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					A Summary of the Current State of Mental Health and Addictions
Services in Nova Scotia




    1   Mental Health and Addictions Strategy Project – June 24, 2011
Contents
Brief Introduction to this Document............................................................................................................. 4
Current State of Mental Health Services and Needs in Nova Scotia ............................................................ 5
   General Governance ................................................................................................................................. 5
   Provincial Mental Health Standards ......................................................................................................... 5
   Service Delivery ......................................................................................................................................... 7
   Mental Health Services Available by DHA/IWK ........................................................................................ 7
      Services common to all DHAs and IWK ................................................................................................. 9
      District 1- South Shore Health .............................................................................................................. 9
      District 2 – South West Health ............................................................................................................ 10
      District 3 – Annapolis Valley Health (AVH).......................................................................................... 11
      District 4 – Colchester East Hants Health Authority (CEHHA)............................................................. 13
      District 5 – Cumberland Health Authority .......................................................................................... 17
      District 6 – Pictou County Health Authority........................................................................................ 19
      District 7 – Guysborough Antigonish Strait Health Authority (GASHA) ............................................. 21
      District 8 – Cape Breton Health Authority .......................................................................................... 23
      District 9 – Capital District Health Authority (CDHA) .......................................................................... 25
      IWK Health Centre .............................................................................................................................. 33
   Issues and Challenges Impacting Mental Health Services ...................................................................... 40
      Issues at the regional level (Atlantic Provinces) ................................................................................. 40
      Issues at the Provincial level ............................................................................................................... 42
   Identified Challenges for Addressing Mental Health Issues ................................................................... 42
      Underserved and hard to reach mental health clients ....................................................................... 44
Current State of Addiction Services and Needs in Nova Scotia .................................................................. 45
   General Governance ............................................................................................................................... 45
   Demographics and Prevalence of Substance Use ................................................................................... 47
   Demographics and Prevalence of Gambling ........................................................................................... 51
   Addictions Services Available.................................................................................................................. 53
   Issues and Challenges Impacting Addictions Services ............................................................................ 53
      Underserved and hard to reach addictions clients ............................................................................. 53
Additional Mental Health and Addiction Services ...................................................................................... 55
   Programs and Services of the Department of Community Services ....................................................... 55

         2      Mental Health and Addictions Strategy Project – June 24, 2011
       Challenges and issues identified by DCS ............................................................................................. 57
   Programs and Services of the Department of Education ....................................................................... 58
   Programs and Services of the Department of Justice ............................................................................. 59
   Mental Health and Addictions Programs and Services for Aboriginal Populations................................ 61
Current Initiatives ....................................................................................................................................... 65
   Community Programs and NGOs Providing Mental Health and Addictions Services ............................. 65
Promising Practices and Recommendations............................................................................................... 66
   Thematic Assessment of Mental Health Recommendations .................................................................. 66
       Client needs ........................................................................................................................................ 66
       Monitoring, evaluation and research ................................................................................................. 66
       Community-based resources .............................................................................................................. 67
       Mental health human resources ......................................................................................................... 67
       Governance ......................................................................................................................................... 67
       Awareness ........................................................................................................................................... 67
   Thematic Assessment of Addictions Recommendations ........................................................................ 68
       Collaboration and governance ............................................................................................................ 68
       Communication ................................................................................................................................... 68
       Approach to addictions treatment ..................................................................................................... 68
       Research, monitoring and evaluation ................................................................................................. 69
       Hard to reach and serve populations.................................................................................................. 69
Documents Reviewed in Preparation of this Document ............................................................................ 70
   Atlantic Canada and Nova Scotia Specific Reports and Articles ............................................................. 70
   National Reports ..................................................................................................................................... 72
Appendix A – Research Methods ................................................................................................................ 74
   Document Review ................................................................................................................................... 74
   Literature Review/Annotated Bibliography ............................................................................................ 74
   Key Informant Interviews........................................................................................................................ 74
   Public Consultation ................................................................................................................................. 75
   Web and Data Base Search ..................................................................................................................... 76
Appendix B – Summary of Legislative Acts Relevant to Mental Health and Addictions............................. 77




          3     Mental Health and Addictions Strategy Project – June 24, 2011
Brief Introduction to this Document
The purpose of the present document is to describe the current state of publicly funded mental health
and addiction services in Nova Scotia. Acknowledging that the consultation process will result in the
document being expanded, this document will be a “living” document; it can be amended and modified,
as more information becomes available. The document will be used to focus initial discussions amongst
key stakeholders at the outset of the development of a Mental Health and Addictions Strategy. It will
become increasingly comprehensive as information is gathered through a variety of sources including
experts in the field, those with experience with mental health and addictions services, and decision
makers in Nova Scotia and across Canada. An updated version of this document will be used to inform
public consultations that will contribute to the development of a Mental Health and Addictions Strategy
for Nova Scotians. A summary of research methods used to collect evidence to inform the development
of a mental health strategy (including the current document) is appended.

Please note that the intent of the Mental Health and Addictions Strategy Project is to develop a strategy
that is inclusive of both mental health and addictions. A key information need for developing a Mental
Health and Addictions Strategy is a description of the current state of affairs in Nova Scotia with regard
to service delivery, governance, needs, incidence and prevalence. In this document, information on
service delivery, incidence and prevalence, challenges, and issues associated with publicly funded
mental health are presented, followed by similar information pertaining to addictions services in Nova
Scotia.

A variety of information sources were accessed in the development of this document. A list of reports,
documents, journal articles and websites consulted during the development of this document are
presented at the end. The development of this document and the Mental Health and Addictions
Strategy Project in general is not occurring in isolation; the Mental Health Strategy Advisory Committee
(MHSAC) is working in partnership with other parties interested in mental health and addictions
services, governance and delivery, including but not limited to work currently being carried out by the
Mental Health Commission of Canada.




       4   Mental Health and Addictions Strategy Project – June 24, 2011
Current State of Mental Health Services and Needs in Nova Scotia

General Governance
Several provincial government departments are involved in the overall governance of various aspects of
the mental health system including the Department of Health and Department of Health Promotion and
Protection (now amalgamated to form the Department of Health and Wellness), Department of
Community Services, Department of Justice, and Department of Education. A search for legislation
pertaining to mental health and addiction services in Nova Scotia revealed more than a dozen Acts that
may have implications for how mental health is governed in the province including:

    •   Mental Health Court Act                            •    Human Rights Act
    •   Involuntary Psychiatric Treatment Act              •    Health Act
    •   Children Family Services Act                       •    Health Authorities Act
    •   Adult Protection Act                               •    Hospitals Act
    •   Incompetent Persons Act                            •    Personal Health Information Act
    •   Personal Directives Act                            •    Health Protection Act
    •   Ombudsman Act

Some of these Acts will have a greater degree of relevance than others depending on the particular
issue at hand, therefore they are not listed in any particular order. A detailed description of relevant
legislation and the acts noted above is appended to the present document.

Provincial Mental Health Standards
Nova Scotia has developed a set of systemic and legislated standards for the delivery of Mental Health
Services within the Canadian public system (Department of Health, 2009). These standards were
developed by the Core Programs Standards Working Group of the Mental Health Steering Committee.
The standards are intended to encompass “the best available information regarding effectiveness
and/or best practice, balanced by the perspective of consumers, expert practitioners and educators.
Input will continue to be sought and revisions will take place every five years to keep pace with the best
practice evidence” (Department of Health, p. 4). The standards offer guidelines for general mental
health issues, which comprise “an overarching set of generic standards [that] represent the preferred
conditions relevant to all mental health service delivery” (p. 4). The generic standards address the
following areas:

    •   Standards – to ensure District compliance with national accreditation standards, professional
        legislation regulations, the provincial Mental Health Standards and to ensure that there is
        individual, family and community participation in the decision making process, planning,
        evaluation and delivery of mental health care.
    •   Access – to ensure equitable access to core mental health services to all Nova Scotians.
    •   Service Delivery – to ensure there are uniform assessment protocols, that treatment,
        community support and discharge plans are developed with the client and that interagency
        collaboration takes place as necessary.
    •   Planning, Evaluation, Monitoring – to ensure that standardized data collection systems and
        provincial quality improvement mechanisms are in place.
        5   Mental Health and Addictions Strategy Project – June 24, 2011
    •   Health Human Resources – to address competency, training and resource gaps.
    •   Governance and Funding – to ensure the required accountability structures are in place.

The core program standards define the key service components to be achieved with each of the core
programs, including:

    •   Promotion, prevention and advocacy – to provide information designed to enhance awareness
        and understanding of mental illness and the mental health service delivery system; to reduce
        stigma and discrimination; to promote mental health; to lead in activities directed at early
        detection and intervention to prevent, delay onset, or mitigate a mental illness.
    •   Outpatient and outreach services – to provide assessment and treatment for those individuals
        who have, or appear to have, a mental illness (e.g. depression, anxiety, schizophrenia, etc.); a
        mental, behavioural or emotional disorder with functional impairment; and those at risk of
        same.
    •   Community supports – to provide support to children, youth, families, and adults who need it.
        Supports offered might include case management, intensive community-based treatment
        teams/family initiatives, accommodation/housing/employment and education supports,
        proactive outreach/case finding, and psychosocial rehabilitation and recovery initiatives.
    •   Inpatient services – provide interdisciplinary care for those of all age groups who cannot be
        effectively cared for in a less restrictive environment. Every district must have access to acute
        inpatient care. This can be achieved through reasoned geographic placement and formal
        arrangements (including bed management processes) among health Districts to ensure
        equitable access.
    •   Specialty services – for most specialty services, there are challenges arising from the need for
        specialty training of service providers and the frequency of illness within the smaller Districts. A
        system of Specialty Networks has been developed to address this with a model of shared
        expertise and services across the province. In each District a clinician may be identified as a
        Network Liaison member. (Department of Health, 2009, p. 4).

A 2004 provincial government report (titled Our Peace of Mind) provides a service model for promotion,
prevention and advocacy of mental health in Nova Scotia. The roles and responsibilities at the provincial,
district and local levels as identified by this model are summarized below:




        6   Mental Health and Addictions Strategy Project – June 24, 2011
Table 1 – Roles and Responsibilities at Three Levels of Governance and Service Provision

               Provincial                         District/Shared                        Local
 •   Establish provincial priorities   •   Identify at risk groups         • Participate in/support
 •   Coordinate provincially           •   Support/participate in            provincial/DHA/IWK
     directed activities                   provincial/local health           initiatives
 •   Collaborate with intersectoral        promotion/prevention            • Coordinate local resources to
     partners in health promotion          initiatives                       respond to community need
     activities                        •   Development of partnerships
 •   Maintain current program              with other service providers
     resources                             and NGOs
 •   Fund DHAs/IWK and local           •   Deliver secondary prevention
     initiatives                           programs


The 2004 report on the mental health promotion, prevention and advocacy strategy and framework for
Nova Scotia titled Our Peace of Mind identifies the following as fundamental characteristics of effective
strategies intended to improve mental health:

      •   Identifying roles, responsibilities and accountabilities across multiple sectors;
      •   Targeting different settings, groups across the lifespan and using a combination of methods to
          target a variety of the determinants of health that contribute to mental health issues; and
      •   Improving outcomes in three primary areas: 1) social supports and networks, 2) structural
          barriers, and 3) coping and life skills.

Service Delivery
In Nova Scotia mental health services are delivered by the nine District Health Authorities (DHAs) and
the IWK either individually or as a combined services across several districts. Each DHA has its own
unique collection of mental health service providers (e.g., psychiatrists, psychologists, social workers,
occupational therapists, nurses, recreation therapists, nutritionists) with services primarily delivered
through local hospitals, community based organizations, and Non-Government Organizations.

Mental Health Services Available by DHA/IWK
Websites for each DHA and the IWK were searched for information on the services offered in each
region, and feedback on this paper was solicited from mental health coordinators in each DHA. The
subsections below offer a brief description of the services available to residents in each district. Unless
otherwise specified, quotes in the DHA/IWK subsections are quotes from the DHA/IWK’s mental health
webpage. Information on staffing, budget, wait times and referral processing times is included wherever
it is available.

Please note – the service descriptions are not intended to be exhaustive – please contact the DHA’s or
IWK for specific information.




          7   Mental Health and Addictions Strategy Project – June 24, 2011
Figure 1 – Reference Map of District Health Authorities in Nova Scotia




      8   Mental Health and Addictions Strategy Project – June 24, 2011
Services common to all DHAs and IWK
Mental Health Programming is available for adults, children and youth, and families through a
combination of in-patient and community based services. The following general mental health services
are available province wide, although access is not equal in all regions: group therapy, family therapy,
inpatient care, community based assisted living services, crisis response, seniors mental health services,
mental health assessment for adults, children and youth, and seniors outreach. The Department of
Health and Wellness mental health home page indicates that these broad categories of services may
vary by region in terms of how services are defined or categorized. Therefore those interested in
provincial services should refer to individual DHA websites.

One program that is consistent provincially is Mental Health Services; it provides enhanced services for
children with autistic spectrum disorders and their families. The focus of the service is on children with
autistic spectrum disorders up to six years of age and support with transition to services in school. The
Autism Service provides two levels of support and intervention to autistic spectrum disorder children
and their families, Early Identification Intervention and Support (EIIS) and Early Intensive Behavioral
Intervention (EIBI).

EIIS services are provided to all autistic spectrum disorder children and their families following a
diagnosis and assessment phase. The services are provided through a collaborative team approach. The
team includes autism skills workers, psychologists, occupational therapists, speech language
pathologists and psychiatrists.

EIIS program children and their families also have access to a more intensive level of autism services
known as Early Intensive Behavioral Intervention (EIBI). EIBE provides up to 15 hours/per week of
intensive services gradually reducing over a year. The intensive services are based on a best practice
program called pivotal response training that has been proven to significantly improve the ability of
children with autistic spectrum disorders to acquire the necessary language and other skills to make
successful transitions to school.

District 1- South Shore Health
This program provides mental health services across Lunenburg and Queens Counties. Programming is
available for adults, children and youth, and families through a combination of in-patient and
community based services. “Services are designed to help [individuals] gain a better awareness of how
to manage [their] personal or family concerns.” The Mental Health Program offers opportunities to
participate in group therapies intended to provide “helpful ideas about staying mentally healthy.”

DHA 1 provides a variety of services to residents; however, to gain entry to the program individuals must
be assessed to determine whether they would benefit from attendance in specific programs. Residents
of DHA 1 can make a self referral by calling mental health services, or a family doctor can make a referral
as long as individuals give them permission to do so and are aware the referral is being made. Following
a referral an assessment will determine the service options that best suit the individual’s needs. Options
for services include individual or family therapy sessions, consultation with a psychiatrist, group
education sessions or a referral to another type of service if deemed appropriate. Inpatient services are


       9   Mental Health and Addictions Strategy Project – June 24, 2011
available through a 10 bed unit at South Shore Regional Hospital. Most clients are voluntarily admitted
to the inpatient unit, however, involuntary admissions occur if an assessment results in the individual
being classified as a safety risk to self or others. Treatment on the inpatient unit is administered by a
team of psychiatrists, nurses and social workers and includes access to support and education for family
and loved ones.

Referrals for children and youth follow the same steps as outlined above. The website notes that the
average wait time is two – three months. Group sessions on anxiety are provided for children, teens,
and adults; a program for dealing with “defiant” children is offered for families struggling with parenting
issues. Additional group programming for adults address issues such as stress management, cognitive
skills, self-esteem, and “mindfulness-based” cognitive therapy. DHA 1 also offers a relaxation program as
part of their mental health programming, which is intended to aid in coping with anxiety, depression
and addictions issues.

Adult community support services are provided for adults living with a mental illness. The service is
aimed at addressing “quality of life issues to assist the person to live and function independently in
his/her community” and consists of two components: 1) individual community support provided
through case management services aimed at helping the individual to set and achieve goals for housing,
finance management, daily living, school/work, health, relationships and legal struggles; and 2) a drop in
centre that provides supportive, community-based social, leisure and recreational programming.

District 2 – South West Health
Mental health services in DHA 2 are provided through mental health clinics in Yarmouth, Shelburne, and
Digby. Access to mental health services may be sought through calling the clinic to make a self referral
or asking a family physician or other community agency to make a referral. An assessment of the
individual’s needs are made to decide which services would be of most assistance and the individual is
notified of when an appointment for those services will be available. For immediate assistance,
residents of this district are advised to contact a mental health center office or go to their local
emergency department.

Services are provided by a multi-disciplinary team of psychiatrists, psychologists, social workers, nurses,
physicians, community support workers, and occupational therapists. A number of adult services are
provided for individuals 19 years of age and older including community support of adults with chronic
mental illness; consultations with partners such as health care professionals and community agencies;
treatment groups and individual counseling for issues such as stress, anxiety, depression, and anger;
medication clinics; community education on mental health issues; and services to seniors including
nursing home consultation and educational sessions.

Children, youth and family services are available for individuals up to 19 years of age and include
individual assessment and treatment; community support for children with mental health issues and
their families; treatment groups and individual counseling for issues such as emotional problems, coping
with loss, body image issues, effects of abuse, anxiety and mood swings; and a family-centered
approach to diagnosing and treating children with autism spectrum disorders.


     10    Mental Health and Addictions Strategy Project – June 24, 2011
Inpatient services are provided through an acute care psychiatry unit with an early response service
staff providing services with the emergency room physician, family physician and/or psychiatrists.
Assessments of risk are made and potential mental health consumers are classified as emergency,
urgent or routine in nature. For emergency cases an assessment is completed within 24 hours; a mental
health assessment for urgent cases is provided within five work days and routine cases receive an
appointment within 10 days, with the accompanying assessment to be completed within 90 days.

District 3 – Annapolis Valley Health (AVH)
Mental Health Services provide support to people of all age groups who are living with mental illness
and experiencing mental health issues. Services are provided by a team of professionals including
psychologists, social workers, psychiatrists, community support workers, nurses and occupational
therapists, all supported by a team of administrative personnel.

Inpatient Mental Health Services are provided when required through referral from a psychiatrist or
other physician. The inpatient unit at Valley Regional Hospital contains nine beds and staffing is
comprised of nurses, licensed practical nurses, psychiatrists, a social worker and psychologist.

Outpatient Community Mental Health Services are located at various sites throughout DHA 3 and
provide: assessment, diagnosis, treatment for children, youth, adults and seniors. Client, family and
community education is also provided. Families and clients are strongly urged to make their family
physician an active part of care and treatment. Services are provided by a multi-discipline team of
psychiatrists, psychologists, nurses, social workers occupational therapists and others. Consultations in
schools, community agencies, physicians and various hospital units are also provided.

The Attention Deficit Hyperactivity Disorder Program (ADHD) program offers assessment, diagnosis,
treatment and education for children/youth and their families. Treatment is delivered by means of
education classes to parents and one to one interventions provided by clinicians, pediatricians, a general
practitioner and psychiatrist (which includes pharmacological treatment). School staff is involved
through a consultation process addressing recommendations/adaptations in the classroom.

Mental health clinicians are available in Youth Health Centers (YHC) across DHA 3. The program offers
clinical services, referrals to other YHC services (Addiction Services/Public Health) and community
resources, case conferencing with school staff, and classroom presentations and education. Staff is
available on a drop-in or appointment basis.

The Early Psychosis Program provides assessment, intervention, community support, and ongoing
follow-up as required to youth at risk for serious mental illness and newly diagnosed young adults. The
program provides services from several disciplines (i.e., Psychology, Psychiatry, Nursing, Occupational
Therapy, Community Support and Addiction Services). The program receives referrals from within the
system but also from the community. A collaborative relationship between the program and all DHA 3
high schools allows youth at-risk to be identified early and followed within our system.

Mental Health Promotion is focused on the development of positive mental health by supporting
individual resilience, creating supportive environments and addressing the influence of the broader

     11    Mental Health and Addictions Strategy Project – June 24, 2011
determinants of health. The program collaborates with Addiction Services and other area agencies to
focus on community education in order to decrease stigma and discrimination. In addition, the program
aims to increase understanding and access to services, improve the overall health of the community
and, where appropriate, advocate influencing public policy.

Crisis Response Service (CRS) ensures the availability of a skilled professional during weekday hours to
provide a mental health/addictions assessment and brief intervention to those presenting in crisis or
with a psychiatric emergency either by telephone or walk-in to outpatients/emergency departments.
After hours services are provided through the Addiction Detox Unit and emergency departments of
Valley Regional Hospital and Soldiers Memorial Hospital. In addition to assisting the individual in
managing the crisis, CRS consults and collaborates with community providers, mental health staff, family
practitioners, police, school, and natural support systems.

 The Police, Mental Health and Addiction Services Liaison Committee reviews and coordinates services
for people living with mental illness and addictions for purposes of improving our emergency response.
This Committee also plans and implements processes and protocols for early intervention with the aim
of decreasing crises for this population.

The Beacon Program provides psychosocial rehabilitation to persons with severe and persistent mental
illness. The program is geared toward young adults who are able to live independently with the
assistance of an individualized plan that works toward improving functional abilities, increasing
community integration and increasing success and satisfaction.

The program is comprised of three components:

    1. Beacon House is a six-bed residence where growth and recovery programming is available as an
       outpatient service for clients who reside in the communities of Annapolis and Kings Counties.
    2. Changing Tides is a day program that offers education and skills development sessions on a
       variety of subjects including social skills, life skills, nutrition, fitness, and medication
       management.
    3. Community Integration helps to transition clients from Beacon House to community living. Staff
       works with community resources to meet individual needs.

Community Support Program (Adult) aids individuals 19 years of age and older with chronic mental
illness by working directly with the individual, his/her family and allied agencies to allow them to enjoy a
full and satisfying life in their community. The service is provided through a team of community support
workers for as long as it is required and is accessed by referral through the AVH adult mental health
program; clients must meet specific admission criteria to be accepted to the program.

