More intensive and specialized support

Challenges & Choices: Finding mental health services in Ontario

On this page:

• Assertive community treatment (ACT) teams
• Intensive case management
• Specialized outpatient services in psychiatric facilities
• Forensic services
• Home care

There are various forms of specialized care for people with severe and continuing mental health problems who have many complex needs.

Assertive community treatment (ACT) teams

Assertive community treatment (ACT) teams may include a psychiatrist, psychologist, psychiatric nurse, social worker, peer support worker (someone with a similar problem or issue who offers support), caseworker, recreation therapist, addiction specialist, vocational (job) specialist and/or occupational therapist who help you with tasks for day-to-day living. Teams often have up to 10 members. Some of the team members are linked to a hospital. Others are based in the community and may work with a local hospital close to where the client lives.

ACT teams offer intensive case management and support for people with severe and continuing mental health problems (e.g., people who may have been hospitalized often, and who need help taking medication or following a prescription, finding a place to live or using work and other support services). ACT team members often meet with the client every day in the person's community (e.g., in the person's home or in a coffee shop). They provide services on a long-term basis to make sure people receive consistent care and strong, ongoing support from the same group of health care workers.

Most of the time, you can get ACT team services through a mental health agency. Like many other services, you may be more likely to find ACT teams in cities and larger communities.

Intensive case management

Intensive case management is similar to the support offered by ACT teams. The difference is that it tends to be provided by nurses or social workers working one-on-one with the person, rather than as part of a team. Case managers see their clients regularly to co-ordinate the person's care and services. They can provide more one-on-one support than outpatient services, for example.

Specialized outpatient services in psychiatric facilities

Specialized outpatient services include special intensive programs, rehabilitation for people with severe and chronic (long-term) problems, and community support through case managers. Specialized services may also include day programs. Clients may participate in educational groups or receive help with medication, which may be checked and given out as part of the day program.

Challenge: Many mental health workers do not have specialized training to respond to certain kinds of problems or needs. Some examples where special training may be helpful include treating people with more than one problem, such as:

• a mental health and an addiction problem or concurrent disorder
• a mental health problem and a developmental disability or dual diagnosis or
• a mental health problem and physical disability.

Health care workers may also need training to help people from different communities: for example, children or older adults; people from specific ethnoracial/ethnocultural groups; people who are lesbian, bisexual, gay, transgendered or transsexual; or people whose needs are not satisfied by existing programs (like someone who can't live completely independently but does not need to be in a group home).

Suggestions: Generally, you have two main options if you are looking for specialized services. You can go to hospitals and health care agencies or you can contact an organization that serves your particular community (e.g., an organization that focuses on helping immigrants and refugees or people with a dual diagnosis).

Specialized services are not very common, so you are more likely to get services from an agency serving the general population. Even if someone does not have specialized training, that person will often have experience working with people from diverse cultures and backgrounds. If you look for mental health services from this type of agency, you may want to ask if they offer the kind of clinic, program or expertise that meets your particular needs (e.g., a cultural interpreter, a concurrent disorder program for people with both a mental health and addiction problem, or a youth clinic for a teenager). If you contact a community organization, they may be able to offer informal counselling, or link or refer you to a mental health agency.

Forensic services

People with mental health problems who break the law (forensic clients) may be placed in forensic psychiatric facilities or community programs, with certain conditions.

People who have committed non-violent or low risk offences (e.g., mischief, minor theft) may be able to enter diversion programs. Diversion programs are set up by the courts as a way to redirect clients and connect them to mental health treatment services or supports. They prevent some people from going to jail and having a criminal record.

You can refer yourself to a diversion program or be referred by a family member, friend or defence lawyer (or duty counsel, if you don't have a lawyer). Court support workers are located in many courts to help you deal with the court system. They help make sure that your case goes through the courts and that alternative sentencing is considered. They can also help you get into supportive housing.

Forensic clients can also use assertive community treatment (ACT) programs, community supports and other mental health services in the community or receive specialized services in certain hospitals.

To find out more about diversion programs, contact a local community mental health agency, or call Legal Aid Ontario at (416) 979-1446 in Toronto or toll-free at 1-800-668-8258.

Home care

Case managers, community support workers, social workers, psychiatric nurses, occupational therapists and other health care workers can visit you at home to provide help with daily living (e.g., shopping for groceries, preparing a budget). They can help support your family and friends, while helping you make the best use of your own strengths. Assertive community treatment (ACT) team members may also conduct home visits. (See Assertive community treatment (ACT) teams)

Community Care Access Centres (CCACs)

Community care access centres are one type of community agency that provides home care. There are 43 CCACs across the province that offer health and personal support services, including home care for people who are less mobile. First, CCAC case managers assess the types of services and amount of help the client needs. Depending on the client's needs, they can provide nursing, social work, occupational therapy, physiotherapy, nutrition counselling, help with daily living (such as bathing and cleanliness or getting dressed) and other care.

Anyone can make a referral to CCAC services, including family members, friends, caregivers, health care professionals -- and clients themselves. However, CCAC services vary within communities across the province. Where CCAC services are limited or unavailable, you may have to find other forms of support.

To find the phone number of the CCAC nearest you, contact the Ministry of Health and Long-Term Care at (416) 314-5518 in Toronto or toll-free at 1-800-268-1154.

Challenge: For programs that don't offer in-home visits, transportation can be a problem. This is particularly true for people living in isolated areas, rural communities, small towns or on First Nations reserves; and for people with physical or developmental disabilities, people whose first language is not English and people with low incomes.

Suggestions: Sometimes in-home care is available. In a crisis, contact a 24-hour distress line. (These phone numbers are listed at the front of your phone book.) Or call the police at 911 if you fear danger to yourself or others.

If you are receiving ODSP (Ontario Disability Support Program) benefits, check to see if the benefits include transportation costs for medical appointments or job training. You can also look into Internet support groups.

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