedtowardself-relianceandself-determination(WHOandUNICEF,1978).Primaryhealthcareshiftstheemphasisofhealthcaretothepeoplethemselvesandtheirneeds,reinforcingandstrength-eningtheirowncapacitytoshapetheirlives.Hospitalsandprimaryhealthcentresthenbecomeonlyoneaspectofthesysteminwhichhealthcareisprovided.Asaphilosophy,primaryhealthcareisbasedontheoverlapofmutuality,socialjusticeandequality.Asastrategy,primaryhealthcarefocusesonindividualandcommunitystrengths(assets)andopportunitiesforchange(needs);maximizestheinvolvementofthecommunity;includesallrelevantsectorsbutavoidsduplicationofservices;andusesonlyhealthtechnologiesthatareaccessible,acceptable,affordableandappropriate.Primaryhealthcareneedstobedeliveredclosetothepeople;thus,shouldrelyonmaximumuseofbothlayandprofessionalhealthcarepractitionersandincludesthefollowingeightessentialcomponents:educationfortheidentificationandprevention/controlofprevailinghealthchallenges;properfoodsuppliesandnutrition;adequatesupplyofsafewaterandbasicsanitation;maternalandchildcare,includingfamilyplanning;immunizationagainstthemajorinfectiousdiseases;preventionandcontroloflocallyendemicdiseases;appropri-atetreatmentofcommondiseasesusingappropriatetechnol-ogy;promotionofmental,emotionalandspiritualhealth;provisionofessentialdrugs(WHOandUNICEF,1978).Thegreatestdifferencebetweenprimarycareandprimaryhealthcareisthatprimaryhealthcareisfullyparticipatoryandassuchinvolvesthecommunityinallaspectsofhealthanditssubsequentaction(Anderson&MacFarlane,2000;Wass,2000;WHO,1999).

Promising Practices:Aprogram,activityorstrategythathasworkedwithinoneorganizationandshowspromiseduringitsearlystagesforbecomingabestpracticewithlongtermsustainableimpact.Apromisingpracticemusthavesomeobjectivebasisforclaimingeffectivenessandmusthavethepotentialforreplicationamongotherorganizations.

Protective Factors:Individualorenvironmentalsafeguardsthatpreventorreducevulnerability(e.g.availabilityofsocialsupport;healthymethodsofcopingwithstress);increasechancesofpositiveresults;protectpeoplefromriskfactors.

Problematic Substance use:Reflectspotentiallyriskylevelsofalcoholorotherdruguse.

Provincial Mental Health Standards:Asetofsystemicandlegislatedrequirementsforthedeliveryofmentalhealthservices.Thesestandardsareintendedtoprovideguidanceforqualityservicedeliveryandreducevariationsacrosstheprovince,whilemaintainingflexibilitytoadaptapproachestouniquedistrict,communityandorganizationconditions.NovaScotiahasthefirstsuchsetoflegislatedstandardswithintheCanadianpublicsystem,implementedin2003,revisedin2009.Numeroussystemstakeholderswereinvolvedinreachingcon-sensusonstandardsbasedonthebestavailableinformationregardingeffectivenessand/orbestpractice,balancedbytheperspectiveofconsumers,expertpractitionersandeducators.Inputcontinuestobesoughtandrevisionsaretotakeplaceeveryfiveyearstokeeppacewithbestpracticeevidence.


Psychiatrist:Amedicaldoctortrainedandqualifiedintheareaofpsychiatryandmentalhealthcare.

Psychologist:Aself-regulatedprofessionaltrainedtoas-sessanddiagnose,andtreatproblemsinthinking,feelingandbehavingusingavarietyofapproachesdirectedtowardthemaintenanceandenhancementofphysical,intellectual,emotional,socialandinterpersonalfunctioning.Psycholo-gistsmayworkwithindividuals(child,youth,adult),families,couplesororganizations.

Psychological Health:Ourabilitytothink,feelandbehaveinamannerthatenablesustoperformeffectivelyatwork,athome,andinsocietyatlarge.

Psychological Safety:“Psychologicalsafetydescribestheindividuals’perceptionsabouttheconsequencesofinterper-sonalriskintheirworkenvironment.Itconsistsoftaken-for-grantedbeliefsabouthowotherswillrespondwhenoneputsoneselfontheline,suchasbyaskingaquestion,seekingfeedback,reportingamistake,orproposinganewidea.Oneweighseachpotentialactionagainstaparticularinterpersonalclimate,asin,“IfIdothishere,willIbehurt,embarrassedorcriticized?”Anactionthatmightbeunthinkableinoneworkgroupcanbereadilytakeninanother,duetodifferentbeliefsaboutprobableinterpersonalconsequences”(HealthForceOntario,Edmondson).

Psychosis:Acategoryofhealthproblemsthataredistin-guishedbyregressivebehavior,personalitydisintegration,reducedlevelofawareness,greatdifficultyinfunctioningadequately,andgrossimpairmentinrealitytesting.

Psychosocial Rehabilitation:Aprocessthatpromotesper-sonalrecovery,successfulcommunityintegrationandsatisfac-toryqualityoflifeforpersonaaffectedbymentalhealthand/oraddictionsissues.

Planning, evaluation, Monitoring:Processestoensureproperaccountabilityforpoliciesandprograms.Thismayincludestandardizeddatacollectionsystems,provincialqualityimprovementmechanisms,andappropriategovernanceandreportingstructures.

Resilience:Theabilitytothrive,matureandincreasecompetence,evenwhenfacedwithnegativecircumstancesorriskfactors;abilitytobouncebackfromstressfuleventsandmoveforward.

Recovery Oriented System:Emphasizesself-determinationandself-managementbythosewithlivedexperienceofmentalhealthproblemsandillness.Thefundamentalunderpinningofarecovery-orientedapproachishopeandthekeyvaluesarerespect,dignity,andchoice.

