Mental Health & Addictions

Mental Health & Addictions

Meeting the Needs of People with Complex Mental Health Challenges: Service Resolution

Mental Health & Addictions, Program & Systems Design

TNC_Website_programBuilding a Service Resolution Function in Toronto

In Ontario, there has been a growing focus on building health and social service systems that are capable of meeting needs of individuals with particularly complex needs. Recent estimates suggest that about 5% of the population accounts for 61% of hospital and home care costs in Ontario[i]. Among this 5% are individuals suffering from acute and chronic mental health struggles combined with other deleterious conditions and experiences. The “right mix of supports” for this subgroup is often hard to discern and, even more concerning, the health and social service systems do not have the capacity to fully meet the need. The outcomes are sobering – people with complex needs often experience housing instability and homelessness, income insecurity, and elevated risk of harm to self or others. They tend to be high users of emergency and hospital in-patient and Alternative Level of Care (ALC) services[ii]. They are more likely to experience criminal charges, the court system, and incarceration. These outcomes represent high costs for health care and justice systems; the human cost is much higher.

As part of a provincial response to these issues, Human Service and Justice Coordinating Committees (HSJCC) have been established in communities across Ontario to directly address the need to enhance the coordination of services to meet the needs of people with mental health and addictions struggles who are in conflict with the law. In the City of Toronto, the local committee (T-HSJCC) recognized an acute need to examine service coordination for individuals with more complex needs. To support this mandate the T-HSJCC Complex Care Sub-Committee was established in collaboration with the Toronto Acquired Brain Injury (ABI) Network. The Sub-Committee’s focus is on individuals 16 years or age or older with cognitive and/or physical disabilities and mental health needs who the service system has not been able to adequately support.

These are people who continue to come up against barriers or slip through the cracks in the service system and have not been able to get the support they need. In some cases, the types of services or programs that could help them are not available to them (e.g., the person in need does not meet the standard eligibility criteria for that particular service), or simply do not exist in their community.

These individuals often experience co-occurring needs across multiple sectors including mental health, substance use and addictions, acquired brain Injury, dual diagnosis, developmental disabilities, housing, and criminal justice.

In 2014, the Sub-Committee began investigating the creation of a service resolution process to help meet the needs of their priority population in Toronto.

Taylor Newberry Consulting was contracted to conduct a needs assessment to inform recommendations on the scope, structure, and implementation of a service resolution mechanism in Toronto.

Click here to find copies of our Executive Summary and our Full Report, outlining the findings of our research and our recommendations.

What is service resolution?

Service resolution is an approach to creative problem solving and customized access pathway into service for people with highly complex needs.

It has been adopted in a number of social service sectors including developmental services, child welfare, supportive housing, and more recently in mental health and addictions sectors.

It should be emphasized that service resolution is not intended for the general population of people with mental health and addictions needs. It targets a smaller number of individuals with highly complex and exceptional needs that cannot otherwise be met by the existing service system.

While models can be structured in a variety of ways, the common feature is that a service resolution committee (often called a “table”) is composed of high level managers representing a cross-section of organizations from multiple health social service sectors: mental health, addictions, justice, developmental services, ABI, child and family services, and range of others.

The function of the table is to engage in creative and collaborative problem solving centering on individuals who have continually experienced challenges in accessing services and getting their needs met. Service resolution is efficacious because the members around the table are decision-makers. They have the power, leverage, and organizational endorsement to enact a range of customized decisions to meet the needs of the person in question. In turn, front-line providers are given direction and license to proceed with a support plan that they would not otherwise have the authority to carry out. Solutions are most often collaborative and cross-organizational and the table sets expectations on how their corresponding organizations will be expected to participate.

Exciting updates since the release of our report!

  • Since the release of our report, the Complex Care Sub-Committee of the T-HSJCC has created a Working Group and secured initial resources to plan implementation of our recommendations.

For continuing updates about implementation of these recommendations, follow the work of the T-HSJCC at http://www.hsjcc.on.ca/Committees/Toronto%20Committee/SitePages/Default.aspx

Connect with the T-HSJCC Coordinator, Domenica Dileo at domenica.dileo@rogers.com

  • Jaime Brown presented this work at the Provincial Human Services and Justice Coordinating Committees Conference held in Toronto in November 2015. We experienced a great deal of interest in the work and a number of attendees noted that our slides were a useful tool for better understanding what Service Resolution is and how it differs from other models of collaborative problem-solving.

We have shared our slides from this presentation here, if you are interested in learning more.

Read our report and recommendations!

Click here to find copies of our Executive Summary and our Full Report, outlining the findings of our research and our recommendations.

 

For questions or further information about our report, please contact Jaime Brown at jaime@taylornewberry.ca.

 

References

[i] Rais, R. et al. (2013). High-cost users of Ontario’s Healthcare Services. Health Policy, 9, 1, 44-51.

[ii] Butterill, D. et al. (2009). From Hospital to Home: The Transitioning of Alternate Level of Care and Long-Stay Mental Health Clients. Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health. Report prepared for the Ministry of Health and Long-Term Care. Toronto, ON: CAMH.

 

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