Community Support Program (Child/Adolescent) serves those up to 19 years of age and their families
to help manage the demands of daily life, and to promote full engagement/citizenship in their
community. Staff collaborate with children/youth/families and their support network to address
functional goals and to provide ongoing outreach/support across service settings as needs change.



     12    Mental Health and Addictions Strategy Project – June 24, 2011
The senior’s mental health program assists seniors to live independently and maintain a level of
satisfaction with life in their later years. Assistance is provided to seniors experiencing depression,
anxiety, grief, memory loss, Alzheimer disease and other mental health issues. The program may be
administered via home or office visits and encourages collaboration with a family physician for
assessment and follow-up. Services provided include caregiver support/education, liaison and
consultation with community agencies.

District 4 – Colchester East Hants Health Authority (CEHHA)
The CEHHA’s Mental Health Services Team works in partnership with community organizations,
individuals and their families to provide support and treatment for various mental health needs. The
mental health program provides mental health services for adults, youth and seniors through a
combination of outpatient, inpatient and community based programs. The programs are organized into
provincially defined core program areas. Each program is encouraged to work with community and
health care partners to enhance their service.

Emergency Crisis Service This service is available through the emergency department and the outpatient
clinic at Colchester Regional Hospital with outreach available to East Hants and Tatamagouche. The crisis
service provides services across the life span. It is available 9 a.m. – 6 p.m. Monday to Thursday and 9
a.m.-4:30 p.m. Friday. Weekends are covered by a Psychiatrist. The crisis team works closely with the
police when possible.

Adult outpatient services are intended for individuals 19 years of age and older requiring help with
problems such as anxiety, depression, trauma, abuse, and onset of dementia and serious mental illness.
Many services are provided through group therapies including auricular acupuncture, mindfulness based
cognitive therapy for depression, coping with anxiety, and dialectical behavior therapy. When group
therapy is unable to address the client’s needs, individual therapy may be provided. Occupational
therapy, psychiatric referral and senior mental health therapies are also available through the adult
outpatient program and offers home visits to seniors in need of services. Referrals may be initiated by a
client, a family doctor, or a community agency familiar with the individual’s needs and concerns.

Inpatient services are available to individuals experiencing a mental health crisis. The unit consists of 12
inpatient beds, “two of which are designated Observation beds.” Individuals gain admission to the unit
through psychiatric assessment. The aim of acute inpatient care is to relieve problems safely and rapidly
in a structure environment that provides support and involvement with an emphasis on strengths and
the development of social skills. A stabilized individual can then return to the community, access
community programs, and lead an independent life. The inpatient unit in CEHHA is the admitting unit for
Cumberland County Health Authority and involuntary patients from Pictou County health Authority.
Staff includes psychiatry, nursing, occupational therapy, and access to social work and psychology.
Services are provided using a number of approaches including meditation, individual counseling and life
skills, group therapy, education about general health and special needs, referral to community based
resources and recreation opportunities intended to encourage a healthy lifestyle.




     13    Mental Health and Addictions Strategy Project – June 24, 2011
Forensic Sexual Behaviour Program This program is offered in collaboration with the East Coast
Forensic Hospital (Nova Scotia Hospital Site) in Dartmouth, Nova Scotia. It is an outpatient service. Most
of the clients are on probation. The overall mandate of the program is to make communities safer by
preventing or making it less likely for clients convicted of sexual offences to commit repeat offences. The
program operates treatment programs in different communities across the province, including
Dartmouth, Kentville, Truro, and Sydney. Referrals to the program go through the Dartmouth office,
most often referred by the Department of Justice.

Adult Psychiatry provides outreach to the Agricultural College (student services) , East Hants resource
center, Tatamagouche primary health and the Opiate Treatment program.

Adult – Community Supports

    1) Community Psychosocial Rehabilitation and Support Service (COMPASS) program is “a
       voluntary program for adults with complex/serious mental illnesses that interfere with their daily
       life.” Conditions treated through COMPASS might also include psychosis and mood disorders.
       COMPASS is implemented by a team of psychiatrists, nurses, social workers and occupational
       therapists who provide a variety of services including: individual support in the home,
       community, or clinic; goal and skill development; wellness education; problem solving and
       support; recreation groups; advocacy; access to community resources; crisis support; and
       relapse prevention.
    2) Clubhouse is a program that provides a work ordered day and includes programs that are aimed
       at improving life skills, work skills, social and recreational skills. It is provided through a
       partnership arrangement with the Canadian Mental Health Association.
    3) Training, Recovery, Empowerment and Employment (TREES) is a program provided through a
       partnership with LakeCity, Canadian Mental Health Association and CEHHA Mental Health
       Services. This support program helps people identify what they want to do, access funds,
       education and preparation for employment. The initiator of this program won an inspiring lives
       award.
    4) MAPP is a partnership program with addictions, mental health and public health. It is federally
       funded and provides a tailored and greatly need smoking cessation program to mental health
       consumers in the community who access out community supports program.

Child, youth and family services are available to CEHHA residents through self referral (for individuals
16 and older), or through a family physician or other community agency familiar with needs of the
child/youth/family. Help is provided to families and youth with developmental issues, emotional issues,
and/or behavioural problems. Services are offered via groups and workshops, individual and family
therapy, occupational therapy, psychiatric services, and community outreach on mental health issues for
children and youth.

ADHD clinic – the Colchester East Hants ADHA Clinic has received international recognition for its
excellence in collaboration and innovative evidence –based service delivery. The clinic operates as part
of the Child Adolescent Family Service in partnership with the local school board (CCRSB) and CEHHA


     14    Mental Health and Addictions Strategy Project – June 24, 2011
pediatrics. Ongoing research initiatives are conducted though the ADHA Clinic, in partnership with
Dalhousie University psychology.

Autism Services – this program is part of the provincial initiative for children with autism and follows the
model for assessment and treatment (EIBI) found across the province. Autism services are provided to
children up to 6 years old. The purpose of autism services in the region is to develop skills in areas such
as communication and play through the use of positive techniques.

Northern Child and Adolescent Psychiatric Services (NoRCAP) – this collaborative model of service
delivery has been set up to ensure the development and continuing availability of psychiatric services to
children, adolescents and their families in Colchester , East Hants, Pictou and Cumberland Health
Authorities, as historically it has proven difficult to maintain these services under the pressure of adult
psychiatric needs. High quality psychiatric care will be an integral component of mental health services
for children and adolescents. It will be provided either directly or indirectly (e.g. Through consultation
with primary therapist, a family, a school, general practitioner or other agency/agencies or service
providers).

Wood Street (community services partnership) – This partnership with the Department of Community
Services provides for professional health services to the secure care program provided at the Wood
Street center. In addition, CEHHA provides child psychiatry consultation services on site weekly.

Child and Youth – Community Supports

    1) Family First is a program aimed at enhancing the social, emotional and mental wellbeing of
       children, youth and families by providing extra in home support. The program may offer services
       through individual and family therapy sessions, access to community programs and resources,
       group programming and referrals and consultations with a variety of community partners.
    2) BEST program is offered using staff affiliated with the Family First program through mental
       health that provide consultation and in home support to families as part of a multi agency
       partnership agreement administered through the schools. The program attempts to address the
       concerns about difficult behavior, aggression and violence among children and youth in schools.
    3) Family Help. When resources allow CEHHA purchases services from Family Help a distance
       treatment service developed to provide up to date, evidence based early intervention for child
       who have mild to moderate problems with such things are difficult behavior, bedwetting, ADHD
       and physical ailments.
    4) ASSIST & TASK – a collaborative initiative with Education, Justice, Addiction, Mental Health and
       Community Services. There is an interagency service team that meet to provide support to
       youth, their families and those professionals who work with them in the community. The
       program is intended for youth between the ages of 10-19 who suffer from severe emotional
       and/or behavioral difficulties and have received services from two or more agencies.
    5) Take Charge is a partnership with the Community health Boards, Volunteers, Addictions and
       Mental Health." Take Charge North Shore/Along the Shore - A Holistic Approach to Mental
       Wellness is a five week program that provides information and teaches skills related to positive
       mental health and wellbeing. It teaches participants how to improve mental wellness through:

     15    Mental Health and Addictions Strategy Project – June 24, 2011
        healthy eating; quality of sleep; physical exercise; recognizing and reducing stress reactions;
        dealing with worries, thoughts and feelings; and understanding the effects of substance use and
        gambling. Mindful relaxation and awareness skills are promoted in each session. Trained
        community-based volunteers, along with Mental Health and Addictions staff facilitate this
        program. "


Prevention, Promotion and Education. There are several initiatives that include partnerships with
Community Health Boards, Community Volunteers, Primary Health, Chronic Disease Management and
Addictions.

        1) Mental Health First Aid is provided to acute care and the community. CEHHA has two in
           house trainers, one in the community and one trained in the Mental Health First Aid – Youth
           Module. CEHHA was the first district to bring Mental Health First Aid to the Province. Since
           then, Mental Health Services Provincially has endorsed the program and developed training
           possibilities within the province. CEHHA received a grant from the Mental Health
           Foundation to be able to provide the training to acute care staff. It is now a regular part of
           the training offered in the district. CEHHA won an Innovations in Quality Work Life Award in
           2010 from Health Association Nova Scotia.
        2) Prevention of Depression - Mindfulness Based Cognitive Therapy is provided to help
           prevent further depression in those that are now stable but have a history of depression,
           This evidence based program improves the individual’s ability to prevent further episodes of
           depression. It is provided by two trained instructors and over eight weeks.
        3) Stress Reduction - Mindfulness Based Stress Reduction – this evidence based program is
           provided by specially trained staff to health authority staff and those in the community
           interested in developing a new approach to managing multiple stressors. Mindfulness Based
           Stress Reduction - is an eight week program modeled on the Mindfulness Based Stress
           Reduction (MBSR) classes offered at the Center for Mindfulness at the University of
           Massachusetts Medical School, founded by Dr. Jon Kabat-Zinn. The mindfulness meditation
           practices that are taught have been shown to reduce stress in participants if they are
           practiced regularly at home.

Community Outreach

First Nations - All services provide outreach to the First Nations Reserves – Indian Brook and Mill Brook

   1) Clinical Services – located on site for both children and adults
   2) Modified clubhouse for the seriously and persistently mentally ill
   3) Home visits
   4) Co-facilitation of the LOVE (Leave Out ViolencE) program along with two representatives from
      the LOVE Halifax branch at the Indian Brook House of Learning (L'nu Sipuk Kina Matuokuom).
      LOVE is an international youth violence prevention/intervention outreach program
   5) Consultation to community health clinics, community leaders and other health staff working in
      the community


    16     Mental Health and Addictions Strategy Project – June 24, 2011
    6) AHTF Mental Health and Addictions Prevention and Promotion Initiative - Millbrook and Indian
       Brook – Partnership with Primary Health, CEHHA Mental Health and Addictions

Primary Health Care in partnership with Primary Health – Mental Health clinical services are provided as
part of the primary health care collaborative team in Tatamagouche, Kennetcock and Bass River.

District 5 – Cumberland Health Authority
The Cumberland Health Authority serves the communities of Cumberland County and “works in
partnership with community organizations, individuals and their families to provide support and
treatment for a wide range of mental health needs” for persons in all age groups. Services are provided
by psychiatrists, social workers, occupational therapists, psychologists and other disciplines through a
combination of outpatient and community-based services, with inpatient services provided through
services in DHA 4. All services may be accessed through referral from a family doctor, from a community
agency or through self referral.

Adult services include outpatient and inpatient services delivered using a variety of therapeutic
methods. Group services for adults are offered when sufficient demand is in place and include sessions
that are gender specific (e.g., women’s therapy group and men’s therapy group), sessions on anxiety
disorders, surviving sexual abuse, mood disorders, coping skills, dialectical behavior therapy and those
that promote socialization and relaxation training. Individual and family approaches to therapy are
offered to those whose needs cannot be met by group therapy programming. Adult Services are offered
centrally in Amherst and in three satellite clinics located in Parrsboro, Springhill and Pugwash.

Inpatient services are accessed through referral from a family physician, psychiatrist, the
Crisis/Emergency/Early Response Service, and local emergency departments. Adult inpatient services
are provided for individuals 16 years of age and older through DHA 4, which offers:

 “…a diverse team of health care providers who work with individuals and their families to provide
comprehensive care. An individual program of care is developed so that each individual’s health and
normal functioning can be restored as quickly and effectively as possible. The goal of hospitalization is to
provide clients with: assessment; treatment; goal-setting; structured programs; a safe environment and
stabilization of symptoms to help them transition to outpatient treatment or a home environment.”

A Health Promotion, Illness Prevention, Community Education and Advocacy approach is used by the
Mental Health Program to allow collaboration with other community agencies to provide clients and
their families with information about a variety of mental health concerns such as depression,
medications, anger management, and coping with stress. An emergency response service is provided
through the Mental Health Program offices during weekday working hours, and through the emergency
department outside regular work hours.

Child and youth mental health services are available in DHA 5 through a main centre located in Amherst
and through three satellite sites located in hubs throughout the local region. Depending on the needs of
the youth, services may be provided through home, school and/or community visits. Outpatient group
therapies available to youth, children and their families cover topics such as anger management,

     17    Mental Health and Addictions Strategy Project – June 24, 2011
parenting and social skill development. For example, a teen group addressing issues such as
“relationship building, social skill development coping with negative feelings, managing conflict and
anger, self care, general life skills and self esteem” is available as is a parent group that provides help
with “parenting children or teens with mental health issues and with understanding child/adolescent
development and behavior.” An ADHD program is offered collaboratively through the mental health
program and the local school system, and “a community approach for children with severe behavioral
disorders is under development.” In addition to group therapies for children and youth, help may also be
available through individual, family and parent therapy sessions.

Inpatient services for children and youth are provided at the local hospital where the child/youth will
be admitted under the care of a local physician and an early response mental health services team may
be provided to conduct assessments and recommendations for care. Currently youth requiring intense
inpatient services receive them through the IWK Health Centre in Halifax.

NORCAP program is available to the four Northern Districts. It is an afterhours emergency telephone
consult service that the child and adolescent psychiatrists for districts 4, 5, 6 and 7 provide through a
rotation schedule which they set up collaboratively.

Community outreach and consultation for youth mental health issues are provided when concerns
about the youth are related to their community involvement (i.e., in schools, pre-schools, other
locations). Outreach programs are also provided for those living in rural areas who may find access to
services difficult due to their location. Public information sessions on topics such as child development,
parenting, bullying, teasing and self esteem are also offered in the region. Two established community-
based programs provide services to youth and families:

    1) The Family Help program is a “distance treatment service developed to provide up-to-date,
       evidence-based primary care (early and immediate interventions) for families whose children
       have mild to moderate problems not currently being treated in mental health services.
       Treatment is delivered via educational (self-help) handbooks and videos (printed or on website).
       Support is provided through a once-a-week telephone or website contact with a professionally
       trained coach who reinforces information outlined in the materials.” Referrals to the program
       come through family physicians and assistance is available for issues such as disruptive
       behaviour disorders, ADHD, bedwetting, anxiety, and recurrent physical ailments such as
       headaches and abdominal pain.
    2) The Behaviour Education Support Treatment (BEST) program is a “multi-agency school, home
       and community based early intervention [and] prevention program for young children with
       behavioral and social difficulties and for their families.” It has been operational in Northern Nova
       Scotia since 1999 and attempts to “address the concerns about behavior difficulties, aggression
       and violence among children and youth.” The program is administered through a collaboration
       of several agencies including school boards, DHAs, departments of community services and
       justice, first nations groups, and Dalhousie University. It is overseen by an advisory group of the
       Northern Partners in Action for Child and Youth Services and is compromised of school-wide,
       individual and group intervention, home-school, parenting program and summer program

     18    Mental Health and Addictions Strategy Project – June 24, 2011
        components. Each component benefits from the involvement of specialized staff who work with
        children, families, teachers, special services school staff and administrators to address issues
        using a team approach. DHA 5 has expressed concern that lack of funding may jeopardize this
        program.

In addition to the two programs noted above, DHA 5 also offers the ASIST program for youth involved
with a variety of agencies because of behavioral and emotional issues. The youth, family members and
representatives from the agencies involved meet to problem solve and create a plan which will address
the many needs of the youth by providing support to the individual and their families through the
collaborative efforts of the agencies involved.

Cumberland Kids is an example of representatives coming together from many settings (e.g. Law
Enforcement, Education, Department of Community Services, Mental Health, Public Health, Addictions,
NGO’s etc.) to address issues pertaining to children and youth through all developmental stages. The
primary focus is to share information, provide education and collaborate around goals and objectives
collectively set to provide better services and outcomes to this population group.

Additional mental health services in Cumberland County are promoted though other non-specified
community resources and services including self-help groups and organizations. There is and has been
longstanding collaboration among Cumberland Mental Health Program and many other organizations
and agencies both Government (eg.DCS, Education, Addictions, Justice etc.) and Non Government
Organizations such as Maggies’ Place, LA Animal Shelter etc.

District 6 – Pictou County Health Authority
Mental health needs of residents of Pictou County are served by Mental Health Services which is
comprised of a multi-disciplinary staff of psychiatrists, psychologists, mental health nurses, social
workers, among others. The service promotes a client-focused approach that allows individuals to be
actively involved in care planning and takes into consideration personal, religious and cultural factors in
care provision. Residents of Pictou County can access the system through self-referral, or may be
referred by physician or other community agency, or parents may refer children (in the case of
individuals up to 16 years of age). Once a referral has been made an assessment is scheduled for within
a few weeks of the initial contact and based on the assessment outcomes specific services are provided
to meet the individual’s needs. Adult and youth services are available through a combination of
inpatient, outpatient and community based services.

The Inpatient Services, Mental Health Short Stay Unit serves individuals from Pictou County who are 16
years of age and older and are seeking admission to hospital for mental health issues on a voluntary
basis. Admission can be arranged in a number of ways through a family doctor, referral following
assessment by the crisis response clinician on duty. On evenings, weekends and holidays admission to
the Mental Health Short Stay Unit is through the Emergency Department of the Aberdeen Hospital.
Programs and services include: individual counseling and support; education; medication and specialized
treatment; self help through independent reading; and referral for continued outpatient care.



     19    Mental Health and Addictions Strategy Project – June 24, 2011
The Crisis Response Service responds to requests for emergency assessment of clients at risk of harm to
self or others or unable to care for themselves in the community as a result of mental illness. This
service is available for all ages. The goals of the service are to: assess risk, provide supports to address
the immediate crisis, and arrange follow up as required to ensure safety and ongoing treatment needs
are met. Triage is conducted by a nurse in the Emergency Department, followed by an assessment by an
Emergency Department doctor who then consults the crisis clinician. The crisis clinician assesses the
client’s needs and develops a crisis plan. Services are provided through risk assessment, crisis
intervention, consultation with other providers, collection of collateral information, and follow up
planning.

The Adult Services Division of Mental Health Services provides a wide range of mental health
assessment, treatment and support services to adult clients 19 years of age and older of Pictou County
who have a primary mental health diagnosis or mental health issues. Clients are actively involved in
setting goals for their mental health treatment, in cooperation with professional staff. Services are
provided through individual therapy, family therapy, group therapy, medication, community education,
consultation and referral, and the Outreach Clinic. All Adult Outpatient Services Division may be
accessed through referral from a family doctor, from a community agency or self-referral.

The Adult Life Management Program provides a wide range of group programs, offered on the basis of
demand as well as rapid response individual supports, including an opportunity to share concerns with
others in similar situations in a friendly, relaxed and respectful environment, where clients receive
support and encouragement to try new solutions. A group therapist aids in learning effective strategies
to manage mental health symptoms. Services are provided through Life Management Groups and Rapid
Response Individual Support.

The Community Support for Adults Program can benefit adults who have experienced severe and
recurrent mental difficulties. The program assists in managing problems doing everyday activities such
as maintaining a home, working, pursuing education or maintaining health, as a result of mental health
challenges. Services are designed to assist with growth and recovery.

The New Hope Site is a component of the Community Supports for Adults Program. Clients with the
Community Supports for Adults Program will meet with their case manager to determine supports
needed to meet recovery goals. Services and activities available through the New Hope Site may be
included in recovery plans. Through this location, Community Supports for Adults staff offer groups such
as acupuncture, community life's challenges and card connections (a group on social networking). Client
led services are also offered including yoga, Qigong, meditation and exercise. Life skills instruction and
recreational opportunities are available through the program.

Mental Health Services has recently hired a Seniors Challenging Behavior Resource Consultant. The
consultant is part of Mental Health Services but works in collaboration the Continuing Care program
through Home Care coordinators and teams in long term care facilities. The Seniors Challenging
Behavior Resource Consultant works closely with the care coordinators or the in-house support person
to support the most effective interventions for individuals presenting challenging behavior. Information


     20    Mental Health and Addictions Strategy Project – June 24, 2011
will be reviewed from a variety of sources to inform staff approaches to care. Support includes
psychiatry involvement with long-term care facilities and the Senior’s (Mental Health) Challenging
Behavior position who works closely with Continuing Care and Mental Health Services. The Seniors
Challenging Behavior Resource Consultant:

    •   Provides ongoing education and mentorship to front-line staff in long term care facilities and
        home care agencies;
    •   Consults with Home Care coordinators and in-house resource staff; and
    •   Ensure linkages between Continuing Care Home Care Agencies, long term care facilities, Mental
        Health Services and the community.

The Child/Adolescent Outpatient program is targeted to individuals or family members up to 19 years
of age and struggling with emotional, behavioral, or learning difficulties, or having difficulties coping at
home, in school or in the community. Opportunities are provided to learn new skills and ways to cope in
a safe, supportive and friendly atmosphere. The program model and services include family treatment,
individual therapy, group treatment, medication, community consultation and inpatient consultation.
Referrals to the Child/Adolescent Outpatient Services Division may be made through contact by a
parent/guardian, family physician, community agency, school, or self-referral by a child/adolescent with
the capacity to consent to treatment.