Recovery:Adeeplypersonalandindividualprocessinwhichpeoplelivingwithmentalhealthproblemsandillnessesareempoweredandsupportedtobeactivelyengagedintheirownjourneyofwell-being.Recoverybuildsonindividual,family,cultural,andcommunitystrengthsandenablespeopletoenjoyameaningfullifeintheircommunitywhilestrivingtoachievetheirfullpotential.Recoverydoesnotnecessarilymean‘cure,’althoughitdoesacknowledgethat‘cure’ispossibleformanypeople.Theprinciplesofrecoveryincludehope,empowerment,self-determinationandresponsibility.Althoughrelevantto

anyoneexperiencingmentalhealthproblemsorillnessestheymustbeadaptedtotheindividual’srealitiesacrossthelifespan(WorldHealthOrganization).

Therearemultiplepathwaystorecoverybasedonanindividu-al’suniquestrengthsandresilienciesaswellashisorherneeds,preferences,experiences(includingpasttrauma),andculturalbackgroundinallofitsdiverserepresentations.Individualsalsoidentifyrecoveryasbeinganongoingjourneyandanendresultaswellasanoverallparadigmforachievingwellnessandoptimalmentalhealth.

Recreational Therapist:Aclinicianwhoprovidesrecreationactivitiestoindividualswithillnessesordisablingconditionstoimproveormaintainphysical,mentalandemotionalwell-being.

Registered Nurse:Self-regulatedhealth-careprofessionalswhoworkautonomouslyandincollaborationwithothers.RNsenableindividuals,families,groups,communitiesandpopula-tionstoachievetheiroptimallevelofhealth.RNscoordinatehealthcare,deliverdirectservicesandsupportclientsintheirself-caredecisionsandactionsinsituationsofhealth,illness,injuryanddisabilityinallstagesoflife.RNscontributetothehealth-caresystemthroughtheirworkindirectpractice,education,administration,researchandpolicyinawidearrayofsettings.

Rehabilitation:Psychosocialrehabilitation(alsotermedpsychiatricrehabilitation,orPSR)promotespersonalrecovery,successfulcommunityintegrationandsatisfactoryqualityoflifeforpersonswhohaveamentalillnessormentalhealthconcern.Psychosocialrehabilitationservicesandsupportsarecollaborative,persondirected,andindividualized,andanes-sentialelementofthehumanservicesspectrum.Theyfocusonhelpingindividualsdevelopskillsandaccessresourcesneededtoincreasetheircapacitytobesuccessfulandsatisfiedintheliving,working,learningandsocialenvironmentsoftheirchoiceandincludeawidecontinuumofservicesandsupports(PsychosocialRehabilitationCanada).

Relapse:Inthecourseofillness,relapsemayoccurwhensymptomsreturnafteraperiodoftimefollowingaperiodofbeingsymptomfree(Encyclopedia of Mental Disorders,re-trievedfromtheinternet:http://www.minddisorders.com/Py-Z/Relapse-and-relapse-prevention.html).

Respect:Anattitudeinarelationshipthatconveyscaring,valuingandacceptanceofanindividualwithoutqualification,discrimination,orstigma.Respectensurestheinclusionandfullparticipationofconsumersinallaspectsoftheirlives.

Respite:Respiteliterallymeansaperiodofrestorrelief.Respitecareprovidesacaregivertemporaryrelieffromtheresponsibilitiesofcaringforindividualswithchronicphysicalormentaldisabilities.Respitecareisoftenreferredtoasagiftoftime.

Respite Care:Theprovisionofshort-term,temporaryrelieftothosewhoarecaringforfamilymemberswhomightotherwiserequirepermanentplacementinafacilityoutsidethehome.

Responsibility:Theactionofconsumersparticipatingintheirownself-careandjourneyofrecoverywheretakingstepstowardsachievingtheirgoalsmayrequiregreatcourage.Con-sumersassumeresponsibilitywhentheyunderstandandgive


meaningtotheirlivedexperiencesandidentifycopingstrate-giesandhealingprocessestopromotetheirownwellness.

Risk Factors:Individualorenvironmentalfactorsthatincreasethelikelihoodofnegativeresultslinkedtodiseases,illhealthorinjury;canbecumulative,increasingtheharmfuleffect(e.g.socialisolationorloweconomicstatus).

Self-direction:Theabilityoftheconsumerstoparticipateinandexercisecontroldeterminetheirownpathofrecoverybyoptimizingautonomy,independence,andcontrolofresourcestoachieveaself-determinedlife.Bydefinition,therecoverypro-cessmustbeself-directedbytheindividual,whodefineshisorherownlifegoalsanddesignsauniquepathtowardsthosegoals.

Self-stigma:Occurswhenpeoplewithmentalhealthprob-lemsormentalillnessinternalizenegativeattitudesabouttheirownconditionpotentiallyleadingtoembarrassmentthatcancausethemtohidethesymptomsoravoidtreatment.

Service delivery:Theprocessthatengagestheclient/patientinacollaborativeprocessofcaredelivery,utilizingarangeofapproachesandservicesthatmayincludeassess-ment,treatment,evaluation,dischargeplanning,follow-upandcommunitysupport.

Service Level Integration:Theactivemanagementofallelementsofthecontinuumofhealthandcareservicesrequiredbyindividualsandcommunitiesinordertoachieveaseamlesscarepathwayfortheindividualorclientgroup(adaptedfrom:NHS,Dept.ofHealth,2001).

Severe Persistent Mental Illness (SPMI):ApsychiatricdiagnosisfoundinDiagnosticStatisticalManual(DSM-IV-TR2000).Itreferstothosewithadisabilityinoneormoreofthelifedomainssuchassocialrelationships,independentliving,employmentandduration,definedbyanextendedperiodoftimereceivingintensivementalhealthservicessuchashospitalizationorsupervisedgroupliving(Schinnar,Rothbard,Kanter,&Jung,1990).

