Building the Path to Home

Connecting with services

Good individual support planning is done in a few places in the mental health and developmental services system. Finding all the right services and supports is a challenge, even more so when you are looking for services for a person who has a dual diagnosis. Expect significant waiting lists. Planning takes skill, knowledge and the willingness to get people around the table to see what they can offer. Be persistent and push for short-term supports while you wait for what you need.

Access points

An access point is a door to get you into a service and support system. In this section, we will talk about the developmental services and mental health sectors, but there are other access points.

211Toronto has a comprehensive database of information about social services. It doesn't use "developmental disability" or "dual diagnosis" as search terms, so you will need to try different key words to find the information you need.

The developmental services sector uses a co-ordinated access model. If you call one agency, you can connect with any service that the sector offers.

The mental health sector doesn't have a single entry point. However, information about mental health services and supports is available from Mental Health Service Information Ontario (part of ConnexOntario). Call 1 866 531-2600 to talk to an information and referral specialist.

Toronto Network For Specialized Care

In 2006 and important new cross-sectoral initiative was funded by the Ministry of Community and Social Services with participation from the Ministry of Health and Long-term Care. The Toronto Network for Specialized Care is intended to ease access to specialized services for individuals with developmental disabilites and mental health issues and / or challengeing needs.

The Developmental services sector

In Toronto, services for adults with developmental disabilities, are provided by a number of organizations. The services are funded by the Ministry of Community and Social Services. MCSS services include:

• crisis response
• short-term respite, emergency placements
• after-school programs and recreational activities
• help with planning or applying for services
• advocacy services
• in-home supports and family-related expertise
• individualized planning and support
• specialized supports including assessment and therapeutic services
• (e.g., hearing tests, psychological assessments, counselling)
• interpretive services
• day programs
• supported work environments and job training
• supported residential placements.

How do I request services?

A single call to one of the agency contact numbers is all you need to access the entire network of developmental services sector agencies in Toronto.

How long will it take for someone to call me back?

All Toronto organizations have agreed to return calls within two to three working days. If your need is more immediate, let the person you've contacted know.

What if I don't hear back?

Call the same person back, as he or she may not have been able to contact you.

What if I need service from more than one organization?

It is very common to receive services from a variety of agencies.

Linking you to an organization is meant to make life simpler for you.It does not limit your ability to choose or receive services from more than one agency.

How often do residential spaces open up?

In August 2006, the Developmental Services Centralized List had 2,669 people waiting for housing and/or day supports in Toronto. 505 of these people had a dual diagnosis. In a recent 18-month period, 41 spaces in existing residential programs became available. The Ministry of Community and Social Services has also provided about 140 new spaces.

What happens when a space becomes available?

If you are on the list for this type of service and an appropriate space becomes available, the organization you are connected with will put your name forward. If a match is made, you will be invited to attend a meeting to discuss the placement.

What do I do while I wait for a space?

If you contact a developmental services organization while you are waiting, explain your situation and what kinds of supports you need. There may be things that can be put in place to make the wait a little easier. Be involved in planning for the future. If the situation changes, call the agency you are connected with and let agency staff know. If you need immediate assistance, they may be able to help.

Policy guidelines

Making Services Work for People is the Ontario policy guideline that outlines the framework for supports and services in the developmental services sector.

Note: The Ministry of Community and Social Services (MCSS) is reorganizing the way developmental services are delivered in Ontario. See the MCSS website for more information. In May 2006, the MCSS released Opportunities and Action: Transforming Suppports in Ontario for People Who Have a Developmental Disability.
For more information about policy, contact:

Ministry of Community and Social Services
Developmental Services
477 Mount Pleasant Ave.
Toronto
416 327-4054.

The Mental health sector

There are many entry points to the mental health system:
family doctors (refer patients to traditional medical and psychiatric services, but less often to community support services)

• hospitals
• crisis response units
• community mental health agencies.

Typical mental health access points include:

• first assessment: family doctor, community health clinic
• re-assessment: hospital (inpatient or outpatient mental health services)
• crisis assessment: regional crisis response team, hospital emergency room.

Policy Guidelines

Making It Happen is the Ontario policy guideline that outlines the supports and services for people with mental health problems.
For more information about mental health policy, contact:

Ministry of Health and Long-term Care
55 St. Clair Ave. East
Toronto
INFOline: 1 800 268-1154 or 416 327-7593 (in Toronto).

