7.4 Access points

Finding a program that is a good fit for your relative can be a challenge for several reasons:

• Many communities have no specialized, integrated concurrent disorders services to assess and treat complex cases.
• In some communities, the waiting lists for specialized services are too long.
• Substance use and mental health programs and services may have admission criteria that exclude clients with concurrent disorders.
• Finding psychiatrists or clinical psychologists who can provide psychiatric diagnoses can be a challenge in many communities.
• Treatment resources may be lacking, even though you, your relative or your doctor understand what would be most helpful.

But you have to start somewhere, so we begin by talking about the most common entry points into the system.

Family doctors and psychiatrists

Family doctors, or general practitioners (GPs), are often the first professionals that people talk to about a mental health problem. Doctors can examine your relative's physical health and rule out problems that could be adding to or affecting changes in his or her mood, thinking or behaviour. Sometimes doctors can do a full psychiatric assessment, particularly for the more common conditions, such as depression or anxiety. Sometimes, doctors will suggest that a person see a psychiatrist.

Psychiatrists almost always need a referral from a doctor before they can see a client. Family doctors often have a list of psychiatrists they can refer a person to. After booking an appointment, a person often has to wait at least two to three months to see a psychiatrist. If you and/or your relative don't agree with the diagnosis, your relative should ask the family doctor for a referral to another psychiatrist for a second opinion. Most doctors are open to clients seeking another perspective and may even suggest it.

Community mental health agencies

Community agencies can also offer assessments. The type of assessment will depend on the health care provider available. Sometimes this may be a doctor, psychologist, social worker or nurse. In smaller cities and rural areas, you are more likely to be seen by a community mental health worker. This person will try to match your needs with the services available.

Substance use agencies

Most substance use agencies accept self-referrals. After an initial assessment, the person will be referred to the level of care (e.g., community-based treatment, residential treatment, withdrawal management) that meets his or her needs at that time. Screening for mental health problems should be part of the assessment process, and referral to a mental health treatment program or a specialized concurrent disorders program is a possibility.

Hospital emergency departments

In a crisis, you and your relative can go to the emergency department of a hospital. If the situation does not require immediate medical care, the next step may be a more in-depth assessment from a crisis worker. This person is often a nurse or social worker. (For more information about emergency treatment, see Chapter 10.)

Access Points is adapted from Challenges & Choices: Finding Mental Health Services in Ontario.

ConnexOntario

ConnexOntario is a bilingual information and referral service in Ontario for the public and professionals wanting to access addiction and mental health treatment for themselves, family, friends or clients. Information and referral specialists offer education and guidance based on each caller's situation.

Toll-free telephone numbers:

• Drug and Alcohol Registry of Treatment: 1 800 565-8603
• Mental Health Service Information: 1 866 531-2600
• Ontario Problem Gambling Helpline: 1 888 230-3505

These information lines are available 24 hours a day, seven days a week. You can find more information about ConnexOntario by clicking here.

Questions to ask a treatment agency

• What is your treatment philosophy and method?
• Do you refer clients to other agencies for some substance use and/or mental health services? If so, who is responsible for overall co-ordination of services?
• What percentage of your clients has co-occurring substance use and mental health problems?
• What is your policy about using medication as a treatment option?
• Does the program support a full range of needs (e.g., social and medical)?
• What role do family members play in their relatives' treatment?
• Do you offer services and referrals for family members?

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