Child/Adolescent Group Programs are available to children up to 19 years of age who are experiencing
difficulties with self-esteem, social skills, or emotional or behavioral issues. The aim of the
Child/Adolescent Group Program is to build resiliency (the ability to withstand stresses in life) through
groups and community opportunities designed to improve coping and social skills. Group Therapy
Programs include fostering resilient children, adolescents and parents, RAPID, Coping with Anxiety
(children and teens), community initiatives.

The Intensive Community Based Treatment Team (ICBTT) for children and youth provides assessment,
intensive in home interventions and multi-systemic case management services to children and youth up
to 19 years of age and their families who are dealing with early onset of severe and persistent mental
illness and/or significant disruptive behavior. Services are provided through an assessment process
which helps determine the specific needs of the child, as well as the challenges faced at home, in school
and in the community, individual counseling and support is provided to assist the child and family in
meeting goals, intensive in-home interventions assist in applying new approaches to family challenges,
multi-systemic case management ensures that all agencies and organizations working with the child and
family are working toward the same outcomes.

District 7 – Guysborough Antigonish Strait Health Authority (GASHA)
Mental Health Services is a district program serving the mental health needs of residents of the counties
of Guysborough, Antigonish, Richmond and parts of Inverness. The services are delivered at a number of
hospital facilities and community sites throughout the health district, the primary mandate is the
assessment, diagnosis and treatment of mental illness. The Service aims to prevent illness, restore
mental health, reduce symptoms and empower clients/clients to manage their symptoms. DHA 7 is


     21    Mental Health and Addictions Strategy Project – June 24, 2011
involved with prevention and promotion and community-based collaborative models that aim to
promote mental wellness through education, early intervention and a prevention focus.

An Inpatient service for adults and youth 16 years of age and over is located at St. Martha's Regional
Hospital in Antigonish. Outpatient services include Adult as well as Child, Youth & Family (CYF) Services.
Clients will be actively involved in planning their care with consideration for best location to access
service as well as personal, religious and cultural values. Clients are assessed for their level of need and
priority is given to clients with the greatest need.

The team includes a variety of health care professionals including psychiatrists, psychologists, mental
health nurses, social workers, occupational therapists, autism support workers and group facilitators.
The team approach allows clients to receive support from the appropriate service providers based on
needs. Others who may be involved in a care plan include family physicians, pediatricians and other
health care providers.

Referral to Mental Health Services is through a single entry system which is managed from St. Martha's
Regional Hospital. Thus a referral from anywhere in the DHA 7 goes through Mental Health Services
Intake at St. Martha's Hospital site. An assessment is completed by an Intake Coordinator. A specific
service will be determined by the information provided during that intake. The service is provided in the
best location in DHA 7, for the client, whether in an office, home or community location.

A referral to Outpatient Services can be made by a family physician, another professional from a
community agency that is familiar with the client, or by the client. Parents may make a referral directly
on behalf of children up to 16 years of age.

The Mental Health Services Inpatient Unit consists of 10 beds in St. Martha’s Hospital which serve
individuals 16 years of age and older from the GASHA catchment area of Antigonish, Guysborough,
Richmond Counties and part of Inverness County, and requiring admission to hospital for mental health
issues. As a provincially designated unit, it provides both voluntary and involuntary care. Antigonish
Town and County clients are generally admitted and attended by family physicians with psychiatry
offering consultation as requested. Clients from surrounding Counties are generally admitted and
attended by one of the psychiatrists. Services are provided through individual therapy, education,
medication and specialized treatment, self-help through independent reading, and referral for
continued outpatient care.

The Mental Health Adult Outpatient Service provides a range of mental health assessment, treatment
and support services to adult clients 19 years of age and older from Antigonish, Guysborough, Richmond
and part of Inverness Counties, who have a primary mental health diagnosis or mental health related
issues that would benefit from individual or group based therapy and supports. Services are delivered
both in the community and hospital sites. The program model and services include, individual therapy,
group treatment/support, psychiatric assessment, medication, community education/consultation, and
referral to community based resources.




     22    Mental Health and Addictions Strategy Project – June 24, 2011
The Challenging Behavior Resource Consultant (CBRC) is a mental health professional who works with
Continuing Care Providers to give care to older persons with complex cognitive/mental health needs and
associated challenging or disruptive behaviors. This work is done through a collaborative, client focused,
team based approach to assessment and care planning utilizing the P.I.E.C.E.S (Physical, Intellectual,
Emotional, Capabilities, Environmental, and Social) model. Seniors Mental Health, while currently not a
full specialty program, benefits from the resources of Adult Psychiatry and the Challenging Behavior
Resource Consultant position. Services are delivered in both community facilities and hospital sites.
Included in this service is, facilitation of ongoing educational strategies, complex case based
consultations (such as cases of agitation, resistance to care, etc.), assisting and supporting P.I.E.C.E.S
program development, advancement of the Seniors Mental Health Standards through consultation, and
direct clinical support.

The Community Supports for Adults Program provides a range of psychosocial rehabilitation, growth
and wellness services to adult residents of GASHA area, 19 years of age and older, who are experiencing
difficulties with daily living as a result of living with a severe and persistent mental illness. Services are
delivered primarily in the community.

The Child, Youth and Family Outpatient Service include individual, family, group and specialized mental
health services. It provides assessment, treatment and support for children and youth up to 19 years of
age, who have a primary mental health diagnosis or mental health issues that would benefit from
individual, family or group based therapy and supports. Family involvement is a ‘key’ component.
Services are delivered in both the community and hospital facility sites. The program model and services
include rapid response, group programs, individual (general mental health), neurodevelopmental, early
autism and early intensive behavioral intervention, community supports for children, youth and families.
Children and families can connect with this program by contacting the CYF Services through the single-
intake and triage process. Referrals can also be made by a family physician, schools, or community
agency.

The Community Supports for Child, Youth and Family Program focuses on supporting youth with severe
and persistent emotional, behavioral, and mental health needs. This service works with youth and
families in their home community. The program model includes assessment and care planning
(family/youth centered - strengths based). Services are primarily delivered in the community.

The Rapid Response Program focuses on youth in a crisis situation who needs immediate attention
because of the concern that he or she could be at risk of hurting themselves or someone else. Services
are primarily hospital based and provided on an emergency or urgent basis. The Program Model and
Services include Assessment of Risk, Short-Term Solution Focused Treatment (One to three sessions)
and potential for other services, as indicated.

District 8 – Cape Breton Health Authority
The mental health services in this region are identified as having the following principle functions:

    •   “To provide core mental health programs throughout the district based on best practice evidence
        and consistent with the provincial standards;

     23    Mental Health and Addictions Strategy Project – June 24, 2011
    •   To provide consultation, support and education to primary care service providers;
    •   To improve the awareness of individuals, families and staff and the public regarding mental
        health, mental illness, mental health care and the mental health delivery system;
    •   To collaborate with other government departments, community agencies, and service providers
        on shared initiatives;
    •   To address the determinants of health in conjunction with the relevant government
        departments, community groups and agencies in planning, delivering and evaluating services;
        and
    •   To involve the patient, family and community in the routine and comprehensive planning and
        evaluating of mental health services.”

For the Cape Breton District Health Authority the Mental Health Services program is a district-wide
program that offers a broad range of general and specialized inpatient, outpatient and community-
based mental health services to residents of all ages across the continuum of care and across the
lifespan. The program is organized into four service streams: Emergency and Acute Outpatient Services,
Child and Adolescent Services, Inpatient Services and Rehabilitation Services. “It is preferred that”
outpatient referrals come through family physicians; however, self referrals are accepted for services
not requiring medical/psychotropic intervention.

Emergency services are provided through an Emergency Crisis Program which is a consultative service
to the Emergency Department of the Cape Breton Regional Hospital. Inpatient services are available
through three separate inpatient units which vary in size (from 8 – 22 beds), average length of stay, and
the services provided.

Acute adult outpatient services are provided in five outpatient mental health clinics (and three
additional satellite clinics) that provide a variety of services to adults residing in DHA 8. Day Centre
(short term daily program for adults with serious mental disorders who require intensive treatment but
not 24-hour supervision/care), Eating Disorder, and Sex Offender Treatment Programs are also offered
as outpatient services. The Seniors Mental Health Program is available to provide consultation and
education services to nursing homes and long-term or transitional care units, and offers Challenging
Behavior Resource Consultants to families and care facilities who need help in dealing with difficult
behaviors associated with mental disorders in this population (e.g. dementia, Alzheimer Disease,
memory loss, depression).

A number of services geared toward children/youth (up to 19 years of age) and families are offered
through Child and Adolescent Services by a multidisciplinary team including psychology, psychiatry,
social work, occupational therapy and in-home behavioral interventionists. General and specialized
services are offered and include:

    1. IWK Stronger Families Program (provides screening for all referrals as well as telephone-based
       counseling for certain mild to moderate disorders);
    2. The Intensive Community Based Treatment Team;
    3. The Autism Intervention Program;

     24    Mental Health and Addictions Strategy Project – June 24, 2011
    4. The Neurodevelopment Clinic (for neurodevelopmental and mental disorders such as autism,
       Asperger’s disorder, Tourette’s disorder and cognitive delay);
    5. The Nova Scotia Initiative for Sexually Aggressive Youth (NSISAY – offers assessment and
       treatment of youth who are sexually aggressive with others); and
    6. A range of individual, family and group-treatment approaches addressing a range of mental
       disorders, including anxiety, depression, post traumatic stress disorder and other disorders.

Rehabilitation Services are community-based and are provided to individuals living with “severe and
persistent mental illness… Support includes assistance in managing mental illness, life skills, housing,
employment and education…It includes a case management program (Community Rehabilitation Team),
depot clinics in each of the Adult Mental Health Clinics and consultation/support to families, caregivers
and community agencies.”

Rehabilitation Services also includes Crossroads, “an internationally recognized community outreach
program that fosters recovery and wellness of persons living with severe mental illnesses.” This program
is intended to “promote hope, full citizenship, consumer/family participation, mutual support, personal
growth, social networks, improved housing and access to numerous employment and educational
opportunities.”

Mental Health Services provides funding to two community-based services including Cairdeil Place and
Pathways to Employment (formerly Touch on Wood), through formal MOUs.“Cairdeil Place is a centre
that offers life skills, support, social and recreational activities for adults who live in the community and
have chronic mental health problems.” Pathways to Employment is a non-profit organization whose
mandate is to promote independence and recovery through self-governance and meaningful supported
employment. Mental Health Services is also affiliated with The Missing Lint Co-operative, which is a not-
for-profit social enterprise whose mandate is to provide employment for individuals who have had
difficulty obtaining/maintaining employment due to mental illness. The Co-operative has provided jobs
for nearly 75 individuals and paid nearly a quarter million dollars in wages.

As part of DHA 8’s commitment to enhancing meaningful involvement of mental health consumers, their
families and caregivers in mental health system decision-making and the community in general, DHA 8
has established several committees comprised of these individuals along with DHA 8 board members,
community agencies, and other subject matter experts. The committees contribute to planning and
evaluation for the formal mental health system and include: 1) the Mental Health Advisory Committee
and its two subcommittees: the Inpatient Mental Health Advisory Subcommittee and the Rural Mental
Health Advisory Subcommittee; and 2) the Family Working Group. A third subcommittee of the Mental
Health Advisory Committee, focusing on services for children, youth and their families, is being
developed.

District 9 – Capital District Health Authority (CDHA)
Capital District Mental Health is a large, multi-faceted clinical, educational and research program,
providing a wide range of secondary, tertiary, and quaternary services to adults (19 years of age and
older) who live in the CDHA Region. DHA 9 also provides a range of clinical tertiary, specialized and


     25    Mental Health and Addictions Strategy Project – June 24, 2011
consultative services throughout Nova Scotia and to other provinces in Canada. As part of the Academic
Health Sciences Centre which is CDHA, the mental health program also provides a multiplicity of
educational opportunities for health care professionals from a range of disciplines and at multiple levels
of training. Professionals who receive training through this facet of CHDA include psychiatry residents,
nurses, social workers, psychologists, and occupational therapists among others. In all cases the
program is offered by an accredited educational facility, accredited by the respective discipline.

Research is a growing part of both the mental health program and of the Dalhousie Medical School’s
Department of Psychiatry. For example, there are currently two Research Chairs in the Department and
the program has a well-recognized quality improvement program with growing links to the research
community. The program is jointly managed by the Director and the Chair of the Department of
Psychiatry, and all clinical areas of the program have both management leads and psychiatrist leads
(Clinical Academic Leaders).

The programs provide two main entry points to the services: 1) through the emergency departments of
the hospitals in the CDHA Region, and 2) through referral from the more than 400 primary care
physicians in the CDHA Region.

Generally for those who are seen as acutely ill by family, friends, family physicians, police, other
healthcare or human service providers, the main entry points are through the emergency departments
(EDs) of hospital in the CDHA Region or through the Mobile Crisis Service. Individuals come to or are
brought to the closest ED, where they are medically screened to ensure that they are not manifesting
signs and symptoms as the result of medical and/or physiological issues. Some clients may then go to
the QEII ED, where they are assessed by the mental health program’s emergency psychiatric clinic staff
and a follow-up plan (which may include inpatient admission) is then worked out with patient, family,
caregiver, and others. The Mobile Crisis Service on the other hand can respond to individuals
experiencing a mental health crisis in their place of residence or elsewhere in the community. If further
assessment and/or admission are needed based on the initial assessment carried out by the Mobile
Crisis team, the individual is then taken to the QEII ED.

In the other cases, individuals are referred, to one of the program’s five community mental health
services located throughout the CDHA Region; this referral is generally, though not always, carried out
through a family physician. Family physician referral is important as the mental health program is a
secondary care program and does not provide primary mental health care.

The Mental Health Mobile Crisis Team provides intervention and short term crisis management for
children, youth and adults experiencing a mental health crisis. It offers telephone intervention
throughout the CDHA Region and mobile response in areas served by Halifax Regional Police (HRM)
including Halifax, Dartmouth and Bedford; and in areas beyond the jurisdiction of HRM with the relevant
RCMP detachment. The program is staffed by experienced clinical mental health professionals (e.g.,
psychiatric nurses and social workers from CDHA, and the IWK Health Centre), and experienced and
trained non-uniformed police officers. When providing intervention outside the Mobile Crisis office
location, a two-person team comprised of a police officer and a clinical mental health staff travel in

     26    Mental Health and Addictions Strategy Project – June 24, 2011
unmarked cruisers to the location where the mental health crisis is occurring. The Mental Health Mobile
Crisis Team also supports families, friends, community agencies and others in managing mental health
crises through education, outreach and consultation.

The Psychiatric Emergency Service functions out of dedicated mental health suite in the new QEII ED.
This service provides psychiatric assessments, interventions and initiation of a treatment plan for
individuals experiencing a psychiatric emergency. It is staffed by experienced clinical staff, psychiatry
residents, and psychiatrists. It provides 24/7 services.

There is a five-bed short-stay unit at the QEII Site. The purpose of this unit is to provide crisis
intervention through a multidisciplinary team for people who are experiencing mental health issues
which appear to be immediately resolvable within a three day timeline. Generally this unit deals with
individuals who have a mixture of substance abuse and psychiatric issues or those who have short and
acute emotional deregulation as the result of personality disorders. Admission to longer stay acute care
units would be contra-indicated as longer stays tend to promote dependency in a group where
recovering adult functioning as soon as possible is paramount.

There are three inpatient acute care units in the CDHA Region. For those who are suffering an acute
phase of their illness, the acute units provide safety, stabilization, comprehensive assessment,
treatment planning, and initiation and linkages to ongoing support and treatment in the less invasive
components of the program. Involvement of family, friends, family physicians, and other caregivers is of
utmost importance in treatment planning and initiation which emphasizes a quick return to a lifestyle
that is as independent as possible. Clients are admitted on the basis of bed availability only, not on place
of residence or program differences between the various units.

The Mental Health Program operates a community focused living unit which supports clients whose
illness has stabilized but who require assistance to regain a level of independence that will allow them to
live successfully in the community.

Longer-term rehabilitation units are available and are increasingly providing care for clients from
various regions of Nova Scotia. One unit specializes in helping individuals with both psychiatric illnesses
and intellectual challenges; the other unit specializes in addressing needs of seniors with mental
illnesses. The units practice psychosocial rehabilitation models of care that focus on recovery and
community reintegration.

Under the provisions of 1991 amendments to the Criminal Code of Canada, those who are charged and
convicted of a Criminal Code offence can be deemed ‘not criminally responsible’ (NCR) for their behavior
by the Courts. Such a disposition would normally be made by the Court following an assessment at a
medium security psychiatric hospital such as The East Coast Forensic Hospital (ECFH), and a report and
recommendations made back to the Court by the hospital. Once a judgment of NCR is made the
individual is held at the ECFH until it is deemed that their illness is under control and they pose limited
threat to society. There are two ‘rehabilitation’ NCR units of 30 beds each in the CDHA Region. In


     27    Mental Health and Addictions Strategy Project – June 24, 2011
addition to providing psychiatric inpatient assessment services to the Courts and periods of
incarceration for those found to be NCR, the service also provides limited ongoing
outpatient/community support, follow-up, and limited transitional housing. In addition, ECFH has a 24
bed Mentally Ill Offender Unit where court ordered assessments are performed and treatment is
provided to offenders in the regular prison population who are diagnosed with mental illness. Under an
arrangement with the Department of Justice, ECFH also provides primary health care to the Province’s
corrections population through the Offender Health Services Program and manages the Provincial Sex
Offender Program. Finally, limited services are provided on an ongoing basis to both Prince Edward
Island and to the Yukon, in collaboration with the respective government departments of Justice and
Health in the various jurisdictions.

In addition the mental health program provides clinical staffing for the Mental Health Court, located in
the Courthouse Building in Dartmouth. The Department of Justice funds this program. Individuals
charged with an offence, whom the court determines have, or appear to have, a mental illness which is
or might be contributing to their criminal behaviour, who are judged competent, who accept
responsibility for their actions, and who evince a desire to engage in counseling/treatment so as to
effect positive changes in their lives, are referred to the Mental Health Court, where a plan, which must
be agreed to and strictly followed by the offender, is worked out between the clinical staff of the Court
and the offender. The Court's two clinical staff are part of the mental health program and report to it.

There are five comprehensive community mental health services in the Capital District Mental Health
Program offering services to the Halifax Regional Municipality and Hants County. The five teams include
the Bayers Road Team (Halifax, Bayers Road Centre); the Bedford-Sackville Team (Cobequid Centre); the
Dartmouth City Team (Belmont House professional building in Dartmouth); the Cole Harbour and HRM
East Mental Health group (Cole Harbour Place); and Hants Community Mental Health Services (Windsor
Hospital). Services are also provided directly in General Practitioner’s offices and in community agencies
through various shared care and collaborative care arrangements.

These clinics provide secondary mental health care, generally by referral from primary care physicians,
to those who have or appear to have non-acute mental illnesses such as complex depression, anxiety,
complicated adjustment disorders, bipolar illness and schizophrenia. The Hants Community Team, in
collaboration with the IWK Health Centre, also provides child and adolescent mental health services.
Services are provided by inter-disciplinary teams including clinicians and learners from nursing,
psychology, occupational therapy, social work, psychiatry, among other health care professions.

The clinics provide a range of treatment modalities including individual treatment using a range
of psychopharmacological and psychotherapeutic approaches, group therapy using various
recognized treatment modalities, public education sessions, and shared care arrangements with
family physician groups. Various group treatment modalities are offered at different sites and
include sessions on Anxiety/Panic Management, Coping With Depression, Healthy Anger
Expression, Process of Change/Goal Setting, Self-Esteem/Assertiveness, Stress Management,
Relationship, Healthy Living, Psychosocial Rehabilitation, and Return to Work. A limited range of
alternative treatment modalities such as acupuncture are also offered.


     28    Mental Health and Addictions Strategy Project – June 24, 2011
Public education sessions are also offered on topics such as depression, bipolar disorder, coping with
psychosis from a family living perspective, and stress management. The clinics also work closely with a
range of partners in their respective communities to promote knowledge and understanding of mental
illness and treatment, to reducing the risk and impact of mental illness, and to promoting mental health.

In addition to the secondary level treatment and intervention services described above, the mental
health program also provides a range of specialized and tertiary/quaternary services. As part of an
Academic Health Sciences Centre, these services take a primarily academic and research approach while
also providing clinical services. These programs operate out of the CDHA, but also provide services in
other regions of Nova Scotia and the country.

The Nova Scotia Early Psychosis Program (NSEPP) is a multidisciplinary program that provides care for
individuals diagnosed with Early Psychosis. The program delivers care through integrating clinical care,
education and research. There is a provincial network that promotes the development of capacity in
centers across the province. The endowed Department of Psychiatry Janssen Chair in Psychosis research
is included in this program.

The Eating Disorders Clinic provides a day treatment program for adults with anorexia nervosa and
bulimia, who generally are referred directly by family physicians or by clinical staff in other program
areas. Clients must have a body mass index (BMI) of 15 or above to be admitted to the program. This
program takes a family-based approach to treatment which is provided through group-oriented
therapies and in collaboration with the IWK Health Centre. The service also leads a provincial network
on eating disorders to support clinicians across the province and to develop capacity in other mental
health programs in Nova Scotia.
The Seniors Mental Health Service provides a comprehensive range of mental health services that focus
on community-based care and include core components of clinical care, education and research. As the
first line of intervention for seniors is frequently the family physician, close collaboration with the
primary care sector is essential to the provision of mental health services to seniors.

The Seniors Service provides outreach, day programming and acute inpatient care. The CDHA is
mandated to provide subspecialty geropsychiatry consultation, direct care, education to clients, family
members, care providers and health care professionals, and assistance with development of services
and programs. The outreach team provides consultation, education and support to residents and staff of
long term care facilities to ensure that the mental health needs of residents are recognized, understood
and met. The team provides a number of outpatient clinics in local hospitals and Long Term Care
facilities.
The Sleep Disorders Program is the tertiary referral centre for the assessment and treatment of sleep
disorders in adults. The program consists of an outpatient clinic, as well as a three bed laboratory. The
mission is to “provide exemplary clinical care, to educate and to participate in research initiatives.”
While this program serves primarily adults, through collaboration with the IWK Health Centre increasing
numbers of children are also being serviced through this program.