Shared Mental Health Care:Sharedmentalhealthcareisaprocessofcollaborationbetweenthefamilyphysicianandthepsychiatristthatenablesresponsibilitiesforcaretobeapportionedaccordingtothetreatmentneedsofthepatientatdifferentpointsintimeinthecourseofamentalhealthprob-lemandtherespectiveskillsofthepsychiatristandthefamilyphysician(CFPC-CPAjointpositionpaperonSharedMentalHealthCareinCanada,1997).

Social determinants of Health:Keyfactorsaffectingpeople’shealthincludingincomeandsocialstatus,socialsup-portnetworks,educationandliteracy,employmentandwork-ingconditions,physicalandsocialenvironments,biologyandgenetics,personalhealthpracticesandcopingskills,healthychilddevelopment,healthservices,genderorculture.

Social Marketing:Theplanned,systematicapplicationofresearchedandwell-designedmediainitiativesthattargetspe-cificissues,populationsegments,formsofknowledgeorbelief,andthataimtoinfluenceattitudesorintentions,orindividualandculturalnormsandbehaviors.Socialmarketingapproachesmaybeusedtopromotehealthandwell-being,ortoamelioratehealth-relatedproblems,ortoreducerisksandharms.

Social Inclusion:Asociallyinclusiveapproachincludesrecovery-orientedpractice,anemphasisonsocialoutcomesandparticipation,andattentiontotherightsofpeoplewithmentalillhealth,aswellastocitizenship,equalityandjustice,andstigmaanddiscrimination(RoyalCollegeofPsychiatrists).

Social Worker:Professionalswhopromotesocialchange,problem-solveinhumanrelationships,andpromotetheem-powermentandliberationofpeopletoenhancethewell-beingofindividualsandgroups.Utilizingtheoriesofhumanbehav-iourandsocialsystems,socialworkintervenesatthepointswherepeopleinteractwiththeirenvironments.Principlesofhumanrightsandsocialjusticearefundamentaltosocialwork(InternationalFederationofSocialWorkers).

Standards:Astandardisanagreedupon,repeatablewayofdoingsomething.Itis adocumentcontainingcriteriadesignedtobeusedconsistentlyasarule,guideline,ordefinition.Standardshelptomakelifesimplerandtoincreasethereli-abilityandtheeffectivenessofserviceprovision. Standardsarecreatedbybringingtogethertheexperienceandexpertiseofallinterestedparties suchas theindividual,familyandthecom-munitytofacilitateparticipationindecisionmaking,planning,evaluationandthedeliveryofmentalhealthcare.

Strengths-based Recovery:Anapproachthatfocusesonvaluingandbuildingonthemultiplecapacities,resiliencies,talents,copingabilities,andinherentworthofindividuals.Bybuildingonthesestrengths,consumersleavebehindliferolesthatarenolongereffectiveandengageinnewliferolesandwaysofbeing.Inthisway,theprocessofrecoverymovesforwardthroughinteractionwithothersinsupportiveandtrust-basedrelationships.

Stakeholder:Anindividualorgrouphavingasignificantin-terestinaspecificareaofconcernthatiscurrentlyunderactivestudyorconsideration.

Standard:Adocument,establishedbyconsensusandap-provedbyarecognizedbodythatprovides,forcommonandre-peateduse,rules,guidelinesorcharacteristicsforactivitiesortheirresults,aimedattheachievementoftheoptimumdegreeoforderinagivencontext(ISO/IEC Guide 2,Clause3.2).

Stigma:Negativejudgment,attitudeorvaluebasedonapersonaltrait(e.g.mentalhealthproblemorillness)promotesprejudiceanddiscrimination.

Strengthening Local Identities:Theactivitypromotesandstrengthensasenseofbelongingandself-reliance.

Substance Abuse/use:Overindulgenceinordependenceonanaddictivesubstance,especiallyalcoholordrugs.

Supported Housing:Supportivehousingishousingthatissafe,secure,andaffordable.Itisnottreatment,butallowstheindividualtofocusonrecovery.Levelsofsupportshouldvaryandrangefromlivein24/7supportthatassistswithmeals,or-ganizationanddaytodayconcerns.Theotherendofsupportedhousingspectrumistoprovideconsistentsupportsthatarenotlivein,butratherthereonasneededbasisandassistwithappointments,crisismanagementandmaintainroutineandwellness.Supportedhousingoffersopportunityforindividualstogrowandrealizetheirpotentialandgainindependence.


Sustainability:Thecapacitytoendure.Forhumans,sustain-abilityisthelong-termmaintenanceofwellbeing,whichhasenvironmental,economic,andsocialdimensions,andencom-passestheconceptofstewardship,theresponsiblemanage-mentofresourceuse(Wikipedia).

System Level Integration:Multiplesystems,suchasjustice,childwelfare,mentalhealth,medicineandotherserviceswork-ingtogetherinwaysthatmaketransitionsbetweenservicesseamlessforthepeopleusingthem.

Tele-psychiatry:Thepracticeofpsychiatryfromalongrangedistance,facilitatedbytheuseoftechnologysuchastelephoneconferencing,videoconferencing,andtheinternet.

Transitional Care:Acomprehensiveplanofcarethatin-cludesasetofactionsdesignedtoensurethecoordinationandcontinuityofhealthcareaspatientstransferbetweendifferentlocationsorlevelsofcarewithinasystem.

Treatment:Themanagementandcareofapersonorthecombatingofdisease,disorder,issueoraddiction.

voluntary Treatment:Voluntarytreatmentoccurswhenapersonwillinglyconsentstoengageintreatmentforanexist-ingproblemorissuesuchasamentalhealthand/oraddiction.

