Integrating the social determinants of health into care, research and education

CAMH Annual Report to the Community 2006 - 2007

On this page:

Integrating housing issues
The connection between housing and healing
Connecting diversity and dignity
Integrating employment and recovery
Connecting clients to employment
Construction works

75%
Percentage of women living on the street who have a mental illness

Every CAMH client is involved in developing an individual plan of care, with goals related to work, housing, income and relationships. These factors are known as the social determinants of health, and they are as central as goals directly related to clients’ mental health or addiction issues. Through the work of our Community Support and Research Unit (CSRU), CAMH promotes a holistic, rather than a medical, view of health to address these broad client needs. Encouraging family involvement, respecting diversity and building clients’ strengths are all part of our focus on recovery, health and well-being.

MHAP's triggered by CAMH clients at admission in 2006 - 07

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MHAP's triggered by CAMH clients at discharge in 2006 - 07

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CAMH led other hospitals in using the Resident Assessment Instrument for Mental Health (RAI-MH), a tool for tracking a wide array of risks and symptoms, which keeps client-centred values at the heart of care. These graphs show how the RAI-MH integrates multidimensional information such as employment, income, relationships, and physical and mental health for CAMH clients admitted during the 2006–2007 fiscal year, and how we track those items for clients discharged at the end of the same period.

Integrating housing issues

“No person, regardless of their circumstances, should be without a decent place to live. We must make it simpler to both find and keep a home in our city,” said Toronto Mayor David Miller as he opened CAMH’s housing forum, titled Navigating the Housing Maze.

The one-day forum focused on clients’ experiences, strategies to find and keep housing, the needs of culturally diverse populations, and harm reduction approaches in housing. Nearly 30 housing providers discussed their services with more than 250 clients, family members, CAMH staff and community members. As a result, some clients received the support they needed to move into permanent housing.

Housing continues to be a key challenge for people who have both a developmental disability and mental health needs. Now family members, professionals, advocates and service providers have CAMH’s Building the Path to Home: Links to Sustainable Housing for Individuals with Dual Diagnosis as a guide to access resources and navigate the system, and to identify people living in marginalized and under-supported circumstances.

The connection between housing and healing

Globe and Mail photo by Tibor Kolley

Dr. Jorge Soni (above) takes time to gain the trust of a homeless man in Toronto. CAMH is part of a new Multidisciplinary Outreach Team (M-DOT) that does street assessments of homeless people’s needs to help connect them to the right mental health and addiction services.

“CAMH’s housing forum was invaluable in connecting members of the mental health community with agencies and public officials. It has kept the issues related to affordable housing on the public agenda.”

Sean Goetz-Gadon, City of Toronto Affordable Housing Office

140,000
Canadians with mental health issues who have temporary or unstable housing

Connecting diversity and dignity

CAMH worked this year to integrate the principles of diversity into every element of its mission, and to provide collaborative, culturally appropriate mental health and addiction services:

Ursula Lipski of the Family Mental Health Alliance presented the Hon. James K. Bartleman, Lieutenant Governor of Ontario, with Caring Together: Families as Partners in the Mental Health and Addiction System, a policy position paper, as he officially opened Family Week at CAMH. This was the second year of the annual event, which focuses on the critical role families play as partners in mental health and addiction care.

We expanded the popular Spanish-language addiction program; worked in partnership with dozens of ethno-specific agencies and racialized and Aboriginal communities; and hired an ethnocultural problem gambling specialist responsible for outreach, education and prevention work in diverse communities.

CAMH worked with the Supportive Housing and Diversity Group (SHAD) in a one-year study, the Best Practices in Developing Culturally Competent Housing Models Project. The results will be part of a resource manual for service and housing providers.
CAMH’s Deputy Chief of Nursing Practice, Rani Srivastava, published The Healthcare Professional’s Guide to Clinical Cultural Competence.
We provided diversity and cultural competence training to a number of new Local Health Integration Networks, hospitals and businesses, health providers and community organizations, and all new CAMH employees.
CAMH helped develop Culture Counts, an online health promotion resource, to help service providers better serve diverse communities and use best practices and culturally sensitive approaches in community education.