     29    Mental Health and Addictions Strategy Project – June 24, 2011
The Emerald Hall C.O.A.S.T. Program (Community Outpatient Assessment and Services Team) is the
outpatient component of the provincial program that serves clients with developmental disabilities
(moderate to profound mental retardation) and a range of mental health issues. Emerald Hall is the in-
patient component of the provincial program.
Referrals are accepted from community health professionals, family members, service providers and
direct care providers. Prior to accepting the referral, verbal or written approval from a family physician
or current mental health clinician is required. Clients who have a mild mental retardation are not
accepted unless there is evidence of a pervasive developmental disorder. All admissions to the in-
patient unit are pre-arranged with the C.O.A.S.T. team.
Mental Health Day Treatment is a specialized six week partial hospitalization service that provides:
    •   A short-term transition between inpatient care and community living for certain defined
        populations; and

     • An alternative and more intensive option for outpatients requiring more intensive assessment
       than can be provided by the Outpatient Department.
The program is designed to accommodate the needs of people who have moderate or severe and
persistent mental illness and/or severe personality issues, who are open to and amenable to a more
structured intensive psychotherapeutic approach. Referral is encouraged of those clients who have been
treated psychiatrically for long periods without success or who have frequently recurring acute
difficulties, providing they are deemed able to engage in this form of rigorous treatment. The program
focuses on carrying out a detailed and comprehensive diagnostic and behavioral assessment and
providing an intensive and comprehensive treatment program based on behavioral and
pharmacotherapeutic principles.
The Reproductive Mental Health Service is a specialized multidisciplinary team located at the IWK
Health Centre, which provides psychiatric assessment, consultation and management for women
receiving maternity care from primary care physicians who have, or appear to have, psychiatric illnesses.
The service can also assist in education around psychiatric illness in the reproductive years and guide
access to other relevant community supports and agencies for mothers and young children.
While the bulk of those who develop mental illnesses are able, with the support and help of the health
care system and their families, to recover and go onto live productive lives – much as most individuals
successfully deal with other chronic illnesses such as diabetes – there is a proportion of people who do
not do as well. Factors such as the severity of the illness, poverty, dysfunctional family units, poor social
skills, and developmental delays may prevent some individuals from reaching and maintaining optimal
functioning. These people are often referred to as ‘seriously and persistently mentally ill’, and require
ongoing support across many aspects of their lives to keep their illness managed appropriately. The
mental health program provides a range of psychiatric, psycho-social, vocational and housing supports
for these individuals under the budget area of recovery and integration.
Connections Clubhouse (Halifax) is a service designed for adults whose lives have been significantly
disrupted by severe and recurring mental illnesses. Membership in the clubhouse is voluntary and open


     30    Mental Health and Addictions Strategy Project – June 24, 2011
to those 18 years of age or older. The program is delivered in a participatory manner, meaning staff and
members are involved in all aspects of clubhouse life, from design to evaluation, public education and
consultation.
New Beginnings Clubhouse (Dartmouth) is a place that provides a variety of opportunities and
programs for individuals who have a severe and persistent mental illness. It is a safe and comfortable
environment where members can meet new people, learn new skills, gain meaningful employment,
pursue further education, engage in social/recreational activities in their community and live in safe and
affordable housing. New Beginnings, a voluntary program, places particular focus on the benefits of
work, and is designed to help members regain confidence, self-worth and purpose.

Intensive Case Management Services are provided at all five of the community mental health team
settings. Explicitly identified Case Managers carry small caseloads and advocate for and broker services
for their clients, as well as providing ongoing supportive psychotherapy. They provide service to
individuals living in the community with a severe and persistent mental illness that has had a major
impact on various aspects of their lives, such as housing, employment, social supports, finances, and the
ability to perform daily living skills. They operate under the Principles of Psychosocial Rehabilitation
which emphasize hope, recovery, empowerment, and effective rehabilitation founded on a partnership
between the person receiving services and the practitioner. The goal of the teams is to support
individuals in 1) achieving the best quality of life possible and 2) in their recovery and growth beyond
their illness.

The Supportive Community Outreach Team (SCOT) provides ongoing clinical care, rehabilitation and
community support to clients with severe and persistent mental illnesses. This is a highly specialized
program for clients who face particular challenges and for whom Intensive Case Management, as
described above, is not adequate in maintaining the client in the community.

Certain individuals may face challenges which are beyond the regular system’s ability to respond and
require complex case management including housing supports. These are typically individuals who have
a long psychiatric history and who also have problems with aggression, are severely intellectually
challenged, or have physiological issues such as acquired brain injury, dementia, or Huntington’s Chorea.
Almost invariably the issues such individuals present with are placement issues. Before coming to the
program many have been living in inpatient psychiatric beds, often for years. In collaboration with the
IWK Health Centre, and the Departments of Health and Wellness, and Community Services, the program
has dedicated staff who develop community placement and support plans for these individuals, so they
too can live in home-like settings. Limited experience over the past couple of years has shown that many
of the clients who have been provided with such community settings have exceeded all expectations in
terms of their habilitation to and active involvement in their new communities.

Staffing and Budget

The overall budget of the mental health and forensic program is $53 million. The descriptions below
(Table 2) indicate the budget of each of the major components of the program.


     31    Mental Health and Addictions Strategy Project – June 24, 2011
Table 2 – Budget Allocation by Program Area

Program Area                                Budget
Mental Health Mobile Crisis Team            $1.9 million
Acute care (inpatient unit and short        $9.6 million
stay unit)
The East Coast Forensic Hospital (ECFH)     $8.6 million
Community mental health services            $8.5 million
Specialized tertiary                        $9 million
outpatient/inpatient services (e.g.,
early psychosis, eating disorders,
seniors service, sleep disorder, COAST,
day treatment, reproductive health)
Recovery and Integration (e.g.,             $9.7 million
Connections & New Beginnings
Clubhouses, medium-intense level case
management inpatient units etc.


Mental health and forensics together have a staff complement of about 540 full time equivalent staff
and 50 full time equivalent psychiatrists and physicians. In terms of actual bodies (full-time and part
time staff and physicians), there are approximately 64 psychiatrists, 6 physicians and 750 staff.

A partial and approximate breakdown of the 585 the ’full-time equivalent’ staff from the forensic and
mental health programs combined is presented in the Table 3. The breakdown is partial as specialized
positions (e.g. short order cook, porter escort, dentist, decision support analyst, etc.) are not listed; the
list is approximate because at any time point there may be a number of vacant positions. For these
reasons, the numbers do not add up to 585 exactly.

Table 3 – Full Time Equivalent Staff - CDHA

Position                                         Approximate number of staff
Registered Nurse                                            190
Licensed Practical Nurse                                     66
Community Mental Health Nurse                                26
Patient Support Worker                                       13
Utility Worker                                               10
Developmental Worker                                         20
Clinical Administrative (Various levels)                     74
Social workers                                               50
Occupational therapists                                      38
Occupational therapy assistants                               7
Psychologists                                                20
Recreation Therapists                                         9
Spiritual care counselors                                     3
Polysomnographic technician                                   4


     32    Mental Health and Addictions Strategy Project – June 24, 2011
Communications director                                        1
Project managers                                               2
Pharmacists                                                    3
Program managers                                               9
Service managers/health service managers                      21
Halifax regional police (seconded)                             3



IWK Health Centre
The Mental Health Program serves children, youth and families throughout Nova Scotia and the other
Maritime provinces. In 2006 the program expanded to include addictions and the name changed to the
IWK Mental Health and Addictions Program. Services are provided through traveling clinics, telehealth
services and access to inpatient unit and day treatment programs.
The program has been in place since 1995 when the Nova Scotia Hospital’s Child and Adolescent Mental
Health, Atlantic Child Guidance Centre and the IWK Mental Health Program merged to create what is
now referred to as IWK Mental Health and Addictions program. Since 1995 the program has almost
doubled in size and now includes Youth Forensic Services, Intensive Community Based Treatment,
Shared Care, and four inpatient (one acute and three community) treatment programs. In 2007,
Women’s Reproductive Mental Health was added to its mandate to help women and families deal with
mental health issues related to maternity and reproduction.
The program has helped raise awareness of the mental health needs of children and youth with
Government and community partners. Programs are increasingly moving into the community to meet
the needs of clients and their families using non-traditional approaches. Partnering with non-profit
community agencies allows the IWK to meet the needs of other populations such as homeless youth,
youth with addiction issues, and immigrant populations.
IWK Mental Health and Addictions aims to provide appropriate services to the children, youth, women
and families they work with through a continuum of care, ranging from early intervention to more
intensive services. They employ a multi-disciplinary approach involving clinical resources as well as
partnerships with non-profit community agencies, which allows them to address needs of diverse
populations including homeless youth, youth with addiction issues, and immigrant populations.
The IWK have recently undertaken research and consultation to produce their own Mental Health and
Addictions Strategy. The first phase of the strategy was launched February 9, 2011.

Central Referral Service is the central intake service for the entire IWK Mental Health Program.
Telephone interviews are conducted with clients referred to the service and the client is directed to the
most appropriate service. It is offered to families and youth up to 19 years of age. The team is comprised
of social workers and administrative assistants.
The crisis team service provides emergency mental health assessments and crisis intervention services
to children, youth and families in the IWK Emergency Department 24/7. It is geared towards children
and youth up to 19 years of age. The team assesses and determines the needs of the child/youth and

     33    Mental Health and Addictions Strategy Project – June 24, 2011
facilitates an inpatient admission if necessary. If more appropriate, the crisis workers can make a referral
to other mental health services. The team is made up of social workers and psychologists.
Mobile Crisis is a partnered service between the IWK, Halifax Regional Police, Capital Health and
Emergency Mental Health Services. Mobile Crisis provides 24/7 days per week telephone support to
individuals and families across the age spectrum who may be experiencing a mental health crisis. The
mobile teams are available daily within most of the HRM, between 1 p.m. and 1 a.m. Mobile services
are set up through the telephone support line. The team is made up of social workers and crisis
interveners as well as plain-clothed, specially trained police officers.
The Community Mental Health Clinics provide direct care to youth and families in the community and
as close to home as possible. There are three main clinics: Halifax, Sackville and Dartmouth. It assists
families and youth up to 19 years of age. This multi-disciplinary team is made up of psychologists, social
workers, youth care workers, administrative assistants and psychiatrists.
Maritime Psychiatry provides sub-specialty clinics for children and youth up to 19 years of age and
consultation to Community Mental Health clinics and other community services. The teams include:
Mood Disorders, Eating Disorders, Pervasive Developmental Disorders, Tourette’s and Obsessive
Compulsive Disorders, Anxiety Disorders, Youth Psychosis, ADHD, and Bipolar Clinical and Research
Specialty. The team is made up of psychiatrists, social workers, psychologists, occupational therapists,
registered nurses and administrative assistants.
The Child and Family Day Treatment Program serves children and families through individual, group
and family therapy in a day treatment setting, which utilizes a therapeutic classroom. It runs for
approximately three and a half months. It is designed to help children 5 to 12 years of age who are in
need of additional support to manage their behavior, and review medications and diagnosis.

The service maintains a consistent behavioral approach and helps the child successfully return to their
community schools. Groups include anger management, school process, parent training, social skills and
relaxation training. The team is comprised of a psychiatrist, psychologist, occupational therapist, social
worker, registered nurse, teacher, developmental workers, and youth care workers.
 The Adolescent Day Treatment Program is a voluntary program that provides medium to high intensity
treatment for youth with mental health issues for up to a three month time period. It is aimed at
helping youth from 13 to 19 years of age who are in need of additional support to return to full time
school attendance. The program reviews diagnoses, assesses medications, and aims to improve self-
esteem and social functioning among program participants.
The service offers individual, group and family therapy to youth and families dealing with mental health
issues. Youth are encouraged to take responsibility for their behavior while learning skills to enable
them to be successful in other settings. Skill based groups such as anger management, school process,
anxiety, self esteem and social skills training are provided as required. There are also individual sessions
and a therapeutic classroom. The staff work with school staff and meet with community partners to help
ensure a successful transition into the community. The team is comprised of a psychiatrist, psychologist,
occupational therapist, social worker, registered nurse, teacher, developmental workers and youth care
workers.

     34    Mental Health and Addictions Strategy Project – June 24, 2011
The Reproductive Mental Health (RMH) Service works to provide specialty services to women with
mental health concerns affecting them during reproductive care. This includes new or returning
problems related to mood, thinking and functioning. It is geared towards pre/postpartum women. The
team provides screening and assessment; individual or evidence-based group treatment, mediation
along with psychiatric consultation services. The team has full or part time disciplines, including
psychiatry; nurse and clinical nurse specialists, social workers and an addictions counselor.
The Intensive Community Based Treatment Team (ICBTT) provides home, community and school based
support for children and teenagers who are having major problems in their daily lives related to
disruptive behavior disorders or long term mental health disorders. The ICBTT consists of a clinical team,
which includes a psychologist, social workers, and a consulting psychiatrist. Case managers work closely
with families, the clinical team and representatives from other involved systems on a daily basis. They
work with children and teenagers up to 19 years of age and their families. The team goes to locations
(home, school, community, office) and times (daytime, after school, evenings) that are convenient to
families. The goal is to overcome barriers that get in the way of children, youth and families being able
to take part in traditional (i.e., office based) mental health services.
This program is based upon a multisystemic treatment approach. It acknowledges that there are many
different things that create problems in families’ lives. The ICBTT works with children, teens, their
families and communities to find solutions to these problems. The team works with all the systems
involved in the lives of families who come to the program ( e.g., home, school, community, work, and
peers).
The team generally works with children, teens and families for a three to eight month period. During this
time they meet with children, youth, families and representatives from other systems (education,
community, justice) as often as needed, which may range from one to four times per week.
The program helps to understand what problems need to be worked on in the family, with friends, at
school and in the community. It teaches parenting skills; offers family therapy/individual therapy; and
offers medication and diagnostic review. In addition, the program helps other systems and people
understand the child /youth and what works for them and their family. The program works together
with the child/teenager, family and schools, health centers, community agencies, and justice system
among others, to solve problems that are creating difficulties in the child or teen’s life.
Shared Care supports early detection, prevention and screening for mental illness, by increasing access
to services for clients who may otherwise not seek mental health services from the IWK directly. The
program works in the community in partnership with general practitioners, community health clinics,
Phoenix Youth Programs, and schools. It works with children and youth up to 19 years of age who reside
within the CDHA. The program works by teaching skills through parent training/education, family and
individual therapy and providing resources to help parents learn to address their children’s behavior.
Also, the team helps youth cope with family, peer, school and community problems. The team consists
of a psychologist, social worker, registered nurses, psychiatrist, administrative assistant and youth care
workers.



     35    Mental Health and Addictions Strategy Project – June 24, 2011
CHOICES (Addictions) is comprised of three teams (Outpatient, Day Program and 24/7 Program),
CHOICES is a voluntary assessment and treatment program assisting adolescents 13 to 19 years of age
with challenges around substance abuse, mental health issues and/or gambling through an integrated
treatment approach. Services provide individual, family and group therapy, drug information groups,
evening school and wilderness experiential therapeutic outings.
The Day Program operates from Monday to Friday and youth can attend on a full-time or part-time
basis. Day Program consists of an onsite therapeutic school, provides individual, family and group
therapy, psycho-educational groups, recreation therapy and community outreach support.

The 24/7 Program provides a structured therapeutic residential environment for youth across the
province who are in need of a more intensive treatment intervention beyond community based therapy
and or who cannot participate in the Day Program due to youths' home location. All youth in 24/7
Program attend the Day Program and participate in the therapeutic classroom and groups.

 The treatment team is made up of a psychiatrist, psychologist, addiction therapists/case managers,
social workers, teachers, nurses, community outreach workers, adolescent/youth care workers and
recreation therapists.

The acute inpatient unit functions as an assessment and treatment unit for children and youth with
serious mental health issues. It services children and youth up to 19 years of age. The unit provides
stabilization, assessment and treatment planning for children and youth who require intensive support
in an inpatient setting. The staff makes recommendations on next-step treatment options.

The treatment team includes a clinical nutritionist, social workers, recreation therapist, occupational
therapist, teacher, psychologist, psychiatrists, pharmacist, nurses, child mental health workers and
youth care workers.

Community Inpatients are referred to Compass, Centre for Collaborative Child and Family Treatment
(APSEA site). Compass is a 12 bed inpatient treatment service for children up to 13 years of age with
severe behavior disorders. Treatment is provided within a 24 hour/5 day per week residential setting,
with an average length of stay of six months. Compass provides a structured weekly program that
includes one-to-one treatment, as well as recreational and occupational therapies. Programming also
includes evidence based groups such as parenting groups for parents/caregivers as well as an on-site
therapeutic classroom. The support team provides community-based support for clients and families
during weekends and as patient’s transitions back to their home community. The program is geared
towards helping children with severe disruptive behaviors and anxiety disorder.

Collaborative Problem Solving (CPS) is the philosophical approach used within Compass. CPS works to
identify the specific skills lacking in children with challenging behaviors especially in the areas of
flexibility, frustration tolerance, and problem solving. CPS is used to help children and their parent/
caregivers learn skills to resolve disagreements and disputes in a collaborative, mutually satisfactory
manner. Other modalities of treatment are also used depending on the clinical needs of the clients. The



     36    Mental Health and Addictions Strategy Project – June 24, 2011
team consists of clinical social workers, psychologists, a psychiatrist, a special education teacher,
recreation and occupational therapists, registered nurses and child care workers.

The Adolescent Centre for Treatment (ACT) provides rehabilitative mental health treatment for teens
13-19 years of age. The facility consists of four apartment-style living areas with four bedrooms each.
The anticipated length of stay is four months within the 24/7 component and four months follow-up
with the Transition Team.
This service assists Nova Scotia youth with chronic and persistent mental health disorders with
serious/profound functional impairment and/or severe disruptive behavior disorders who would benefit
from treatment. The caregiver and referral source must be committed to participate in the admission,
treatment and discharge plan.
An integral part of treatment intervention involves the transfer and practice of new skills learned to the
family/community setting. Upon admission, the ACT Team, clients and parents/guardians will begin
planning for discharge and aftercare. Treatment is provided based on a holistic approach to mental
health care for clients and their families. All programming is based on client’s needs and may include
individual therapy, skill training, medication management, parent education and support, family
therapy, behavior management, educational programming and liaisons with community schools and
organizations. The treatment team is a multidisciplinary team consisting of a psychiatrist, psychologists,
social workers, occupational therapists, teachers, case managers, a case coordinator, a recreational
therapist, nurses and youth care workers.
Forensic Services include Youth Court Assessment Services, Forensic Rehabilitation Services, province-
wide assessment and treatment program for youth who have engaged in sexually inappropriate
behavior and Primary Health Care and Mental Health Services for incarcerated youth.

Youth Justice Assessments are completed for the Youth Justice Courts in Nova Scotia under the Youth
Criminal Justice Act (YCJA). The majority of court ordered assessments are requested to assist the court
in making or reviewing a youth sentence under Section 34 of the YCJA.

The court may order an assessment with the consent of the young person or on its own motion if one of
the following conditions is met: the court has reasonable grounds to believe that the young person may
be suffering from a physical or mental illness or disorder; a psychological disorder; an emotional
disturbance; a learning disability; a mental disability; the young person has a pattern of repeated
findings of guilt; or the young person has been alleged to have committed a serious violent offense.

Assessment completed under the Mental Disorders Section of the Criminal Code of Canada occurs when
the Youth Justice Court is questioning the mental status of the young person and wants an assessment
in relation to youth’s fitness to stand trial, or the youth’s culpability for his actions at the time of an
offense due to a diagnosed or suspected mental illness.

Assessments for sentencing are multi-dimensional and focus on risk factors identified in research as
being associated with criminal and violent recidivism. Recommendations relate directly to these risk
factors in an effort to manage a youth’s risk and promote prosocial behavior. Assessments under the

     37    Mental Health and Addictions Strategy Project – June 24, 2011
Criminal Code consider the capacity of a young person to form intent, understand and appreciate the
consequences of their actions, communicate with council, participate in their own defense and
understand the function of the participants in the court process. Youth with serious mental disorder or
disability at the time of trial may not be fit to stand trial whereas youth with a serious mental disorder or
disability at the time of the offense may not be criminally responsible for their actions.

The team helps by conducting thorough multi-disciplinary assessments and producing an integrated
report providing the court with rehabilitative recommendations and recommendations with respect to
risk management. The forensic services unit also provides rehabilitative services to youth as elaborated
below. The team is made up of social workers, psychologists, and psychiatrists.

The multi-step Forensic Rehabilitation Service follows youth deemed Not Criminally Responsible or
Unfit to Stand Trial due to a Mental Disorder. At the highest level of security, this service consists of a
four bed wing designated for Forensic Youth on the Mental Health Inpatient Unit of the health centre.
This unit is used for initial assessment or reassessment following a breach and for medication
stabilization when the youth are actively ill and risk to the public is considered moderate to high.

Clinical case management provides supervisory support to youth who have been given a conditional
discharge or who are found unfit to stand trial by the Criminal Code Review Board and to monitor
adherence to the conditions dictated by the CCRB. The goal is community reintegration up to the level of
individual capacity.

Services are also offered to youth who are involved with the Youth Justice Court and are subject to
intensive supervision orders, probation orders, or conditional sentences. For youth involved in the Youth
Justice Courts under Section 34 of the Youth Criminal Justice Act, the Forensic Complex Case Manager
may be assigned to oversee their transition from the Nova Scotia Youth Facility into the community by
identifying and coordinating services for the youth and their families. The services identified and
implemented are to help manage a youth’s risk and to support their rehabilitation in the community.
The team consists of a clinical social worker who consults with psychologists and psychiatrists.

