Executive Summary

In its 2013 investment strategy, United Way of Peel Region identified mental health as a priority. As part of the “Healthy people, strong communities” focus area, United Way aims to support people with challenges related to mental health and to combat stigma by increasing public awareness of mental health and mental illness. United Way is also committed to addressing the unique needs of Peel Region’s diverse ethnocultural communities.

United Way commissioned a community research project that would create an improved understanding of the mental health and addictions system in the region which includes the municipalities of Mississauga, Brampton and Caledon. This report provides the findings of the research and associated recommendations for system improvement.

In this report, Mapping the Mental Health System in Peel Region: Challenges and Opportunites, we describe the main features of Peel’s mental health system and how they interrelate, with a focus on how people access and navigate services and supports. We were specifically concerned with identifying common challenges and gaps in the local system, as well as promising practices and opportunities for system improvement. Of equal concern was the examination of how different ethnocultural communities specifically, Chinese, Black and South Asian communities, in Peel access mental health services and the unique challenges they may face in navigating the system.

This work occurs within a broader context of federal and provincial social policies that seek to improve service coordination, flexibility, and responsiveness, within a holistic person-centred system. The purpose of this report is to share our findings with local stakeholders about the mental health system in Peel and to invite discussion and action on ways in which it can be improved. We provide a wide range of recommendations and next steps on how to move forward.

We encourage interested stakeholders across the region to share this document and with your networks and reflect on how our project findings fit your own practices, context, and experiences. For additional information on this project, please contact Anita Stellinga at This email address is being protected from spambots. You need JavaScript enabled to view it..

This report was made possible with funds from United Way of Peel Region and the Ministry of Citizenship and Immigration / Ministry of Tourism, Culture and Sport.

Project Design and Scope

An advisory committee comprised of local organizations, funders and community stakeholders directed the project, with United Way taking a leadership role. It was clarified early in the project that we did not want to merely provide an inventory of mainstream mental health services.  There was an expressed interest to broaden the scope of the project to include a range of social and health services, beyond mental health-specific organizations.  
We conducted interviews and focus groups with service providers, government representatives, funders, and other community members.  We reached over 80 individual participants representing 40 organizations operating in many sectors, including health, mental health, addictions housing, shelters, dual diagnosis, education, youth transitions, family and neighbourhood services, newcomer settlement, and other community services.  
Our methods and analysis were organized around the development of what we call “system maps”.  System maps display the common (or intended) flow of service users, beginning with first contact and access to services and supports, followed by any additional short- or longer-term supports that may subsequently follow.  The goal is to illustrate the key “junction points” that people must go through in order to receive help. This provides a visual representation of different areas of the system in order to highlight common practices: where the system is working well, and where it is breaking down.  System maps are a first important step in identifying system gaps and barriers, and opportunities for improved integration, coordination, and access.   Five different maps were created to capture a wide spectrum of services and supports within the overall system:
  • Map A - Mobile Crisis Intervention
  • Map B - Hospital Emergency, In-Patient and Out-Patient services
  • Map C - Outreach and Emergency Shelter Services
  • Map D - Case Management Services
  • Map E – Family, Neighbourhood and Ethnocultural Services
The maps do not represent generic descriptions of any given modern mental health system in a general sense; they are meant to represent what is happening in Peel Region specifically.  They also do not represent the detailed practices of specific organizations, or relationships between specific organizations.  The maps fall somewhere between, capturing common “service types” that have been summarized by talking to many different people working in the system.  This means that system barriers (and successes) should not be generalized to single organizations.  Furthermore, many of the project participants provided examples to illuminate system barriers and successes.  The reader is cautioned that examples may not represent a consistent or recurring problem.  With these caveats in mind, the information we received from project stakeholders pointed to common practices and related barriers within a number of broad types of service areas.
This project was undertaken with the recognition that other similar and important projects are happening in the region.  This project focused on adult mental health services and therefore does not speak directly to child and youth mental health issues or specific issues regarding geriatric mental health.  
The project is otherwise unique in that the scope was quite broad and not limited to “mainstream” mental health services.  We attempted to capture many different parts of the mental health system, including a range of social and health services areas.  There was also a focus on understanding the unique service barriers experienced by people from different ethnocultural backgrounds in Peel.

Project Findings and Their Use

Project findings and recommendations are organized according to each of the maps.  Each section provides an overview of the service/system area in question followed by a  description of the common challenges and gaps in the system.  Each listed barrier is numbered and each number also appears on the map itself to illustrate where in the system the challenge/gap is occurring.  This approach is useful because it points to particular transition points in the system where navigation and access may be breaking down.  Often we see that challenges occur in these transitions because service users are moving between organizations; when service coordination and integration falters, problems tend to occur.
Following the discussion of common barriers for each map, we provide a set of recommendations and strategies to improve the system.  Depending on the barriers being addressed, the recommendations range from very specific programmatic changes to the creation of much broader initiatives.  All the recommendations are compiled and listed in Appendix A of the full report for convenient reference and we encourage you to examine the findings of each system area in more detail in the body of the document.

A Quick Overview of the Findings

The following are some high-level summary points of the main project findings.