Wellness:Theoptimalstateofhealthforindividualsandgroups;Therearetwofocalconcerns:therealizationofthefullestpotentialoftheindividualphysically,psychologically,socially,spirituallyandeconomicallyandthefulfillmentofone’sroleexpectationsinthefamily,community,placeorwor-ship,workplaceandothersettings(Nutbeam,1986).

Wise Practices:Actions,tools,principlesordecisionsthatcontributesignificantlytotheachievementofenvironmentally

sustainable,sociallyequitable,culturallyappropriate,andeconomicallysounddevelopment.

Withdrawal Management:Amedialprotocolestablishedtoassistclienttodetoxfromsubstanceuse(drugs,alcoholorgambling)inastaffclinicalenvironment.

Woman-centered Care:Aphilosophyofcarewithintheoverallhealthcaresystemthatgivesprioritytothewishesandneedsoftheuser,andemphasizestheimportanceofinformedchoice,continuityofcare,userinvolvement,clinicaleffective-ness,responsiveness,accessibility,policyandprogramdevel-opmentanddesign.Thefundamentalprinciplesofwoman-centeredcarefocusonthewomen’schanginghealthcareneedsacrossthelifespan.Thisphilosophyconsiderstheculturalandpoliticalconstructofwomen’slives,andacknowledgeshowwomenhavehistoricallyvaluedwomen’s-onlyprogramstomeetandcreateasafeplaceforwellness.

Youth:TheGovernmentofCanadahasextendedtheagedefi-nitionofyouthforseveralofitsprogramsastheimplicationsofdelayedyouthtransitionswereconsideredinpolicydevelop-ment.In2006-07,ThePolicyResearchInitiative(PRI)initiatedseveralstudies,4examiningyouthtransitioning,particularlyforat-riskyouth,onprovincialandfederalyouthpoliciesandpracticesacrossthecountry.Theareasoffocus,employment,educationandmarriageandparenthood,alignwiththecoreyouthtransitionareas.

Youth:TheUnitedNationsdefinesyouthasbeingbetweentheagesof15and24years.Theagedefinitionofwhensomeoneislegallydeemedanadultvariesamongstcountriesbuttendstoalignwiththelegalageofmajorityusuallyat18or21years.However,internationallymoreandmorecountriesareextend-ingtheagelimitsforyouthintheirgovernmentservicesintothemid-20sorearly30s.

Glossary ReferencesAmericanGeriatricsSociety:Retrievedfromtheinternet:http://www.american geriatrics.org/products/positionpapers/complex_care.shtml

FreemanHP.Amodelpatientnavigationprogram.Oncol Issues.September/October2004:44-46.

FreemanHP.VoicesofaBrokenSystem:RealPeople,RealProblems.President’s Cancer Panel: Report of the Chairman 2000–2001.ReubenSH,ed.Bethesda,Md:NationalInstitutesofHealth,NationalCancerInstitute;2001.

HMOWorkgrouponCareManagement.One Patient, Many Places: Managing Healthcare Transitions.Washington,DC,AAHPFoundation,February2004.

Nutbeam,D.(1986).HealthPromotionGlossary.Health Promotion.1,113-127.

Sheldon,Brian(1995,2011).Cognitive Behavior Therapy,NewYork:Routledge


Appendix A: Terms of Reference

PurposeTheMentalHealthStrategyAdvisoryCommitteewillprovideadviceandguidanceintheapproachanddevelopmentofthementalhealthstrategyfortheprovince.

MandateTheAdvisoryCommitteewillprovideadvicetotheNovaScotiaHealthResearchFoundation(NSHRF)onthefollowing:

• Theproposedapproachtothedevelopmentofamentalhealthstrategy.

• EvidenceneededtosupportthedevelopmentoftheStrategy.

• SourcesofevidencethatneedtobeconsideredinthedevelopmentoftheStrategy.

• Theconsultationprocessandformat.

• FeedbackonthevariousiterationsoftheStrategy.

Decision-makingTheultimatedecision-makingauthorityrestswiththeMinisterofHealth.TheAdvisoryCommitteewillprovideguidanceandadvicetotheNSHRFwhowillcoordinatethedevelopmentofthestrategy.

Reporting StructureCo-ChairswillreportontheprogressofthedevelopmentoftheStrategytotheMinister/DeputyMinister.

MembershipMembershipfortheAdvisoryCommitteehasbeenidentifiedbytheMinisterofHealth.Membersareappointedasindividualswithexpertiseinmentalhealthandwillnotrepresenttheirindividualorganizations,institutionsorotheraffiliationsdirectly.

TenureMembersareappointedforadurationof12months,oruntilthestrategyissubmittedtotheMinisterofHealth.


Appendix B: Ottawa Charter for Health PromotionRetrieved from: http://www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf Oct. 29, 2011

First International Conference on Health PromotionOttawa, 21 November 1986 — WHO/HPR/HEP/95.1

thE firSt iNtErNatioNal coNfErENcE oN hEalth promotioN,meetinginOttawathis21stdayofNovember1986,herebypresentsthisCHARTERforactiontoachieveHealthforAllbytheyear2000andbeyond.

Thisconferencewasprimarilyaresponsetogrowingexpectationsforanewpublichealthmovementaroundtheworld.Discussionsfocusedontheneedsinindustrializedcountries,buttookintoaccountsimilarconcernsinallotherregions.ItbuiltontheprogressmadethroughtheDeclarationonPrimaryHealthCareatAlma-Ata,theWorldHealthOrganization’sTargetsforHealthforAlldocument,andtherecentdebateattheWorldHealthAssemblyonintersectoralactionforhealth.