Clinical Services at the Nova Scotia Youth Facility in Waterville, Nova Scotia offers a broad range of
Primary Health Care and Mental Health Services for incarcerated youth. Referrals for Clinical Services
come from multiple sources, including youth and their family, the courts, probation officers, teachers,
corrections staff, child protection services, mental health providers, or primary health providers.
Referrals can also be initiated through the intake screening that all youth receive at the Facility.

Services include health and mental health screening, medical monitoring of disease processes, acute
care, medications management, cognitive behavioral interventions for anger management, social skills,
anxiety or depression, suicide risk assessment and management, violence risk assessment, consultations
with corrections staff, family therapy, individual therapy, community reintegration, liaison with services
for addiction services, community resources, and outpatient mental health/health services. Clinical
services are offered to youth voluntarily. Some youth may be court mandated to participate in
assessment/treatment as a part of their rehabilitation. The clinical team is composed of nursing,
psychiatry, social work, psychology, addictions counselor, care coordinator, and general medicine.

     38    Mental Health and Addictions Strategy Project – June 24, 2011
Under the umbrella of the IWK Youth Justice Service, the Initiative for Sexually Aggressive Youth (ISAY)
is a province-wide assessment and treatment program for youth who have engaged in sexually
inappropriate behavior. Services are delivered through a partnership between the IWK Health Centre
and the provincial district health authorities. The IWK-ISAY team is responsible for providing
comprehensive psychological risk assessments and consultation services for youth across the province.
In addition, the IWK-ISAY team provides treatment services to youth within the Halifax Regional
Municipality. Designated mental health clinicians working with youth in local district health authorities,
conduct initial mental health assessments and deliver treatment to the youth in their areas. The team
consists of social workers and psychologists located throughout the province.

The IWK continues to provide services to the Halifax Youth Attendance Centre (HYAC). HYAC is a
community based transition facility. It is a partnership in cooperation with the Department of Justice
and key partners: IWK Mental Health, Department of Community Services, and the Department of
Education. The focus of the program is to enhance public safety by encouraging positive attitudes and
providing appropriate supports for youth and their family members to engage and be successful in their
communities. It is geared towards children and youth referred to the service through Probation Services.
The program provides advocacy for youth, academic programming, mental health services, job skills
training, life skills and referrals for existing services in the community. The team consists of
psychologists, social workers, youth care workers, teachers, community support workers, and probation
services.

The IWK Mental Health Child Welfare Initiative is a program through which the IWK is committed to
providing compassionate care mental health services to children and their families. The IWK Mental
Health Service will provide mental health services to children who are exposed to child maltreatment
providing comprehensive assessments of youth and family. Child psychotherapy, parent and foster
parent consultations relevant to the child’s mental health as well as delivery of the Resourceful
Adolescent Program (RAP). The IWK Child Welfare Program serves children and families involved with
the HRM Department of Community Services and it is the intent to build strong collaborative
relationships with the Department of Community Services. It is geared towards children and youth
referred to our service by the Department of Community Services. The team consists of social workers
and psychologists.

The SunLife Financial Chair in Adolescent Mental Health helps adolescents, families, clinicians,
policymakers, researchers, education institutions and healthcare providers. Many severe and persistent
mental disorders, including depression, schizophrenia, bipolar illness, anxiety disorders, often begin
during the adolescent years. Mental illness is a serious problem, and if it is not properly diagnosed and
treated it can negatively impact the health and well-being of youth for years to come. By creating a
greater public understanding and awareness of mental health issues the program can help to overcome
the stigma of mental illness and provide a greater chance for young people with mental disorders to feel
comfortable in coming forward and asking for help.

The Chair combines research, education and health promotion in the area of adolescent mental health
to support adolescent development. The Chair will focus on the translation of scientifically-valid

     39    Mental Health and Addictions Strategy Project – June 24, 2011
information pertaining to youth mental health for the purpose of informing the public, youth, policy
makers, educators and clinicians.

Issues and Challenges Impacting Mental Health Services
The following sections present mental health issues at the regional, and provincial level, as identified
based on document review of federal and provincial publications, as well as interviews with key
informants and subject matter experts. Issues at the national level will be identified through future
consultations and literature review. The list of issues identified here is by no means exhaustive, but it
provides a broad overview of common mental health issues, as well as the opportunity for some initial
comparisons of Nova Scotia to other jurisdictions in Canada.

Issues at the regional level (Atlantic Provinces)
An environmental scan of mental health and mental illness in Atlantic Canada presented an
epidemiological review that included findings on prevalence of mental health issues in Atlantic Canada
as compared to the rest of Canada (Muzychka, 2007). In terms of prevalence, based on the Canadian
Community Health Survey, there appears to be “no appreciable differences at this time between rates of
mental health disorders in Atlantic Canada compared to Canada as a whole” (p. 15).

This scan identified that in general the issues of stigma, lack of cohesion, and comprehensiveness are
nation-wide challenges to developing a sustainable mental health system (Muzychka, 2007). The same
scan reported that subject matter experts from the Atlantic Provinces identified the key priorities for
mental health in this region to be 1) delivery, 2) access, and 3) knowledge. The report notes variation in
priorities across the Atlantic Provinces at the local, regional and provincial levels; thus the specific
priorities for Nova Scotia and its districts will be further investigated through consultation. However, it is
worthwhile to consider the priorities for Atlantic Canada in general as a starting point for understanding
specific concerns of Nova Scotians. The findings relating to the three broad priority areas as presented
by Muzychka (2007) are summarized below.

Delivery priorities

    •   Support for mental health service providers
    •   Establishment of competency-based standards for care in mental health
    •   Development of diverse models of service provision
    •   Development of forensic mental health services
    •   Increase services for individuals living with concurrent disorders
    •   Strengthen links between mental health and addictions

Access priorities

    •   Improve community access to mental health services
    •   Improve access to community based supports
    •   Improve equality of access to services
    •   Improve mental health services for rural populations
    •   Develop provincial/local coalitions to advocate to governments about mental health

     40    Mental Health and Addictions Strategy Project – June 24, 2011
    •   Improve collaboration within systems so that client voices are stronger and can be shared
    •   Improve access to specialized mental health services

Knowledge priorities

    •   Share available knowledge, expertise, best practices for mental health
    •   Improve research capacity
    •   Build expertise among mental health professionals
    •   Improve knowledge around and identify best practices
    •   Enhance knowledge around the value of early intervention, development of coping skills and
        prevention in mental health
    •   Enhance knowledge around issues related to young people

Key informant interviews conducted as part of the 2007 environmental scan of mental health in Atlantic
Canada identified a number of emerging issues for mental health systems. The aging population in
Atlantic Canada was most often cited as an important consideration for mental health service delivery
and governance. Other issues included coping with stigma, concurrent disorders clients, increased stress
due to work life balance issues and resettlement, impact of military deployments to Afghanistan,
complex cases that are linked to other social issues (such as housing, poverty, etc.), increased
competition for limited resources as need/demands for other services, increase alternative methods of
service delivery that use technology and decrease reliance on acute care services, changes in the nature
of drug abuse, health human resource issues and the need for training to ensure standards of care are
met.

More recently, the Atlantic Mental Health Summit was hosted in Halifax (October 27-29, 2010). The
Summit allowed many Atlantic Ministers and Deputy Ministers of Health to discuss regional
issues/challenges as a first step to promote collaboration and partnerships. Speakers and presentations
were both broad and varied and included such topics as the Mental Health Commission of Canada, child
and youth mental health, promotion and prevention of mental health/mental illness, mental health and
homelessness, mental health in the workplace and perspectives from mental health consumers.

A number of key issues and considerations relevant to the development of Nova Scotia’s Mental Health
Strategy emerged from discussions at the summit. As can be seen from the list of issues and
considerations below, many of the concerns today are reflective of those identified in 2007:

    •   The need for greater promotion and dissemination of promising practices for mental health
        services at the district level. Similarly, the need to identify and promote positive outcomes in
        mental health was noted;
    •   Considering the Department of Health’s Models of Care Initiative in building a Mental Health
        Strategy;
    •   The need for the Strategy to take a population health approach;
    •   The need for collaboration between many government departments;
    •   A need to develop clear direction for meeting needs of those with concurrent disorders;

     41    Mental Health and Addictions Strategy Project – June 24, 2011
    •   Poverty and housing are key issues that must be considered;
    •   Collaboration at the regional level to create economies of scale and consistency in the region;
    •   Stigma remains a major issue;
    •   Increased funding is needed;
    •   Accountability and transparency is necessary from the outset; and
    •   The involvement of consumers of mental health and addictions services is paramount.

Issues at the Provincial level
Unless otherwise noted much of the information in this subsection has been garnered by informal
interviews and communication between the project manager and diverse key informants who are
knowledgeable about the state of mental health and addictions services in Nova Scotia. As with other
information presented in this report, the list is by no means exhaustive, but provides insight into some
of the more pressing concerns, many of which were expressed repeatedly by a diverse group of
stakeholders including health care professionals, care providers, organizational leaders, and
representatives of government departments. It is expected that these issues will be further refined as
the data collection and public consultations progress over the course of developing a mental health and
addictions strategy.

Some of the key mental health issues in Nova Scotia have been identified as pertaining to:

    1. Access to services required including access to community-based services and interventions as
       well as ineffectiveness of multiple points of entry to the system;
    2. Coordination, collaboration, communication and knowledge sharing amongst interested
       departments, agencies, organizations, and stakeholder groups;
    3. Resources and funding issues;
    4. Data collection, accountability, evaluation and outcome measures;
    5. Service provider and family supports;
    6. Stigma;
    7. Population health issues (i.e., housing, employment, community support); and
    8. Needs of specific populations (i.e., youth, seniors, immigrant/minority women, and those living
       in rural areas).

Several of these issues are further supported by information gathered during document review. As such,
some of these issues are elaborated upon in the following sections that speak specifically to challenges
and underserved/hard to reach populations.

Identified Challenges for Addressing Mental Health Issues
A review of recent Department of Health and Wellness reports indicate that mental health service
providers struggle with a lack of community based resources resulting in over-reliance on acute care
services. Such care services may be inefficient or ineffective for addressing the needs of mental health
clients. The over-reliance on acute care services may make it appear as if by simply increasing the
number of beds dedicated to mental health Nova Scotia could solve many of its wait time and service
gap issues. While increasing beds may help alleviate some pressure on certain aspects of the mental

     42    Mental Health and Addictions Strategy Project – June 24, 2011
health system in some regions of the province, it is by no means a panacea for addressing all of the
challenges and issues of mental health in Nova Scotia. In fact, emergency and acute care hospital
services are intended to provide only emergency or crisis treatment in most DHAs, as “generally, clients
with mental health problems are better served outside an Emergency Department” (Ross, 2010, p. 74).
Dr. Ross’ report on emergency room care in Nova Scotia offers a number of recommendations from a
crisis management perspective on how mental health services could be improved in a manner that
alleviates over-reliance on emergency room services. In response to those recommendations, the
Department of Health and Wellness has released a “plan to improve emergency care” in the province,
which includes actions to be taken in response to recommendations. In response to recommendations
surrounding the treatment of individuals with mental illness the Department of Health and Wellness has
made it an objective to “provide people with mental illness emergency care better suited to their
needs.”

A lack of mental health human resources has been identified as an issue in Nova Scotia due to both a
lack of professionals and transportation issues across geographically broad regions. This is a problem
nationally, and Nova Scotians as well as Canadians in other provinces are faced with unacceptable wait
times for assessment and treatment of mental health issues, particularly those that arise as crisis or
emergency situations.

Overcoming stigma was identified as another challenge for mental health services. A report based on
findings of the Canadian Community Health Survey indicated that the two most frequently citied
reasons care was not received when it was felt it was needed were: 1) because the person preferred to
manage the mental health issue on their own, and 2) because they were afraid to ask for help or afraid
of what others would think if they went for therapy or counseling. Furthermore, according to one
source, approximately 50 percent of the complaints to the Human Right Commission involves mental
health issues.

Collaboration to ensure a seamless and efficient system was repeatedly cited as a challenge by key
stakeholders and the reports and documents reviewed. This challenge is well recognized amongst the
departments, organizations, agencies and individuals who structure mental health and addiction
services in Nova Scotia and there is some evidence that motions are being made to enhance
collaboration, communication and coordination to improve use of resources, provide seamless services,
to devolve silos within the health care system, and increase efficiency of the system as a whole.

Subject matter experts from the Atlantic Provinces identified some of the major gaps in mental health to
be funding, access, and knowledge (Muzychka, 2007). Funding issues centered around the need for
increased spending on community based services that are stable and will offer longer term solutions for
mental health clients. Access issues focused on the needs in rural and isolated areas and breaking down
barriers to services resulting from cultural, linguistic and ethnic diversity. Finally, knowledge issues
focused on the lack of knowledge around mental health issues for populations identified as posing
unique mental health concerns (e.g., Aboriginals, immigrants, women, African Canadians, youth and
seniors) and the need to develop competencies, standards and an evidence-based decision making
approach to mental health (Muzychka).

     43    Mental Health and Addictions Strategy Project – June 24, 2011
Underserved and hard to reach mental health clients
Studies of mental health populations have indicated that in the Atlantic region a number of populations
are at increased risk for mental health issues, including Aboriginal peoples, youth, elderly and caregivers
(Muzychka, 2007). In Nova Scotia there is a particular need to address youth between 16 -19 years of
age; this issue was identified by the auditor general’s report as a key priority for Nova Scotia. Youth in
general have been identified as a priority population for mental health services, and in response the IWK
has been working on developing its own mental health strategy for youth. As previously mentioned, the
IWK has recently completed consultations to assist in the development of a mental health and
addictions strategy for the health centre. The main issues identified by the IWK through consultation
include no single point of entry to the system, inpatient to outpatient transitions, wait times, budgeting,
gaps in services – for outclients in particular, data integrity issues and staff training.

Recent research has identified immigrants and racial minorities as potentially hard to reach and
vulnerable populations, due to challenges related to “language, culture, social isolation, along with the
resettlement stress faced by new immigrants” (Muzychka, p. 8). Immigrant women in particular have
been identified as at risk for unique mental health issues (Reitmanova & Gustafson, 2007). These
women tend to experience “limited social support, financial resources, and access to meaningful
employment coupled with managing multiple roles and meeting family needs” (Muzychka, 2007).
Similarly, studies of African Canadian communities in Nova Scotia, indicate that African Nova Scotian
women may be at risk for poor mental health due to stigma, few personal support systems, and
heightened responsibilities in the community leading to increased stress (Bernard, 2001; Etowa &
Keddy, 2005).

Muzychka (2007) also reported that a review of relevant literature indicated rural Canadians have
poorer health in general than those living in less remote areas; however, those living in rural areas were
also found to benefit from a heightened sense of belongingness, which may assist in coping with mental
health issues. That being said, a 2006 report from the Canadian Institute of Health Information found
that rural Canadian suicide rates are proportionately higher than urban rates due to higher rates of
poverty, unemployment, isolation coupled with decreased control over work and life issues and a
greater number of negative life experiences.

Atlantic Canada has a disproportionately high number of military personal. Serving in the military makes
one vulnerable to mental health issues for obvious reasons such as experienced physical and emotional
trauma, which may result in depression, anxiety issues, and Post Traumatic Stress Disorder (PTSD). The
families of those serving in military positions are also vulnerable to mental health issues as they cope
with the stress of a loved one working in a high risk environments, long periods of separation, and
disruption to family life. As such, the unique and specific needs of military personnel and their families
should be considered in developing a mental health strategy.




     44    Mental Health and Addictions Strategy Project – June 24, 2011
Current State of Addiction Services and Needs in Nova Scotia

General Governance
In Nova Scotia addiction services, like mental health services, are delivered at the district level and are
administered by the nine District Health Authorities (DHAs) either individually or as a combined service
across several districts; the IWK Health Centre provides services to children and youth throughout Nova
Scotia through its CHOICES Adolescent Treatment program .

The Department of Health and Wellness is responsible for the following aspects of providing addictions
services:

            1.   Defining core services;
            2.   Developing and reviewing standards and best practices for service delivery;
            3.   Developing provincial policies;
            4.   Monitoring and auditing of programs;
            5.   Consulting with service providers in the DHA’s/IWK; and
            6.   Facilitating provincial program development.

The DHAs/IWK are responsible for the operational delivery of addiction services, including direct staffing
for a range of services and supports, including prevention and treatment services. They are also
responsible for managing funding provided by government and requests for funding are directed to
DHAs/IWK and processed based on the DHA/IWK business plan. DHAs/IWK across Nova Scotia employ
more than 400 workers full time to provide continuum of services and supports to more than 13,000
clients through 42 community based offices. A diversity of professionals comprises the roster of
employees offering prevention and treatment for addictions in Nova Scotia. The following figures offer a
breakdown of staff by occupation and a breakdown of staff by DHA/IWK. The total budget for Addiction
Services in 2009-2010 was $39 m.




     45    Mental Health and Addictions Strategy Project – June 24, 2011
Figure 2 – Addictions Staffing by Occupation




The stated mission of Addiction Services in the province is “to promote the health of Nova Scotians by
providing a range of specialized addiction prevention, early identification, early intervention and
treatment services and supports to individuals, families and communities experiencing problems with
alcohol, other drugs and gambling.” The services and supports offered are client-centered in nature; the
treatments are based on client needs/assets, aim to minimize intrusiveness, are holistic and planning
and delivery is community-based. The services are comprehensive in that programming is available to
individuals at all stages of risk for addiction based on the model of health promotion and recovery
depicted in Figure 3.

Figure 3 – Continuum of Risk for Addictions




     46    Mental Health and Addictions Strategy Project – June 24, 2011
Prevention services are community-based and are appropriate for clients along the full continuum of
risk. The specific services offered in each DHA/IWK are evidence based and aim to promote and enhance
health while reducing/minimizing harms associated with substance use and gambling. Treatment
programs help individuals, families and communities with problems created by the harmful use of
alcohol, other drugs and gambling. A comprehensive set of standards are in place to guide program
implementation and evaluation.

Some of the programs and services provided through addiction services are:

    •   Withdrawal Management (Detox)              •   Methadone Maintenance Treatment
    •   Addiction Education Program                •   Enhanced Services for Rural Women and Youth
    •   Structured Treatment Program (21-          •   Addiction Services Statistical Information System
        day)                                           Technology (ASsist)
    •   Health Promotion, Prevention &             •   The Roster of Electronic Assessment Tools
        Community Education                            (TREAT)
    •   Driving While Impaired                     •   Community Based Services
    •   Nicotine Treatment Services                •   Problem Gambling Services
    •   CHOICES Adolescent Treatment


Demographics and Prevalence of Substance Use
The cost of substance abuse in Nova Scotia is $1.24 billion: tobacco accounts for $625.5 million, alcohol
accounts for $418.9 million, and illegal drug use $202.2 million (The Costs of Substance Abuse in Canada
2002 http:www.ccsa.ca). Costs accrue from injury while under the influence (including accidental injury,
suicide, homicide, and other forms of violence), chronic conditions resulting from use over extended
periods, as well as “the various social, health, criminal justice and lost productivity costs incurred by
these forms of problematic use (as well as the cost of the various measures taken to try to reduce or
avoid these costs)” (Gary Roberts & Associates, p. 13).

According to a 2005 report produced based on data collected using the Canadian Community Health
Survey cannabis use varies by DHA and ranges from a low in Cape Breton Health Authority to a high in
the Pictou County Health Authority Region. The graph below is reproduced from the 2005 report.




     47    Mental Health and Addictions Strategy Project – June 24, 2011
Figure 4 – Cannabis use across DHA’s in Nova Scotia



                                                  Varriations in cannabis use in Nova Scotia
                                                                 across DHA's
                                       20
   Percentage reporting cannabis use




                                       15
                                                                                               16.3                         15.8
                                                                  14.2     15.1
                                       10      13.2     12.3
                                                                                                                  10.7
                                        5

                                        0
                                              1- SSH   2 - SWH   3 - AVH 4 - CEHHA 5 - CHA   6 - PCHA 7 - GASHA 8 - CBHA     9-
                                                                                                                           CAPITAL

                                                                   DHA (data is not available for DHAs 5 & 7)


A 2008 report on best practices for addressing substance abuse issues presented data on alcohol and
other substance use in Nova Scotia at various life stages (Gary Roberts & Associates, 2008a). The
findings of that report are summarized in Table 4 below.