Note: In 2004, the Ministry of Health and Long-Term Care (MOHLTC) announced a reorganization of the way health care services are delivered in Ontario. See the MOHLTC website for information about this initiative.

Dual Diagnosis

There are few services with the knowledge and expertise to span the two sectors. Key contacts are:

• Griffin Community Support Network
• Dual Diagnosis Resource Service (CAMH)
• Surrey Place Centre.

For more information about dual diagnosis services, see:

• Supports & Services Resource Handbook.

For information about developmental services sector providers, see:

• Child Development Resource Connection Peel.

Mental health service providers can be found through:

• 211Toronto
• Community Resource Connections of Toronto
• ConnexOntario.

Policy guidelines

The Policy Guideline for the Provision of Services for Persons with a Dual Diagnosis (1997) states that both the developmental sector and the mental health sector have a responsibility to serve and support people with a dual diagnosis.

Developmental sector agencies may require an assessment of functioning. Some mental health agencies will argue that the person needs to have a DSM-based diagnosis of an Axis I disorder (all mental health disorders--e.g., schizophrenia, bipolar disorder, substance dependence disorder--except personality disorders and developmental disorders).

But the policy mentioned above clearly defines dual diagnosis as a developmental disability and mental health needs. The policy is written this way because getting a clear mental health diagnosis for a person with a developmental disability may not be possible, or it may take a long time and many different kinds of assessments. Both the Ministry of Health and Long-Term Care and the Ministry of Community and Social Services have acknowledged this fact and do not want the absence of a clear diagnosis to be a barrier to mental health service. So, the important thing to establish is if the person is experiencing a significant change or deterioration in his or her functioning.

Questions to ask an organization

When you decide to contact a service organization of any kind, make sure that you are within its catchment area and that you speak with someone who is well informed about the full range of services the organization offers (e.g., an intake worker).

You can certainly tell the staff person about the person's needs, but don't forget the person's strengths and interests. Remember to record the names and phone numbers of the staff members whom you speak to, the dates and the responses. If you aren't getting informed responses, you can always ask to speak with a manager.

The next few pages suggest questions to help you identify what the agency can provide. (The notes in parentheses will help you interpret what you hear.)

• What is your experience with people who have a dual diagnosis? What have been some of your successes and challenges? (The organization is required to work with people who have a dual diagnosis; but you want to know that it has the capacity and interest.)
• How do you define dual diagnosis? (Compare this with what you know and what you read in this guide.)
• When was the last time you accepted someone with a dual diagnosis into your program? 

If it's a mental health agency:

• Are there other people in your program with a developmental disability? How long have they been there? What services do you offer them? If they can't manage the demands of the program, what do you do? How do you adjust your services to meet their needs? How do you communicate with them?

If it's a developmental services agency:

• Are there people in your program with significant mental health problems? How long have they been there? How comfortable are your staff in responding to them? (Give an example of an individual similar to the person you are working with--e.g., hears voices that aren't really there.)

*Adapted with permission from Concerned Parents of Toronto, Inc. (2002). Supports & Services Resources Handbook. Toronto: Author.

• How do you manage many different types of behaviour, including disruptive behaviour? (You need to know how tolerant the environment is so that you can match the person's needs to the environment.)
• Can your program be tailored to the individual? How do you do that? Give an example of someone who has an individualized program within your agency. (You need to know that the agency is prepared to take an individual approach, rather than assuming that all participants will follow exactly the same routine.)
• How do you decide if more specialized input is needed? (You want the agency to be open to collaboration and to know when to ask for help.)
• Do you have consultants for your program? (You need to know that if there is a knowledge/expertise gap, the organization will call on someone who knows what to do.)
• Are you a member of the Griffin Community Support Network? What role do you play? (If the organization is a member, it will likely have more understanding and knowledge about people who have a dual diagnosis, and will be able to call on the network if it needs help.)
• Do you ever ask for mental health consultations from the Centre for Addiction and Mental Health or Surrey Place Centre? If not, would you be open to a consultation from a specialized service that knows this person well?
• What specific training do your staff have to work with people with a dual diagnosis? Do they have any other special training qualifications?
• Do you include families and other supporters in planning services for the person? (You want to be able to stay involved to make sure needed supports are in place.)
• Have you implemented the abuse policy? (This is a multi- agency training response to minimize potential for abuse. It's an important initiative for agencies to be aware of and put in place.)
• What age are most of the people in the program? Do people spend most of their time there, or do you arrange for them to take part in activities outside the program?

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