SYSTEM CHALLENGES:

  • There are long wait lists and significant wait times to access a wide range of mental health services. 
  • In many places of the system, there is a lack of coordinated referral.  Referrals may be made but there is often insufficient follow up to ensure further connections to services are made.  For example, coordinated linkages between hospital emergency discharge and community supports are often lacking.
  • Formal mental health services are often not the first contact point for individuals who need help.  General physicians, walk-in clinics, family and neighbourhood services, settlement organizations, faith groups and other social service contexts are where people are first identified as needing supports.  In general, these points of contact lack the resources and formal connections to provide support and/or refer to other services.
  • The dominant attitudes of many cultures tend to stigmatize mental illness, and in many cases the concept itself does not translate well into many cultural experiences.  Shame and embarrassment prevent many families from identifying mental health concerns and obtaining support.
  • There are a number of barriers to coordinating mental health and addictions supports for individuals who are homeless and who frequent emergency shelters. The complexity and transient nature of the people being served is exacerbated by a number of confusing overlaps of different workers/sectors in the system.
  • Across the system there are a range of different eligibility requirements, exclusionary criteria, and narrow intake processes that govern services.  This makes system navigation frustrating for citizens and makes service access particularly challenging for people of different ethnocultural backgrounds.
  • There is a significant need for more preventative, group based mental health education and awareness opportunities for individuals who need some support but do not require long-term, formalized services (e.g., intensive case management).
  • In Caledon, there is a general lack of mental health and addictions services and opportunities for peer support and community connections around mental health issues.  As with most rural areas, lack of transportation is a significant barrier.

RECOMMENDATIONS TO IMPROVE THE SYSTEM:

  • Focus on the referral connections between major parts of the system to ensure a more coordinated set of services.  For example, discharge planning upon discharge from hospital emergency is a key area to ensure that individuals become connected to a primary worker and/or support organization.
  • Improve collaborative practices  and integration between shelter, outreach, and transitional workers to ensure optimal information sharing and continuity of care for the most vulnerable.  This should include greater access to primary care and flexible coordinated services to meet multiple complex needs associated with mental illness, addictions, physical health, income, employment, housing,  etc.  Establish a “wet” shelter for people addicted to alcohol.
  • Provide greater support and communication with general physicians so that they can better support their patients.  This includes more timely communication with hospitals (i.e., when a patient is admitted/discharged) and ongoing education and support regarding local service options.
  • Deliver supports and services where people naturally congregate and improve access by ensuring cultural and linguistic competence.
  • Expand the reach, capacity, and hours of Mobile Crisis/COAST to reduce the number of mental health calls fielded by Police Services.
  • Build the capacity of family, neighbourhood and ethnocultural service organizations to meet the mental health needs of the people they serve, through improved funding and creative collaborations with mental health organizations.  Explore community development strategies that help different ethnocultural communities play a central role in developing and delivering local mental health promotion strategies.  Build opportunities for more education groups and peer support through multi-agency partnerships to reduce stigma.
These are just a few of the major recommendations.  There are many more in the report that specifically address certain challenges in each system area.  Please see the individual sections for a full list and additional detail. 

The Work Continues

It is our hope that Mapping the Mental Health System in Peel Region: Challenges and Opportunites, will become a starting point for discussions among local stakeholders regarding ways to improve the mental health system in Peel.  United Way will continue to play a leadership role in pursuing certain recommendations and a convening role in other areas, so that the full set of recommendations is considered in the Region.  The project committee is currently reviewing the recommendations in order to create a strategy for region-wide dialogue.

Acknowledgements

Mapping the Mental Health System in Peel Region: Challenges and Opportunities was prepared by Dr. Jason Newberry of Taylor Newberry Consulting. A Mental Health Advisory Committee was struck to support this project. United Way of Peel Region would like to thank the members of the Advisory Committee for their guidance, knowledge and contribution to this project:

  • Aamna Ashraf, Director, Peel Newcomer Strategy Group
  • Ed Castro, Mental Health and Addictions Lead, Mississauga Halton Local Health Integration Network
  • Jen Davis, Manager, Stakeholder Engagement, United Way of Peel Region
  • Andrew Defor, Advisor, Health Policy Diplomacy, Department of Foreign Policy and Global Health, World Health Organization
  • Sharon Douglas, Director, Community Investment, United Way of Peel Region
  • Dr. Ilmana Fasih, Community Outreach Coordinator, South Asian Advisory Council, United Way of Peel Region
  • Lorraine Hogan, Regional Advisor Halton-Peel, Ministry of Citizenship and Immigration
  • Ministry of Tourism, Culture and Sport
  • Ava Joshi, Manager, Community Initiatives, United Way of Peel Region
  • Suelyn Knight, Community Outreach Coordinator, Black Advisory Council, United Way of Peel Region
  • Judy Labelle, Manager, Community Health Initiatives Strategic Policy, Planning and Initiatives Division, Health Services, Region of Peel
  • Jason Linton, Peel Region Director, Catholic Crosscultural Services
  • Heather McGillis, Program Director Mental Health (Interim), Trillium Health Partners
  • Sandy Milakovic, Chief Executive Officer, Canadian Mental Health Association, Peel Branch
  • Jenny Qin, Manager, Community Engagement, United Way of Peel Region
  • Suzanne Robinson, Director, Health System Integration, Central West Local Health Integration Network
  • Dr. Colin Saldanha, Physician, Saldanha Health Centre
  • Anita Stellinga, Vice President, Community Investment, United Way of Peel Region
  • Shelley White, President & CEO, United Way of Peel Region

The Advisory Committee would like to thank all those who took the time to participate in the interviews, focus groups and workshops.

This report was made possible with funds from United Way of Peel Region and the Ministry of Citizenship and Immigration / Ministry of Tourism, Culture and Sport.