                          48                Mental Health and Addictions Strategy Project – June 24, 2011
Table 4 - Prevalence of Substance Use at Various Life Stages

 Life Stage                                         Prevalence in Nova Scotia
Prior to         •    Nationally 14% of women report drinking alcohol at some point during their
birth (use            pregnancy.
of               •    There is no data available on the use of alcohol during pregnancy amongst Nova
substances            Scotian expectant mothers; however, between 1999 and 2003 an estimated 403
by                    babies in Nova Scotia were affected by in-utero exposure to alcohol – an average of
expectant             81 babies annually.
mothers)         •    Of the babies affected by in-utero alcohol exposure it is estimated the percentage of
                      those with Fetal Alcohol Syndrome lies between 13% and 40% - which is an average of
                      32 babies per year born in Nova Scotia with lifelong effects of in-utero exposure to
                      alcohol.
                 •    No data were found on the use of other substances during pregnancy in Nova Scotia
                      or any other Canadian province.
Adolescents •         The most commonly used substances among adolescents in Nova schools are alcohol,
                      cannabis and tobacco.
                 •    The results of a student drug use survey indicate that in Nova Scotia rates of use for
                      all substances included for questioning on the survey decreased during the five year
                      period from 2002 – 2007, with the exception of MDMA (ecstasy).
                 •    The 2007 findings report that among students in grades 7 – 12 approximately 50%
                      reported consuming alcohol in the past year, a third reported using cannabis, and 1/6
                      reported smoking cigarettes; 8% reported using psilocybin or mescaline and 7%
                      reported using MDMA (up from 4.4% in 2002).
                 •    42% of Nova Scotian students reported no substance use in 2007, which represents a
                      40% increase in non-use from 2002 findings; however, non-use diminishes as grades
                      increase, particularly for alcohol and cannabis use. The findings show that in grade 7
                      prevalence of non-use was 88%, while only 20% of grade 12 students reported non-
                      use.
                 •    Findings of a 2006 study of 70 Halifax street youth (average age 19.82) found that 39%
                      of those interviewed considered their use of drugs and alcohol as problematic or as an
                      addiction and 17% identified themselves as regular users. Nine percent described
                      their drug use as occasional or rare and 31% would not discuss their use of alcohol
                      and other drugs. A significant proportion of the youth interviewed indicated they felt
                      depressed (n=19), had suicidal ideation or had made suicide attempts (n=13) or
                      reported other mental health issues.
                 •    Average age of first use reported by students was 12.9 years for alcohol and tobacco,
                      and 13.5 for cannabis.
                 •    No significant gender differences were reported for alcohol, tobacco and cannabis use
                      overall.
                 •    30% of students surveyed reported having 5 or more drinks at one time and/or being
                      drunk in the 30 days prior to taking the survey. 30% also reported drinking at least
                      monthly in the past year.
                 •    Hazardous behaviors:
                     → 14% of students with driver’s licenses operated a motor vehicle within one hour of
                          consuming alcohol; 23% did so after using cannabis. 19% reported being a
                          passenger in a vehicle operated by an impaired driver, with females reporting this

     49       Mental Health and Addictions Strategy Project – June 24, 2011
 Life Stage                                          Prevalence in Nova Scotia
                          more frequently than males.
                     → 1/3 students who has sex in the past year indicated they had engaged in unplanned
                          sex after using alcohol or other drugs on at least one occasion.
                     → While prevalence rates are similar over all, males were more likely to engage in
                          hazardous substance use. Males were more likely to use cannabis daily, drive under
                          the influence of alcohol or other drugs; however, as noted previously, females
                          were more likely to report being a passenger in a car with a driver who’d been
                          drinking and were as likely as their male counterparts to report instances of binge
                          drinking in the previous 30 days. Reports of harms associated with alcohol or drug
                          use was the same for males and females, though males were more likely to report
                          encounters with the police and damaging material objects.
Young            •    Rates of use remain high with 90% of respondents in this age group having reported
adults                drinking alcohol.
(19-29)          •    While not available provincially, usage of cannabis within the last year was 42% for
                      Canadians between 18 and 24; past year use of other illegal substances is much less
                      common. For example, 2.3% of Nova Scotians over 15 years of age report using an
                      illegal substance other than cannabis in the past year.
                 •    Findings of the Canadian Campus Survey of undergraduate students with an average
                      age of 22 years indicate that 91% of students in Atlantic Canadian Universities report
                      alcohol use in the past year; 37% report cannabis use and 11% reported using illegal
                      drugs other than cannabis.
                 •    The reported use of cannabis in the Atlantic Provinces increased from 27% to 37% in
                      the period from 1998 to 2004.
                 •    Hazardous use:
                      → Youth between 19 and 24 years of age were more likely to report drinking heavily
                           at least monthly than those over 30 years of age.
                      → Students in universities in the Atlantic region reported frequent drinking and
                           hazardous drinking at rates significantly higher than the national average.
                      → Although provincial statistics are unavailable, approximately 12% of Canadian
                           drivers between 20 and 24 years of age reported driving after using cannabis.
                      → Atlantic Canadian university students reported significantly higher rates of
                           harmful drinking and harms experienced than the national average.
                      → In the population of individuals aged 15 years of age and older men are more
                           likely to use alcohol in hazardous ways (e.g., men were four times more likely
                           than women to consider themselves high risk drinkers ).
Older            •    Prevalence of alcohol and most other substance use decreases with age.
adults           •    In Nova Scotia, those in the 60 years of age and older group are less likely to currently
                      drink (55.5%) than any of the other age groups.
                 •    There is a tendency to experience greater effects from alcohol and other substances
                      with age as a result of reduced tolerance, increased sensitivity, and interaction with
                      prescribed medications.
                 •    The use of benzodiazepines and other depressant medication use is higher in this age
                      group as compared to others.
                 •    A study of prescriptions to Nova Scotia seniors revealed that benzodiazepines had
                      been prescribed to approximately 25% of this population in 1995-1996, which is a
                      decrease from 1993-1994; however, the study revealed that many of the

    50        Mental Health and Addictions Strategy Project – June 24, 2011
 Life Stage                                      Prevalence in Nova Scotia
                     prescriptions were inappropriate and that women were more likely to have been
                     prescribed these medications than men.
                 •    A New Brunswick study indicated that less than 1% of individuals 55 years of age and
                     older had used cannabis in the past year; however, it is expected that an upward
                     trend in cannabis use may occur in Canada as an increasing number of “baby
                     boomers” who have greater exposure to and experience with recreational drug use
                     reach this age.

Demographics and Prevalence of Gambling
A series of four studies on the prevalence of gambling in Nova Scotia were conducted between 1993 and
2007. Over the years two types of data collection instruments have been used to collect information on
gambling behaviors. The first instrument is called the South Oaks Gambling Screen (SOGS) and was used
to collect data for the 1993 and 1996 rounds of surveying; the second instrument is called the Canadian
Problem Gambling Index (CPGI) and was used to collect data from the 2003 and 2007 samples. The
reports group respondents into four categories: non-gamblers, non-problem gamblers, at-risk for
problem gambling, and problem gamblers. According to the most recent findings, Nova Scotia has the
second lowest overall risk for any sort of risky or problem gambling; only PEI experienced lower risk
levels (Schrans & Schellinck, 2007). Furthermore, the percentage of people in the “at-risk” group was
significantly lower for Nova Scotia than for other provinces with the exception of PEI.

Based on 2007 findings, it is estimated that approximately 6.1 percent (47,000 people) were at some
level of risk for problem gambling and of those who showed any level of risk, about a third (19,000
people) scored at the problem level (Schrans & Schellinck, 2007). The same report found that there were
very few differences in gambling risk across the four regional areas identified for the province (Capital,
Eastern, Northern, and Western). One difference observed is a higher proportion of non-gamblers and a
higher proportion of non-problem gamblers in the Western service region (comprised of DHAs 1, 2, and
3). Those living in the eastern region of the province (DHAs 7 and 8) were more likely than the rest of
the province to have participated in some form of gambling over the past year (Schrans & Schellinck).

The table below is a partial re-creation of a table presented by Schrans & Schellinck (2007), which
summarizes the findings around gambling risk for key segments of the population and provides a profile
of gambling in the province based on the most recent administration of the CPGI.




     51       Mental Health and Addictions Strategy Project – June 24, 2011
Table 5 – Gambling risk for key population segments in Nova Scotia

                  Non-gamblers       Non-problem           At-risk           Problem   Total adults
Percent of            13%               80.9%               3.6%               2.4%       100%
adults in NS
Shared Service Area (Health Districts):
DHA 9 (Capital)         32.8%              39.5%            39.6%            42.6%       38.7%
DHAs 7&8                10.4%              17.7%            20.9%            13.1%       16.7%
(Eastern)
DHAs 4,5,& 6            23.6%               21.2%           19.8%            23.0%       21.5%
(Northern)
DHAs 1,2, & 3           33.1%               21.6%           19.8%            21.3%       23.0%
(Western)
Gender
Male                    46.9%              45.5%            57.1%            67.2%       46.6%
Female                  53.1%              54.5%            42.9%            32.8%       53.4%
Age (in years)
19-24                    4.6%               5.4%            12.1%            9.8%        5.6%
25-34                    8.0%               11.7%           14.3%            21.3%       11.6%
35-44                   12.9%               21.6%           28.6%            24.6%       20.8%
45-54                   15.0%              24.9%            22.0%            24.6%       23.5%
55-64                   21.8%               18.5%           13.2%            18.0%       18.8%
65+                     37.7%               17.8%            9.9%             1.6%       19.7%
Household income
<$30,000                20.2%              14.6%            19.8%            16.4%       15.6%
(Low)
$30-59,999              22.7%               28.0%           35.2%            34.4%       27.7%
(mid)
$60,000 +               19.6%              37.2%            26.4%            34.4%       34.4%
(high)
Don’t know/             37.4%               20.2%           18.7%            14.8%       22.3%
Refused to give
information on
income
Education
Less than               38.7%              21.8%            20.9%            29.5%       24.1%
Grade 12
High School             15.0%              20.0%            19.8%            19.7%       19.3%
Some                     9.5%               10.6%           15.4%            14.8%       10.7%
University/
College
University/             28.5%              41.3%            40.7%            31.1%       39.4%
College grad
Post graduate            8.3%               6.3%             3.3%             4.9%        6.4%
Bold Italicized text indicates significant differences among risk segments



     52    Mental Health and Addictions Strategy Project – June 24, 2011
Addictions Services Available
As noted, addiction services in Nova Scotia are governed at the provincial level by the Department of
Health and Wellness. The department offers many resources through their website including important
contact information for help lines to assist with problem gambling, smoking, alcohol and other drug use
for all residents of Nova Scotia. The website also provides information on accessing Addictions Services
Offices throughout the province, which are governed by the DHAs and IWK. Websites for most of the
DHAs/IWK do not provide a listing of specific programs offered; rather, the interested individual is given
some basic and general information on the types of services available and provided with contact
information to seek further assistance.

The website of the former Department of Health Promotion and Protection also provides access to
public service information publications/brochures, research publications/reports on key addictions
issues such as gambling, alcohol and other drug use, smoking cessation, and a drug education resource
for teachers interested in teaching students about drug addictions and substance use.

Issues and Challenges Impacting Addictions Services
There are a number of important contextual issues to consider when developing a strategy for
addressing addictions services issues in the province. There seem to be gaps in communication between
the various departments and stakeholder levels that impede the provision of a seamless service to
clients. This is particularly true for clients who present with concurrent disorders and require the use of
both mental health and addiction services.

Another key issue for addictions services pertains to the role of primary health in meeting the needs of
clients with addictions issues. A 2008 study commissioned by the Department of Health and Wellness
explored issues surrounding primary health care providers’ role in screening for and providing brief
intervention for addictions issues. Primary health care professionals such as family physicians, social
workers, and nurse practitioners are known to be the preferred choice of clients looking to discuss
substance issues (Research Power Incorporated, 2008); however, this report revealed a number of
systemic barriers to primary health care providers providing assessment and early/brief intervention.
Among other reasons, stigma associated with addictions, a lack of knowledge of services available or
lack of accessibility to services, feelings of inadequacy in diagnosing, lack of time and remuneration, lack
of assessment tools and knowledge, and viewing addictions as outside the realm of their position were
identified as systemic barriers to primary health care providers addressing addictions issues effectively.

Underserved and hard to reach addictions clients
Adolescent youth and young adults are considered to be unique and high risk populations for substance
abuse issues, as it is during these developmental stages that substance abuse is generally initiated and
when usage patterns tend to be most dangerous for the individual and others (Gary Roberts &
Associates, 2008a). A recent (Ring, 2007) review of the literature and report on youth withdrawal
management programs and strategies in Canada indicated that Nova Scotia did not have any youth-
oriented detoxification services.




     53    Mental Health and Addictions Strategy Project – June 24, 2011
“Youth who require withdrawal management services currently enter an adult detoxification service, or
receive treatment in an emergency room where they may (or may not) be linked up with subsequent
treatment options. Youth admissions to retention facilities for public intoxication and underage drinking
are also on the rise, indicating that law enforcement officers lack viable alternatives to arrests and
impromptu, short-term detoxification.” (Ring, p. 40).

Older populations are considered to be a high risk group for prescription substance abuse (Gary Roberts
& Associates, 2008a). Given reports that the Atlantic Canadian population is aging rapidly,
understanding the nature of and best treatments for prescription substance abuse should be a key
factor in strategizing about addiction services in Nova Scotia.

Research on gambling problems in Nova Scotia indicate although problem gambling affects all facets of
the population, adolescents, young adults, males, Aboriginal people, and those with lower levels of
education are at increased risk for gambling problems (Gary Roberts & Associates, 2008b). Men are
more prone to risk for gambling problems than women, with the risk for men being estimated at about 8
percent as compared to 4.4 percent for women. That being said, this translates into women making up
one third of individuals with gambling problems. To elaborate, “men and women in Nova Scotia were
equally likely to have gambled in the last year but for men, the overall risk for problem gambling was
almost two times greater… Men across the province have higher rates of those scoring At-Risk… or for
problem gambling” (Schrans & Schellinck, 2007, p. 53).

There is also an increased risk for gambling problems to emerge among young adults in the province.
The general trend indicates that risk for gambling problems declines with age; however, “gambling
problems were highest among those under 35 years of age but did not differ significantly among those
aged 35 to 64 years… only adults over 65 years of age had significantly lower rates of gambling
problems” (Schrans & Schellinck, p. 54). This trend of increased risk among young adults was first
identified in 2003, it will be interesting to observe whether this will result in higher rates of gambling
problems over time as these young people mature. To elaborate, the 2007 study indicated that problem
gambling rates were slightly but consistently higher in all age categories under 65 in 2007 as compared
to 2003 study findings:

 “In 2003 the prevalence of problem gambling was significantly lower for older adults over 55 years of
age (<55 yrs:2.1%-3.4% versus 55 yrs+:0.5% - 1.5%). Four years later this pattern was extended so that
only adults 65 years old or older have significantly lower problem gambling rates (<65 years:2.3% - 4.5%
versus 65 years + :0.2%)” (p.55).




     54    Mental Health and Addictions Strategy Project – June 24, 2011
Additional Mental Health and Addiction Services

Programs and Services of the Department of Community Services
The Department of Community Services (DCS) “is committed to a sustainable social service system that
promotes the independence, self-reliance, and security of the people we serve. This will be achieved
through excellence in service delivery, leadership and collaboration with our partners.” Many of the
individuals who access services through DCS (including children, youth and families) are also in need of
mental health and/or addictions services; as such, DCS will be a key player in the development of a
mental health and addictions strategy for the province.

DCS delivers a variety of social services to individuals in need – particularly children and youth,
individuals with disabilities, individuals receiving income assistance, and individuals in need of housing
assistance. The department is also responsible for licensing of facilities such as daycare centers,
residential child care facilities, and special care facilities. These services are provided by approximately
1,200 staff who work in 40 community services offices across the province.

One sub-group of DCS that will play a role in informing the development of a mental health and
addictions strategy for Nova Scotia is family and youth services division. Our Kids Are Worth It - The
Child and Youth Strategy (CAYS), which developed in response to recommendations of the Nunn
Commission, is one key program of this division, which attempts to improve services to children, youth
and families by collaborating with the four key government departments that will also play a role in
developing a mental health and addictions strategy: Health and Wellness, Education, Community
Services, and Justice. Providing community based services is a key part of the DCS service mandate in
general and CAYS aims to develop community based programs that bring services closer to children and
their families, thus increasing accessibility.

Some of the community based organizations supported by family and youth services include women’s
centers, transition houses, family resource programs, men’s intervention programs, boys and girls clubs,
youth service organizations and services geared toward natives through the Native Council of Nova
Scotia (see aboriginal services section below). These programs are funded through the family and youth
services division of DCS and delivered in communities across Nova Scotia. To access a service, interested
individuals can seek contact information for an appropriate centre via the DCS website or through
contact with a local office.

Three pilots funded under the CAYS were designed to directly impact mental health outcomes. The
leading government department for each of these pilots is the Department of Health and Wellness. The
pilots are:

    1. Family Help Expansion – This program is intended to improve access to effective treatment for
       mild to moderate mental health disorders in children and youth.
    2. Child Welfare Mental Health Service – This service is in place to enable more timely access for
       mental health services to children, youth, and families involved in child welfare services. Clients
       are: children and families involved in child welfare in the HRM.


     55    Mental Health and Addictions Strategy Project – June 24, 2011
    3. Follow Up Next Day Service – An afterhours emergency response service to stabilize crisis
       situations. The underlying theory of this program is that systematic collaboration between
       emergency response services and service providers can maximize the opportunity for best
       outcomes. The program provides next-day or immediate follow-up services to facilitate the
       stabilization of the family crisis and/or follow-up for short-term crisis management.
       Intervention services provided include: mediation; parent education and skill building; crisis
       intervention; next-day follow-up and system navigation. Clients are Central Region - HRM
       families and youth, under 16 years of age, experiencing severe parent/child conflict either on a
       first time or on-going basis. In some instances, the child remaining in home may not be viable
       option.

The Children, Youth and Families Division is also responsible for the provision of residential services for
children in care of the Minister of Community Services. Additionally, this division operates a secure care
facility called the Wood Street Centre in Truro. The average age of admission is between 12 – 18 years,
though younger children may be admitted depending on individual circumstances or need. The facility
has 20 beds and two living units as well as classrooms, indoor and outdoor recreational areas, and
clinical, administrative and meeting spaces. As many as 140 youth may be admitted to the centre in the
course of one year. The Centre provides a “secure treatment program for youth who are in the care of
the Minister of Community Services and are suffering from an emotional and/or behavioural disorder,
who require confinement in order to remedy or alleviate the disorder and who refuse or are unable to
consent to treatment.” This is the only centre of its kind east of Montreal and it operates 24/7.

Youth who enter the centre suffer from a wide range of very complex emotional and behavioural
challenges, which can be best treated through individualized treatment plans. Such plans are developed
and implemented by an interdisciplinary team composed of youth workers, social workers, teachers,
registered nurses, psychologists, a clinical director, unit supervisor, and coordinator of youth services in
consultation with psychiatrists and medical doctors. Treatment plans and progress are assessed weekly
by the team and the plan is adjusted accordingly. Residents are provided with structure through a daily
routine that includes education, recreation, chores and individual and group programming geared at skill
development and addressing specific needs and issues. The approach/plan is based on the cognitive
abilities, emotional maturity, and individual needs of the individual youth. “The overall goal of the
program is to assist youth to change in order to self manage and monitor their own behaviour and
maintain these changes in the community.”

Child, Youth and Family Services offers Early Intervention Programming (EIP) for families with preschool
aged children who have developmental disabilities or special needs. Referral for services can be made by
the child’s family or a community agency (e.g., doctor, speech pathologist) with the family’s consent.
There are currently 18 EIPs established in the province; a link to the Special Needs Information Service
(SNIS) on the DCS website provides detailed information for individuals seeking such services by offering
a searchable listing of all special needs services available in the province and links to additional
resources.



     56    Mental Health and Addictions Strategy Project – June 24, 2011
Finally, the DCS supports a number of community-based programs that represent a broad range of
holistic supports to children, youth and families. For example, DCS supports after-school programming
for at risk youth, parenting support for families, breakfast and lunch programs, family resource centers,
transitional housing, and a multitude of supports throughout the province based on community need.
Although these programs may not have a specific mandate to deliver mental health or addictions
services, the programming they provide include such services as family-support, mentoring, advocacy,
crisis counseling, capacity building and shelter assistance, which address areas that may be considered
underlying or contributing factors associated with mental health and addictions issues. As such, these
programs have the ability to support mental wellness and aid in mitigating the effects of mental illness
and addictions for clients of the programs.

Challenges and issues identified by DCS
In a recent report presenting the results of an assessment of the Child Welfare Steering Committee
aimed at improving services for children and families, a key issue was placement services for children
presenting complex needs (Nova Scotia Department of Community Services, 2006).

“The project found that a small but still appreciable number of children and youth enter care with very
complex and challenging needs, including behavioural and emotional disturbances, serious mental health
and medical problems, and significant long term disabilities. Many residential providers reported that
interventions that were successful in the past are no longer as effective in managing children’s
dangerous behaviour, as expressed through high risk taking, self harm and aggression towards others.”
(p. 26).

As such, there were difficulties associated with placing children with such complex needs into
appropriate care as many of the service providers will not accept children who have had incidents of
dangerous behavior. Furthermore, according to this report, occupancy rates and discharge data seemed
to indicate that many residential programs have human resource needs in that staff are not adequately
trained or prepared to meet the needs of children that present dangerous behaviors.

The report also reviewed professional literature and best practices and found:

“Most children in care require assistance with:

    •   Cognitive difficulties, arising from chronic deprivation and /or chaotic experiences during their
        early years, when critical brain development and organization occurs;

    •   Emotional difficulties, such as depression and impairments in daily functioning, arising from
        insecure attachments, chronic stress, loss, trauma from abuse; and

    •   Behavioural difficulties such as chaotic behaviour, poor impulse control, inappropriate sexual
        behaviour, and aggression, arising from abuse and neglect.” (p. 28)

Among other service principles, the Child Welfare Steering Committee indicated a need to increase
collaboration and joint service delivery with other departments including health, particularly mental
health, justice and education. CAYS has produced two annual reports that summarizes the progress
being made on improving services for children, youth and families. The most recent report (2009)


     57    Mental Health and Addictions Strategy Project – June 24, 2011
indicates a new governance structure and approach that connects four government departments
(Health and Wellness, Justice, Education, and Community Services, which are referred to as the ‘social
prosperity departments’) as well as other stakeholders as a means of collaborating to provide better
service to children, youth and families in need. CAYS also recognizes ongoing collaborations at the
community level that are both formal and informal in nature.

The new governance structure also allows for “continuous feedback so that [they] can assess progress
and make changes” (p.2) as the strategy moves forward. Related to the need for continuous feedback,
this report focuses heavily on the need for evaluation. The first CAYS annual report indicated the value
and need for rigorous evaluative processes to ensure the strategy uses its resources effectively and
efficiently. Commissioner Nunn advised that evaluation is important for ensuring an improved system of
services and CAYS has embraced this recommendation as is evidenced by the following quote: “The child
and youth strategy emphasizes the importance of evaluation before moving forward too quickly. Too
much is at stake to rush ahead without carefully assessing what we are doing now and testing new
approaches and programs before rolling them out province-wide” (p. 5).