HeALTH PROMOTIONHealthpromotionistheprocessofenablingpeopletoincreasecontrolover,andtoimprove,theirhealth.Toreachastateofcompletephysical,mentalandsocialwell-being,anindividualorgroupmustbeabletoidentifyandtorealizeaspirations,tosatisfyneeds,andtochangeorcopewiththeenvironment.Healthis,therefore,seenasaresourceforeverydaylife,nottheobjectiveofliving.Healthisapositiveconceptemphasizingsocialandpersonalresources,aswellasphysicalcapacities.Therefore,healthpromotionisnotjusttheresponsibilityofthehealthsector,butgoesbeyondhealthylife-stylestowell-being.

PReRequISITeS FOR HeALTHThefundamentalconditionsandresourcesforhealthare:

• peace,

• shelter,

• education,

• food,

• income,

• astableeco-system,

• sustainableresources,

• socialjustice,andequity.

Improvementinhealthrequiresasecurefoundationinthesebasicprerequisites.


AdvOCATeGoodhealthisamajorresourceforsocial,economicandpersonaldevelopmentandanimportantdimensionofqualityoflife.Political,economic,social,cultural,environmental,behaviouralandbiologicalfactorscanallfavourhealthorbeharmfultoit.Healthpromotionactionaimsatmakingtheseconditionsfavourablethroughadvocacyforhealth.

eNABLeHealthpromotionfocusesonachievingequityinhealth.Healthpromotionactionaimsatreducingdifferencesincurrenthealthstatusandensuringequalopportunitiesandresourcestoenableallpeopletoachievetheirfullesthealthpotential.Thisincludesasecurefoundationinasupportiveenvironment,accesstoinformation,lifeskillsandopportunitiesformakinghealthychoices.Peoplecannotachievetheirfullesthealthpotentialunlesstheyareabletotakecontrolofthosethingswhichdeterminetheirhealth.Thismustapplyequallytowomenandmen.

MedIATeTheprerequisitesandprospectsforhealthcannotbeensuredbythehealthsectoralone.Moreimportantly,healthpromotiondemandscoordinatedactionbyallconcerned:bygovernments,byhealthandothersocialandeconomicsectors,bynongovernmentalandvoluntaryorganization,bylocalauthorities,byindustryandbythemedia.Peopleinallwalksoflifeareinvolvedasindividuals,familiesandcommunities.ProfessionalandsocialgroupsandhealthpersonnelhaveamajorresponsibilitytomediatebetweendifferinginterestsinsocietyforthepursuitofhealthHealthpromotionstrategiesandprogrammesshouldbeadaptedtothelocalneedsandpossibilitiesofindividualcountriesandregionstotakeintoaccountdifferingsocial,culturalandeconomicsystems.

Health Promotion Action Means:

BuILd HeALTHY PuBLIC POLICYHealthpromotiongoesbeyondhealthcare.Itputshealthontheagendaofpolicymakersinallsectorsandatalllevels,directingthemtobeawareofthehealthconsequencesoftheirdecisionsandtoaccepttheirresponsibilitiesforhealth.

Healthpromotionpolicycombinesdiversebutcomplementaryapproachesincludinglegislation,fiscalmeasures,taxationandorganizationalchange.Itiscoordinatedactionthatleadstohealth,incomeandsocialpoliciesthatfostergreaterequity.Jointactioncontributestoensuringsaferandhealthiergoodsandservices,healthierpublicservices,andcleaner,moreenjoyableenvironments.

Healthpromotionpolicyrequirestheidentificationofobstaclestotheadoptionofhealthypublicpoliciesinnon-healthsectors,andwaysofremovingthem.Theaimmustbetomakethehealthierchoicetheeasierchoiceforpolicymakersaswell.

CReATe SuPPORTIve eNvIRONMeNTSOursocietiesarecomplexandinterrelated.Healthcannotbeseparatedfromothergoals.Theinextricablelinksbetweenpeopleandtheirenvironmentconstitutesthebasisforasocioecologicalapproachtohealth.Theoverallguidingprinciplefortheworld,nations,regionsandcommunitiesalike,istheneedtoencouragereciprocalmaintenance—totakecareofeachother,ourcommunitiesandournatural


environment.Theconservationofnaturalresourcesthroughouttheworldshouldbeemphasizedasaglobalresponsibility.

Changingpatternsoflife,workandleisurehaveasignificantimpactonhealth.Workandleisureshouldbeasourceofhealthforpeople.Thewaysocietyorganizesworkshouldhelpcreateahealthysociety.Healthpromotiongenerateslivingandworkingconditionsthataresafe,stimulating,satisfyingandenjoyable.

Systematicassessmentofthehealthimpactofarapidlychangingenvironment—particularlyinareasoftechnology,work,energyproductionandurbanization-isessentialandmustbefollowedbyactiontoensurepositivebenefittothehealthofthepublic.Theprotectionofthenaturalandbuiltenvironmentsandtheconservationofnaturalresourcesmustbeaddressedinanyhealthpromotionstrategy.

STReNGTHeN COMMuNITY ACTIONSHealthpromotionworksthroughconcreteandeffectivecommunityactioninsettingpriorities,makingdecisions,planningstrategiesandimplementingthemtoachievebetterhealth.Attheheartofthisprocessistheempowermentofcommunities—theirownershipandcontroloftheirownendeavoursanddestinies.

Communitydevelopmentdrawsonexistinghumanandmaterialresourcesinthecommunitytoenhanceself-helpandsocialsupport,andtodevelopflexiblesystemsforstrengtheningpublicparticipationinanddirectionofhealthmatters.Thisrequiresfullandcontinuousaccesstoinformation,learningopportunitiesforhealth,aswellasfundingsupport.

deveLOP PeRSONAL SKILLSHealthpromotionsupportspersonalandsocialdevelopmentthroughprovidinginformation,educationforhealth,andenhancinglifeskills.Bysodoing,itincreasestheoptionsavailabletopeopletoexercisemorecontrolovertheirownhealthandovertheirenvironments,andtomakechoicesconducivetohealth.