Integrating employment and recovery

A client of CAMH’s Gender Identity Clinic, Rachel Paige Price knows first-hand how work aids recovery. Born biologically male and struggling with feelings of confusion over gender since childhood, Paige was formally diagnosed with gender identity disorder in 2003. Over the next two years, the impact of 9/11 and the sars epidemic on the airline industry challenged Paige’s long career in airport and airspace operations analysis, leaving her grappling with employment difficulties as well as the expected challenges of her gender transition process.

Vincent Welcome and other clients in CAMH’s Integrated Rehabilitation Unit were given disposable cameras to photograph themes related to work. A show of their work, titled The Working Life, was displayed at Propeller Gallery on Queen Street West.

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Diana Capponi, CAMH’s Employment Works! Co-ordinator, with Rachel Paige Price, a former client of the program, in CAMH’s Information Technology Department.

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During her transition Paige remained uneasy about interacting in a formal workplace environment. With the help of CAMH clinical staff at the Gender Identity Clinic and Diana Capponi of our Employment Works! program, she was hired to work with CAMH’s information technology team in developing our internal website.

“Working at CAMH was an invaluable learning experience,” Paige says. “It helped me gain confidence in adapting to working in a formal environment, and to feel more comfortable with my new self in all situations.” With this new confidence and self-acceptance, Paige was soon consulting with staff in CAMH’s various programs in developing the website.

After a successful six months (both personally and professionally), Paige felt ready to compete again for consulting work in her area of expertise. She soon found work with the company she had worked for before her transition, and with their support has had a successful career since.

“There is a lot of stigma, and people in the trans community are not always accepted on their merits,” says Paige. “Being able to work has really helped me to adjust, and the support I have received from my family, friends and colleagues has helped me be who I really am."

#1
Ranking of depression among causes of workplace absenteeism (replacing cardiovascular disease)

85% and 65-85%
Percentage of people with histories of serious mental illness and addiction, respectively, who are without work

Connecting clients to employment

Anthony Silvester Murdoch (above) and Clarington Miller (below) perfect their technique in Construction Craft Worker Extended Training, a partnership between CAMH’s Employment Works! program and George Brown College in Toronto.

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“We should all be champions of the importance of work. It reinforces who we are and what we do—it’s a powerful determinant of how we value ourselves.” Dr. David Goldbloom, Senior Medical Advisor.

“If we want other employers to offer jobs to people with mental illness and addiction, we need to lead by example,” says Dr. John Trainor, director of CAMH’s Community Support and Research Unit (CSRU).

The Employment Works! initiative provides mandatory training for CAMH managers to raise their awareness about what is required to recruit and retain employees with histories of mental health or addiction problems.

“This is an important first step in creating a supportive work environment, but we must do more,” says Diana Capponi, leader of the initiative. “Today mental health issues are the leading cause of absenteeism in Canadian workplaces. Employers need to develop accommodation policies and workplace supports.”

“The Unusual Suspects,” an informal CAMH employee support group of staff with disclosed and undisclosed mental health and addiction histories, meets regularly to provide peer support.

This year, CAMH proudly posted our first job advertisement that listed “experience of mental health or addiction challenges” as a desired qualification.

Construction works

"We should all be champions of the importance of work. It reinforces who we are and what we do - it's a powerful determinant of how we value ourselves."

-- Dr. David Goldbloom, Senior Medical Advisor

CAMH’s Queen Street site redevelopment will generate many construction jobs, and we are making sure our clients benefit.

CAMH has developed a new course, in partnership with George Brown College, to give training in construction to 25 people with mental health and addiction histories. The program—called Construction Craft Worker Extended Training—offers communication courses, job-readiness training and ongoing support, as well as the college’s basic construction curriculum. Participants are guaranteed paid employment when they graduate.

Recently, CAMH posted a job advertisement for full-time pre-apprentices to work with the brick and masonry contractor repairing the Queen Street site’s historic wall. This partnership—developed with the Brick and Allied Craft Union of Canada, Local 2, and the Labourers’ International Union of North America, Local 506—is a first for CAMH and provides a model for creating more jobs for clients.

Making Connections: Integration in Mental Health and Addiction