Programs and Services of the Department of Education
The Department of Education is another key stakeholder in developing a Mental Health Strategy for
Nova Scotia as students and youth are identified as at risk populations for being underserved in terms of
mental health and addictions services. The Department of Education currently collaborates with the
Department of Health and Wellness and the Department of Community Services to offer a number of
programs/initiatives aimed at meeting mental health and addictions needs of students and their
families.

The Association of Psychologists of Nova Scotia (APNS) offers a link on their website to a document
about psychologists in schools in Nova Scotia. They note that psychologists offer a unique perspective
and have the training and tools to evaluate behavior, diagnose learning disorders and mental illness, and
implement sound treatment plans for students. Psychologists are also able to assist in responding to
crisis and emergency situations in schools. The role of school psychologists are quite broad and varies
depending on perceived need as described by APNS:

“The way psychologists work can vary from school to school or board to board according to policies and
practices adopted in each school and/or board… Canadian epidemiology research over the past two
decades has consistently shown that approximately 18% - 20 % of children will qualify for one or more
psychiatric diagnoses during their time in school. These diagnoses range from AD/HD to depression and
conduct disorder. These are mental health issues with major impacts on a child’s or adolescent’s
behaviour in school and serious impacts on learning. At the same time, learning difficulties can affect a
student’s social, emotional, and behavioural adjustment, and impact negatively on the child’s mental
health. In a primary mental health care model, the school-based psychologist can provide direct provision
on first-contact services and a coordination function to ensure continuity and ease of movement when
longer term or specialized services are required.”




     58    Mental Health and Addictions Strategy Project – June 24, 2011
The Department of Education offers health promotion and prevention programming through the Nova
Scotia Health Promoting Schools Program. The program takes a broad approach to health promotion
that includes the physical, social, spiritual, mental and emotional well-being of all students and staff.
The program includes collaboration with all eight school boards, First Nations school boards, DHAs/IWK
and other community agencies and representatives.

A Child and Youth Strategy initiative that is implemented by the Department of Education in
collaboration with the Department of Community Services is the Schools Plus Program. The program
envisions the use of schools as a convenient hub where government and other services can be delivered
to children and their families. The premise is that using the school as a delivery centre facilitates
collaboration between professionals who deliver services to children, youth and families as the service is
delivered in a welcoming, familiar and accessible place, as opposed to various services being offered in
different locations throughout the region. In schools where a Schools Plus Program is in place, a variety
of services such as social work, justice, health, mental health and addictions are delivered at the school
site. Each region of the province has an advisory board composed of representatives from key
departments (e.g., Health and Wellness, Education, Justice, Community Services) who work together to
identify needs, gaps in service, as well as resources and solutions to meet needs and fill gaps. Each
advisory board has a Schools Plus Facilitator whose job it is to liaise between the community
(professionals, service providers, etc.) and the school to coordinate, advocate for and expand services
for students and families.

Another initiative that was piloted in Nova Scotia schools in 2001-2002 is the Healthy Mind, Healthy
Body program. The program is a curriculum supplement intended to be delivered by teachers in the
classroom with a short term goal of enhancing the public dissemination of mental health materials and a
long term goal of reducing stigma around mental health issues and mental illness and encouraging
individuals to seek early interventions. It was first piloted with students in grades 1-7 in a Francophone
community and evaluation findings of the pilot indicated that the program met its defined outcomes;
children’s knowledge and attitudes of such mental health issues as anxiety, depression and ADHD were
improved (Lauria-Horner, Kutcher, & Brooks, 2004). The extent to which the curriculum is currently
being implemented in Nova Scotia schools will be explored further through consultation with
stakeholders.

In October 2010, a mental health high school curriculum guide was developed by the Canadian Mental
Health Association and its partners. This program was developed primarily by two researchers at
Dalhousie University. The prevalence of its use by Nova Scotia’s school boards will be assessed through
the consultation process. Key informants have reported the existence of a pilot program to develop
teachers’ abilities to identify mental illness in children, as well as assist in navigation of the mental
health system for families so they can obtain the best services.

Programs and Services of the Department of Justice
Nova Scotia’s provincial Department of Justice also has an important role to play in the development of
a Mental Health Strategy for the province. Much criminal activity is linked to a lack of mental health, or
serious mental illness and addictions issues. For example, crimes may be committed in the interest of

     59    Mental Health and Addictions Strategy Project – June 24, 2011
feeding a substance or gambling addiction; mental illnesses such as depression, anxiety, or personality
disorders may result in individuals taking extreme criminal actions due to altered perceptions, and/or an
inability to cope with life stressors and complicated situations. The remainder of this section discusses
the role of the Department of Justice and its initiatives relevant to mental health and addictions services
in the province.

The Nunn commission has had an important impact on the youth criminal justice system in Nova Scotia
and the Department of Justice’s role in mental health initiatives across the province. The result of the
Nunn commission was a report entitled Spiraling out of control: Lessons learned from a boy in trouble,
which provided a detailed analysis of the actions of a youth who had a long history with the youth
criminal justice system that led to the untimely death of Theresa McEvoy. The report made 34
recommendations in three areas:

    1. Youth justice administration and accountability;
    2. Youth crime legislation; and
    3. Prevention of youth crime in the province.

As a result of the report the government of Nova Scotia has implemented the Child and Youth Strategy
which aims to support Nova Scotia’s children and youth by providing the right programs and services at
the right time to ensure that youth can reach their full potential. This is relevant to the present report
because children and youth have been noted as special populations in need of both mental health and
addictions services. As noted elsewhere in this report, the Department of Justice was identified as a key
collaborator in developing and implementing a child and youth strategy and has a keen interest in
provision of mental health and addictions services as part of its youth crime prevention initiatives.

Judge Anne Derrick was appointed in October 2008 to look into the death of Howard Hyde, who died
while in custody at the Central Nova Scotia Correctional Facility in November 2007. Judge Derrick was
asked to make recommendations on:

    •   The date, time and place of death;
    •   Circumstances under which the death occurred;
    •   Cause of death; and
    •   Manner of death; and any other matter which may arise from the inquiry.

The inquiry began in February of 2009 and concluded in June 2010. Once the report has been reviewed,
the province will issue a response to The Report of the Fatality Inquiry into the Death of Howard Hyde.
These recommendations are currently being studied by the Department of Health and Wellness.

The Department of Justice has developed the Mental Health Court Program for individuals who have
“been charged with a criminal offence and have a mental disorder but are competent to participate in
the criminal justice system.” The stated mission of the Mental Health Court is “to enhance public safety
and improve the mental health and quality of life of persons with mental disorders, which have
contributed to their involvement in the criminal justice system, by assisting them to access treatment
and service.” For a case to be considered for Mental Health Court the accused must have a mental

     60    Mental Health and Addictions Strategy Project – June 24, 2011
disorder as defined by the court, and they must indicate they are accepting responsibility for their
actions. “Court participants, in accepting responsibility for their actions which lead to criminal offending
agree to adhere to recommended treatment and supports, enabling them to make positive changes in
their lives.”

The Mental Health Court goals are:

    1. To reduce the involvement of persons with mental disorders in the criminal justice system
       thereby addressing public safety concerns;
    2. Improving health outcomes and quality of life of persons living with mental disorders by
       increasing their capacity to successfully live in the community; and
    3. Facilitating access to mental health and social services/supports by connecting, or reconnecting,
       participants with needed services/supports.

There are a number of underlying principles which guide the Mental Health Court including:

    1.   Safety and security;
    2.   timeliness of assessments;
    3.   Confidentiality;
    4.   Informed decision-making and consent for participants;
    5.   Accessibility to appropriate services and collaboration amongst service providers;
    6.   A recovery focused approach;
    7.   Education and support to address needs of participants and families; and
    8.   Evaluation of processes and outcomes to ensure appropriate service is provided to participants.

Mental Health and Addictions Programs and Services for Aboriginal Populations
As noted previously, Aboriginal persons present unique mental health and addictions needs and thus
require specialized programs and services to meet these needs. The Aboriginal population of Nova
Scotia is composed of both on and off-reserve residents. There are 13 First Nations Communities with
populations ranging from less than 300 to nearly 4,000.

The Native Council of Nova Scotia (NCNS) is an organization that represents Aboriginal persons living off-
reserve in Nova Scotia. A sub-component of the NCNS is the Native Social Counseling Agency, whose
goal is to assist off-reserve Aboriginal clients facing social problems and conditions, with confidential
support referral services. The agency’s website identifies a number of ways in which it attempts to meet
this goal:

    •    By providing case finding, assessment and documentation of concerns, issues and
         problems;
    •    By providing case documentation, identification of support agencies and confidential file
         management;
    •    By providing case intervention with the client when accessing and working with the
         different social agencies;



     61     Mental Health and Addictions Strategy Project – June 24, 2011
    •   By providing case referral to identified support resources, maintaining contact with
        resource community support agencies, professionals and others working towards
        developing networking for client referrals; and
    •   By providing case follow-up to ensure that clients receive appropriate services and are
        working towards resolution of social problems and concerns.

A search of individual Mi'kmaq First Nation websites shed some light on the types of mental health
services offered to Aboriginal persons living on reserves in Nova Scotia. The most comprehensive
information was available from the Eskasoni First Nation website; information for other First Nation
Communities will be sought through consultation and interviews.

In April 2010 Eskasoni Mental Health Board joined all mental health services under a single department.
The Department f Mental Health and Social Work aims to offer services that are culturally appropriate,
timely, and accessible to the people of Eskasoni and other First Nation communities in the Unama’ki
(Cape Breton) Region and province-wide. Services include group therapies, liaison services, outreach and
“special projects.” Counseling is available for individuals, couples and families for a wide range of issues
including grief, crisis intervention, sexual abuse/assault, suicide intervention/prevention, family break-
up, trauma, residential school issues, depression, family violence, addictions, anger management, stress
management, parenting skills, home based behaviour management for families and children. The
community also hosts a crisis and referral centre that is accessible to all 13 First Nation Communities in
Nova Scotia.

Demographic information is available from results of the First Nations Regional Longitudinal Health
Survey (RHS). The survey was designed by first nations people for gathering health information from on-
reserve Aboriginals in Canada. The survey collects information on determinants of health including
mental health, community wellness, access to health care, smoking, alcohol, drugs, and suicide over
multiple phases. The RHS was first launched in 1997 and the most recent round of data is currently
being analyzed and will be available to inform the development of a Mental Health Strategy for Nova
Scotia. According to the Union of Nova Scotia Indians’ website “The RHS is taking place in ten regions
across Canada using a standardized set of questions asked across the country; however, separate from
the National survey, there is a Nova Scotia regional survey that asks specific questions pertinent to First
Nations in Nova Scotia. The Nova Scotia regional survey was designed by the Nova Scotia RHS Advisory
Committee, which is comprised of Health Directors and Health Practitioners from several Mi’kmaq
Communities throughout Nova Scotia. The purpose of the Nova Scotia regional survey is to reveal Nova
Scotia RHS specific data.” When available this information is expected to be very helpful in identifying
the specific needs of Aboriginal populations in Nova Scotia.

Information on addictions services available for Aboriginal populations was gathered from the
Confederacy of Mainland Mi’kmaq (CMM) websites and the Native Alcohol and Drug Abuse Counseling
Association of Nova Scotia. The CMM is a Tribal Council incorporated in 1986 as a not-for-profit
organization comprised of six first nation member communities: Annapolis Valley, Bear River, Glooscap,
Millbrook, Pictou Landing and Paqtnkek. The governing body of the CMM is made up of the Chiefs of the
six member communities. The CMM has its own Health Program that offers health promotion and


     62    Mental Health and Addictions Strategy Project – June 24, 2011
education services to its member communities. The program takes a holistic approach to health as it
takes physical, mental, spiritual and environmental factors into consideration. Two relevant sub-
components of the CMM Health Program are the First Nations and Inuit Tobacco Control Strategy and
the Fetal Alcohol Spectrum Disorder (FASD) Initiative. The Tobacco Control Strategy offers education
and workshops on the dangers of deciding to start smoking as well as cessation programming to
encourage those who smoke to quit. The FASD initiative increases awareness and knowledge about
FASD including its effects and prevalence in First Nations communities. Workshops focus on what FASD
is, prevention, and addressing special needs of community members with FASD.

The Native Alcohol and Drug Abuse Counseling Association of Nova Scotia (NADACA) has been in
operation for nearly four decades; it started in 1971 as component of the Union of Nova Scotia Indians
and has since surfaced as a leader in the development and implementation of addictions services to the
Aboriginal population in Atlantic Canada. With counselors on every Nova Scotian reserve and two full
treatment facilities NADACA has been a key player in addressing the addictions needs of Aboriginals in
the Maritimes.

Mi’Kmaw Lodge Treatment Centre is located on the provinces largest reserve (Eskasoni) and houses
fifteen residents at a time for a 35-day initial stages treatment cycle. Eagles’ Nest is located in
Shubenacadie and where the Mi’Kmaw Lodge 35-day program ends the Eagles Nest program begins.
“The Recovery House offers a transitional program to help recovering individuals to continue in a
"substance free" state beyond the first stages of treatment. At this point the individual is usually
confused, scared and filled with uncertainty. The basic goal of the program, therefore, is to eradicate
these psychological barriers and replace them with more positive values so the individual can easily
adapt to a new lifestyle.”

NADACA also offers a number of maintenance and prevention programs as summarized below:

Counseling – There are 15 counselors employed to cover the 13 Bands in Nova Scotia to meet individual,
group and family counseling needs.

Referral – After initial contact and counseling, clients are referred to appropriate resources as required
(e.g., detox, treatment, doctor, hospital, mental health unit).

Follow-up – Community Addiction Counselors provide follow-up services following exit from the
treatment program to assist the client in maintaining a lifestyle that is free of addictive materials.

After-care – As part of a total recovery program, NADACA introduces clients to new lifestyle and
prevention options such as: A.A., job training and job counseling, and career upgrading with a goal of
permanently breaking the addiction cycle.

Diversion Program – NADACA offers clients positive substitutes to addictive substances including
recreational activities, fitness and cultural programming.

Education – Alcohol and drug education programs are now a part of the curriculum in most Federal and
Band schools.

     63    Mental Health and Addictions Strategy Project – June 24, 2011
Education Workshops – Aimed primarily at youth, these workshops are conducted by the Community
Addiction Counselor in an attempt to prevent drug abuse before it starts.

Public Information Program – Conducting community workshops, distributing information packages,
publishing "Different Paths," and publishing articles in the "Mi'kmaq-Maliseet Nations News,"
community newsletters, and local media highlight this program.

Solvent Abuse Program – The primary objective of this program is to design, organize, and implement a
range of community based services and activities to combat solvent abuse. Such services are delivered
to all 13 Bands and include prevention/community development services; early intervention services;
community based treatment and assessment services; case management and outpatient treatment
services; and community aftercare programs.

Peer Counselors – To encourage youth to focus their energies away from alcohol and drugs and towards
a positive contribution to the community, this program gets youth involved in the development of
special projects in the community.

Education Day Program – Operating in two-week cycles, the Education Day Program serves as a pre-
treatment educational program. In an informal workshop setting, the program uses lectures, films, and
group discussion to give a clear illustration of the negative effects of alcohol and drugs. This program is
mobile and can be taken to any Reserve in the Province.

DWI Program – Operating as a part of the Education Day Program, the DWI Program allows native
offenders to fulfill the requirements of the courts to regain their right to drive. This two day program,
which is run at periodic intervals, accepts clients as ordered by the courts or the Provincial Department
of Transportation.

Educational Youth Program – The Educational Youth Program is an extension of the Day Program that
operates in the school system. The program was developed in response to a request from school
officials, the program has been provided in schools with an important message regarding solvent and
drug abuse. NADACA sees solvent abuse and drug experimentation as one of the main concerns for
youth and children. The program offers workshops as needed; the primary focus is with the grade four
to nine students, but special video presentations for the younger students are also provided.

Post-Traumatic Stress Crisis Team –This team has been created in response to a high number of suicides
on Atlantic Canada reserves and aims to help families cope with suicides and other high stress
situations. The crisis team, made up of native social workers, suicide prevention counselors, and alcohol
and drug counselors, is very visible in the community. The team not only offers grief counseling, but also
plays a major role in helping communities develop prevention programs.




     64    Mental Health and Addictions Strategy Project – June 24, 2011
Current Initiatives
Since the initial creation of this background paper multiple initiatives have been announced that will
support Mental Health and Addictions services in Nova Scotia. See announcements listed below:

    •   Provincial plan to improve care in custody: Response to Hyde inquiry
            o Health and Wellness Minister Maureen MacDonald and Justice Minister Ross Landry
                released government's response, May 12 2011, to Judge Anne Derrick's report into the
                death of Howard Hyde. The Building Bridges: Improving Care in Custody for People
                Living with Mental Illness plan outlines about 90 actions to address Ms. Derrick's
                recommendations. The report can be found at www.gov.ns.ca

    •   Accountability Report on Emergency Departments
           o On May 19, 2011, Health Minister Maureen MacDonald released, the second annual
               Accountability Report on Emergency Departments. The report is available at
               www.gov.ns.ca/health

    •   First Collaborative Emergency Center
             o The province's first Collaborative Emergency Centre, announced by Premier Darrell
                 Dexter and Minister of Health and Wellness Maureen MacDonald, on April 6, 2011 will
                 be located in Parrsboro, NS. The center plans to open in July 2011. For more
                 information on the province's Better Care Sooner plan, visit
                 www.gov.ns.ca/health/bettercaresooner


    •   Provincial Autism Spectrum Disorder Action Plan
            o On April 12, 2011, Premier Darrell Dexter announced the provincial Autism Spectrum
                Disorder Plan. The plan focuses on five main themes including intervention services for
                families with pre-school children, supports for school-aged children, supports for adults,
                training to raise skills and awareness, and partnerships to support programming and
                services. The view the report in full visit www.gov.ns.ca/health.


Community Programs and NGOs Providing Mental Health and Addictions Services
As noted previously, there exist a great number of community-based programs and non-government
organizations that provide services aimed directly at assisting those with mental health or addictions
issues, or which address issues that are associated and further complicate mental health and addiction
problems. Many of these programs are supported by the Department of Community Services as
discussed above. Although this document is intended to describe publicly funded services,
acknowledgement of the significant role of these organizations must be noted.




     65    Mental Health and Addictions Strategy Project – June 24, 2011
Promising Practices and Recommendations
A number of reports have provided recommendations and identified promising practices for mental
health and addictions services in Nova Scotia. We use the term ‘promising practices’ because many of
the approaches suggested – particularly for addictions services – require further monitoring and
research before their utility is proven. In analyzing the various recommendations and identified
promising practices a number of themes emerged in terms of mental health and addictions services
requiring attention. For the interested reader, a complete list of recommendations and best practices
reviewed in this analysis are appended to the present document.

Thematic Assessment of Mental Health Recommendations
An analysis of the recommendations from several recent reports on mental health, including a recent
auditor general’s report, revealed several key areas of mental health in need of attention. Broadly, the
main areas of consideration identified are issues pertaining to:

    1. The varying needs of clients/consumers including outclients, inclients and those in need of
       specialty services (e.g., eating disorders, forensic mental health);
    2. Monitoring, evaluation and research needs;
    3. Community-based services;
    4. Mental health human resources;
    5. Governance; and
    6. Awareness.

Each of these is discussed in greater detail below.

Client needs
Several recommendations were geared specifically at improving the mental health system’s ability to
respond to the needs of various client groups with diverse care needs. This includes recommendations
pertaining to emergency and first response services for individuals experiencing a mental health crisis,
wait times associated with various client groups and specialized services, and the efficiency of mental
health service procedures and processes. The ability of the system to provide comprehensive, consistent
and seamless services can also be considered in this regard. The needs of mental health service
consumers change regularly; because a single individual may present with more than one mental health
issue, or the main issue of concern may change from time to time, it is important that the procedure for
accessing a variety of services be clear and consistent if the system is to provide comprehensive and
seamless services to all its users.

Monitoring, evaluation and research
Recommendations pertaining to monitoring, evaluation and research were many and varied. The
auditor general’s report in particular made many recommendations that centered on standards,
planning and evaluation needs of mental health services in Nova Scotia. This report noted that while
Nova Scotia has standards for mental health in place (unlike other provinces in Canada) the province’s
efforts in data collection and analysis pertaining to these standards as well as other aspects of the
system need some work. The recommendations point to the need for a consistent and compatible

     66    Mental Health and Addictions Strategy Project – June 24, 2011
provincial system of data collection and analysis that would allow easy assessment of strengths and
weaknesses of various regions as well as comparisons across districts.

Community-based resources
Some recommendations spoke to the need for increased community resources to alleviate over-reliance
on acute care services and emergency rooms for mental health issues that are more effectively
addressed by community programs. Recommendations were also made about housing needs for those
with mental health issues that limit their ability to secure or maintain a place of residence in the
community. Recommendations were also made pertaining to the need for consumers of mental health
services to become increasingly involved in decision making and policy development. Because specific
mental health needs may vary across regions of the province, a focus on community level interventions
and services would allow regions to specialize its mental health services such that the system is
responsive to the needs of the residents in various regions.

Mental health human resources
Recommendations spoke to the need to improve human resources in mental health – particularly the
need for more psychologists and professionals dealing with specialty diagnoses and populations.
Included in this broad category are recommendations pertaining to the needs of hard to reach,
underserved or difficult to serve populations including youth, women, aboriginals, and those with
concurrent diagnoses. Wait times are also important to consider in relation to human resources as
enhancing the resources available to the mental health system would also reduce wait times associated
with getting access to services.

Governance
Governance recommendations centered around collaboration between stakeholders, responsibilities
and roles of governing bodies, shared service regions and seamlessness of service. As noted, mental
health was previously governed by the Department of Health while the Department of Health
Promotion and Protection was responsible for decision making regarding addictions services. Several
local reports, as well as national and international research findings, seem to support the idea of mental
health and addictions being melded together into a single service. The recent integration of the two
departments may address some of these issues.