Enablingpeopletolearn,throughoutlife,topreparethemselvesforallofitsstagesandtocopewithchronicillnessandinjuriesisessential.Thishastobefacilitatedinschool,home,workandcommunitysettings.Actionisrequiredthrougheducational,professional,commercialandvoluntarybodies,andwithintheinstitutionsthemselves.

ReORIeNT HeALTH SeRvICeSTheresponsibilityforhealthpromotioninhealthservicesissharedamongindividuals,communitygroups,healthprofessionals,healthserviceinstitutionsandgovernments.Theymustworktogethertowardsahealthcaresystemwhichcontributestothepursuitofhealth.Theroleofthehealthsectormustmoveincreasinglyinahealthpromotiondirection,beyonditsresponsibilityforprovidingclinicalandcurativeservices.Healthservicesneedtoembraceanexpandedmandatewhichissensitiveandrespectsculturalneeds.Thismandateshouldsupporttheneedsofindividualsandcommunitiesforahealthierlife,andopenchannelsbetweenthehealthsectorandbroadersocial,political,economicandphysicalenvironmentalcomponents.Reorientinghealthservicesalsorequiresstrongerattentiontohealthresearchaswellaschangesinprofessionaleducationandtraining.Thismustleadtoachangeofattitudeandorganizationofhealthserviceswhichrefocusesonthetotalneedsoftheindividualasawholeperson.

MOvING INTO THe FuTuReHealthiscreatedandlivedbypeoplewithinthesettingsoftheireverydaylife;wheretheylearn,work,playandlove.Healthiscreatedbycaringforoneselfandothers,bybeingabletotakedecisionsandhave


controloverone’slifecircumstances,andbyensuringthatthesocietyonelivesincreatesconditionsthatallowtheattainmentofhealthbyallitsmembers.Caring,holismandecologyareessentialissuesindevelopingstrategiesforhealthpromotion.Therefore,thoseinvolvedshouldtakeasaguidingprinciplethat,ineachphaseofplanning,implementationandevaluationofhealthpromotionactivities,womenandmenshouldbecomeequalpartners.

COMMITMeNT TO HeALTH PROMOTIONTheparticipantsinthisConferencepledge:

• tomoveintothearenaofhealthypublicpolicy,andtoadvocateaclearpoliticalcommitmenttohealthandequityinallsectors;

• tocounteractthepressurestowardsharmfulproducts,resourcedepletion,unhealthylivingconditionsandenvironments,andbadnutrition;andtofocusattentiononpublichealthissuessuchaspollution,occupationalhazards,housingandsettlements;

• torespondtothehealthgapwithinandbetweensocieties,andtotackletheinequitiesinhealthproducedbytherulesandpracticesofthesesocieties;

• toacknowledgepeopleasthemainhealthresource;tosupportandenablethemtokeepthemselves,theirfamiliesandfriendshealthythroughfinancialandothermeans,andtoacceptthecommunityastheessentialvoiceinmattersofitshealth,livingconditionsandwell-being;

• toreorienthealthservicesandtheirresourcestowardsthepromotionofhealth;andtosharepowerwithothersectors,otherdisciplinesand,mostimportantly,withpeoplethemselves;

• torecognizehealthanditsmaintenanceasamajorsocialinvestmentandchallenge;andtoaddresstheoverallecologicalissueofourwaysofliving.

TheConferenceurgesallconcernedtojointhemintheircommitmenttoastrongpublichealthalliance.

CALL FOR INTeRNATIONAL ACTIONTheConferencecallsontheWorldHealthOrganizationandotherinternationalorganizationstoadvocatethepromotionofhealthinallappropriateforumsandtosupportcountriesinsettingupstrategiesandprogrammesforhealthpromotion.

TheConferenceisfirmlyconvincedthatifpeopleinallwalksoflife,nongovernmentalandvoluntaryorganizations,governments,theWorldHealthOrganizationandallotherbodiesconcernedjoinforcesinintroducingstrategiesforhealthpromotion,inlinewiththemoralandsocialvaluesthatformthebasisofthisCHARTER,HealthForAllbytheyear2000willbecomeareality.

Charter adopted at an international conference on health promotion.

* Themovetowardsanewpublichealth,November17–21,1986Ottawa,Ontario,Canada

* Co-sponsoredbytheCanadianPublicHealthAssociation,HealthandWelfareCanada,andtheWorldHealthOrganization


Appendix C: Selected Works ReviewedIn preparation of this document a plethora of information was reviewed by the Advisory Committee. Sources of information include peer reviewed literature, gray literature, government reports and legislative documents. The list of references below provides a selection of works used to support the Advisory Committee’s work.

Abbey,S.,Charbonneau,M.,Tranulis,C.,Moss,P.,Baici,W.,Dabby,L.Gautam,M.,Paré,M.StigmaandDiscrimination.A position paper of the Canadian Psychiatric Association, 2011

Asbridge,M.,Pauley,C.,Langille,D.,Kisely,S.,&Whipp,A.(2011).MentalHealthandAddictionsEpidemiological&DemographicAnalysis.Unpublishedmanuscript,DalhousieUniversity,DepartmentofCommunityHealthandEpidemiology.

Aubina,H-J,Rollemad,H,Torgny,H.Svensson,T.,Winterer,G.Smoking,quitting,andpsychiatricdisease:AreviewNeuroscienceandBiobehavioralReviews,2011,inpress.

Borwein,A.,Langille,D.,Asbridge,M.,Kisely,S.,Turnbull,M.(2011).ReviewandSynthesisofExtantKnowledgeofMentalHealthandAddictionsStrategies,DalhousieUniversity,DepartmentofCommunityHealthandEpidemiology.

Calverley,D.(2010)AdultCorrectionalServicesinCanada,2008/2009.Component of Statistics Canada catalogue no. 85-002-X Juristat Article. RetrievedOct.31,2011:http://www.statcan.gc.ca/pub/85-002-x/2010003/article/11353-eng.pdf

DeclarationofAlma-Ata.InternationalConferenceonPrimaryHealthCare,Alma-Ata,USSR,6-12September1978

Derrick,A.,(2010)FatalityInquiryintotheDeathofHowardHyde.NovaScotiaDepartmentofHealthandWellness.RetrievedJan.5,2012:http://www.courts.ns.ca/hyde_inquiry/hyde_inquiry_report.pdf

Findinghopeinthewordsandsupportofthosewhohavelivedwithmentalillness:BRINGINGTHEPEERPROJECTTOLIFE-THEROADTOSUSTAINABILITY.MentalHealthCommissionofCanada.Aug2011draft

GovernmentofCanada.(2006).ThehumanfaceofmentalhealthandmentalillnessinCanada.

GuidelinesforcomprehensivementalhealthservicesforolderadultsinCanada,MentalHealthCommissionofCanada,2011

HealthcareHumanResourceSectorCouncil(2003).AStudyofHealthHumanResourcesinNovaScotia,Halifax,NS.RetrievedfromJan.5,2012:http://www.gov.ns.ca/health/reports/pubs/hhr_ns_study_report_2003.pdf

Kessler,R.C.,Chiu,W.T.,Demler,O.,Walters,E.E.(2005).Prevalence,Severity,andComorbidityof12-MonthDSM-IVDisordersintheNationalComorbiditySurveyReplication.ArchivesofGeneralPsychiatry,62(6),617–627.


Kirby,M.(2006).OutoftheShadowsatLast,GovernmentofCanada,RetrievedJan.5,2012:http://www.parl.gc.ca/Content/SEN/Committee/391/soci/rep/rep02may06-e.htm

Kisely,S.,Duerden,D.,Shaddick,S.,&Jayabarathan,A.Collaborationbetweenprimarycareandpsychiatricservices.Doesithelpfamilyphysicians?Canadian Family Physician. Vol52:July2006

Kutcher,S.&McLuckie,A.fortheChildandYouthAdvisoryCommittee,MentalHealthCommissionofCanada.(2010).Evergreen: A child and youth mental health framework for Canada.RetrievedOct.31,2011:http://www.mentalhealthcommission.ca/SiteCollectionDocuments/family/ Evergreen_Framework_English_July2010_final.pdf

LimK,JacobsP,OhinmaaA,SchopflocherD,DewaCS.AnewpopulationbasedmeasureoftheeconomicburdenofmentalillnessinCanada.ChronicDiseasesinCanada2008;28(3):92-98.

McGrath,P.J.,Lingley-Pottie,P.,Thurston,C.,MacLean,C.,Cunningham,C.,Waschbusch,D.A,Watters,C.,Stewart,S.,Bagnell,A.,Santor,D.&Chaplin,W.(2011).Telephone-BasedMentalHealthInterventionsforChildDisruptiveBehaviororAnxietyDisorders:RandomizedTrialsandOverallAnalysis.JournaloftheAmericanAcademyofChildandAdolescentPsychiatry;50(11):1162–1172.

MentalHealthCommissionofCanada(2009)TowardRecoveryandWellbeing:AFrameworkforaMentalHealthStrategyforCanada.RetrievedOct.31,2011:http://www.mentalhealthcommission.ca/SiteCollectionDocuments/boarddocs/15507_MHCC_EN_final.pdf

Nunn,M.(2006).SpiralingOutofControl:LessonsLearnedfromaBoyinTrouble:ReportoftheNunnCommissionofInquiry.RetrievedJan.5,2012:http://gov.ns.ca/just/nunn_commission/_docs/Report_Nunn_Final.pdf

O’Hagan,M.,Cyr,C.,McKee,H.&Priest,R.MakingtheCaseforPeerSupport:ReporttotheMentalHealthCommissionofCanada,Sept2010

Patterson,M.,Somers,J.,McIntosh,K.,Shiell,A.,&Frankish,C.J.,(2007).HousingandSupportsforAdultswithSevereAddictionsand/orMentalIllnessinBC.GovernmentofBritishColumbia,DepartmentofHealth,retrievedOct.31,2011:http://www.health.gov.bc.ca/library/publications/year/2007/Housing_Support_for_MHA_Adults.pdf

Prince,M.,Patel,V.,Saxena,S.,Maj,M.,Maselko,J.,Philips,M.R.,&Rahman,A.(2007).Globalmental

ReportoftheAuditorGeneral(2010),JacquesR.Lapointe,RetrievedJan.5,2012:http://www.oag-ns.ca/june2010/full%20report.pdf

RetrievedonSeptember12,2009from:http://www.phac-aspc.gc.ca/publicat/human-humain06/pdf/

Roberts,G.&Grimes,K.ReturnonInvestment:MentalHealthPromotionandMentalIllnessPrevention,Canadian Policy Network at the University of Western Ontario March2011

Ross,J.(2010)ThePatientJourneyThroughEmergencyCareinNovaScotia:APrescriptionforNewMedicine,NovaScotiaDepartmentofHealthandWellness.RetrievedJan.5,2012:http://www.gov.ns.ca/health/emergencycarereport/docs/ Dr-Ross-The-Patient-Journey-Through-Emergency-Care-in-Nova-Scotia.pdf


Shared Mental health Care in Canada.2000,CollegeofFamilyPhysiciansofCanadaandCanadianPsychiatricAssociation.3.17

TheCanadianCentreonSubstanceAbuse(CCSA)(2006).The Costs of Substance Abuse in Canada 2002,

TowardRecovery&Well-being:aFrameworkforaMentalHealthStrategyforCanada.MentalHealthCommissionofCanada(2009).RetrievedJan.5,2012:http://www.mentalhealthcommission.ca/SiteCollectionDocuments/Key_Documents/en/2009/Mental_Health_ENG.pdf

Turnbull,M.Langille,D.,Asbridge,M.,Kisely,S.Borwein,A&Campbell,J.(2011)NationalJurisdictionalReviewofMentalHealthandAddictionServiceDeliveryModels.DalhousieUniversity

Waschbusch,D.A.,Pelham,W.E.,Massetti,G.M.,&NorthernPartnersInActionforChildrenandYouth.(2005).TheBehaviorEducationSupportandTreatment(BEST)schoolinterventionprogram:Pilotprojectdataexaminingschool-wide,targeted-school,andtargeted-homeapproaches.Journal of Attention Disorders, 9(1),313–322.

WHO.Keycomponentsofawellfunctioninghealthsystem.May2010

WorldHealthOrganization(2007).Whatismentalhealth?RetrievedonSeptember12,2009fromhttp://www.who.int/features/qa/62/en/index.html

WorldHealthOrganization(WHO),(2003)InvestinginMentalHealth.RetrievedOct.31,2011:http://www.who.int/mental_health/en/investing_in_mnh_final.pdf


Consultations

thE adviSory committEE coNSultEd with ovEr 100individuals,groupsandorganizationsrepresentingmorethan1,200NovaScotians.

Inadditiontotheseconsultations,theAdvisoryCommitteereceivedwrittensubmissionsandhadinformationmeetingswithavarietyofstakeholders.Alloftheinformationprovidedthroughtheconsultations,writtensubmissionsandinformationmeetingswasconsideredbytheAdvisoryCommitteeinthedevelopmentoftheirrecommendations.

Thefollowingisalistoftheindividuals,groupsandorganizationsthatparticipatedintheformalconsultations.

• AlliedcommunitymemberswhoworkwithmembersoftheAfricanNovaScotiancommunity

• EastCoastForensicHospital

• AcadiaUniversity

• NovaScotiaLegalAid

• NovaScotiaDisabledPersonsCommission

• CanadianFederationofMentalHealthNurses

• QEIIEatingDisorderTeam

• HealthAssociationNovaScotia

• HalifaxChamberofCommerce

• NovaScotiaEarlyPsychosisProgram

• PictouCountyHealthAuthority

• GuysboroughAntigonishStraitHealthAuthority

• CumberlandHealthAuthority

• CapeBretonUniversity

• NovaScotiaSchoolBoardsAssociation

• ChiefsofPolice

• St.FrancisXavierUniversity

• ColchesterEastHantsHealthAuthority

• SpecialtyMentalHealthServices

• SchizophreniaSociety

• IWKHealthCentre

• HalifaxMilitaryFamilyResourceCenter

• SaintMary’sUniversity

• MountSaintVincentUniversity

• ChiefsofPsychiatryofthedistricthealthauthorities

• DHWDirectors,MentalHealthPlanningGroup

• AssociationofPsychologistsofNovaScotia

• DepartmentofCommunityServices


• TransgenderGroup

• ContemplativePracticesinMentalHealthCare

• PhysicalActivity,SportandRecreation

• NovaScotiaDepartmentofHealthandWellness

• SelfHelpConnection

• Direction180

• NovaScotiaResidentialAgencies

• AffirmativeIndustries

• CelticCommunityHomes

• AnnapolisValleyHealth

• MetroCommunityHousing

• FamilyandCaregiversGroup

• WorkersCompensationBoard

• GraduateClass,SchoolofSocialWork,DalhousieUniversity

• ProvincialSuicidePreventionStrategy

• PresidentandVPs,DalhousieUniversity

• SchoolofSocialWork,DalhousieUniversity

• NovaScotiaHealthBoards

• FirstVoice

• CapeBretonDistrictHealthAuthority

• SouthWestNovaDistrictHealthAuthority

• Alzheimer’sSociety

• SeniorsMentalHealthTeam,CDHA

• DirectorsofAddictionServices,DHW

• ServiceProviderConsult—Yarmouth

• ServiceProviderConsult—Dartmouth

• PublicConsult—Greenwood

• ConnectionsHalifax

• ServiceProvider—Truro

• SchoolofOccupationalTherapy,DalhousieUniversity

• PublicConsult—Amherst

• PublicConsult—Sydney

• ServiceProviderConsult—PortHawkesbury

• ServiceProviderConsult—Antigonish

• DigbyClareMentalHealthVolunteers

• KingsChapteroftheSchizophreniaSociety

• PublicConsult—Halifax

• DualDiagnosis,NSHospital

• IWKHealthCentre

• CommunityActionHomelessness

• PublicConsult—Bridgewater

• SouthShoreDistrictHealthAuthority


• EatingDisorderActionGroup

• ProvincialSeniorsMentalHealthGroup

• EngagementwithEskasoniFirstNationCommunity

• NovaScotiaAdvisoryCommissiononAIDS

• CentreforEmotionsandHealth,Dr.A.Abbass

• MentalHealthLeadershipCouncil

• SaintLeonard’sSocietyofNovaScotia

• ImmigrantSettlement&IntegrationServices

• AlliedHealthcareGroup

• PublicHealthComponents,DHW

• CaregiversNovaScotiaAssociation,CCANSandstafffromvarioushomecareandnursinghomefacilities

• PublicFrenchLanguageConsultation

• CanadianMentalHealthAssociation,NovaScotiaDivisionBoardofDirectorsandstaff

• MentalHealthConsumers

• SuicideStrategySteeringCommittee

• EatingDisorderFocusGroup

• MentalHealthDayTreatmentProgram

• WagmatcookFirstNationCommunity

• PeerSupport

• FrontlineShelterStaff

• LBGTIGroup

• FollowUpConsultationwithAnnapolisValleyDHA

• ChildhoodObesityPreventionStrategy

• AcadianCommunity

• Concurrentdisorderssubjectmatterexperts

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