To elaborate, many individuals who are consumers of addictions services are also consumers of mental
health services. There is a correlation between addictions and mental health issues; such individuals are
commonly referred to as concurrent diagnosis clients. Recommendations have been made to improve
the manner in which such clients are handled to ensure that these individuals who are arguably in the
greatest need for services do not slip through cracks within and between the mental health and
addictions systems.

Awareness
Awareness recommendations include those advising increased marketing and campaigning about
mental health issues (i.e., costs, needs, stigma) to the population in general, but also include
recommendations aimed at improving easy access to services. For example, information about how to


     67    Mental Health and Addictions Strategy Project – June 24, 2011
enter the mental health system and get help should be made more readily available in a number of
forms (e.g., print, online, word of mouth) and locations (e.g., schools, doctor’s offices, community
program venues, linked to a variety of community websites, television).

Thematic Assessment of Addictions Recommendations
Two reports provided recommendations for addictions services – one pertaining to substance abuse and
one pertaining to gambling. The main themes emerging from an analysis of these reports are:

    1.   Collaboration and governance;
    2.   Communication;
    3.   Approaches to addiction treatment;
    4.   Research and evaluation needs; and
    5.   Hard to reach/serve populations.

The following sub sections of this report elaborate on each of the themes.

Collaboration and governance
As with mental health services, some recommendations focused on a need for collaboration in offering
mental health and addictions services to those meeting criteria for services from both systems.
Recommendations were also made around the need to involve primary care health service providers
and define the role of these key players in addressing addictions. Governments have the ability to
influence the cost and availability of some substances (e.g., tobacco, alcohol, government sanctions
gambling venues) and therefore should consider their role in controlling such substances in the
province.

Communication
Several recommendations pertained to the need to develop marketing campaigns that would target
specific sectors of the population and create awareness about addictions/gambling issues, getting help
for oneself or others and preventing addictions from occurring to begin with. Communication should be
population specific and cater to the learning needs, particular types of issues and styles of the target
audience for it to be effective. Communications (i.e., advertisements) intended to promote the use of
controlled substances such as tobacco and alcohol and government sanctioned gambling (e.g., lotteries
and casinos) should be assessed and regulated.

Approach to addictions treatment
Issues related to a harm reduction (as opposed to abstinence) model of addiction control are discussed,
as addiction services are based on a harm reduction model in Nova Scotia. Various new methods and
services such as community based and in-home interventions, harm reduction initiatives (e.g., needle
exchange, heroine prescriptions), innovative and unconventional advertising and communication
methods and gambling controls such as monitored players cards were all made reference to in the
reports. The role of primary care physicians in addictions services was also an issue.




     68    Mental Health and Addictions Strategy Project – June 24, 2011
Research, monitoring and evaluation
Research and evaluation was particularly relevant to gambling addictions. The need for consistent
monitoring, reporting and evaluation is of course relevant to substance abuse, however, the need for
research on gambling addictions and issues was deemed particularly important as the available local
research this topic is modest in comparison to that which is available for other types of addictions
needs. Research is needed to identify the predictive variables of gambling addictions as well as basic
patterns of behaviour and epidemiology generally observed in individuals with gambling addictions.
Impacts of interventions and models of care are also in need of assessment.

Hard to reach and serve populations
Hard to serve and underserved populations were noted by the recommendations of these reports.
Aboriginals, youth, those with lower socio-economic status, concurrent diagnosis clients, and homeless
individuals are all worth considering as having unique needs for addictions services. In addition to socio-
economic status, other determinants of health are suggested to be of importance in understanding both
gambling and substance addictions.




     69    Mental Health and Addictions Strategy Project – June 24, 2011
                      Documents Reviewed in Preparation of this Document

Atlantic Canada and Nova Scotia Specific Reports and Articles

Addiction Services Alcohol Task Group. Province of Nova Scotia Department of Health Promotion and
        Protection, Addiction Services. (2007).Changing the culture of alcohol use in Nova Scotia
        Retrieved from: http://www.gov.ns.ca/hpp/publications/Alcohol_Strategy.pdf
Bland, R, and Dufton, B. Province of Nova Scotia Department of Health, (2000). Mental health: a time
        for action Retrieved from:
        http://www.gov.ns.ca/health/reports/pubs/Mental_Health_Review%20.pdf
Community Action on Homelessness (2009). Health and Homelessness in Halifax: A report on the health
     status of Halifax’s homeless population. Halifax, NS. Retrieved from:
     http://www.cahhalifax.org/DOCS/HealthReport2009.pdf

Focal Research Consultants. Nova Scotia Health Promotion and Protection, (2008). 2008 Nova Scotia
      adolescent gambling exploratory research: Identification of risk and gambling harms among
      youth (13-18 years) Retrieved from:
      http://www.gov.ns.ca/hpp/publications/2008_Adolescent_Gambling_Report.pdf

Focal Research. Province of Nova Scotia Department of Health, (1998). Nova Scotia video lottery
     players’ survey 1997/98: Highlights. Retrieved from:
     http://www.gov.ns.ca/hpp/publications/highlites.pdf

Focal Research. Province of Nova Scotia Department of Health, (1998). 1997/98 Nova Scotia video
      lottery players’ survey. Retrieved from:
      http://www.gov.ns.ca/hpp/publications/VL_players_survey_9798.pdf

Gary Roberts and Associates. Province of Nova Scotia Department of Health Promotion and Protection,
       (2008 a). Best practices for preventing substance use problems in Nova Scotia. Halifax, Nova
       Scotia: Retrieved from:
       http://www.gov.ns.ca/hpp/publications/pg/Best_Practices_Substance_Abuse.pdf
Gary Roberts and Associates. Province of Nova Scotia Department of Health Promotion and Protection,
       (2008 b). Best advice for preventing gambling problems in Nova Scotia. Retrieved from:
       http://www.gov.ns.ca/hpp/publications/pg/Best_Advice_Gambling_Problems.pdf
Graham, L. Province of Nova Scotia Department of Health Promotion and Protection, Addiction
      Services. (2007). Canadian addiction survey - ns report: prevalence of alcohol & ilicit drug use
      and related harms in Nova Scotia. Retrieved from:
      http://www.gov.ns.ca/hpp/publications/CAS-2007.pdf

Graham, L. Province of Nova Scotia Department of Health Promotion and Protection, Addiction
     Services (2005). Alcohol indicators report: Executive summary: A framework of alcohol indicators
     describing the consumption of use, patterns of use, and alcohol-related harms in Nova Scotia.
     Retrieved from: http://www.gov.ns.ca/hpp/publications/ExecSumFINAL.pdf

Keefe, J., Hawkins, G., & Fancey, P.; Healthy Balance Research Program (2006).A portrait of unpaid care
        in Nova Scotia. Retrieved from:http://www.caregiversns.org/userfiles/PortraitUnpaidCare.pdf.



     70    Mental Health and Addictions Strategy Project – June 24, 2011
Muzychka, M. Public Health Agency of Canada, Atlantic Regional Office. (2007). An environmental scan
      of mental health and mental illness in Atlantic Canada Halifax, NS: Retrieved from
      http://www.phac-
      aspc.gc.ca/canada/regions/atlantic/Publications/Mental_Health_Scan/Mental_Health_Scan_2
      007.pdf
Horner, L., Kutcher, S., & Brooks, S. (2004). The feasibility of a mental health curriculum in elementary
       school. Canadian Journal of Psychiatry, 49 (3), 208-211.
Nova Scotia Department of Community Services, Strategy for Children and Youth (2008). Our Kids Are
       Worth It: Our first year. Retrieved from:
       http://www.gov.ns.ca/coms/department/documents/First_year-Our_kids_are_worth_it.pdf
Nova Scotia Department of Community Services, Strategy for Children and Youth (2009). Our Kids Are
       Worth It: Our second year. Retrieved from:
       http://www.gov.ns.ca/coms/department/documents/Our_Kids_Are_Worth_It-
       second_year.pdf
Nova Scotia Department of Community Services, Child Welfare Steering committee (2006). Improving
       services for children and families. Retrieved from:
       http://www.gov.ns.ca/coms/department/documents/Child_Welfare_Committee_Report.pdf
Nova Scotia Department of Health (2004). Canadian Community Health Survey Topics: Mental health
       service providers in Nova Scotia – from CCHS 1.2. Retrieved from:
       http://www.gov.ns.ca/health/reports/pubs/cchs_mh_service_providers.pdf
Nova Scotia Health. Province of Nova Scotia Department of Health, (2005). Cannabis use and alcohol
       dependence in Nova Scotia Retrieved from:
       http://www.gov.ns.ca/health/reports/pubs/CCHS_Cannabis_Alcohol.pdf
Nunn, D.M. (2006). Province of Nova Scotia, Department of Justice, Report of the Nunn Commission of
       Inquiry. Spiraling out of control: Lessons learned from a boy in trouble. Retrieved from:
       http://www.gov.ns.ca/just/nunn_commission/_docs/Report_Nunn_Final.pdf
Office of the Auditor General. Province of Nova Scotia, (2010). Office of the auditor general 2010
        (report on performance audits) Retrieved from: http://www.oag-
        ns.ca/june2010/full%20report.pdf

Poulin, C, & Elliott, D. Province of Nova Scotia - Dalhousie University, Communications Nova Scotia.
      (2007). Student drug use survey in the Atlantic provinces. Retrieved from:
      http://www.gov.ns.ca/hpp/publications/Atl_Tech_Report_2007.pdf

Provincial Mental Health Steering Committee. Province of Nova Scotia Department of Health (2004). Our
        peace of mind: Mental health promotion, prevention and advocacy strategy and framework for
        Nova Scotia. Retrieved from: http://www.gov.ns.ca/health/mhs/pubs/Our_Peace_Mind_ISBN0-
        88871-887.pdf
Research Power Incorporated. Province of Nova Scotia Department of Health Promotion and
       Protection, (2008). Environmental scan exploring systemic barriers for screening and brief
       intervention for primary health care providers. Halifax, NS: Retrieved from:
       http://www.gov.ns.ca/hpp/publications/Systemic_Barriers_to_Brief_Intervention.pdf



     71    Mental Health and Addictions Strategy Project – June 24, 2011
Research Power Incorporated. Province of Nova Scotia Department of Health Promotion and
       Protection, (2008). Environmental scan exploring systemic barriers for screening and brief
       intervention for universal and targeted prevention by health care providers: LITERATURE
       REVIEW. Halifax, NS: Retrieved from:
       http://www.gov.ns.ca/hpp/publications/Brief_Intervention_Lit_Review.pdf
Research Power Incorporated. Province of Nova Scotia Department of Health Promotion and
       Protection, (2008). Fetal Alcohol Spectrum Disorder [FASD]: Stakeholder Forum - Towards a
       coordinated approach to FASD in Nova Scotia. Halifax, NS: Retrieved from:
       http://www.gov.ns.ca/hpp/publications/fasd-2008.pdf
Research Power Incorporated. Province of Nova Scotia Department of Health Promotion and
       Protection, (2009). Literature review: Effects of alcohol advertising on alcohol consumption
       among youth. Halifax, NS: Retrieved from:
       http://www.gov.ns.ca/hpp/publications/Alcohol_Advertising_Literature_Review.pdf
Ring, T.L. Province of Nova Scotia Department of Health Promotion and Protection, (2007). Youth
         withdrawal management in the Canadian context: A literature review and report on youth-
         specific withdrawal management programs and strategies in Canada. Halifax, NS.
Ross, J. Province of Nova Scotia Department of Health (2010). The patient journey through emergency
         care in Nova Scotia: A prescription for new medicine. Retrieved from:
         http://www.gov.ns.ca/health/emergencycarereport/docs/Dr-Ross-The-Patient-Journey-
         Through-Emergency-Care-in-Nova-Scotia.pdf
Schrans, T., & Schellinck, T. Province of Nova Scotia Department of Health Promotion and Protection,
       (2007). 2007 Nova Scotia adult gambling prevalence study. Retrieved from:
       http://www.gov.ns.ca/hpp/publications/Adult_Gambling_Report.pdf
Schrans, T., Schellinck, T., McDonald, K. Province of Nova Scotia Department of Health Promotion and
       Protection, (2008). Culture of Alcohol Use in Nova Scotia: HIGHLIGHT REPORT. Retrieved from:
       http://www.gov.ns.ca/hpp/publications/2008-Alcohol-Benchmark-Report.pdf
The Core Programs Standards Working Group of the Mental Health Steering Committee. Province of
       Nova Scotia Department of Health (2009). Standards for mental health services in NS.
       Retrieved from:
       http://www.gov.ns.ca/health/mhs/pubs/Standards_Mental_Health_Services_2009.pdf



National Reports
Jacobs, P., Dewa, C., Lesage, A., Vasiliadis, H., Escober, C., Mulvale, G., and Yim, R. (2010). The Mental
        Health Commission of Canada, Institute of Health Economics. The cost of mental health and
        substance abuse services in Canada: A report to the Mental Health Commission of Canada.
        Retrieved from:
        http://www.ihe.ca/documents/Cost%20of%20Mental%20Health%20Services%20in%20Canada
        %20Report%20June%202010.pdf
Kirby, M.J.L., and Keon, W.J. (2006). The Senate of Canada, The Standing Senate Committee on Social
        Affairs, Science and Technology. Out of the shadows at last: Transforming mental health, mental
        illness and addiction services in Canada. Retrieved from:


     72    Mental Health and Addictions Strategy Project – June 24, 2011
       http://www.mentalhealthcommission.ca/SiteCollectionDocuments/boarddocs/15507_MHCC_E
       N_final.pdf
Kirby, M.J.L., Howlett, M., and Chodos, H. (2009). Mental Health Commission of Canada. Toward
        recovery & well being: A framework for a mental health strategy for Canada. Retrieved from:
       Part 1: http://www.parl.gc.ca/39/1/parlbus/commbus/senate/com-e/soci-e/rep-
       e/pdf/rep02may06part1-e.pdf
       Part 2: http://www.parl.gc.ca/39/1/parlbus/commbus/senate/com-e/soci-e/rep-
       e/pdf/rep02may06part2-e.pdf




    73    Mental Health and Addictions Strategy Project – June 24, 2011
                                   Appendix A – Research Methods
Meeting the information needs required to develop a mental health and addictions strategy
necessitates that several methods of data collection and analysis be employed. This section provides
detailed information on the methodological process used by NSHRF in gathering, analyzing and
presenting information to the committee.

Document Review
The initial documents reviewed for this portion of the project were accessed through searching websites
for Nova Scotia government’s department of health and health promotion and protection, district health
authority websites, and based on reference lists of the initial reports reviewed. Prior to searching for
documents, the NSHRF research team identified what they considered to be important issues to be
explored in developing a mental health and addictions strategy for Nova Scotians. The MHSAC will be
consulted for their expertise in identifying additional issues of consideration as a means of further
informing the review of relevant documents to capture a snapshot of the current mental health and
addictions system or services and needs.

Literature Review/Annotated Bibliography
A review of the extant literature on issues related to mental health and addictions governance and
delivery will provide the MHSAC with sound evidence to inform the development of a mental health
strategy in Nova Scotia. NSHRF will search the relevant literature and unpublished documents (e.g.,
consultant reports, policy statements) to identify documents useful for informing decision making
around mental health and addictions. NSHRF will develop an annotated bibliography, which will
subsequently be provided to a consultant who will assemble the acquired evidence into a
comprehensive literature review.

 Information on the credibility of the source from which the document was obtained will be provided. If
deemed necessary, cautions and/or limitations regarding the content of the literature review will be
noted. The literature review will be broad in terms of scope and will cover local, national and
international publications; Literature that pertains to mental health and addictions in general, as well as
literature that pertains specifically to mental health and addictions issues, governance and delivery in
Nova Scotia will be reviewed.

The literature search will be conducted by electronically searching commonly used interdisciplinary
academic research databases (e.g., Scholars Portal, Web of Knowledge, Web of Science, JSTOR);
databases specific to the field of mental health and addictions research (e.g., Medline, PubMed,
Embase, Cochrane, EconLit, and PsychInfo); databases specific to Public Policy research (e.g., Canadian
Research Index); and the world wide web. Reference lists of obtained articles and documents will also
be consulted during literature search.

Key Informant Interviews
Semi-structured phone interviews will be conducted with subject matter experts (SMEs) from Nova
Scotia and from others jurisdictions. The representatives of other jurisdictions will be identified through
interviews with the SMEs in Nova Scotia, consultation with the MHSAC, website search, and based on

     74    Mental Health and Addictions Strategy Project – June 24, 2011
recommendations of other interview participants (snowball sampling). Interview scheduling will be
carried out by the project manager, who will also conduct the interviews. Interview guides will be
developed by NSHRF with approval from the MHSAC. Interview participants should be sent an electronic
version of the interview guide in advance of the scheduled interview to allow them the opportunity to
think about their responses and prepare for the interview. This practice generally results in deep, rich
data and greater accuracy as participants are able to review relevant notes or documents that might
refresh their memory of events that took place some time ago.

Semi-structured interviews require the interviewer to be very attentive and to think on their feet in
order to ensure useful data is collected. It is imperative that the interviewer be free to focus intently on
the interviewee’s response to each interview question to ensure appropriate follow up questions are
posed and any needed clarifications are requested. Thus, interviews should be audio recorded for the
purposes of ensuring accuracy and utility of the data.

Interview findings will be analyzed by at least two members of the research team. Multiple analysts are
suggested to enhance the accuracy and rigor of findings. Raw interview data (i.e., raw interview notes
and transcriptions) will be kept secure and confidential by NSHRF. This ensures greater confidentiality
and anonymity for participants.

Public Consultation
A comprehensive consultation process will be implemented to ensure that the knowledge and input of
stakeholders is included. Consultation with key stakeholders within the mental health and addiction
services system will include representatives of a number of government departments, DHAs, IWK,
community organizations, arms-length agencies (i.e. Nova Scotia Gaming Foundation) and other
identified stakeholders. The MHSAC will participate in its own consultation to ensure that members are
able to provide their expert input to the mental health strategy development. In addition to consultation
with the committee, five half-day consultations will be held across the province to ensure adequate
opportunities for engagement with the public, clients, and consumers of mental health and addictions
services. Finally, a web-based consultation for those not able to participate in person will be made
available through the NSHRF’s Website.

As the consultation process continues, the NSHRF will respond to additional meetings/consultations as
required. The NSHRF is committed to ensuring both the public/stakeholder consultations, and ultimate
Mental Health Strategy, are robust and inclusive. There will be targeted consultations for specific
interest groups and populations and the process will be iterative so that individuals can have their say
and their feedback is built upon and shared with future consultations in an aggregate manner.

The final consultation is the Mental Health Summit which will present the consultation findings to date.
This will provide senior leaders in the field with an opportunity to provide systems-level advice to inform
the Mental Health and Addictions Strategy Project. Consultation is tentatively scheduled to take place
from December 2010-May 2011.




     75    Mental Health and Addictions Strategy Project – June 24, 2011
Web and Data Base Search
Much of the information useful for meeting the information needs of the committee will be acquired
through searching websites related to mental health and addictions governance and services in Nova
Scotia and other jurisdictions. As such web searches will be conducted by the research team as required
over the course of the project.

NSHRF will work with the MHSAC to identify provincial and national databases useful for collecting
demographic information on the current state of mental health and addictions services in the province
and Canada-wide.




     76    Mental Health and Addictions Strategy Project – June 24, 2011
     Appendix B – Summary of Legislative Acts Relevant to Mental Health and Addictions


LEGISLATION APPLICABLE TO MENTAL HEALTH IN NOVA SCOTIA:

Preliminary research suggests there are no legislative initiatives applicable to these issues.

What follows is a preliminary list of Acts which may be applicable, and two which are not in current
use. Information was collected via website search and personal communication between the project
manager and key informants.

Involuntary Psychiatric Treatment Act (“IPTA”)

The Act may be found at http://nslegislature.ca/legc/bills/59th_1st/3rd_read/b203.htm

The regulations may be found at http://www.gov.ns.ca/just/regulations/regs/IPTtreatmentregs.htm

The Involuntary Psychiatric Treatment Act (IPTA) was enacted in July 2007. One of the significant
developments in the Act is the creation of Community Treatment Orders (CTOs) and expanded powers
of intervention. Formerly if a person was threatening or likely to cause serious harm to themselves or
others, they were subject to an involuntary admission. The new Act has expanded the definition to
include people who are likely to suffer serious physical impairment or serious mental deterioration or
both if they are not admitted into hospital or monitored under a Community Treatment Order. Adult
Protection clients have a permanent, irreversible condition that affects their capacity to protect
themselves from assessed risks- what distinguishes them from mental health consumers is that their
capacity to protect themselves from risk will not return with medication or treatment.

The 3 criteria utilized to determine whether a person is an adult in need of protection are:

Living at significant risk
Does not have the physical or mental capacity to protect him/herself from the significant risk
Has a permanent, irreversible condition that affects his ability to protect himself from the assessed
significant risk

The Provincial Website indicates;

“In October 2005, the Nova Scotia House of Assembly passed the Involuntary Psychiatric
Treatment Act. The Act is about making sure that those who are unable to make treatment
decisions, due to their severe mental illness, receive the appropriate treatment. It became law on
July 3, 2007.

The Involuntary Psychiatric Treatment Act is appropriate when someone with a mental disorder:

             • as a result of the mental disorder
                  o is threatening or attempting to be or has recently been a danger to him/herself or
                       others; or
                   o   is likely to suffer serious physical impairment or serious mental deterioration or
                       both;
     77    Mental Health and Addictions Strategy Project – June 24, 2011
            •   lacks capacity to make decisions about his or her care,
            •   requires care in a psychiatric facility and cannot be admitted voluntarily.

There are changes to the responsibilities of mental health and other health professionals,
hospital administrators, and law enforcement under the legislation.”

This Legislation does not allow forcing someone into a treatment program. It allows psychiatrists to
admit someone to hospital involuntarily if they meet certain criteria. Consent for treatment must be
obtained from the patient's substitute decision maker (part of the criteria for involuntary admission is
“as a result of the mental disorder, the person does not have the capacity to make admission and
treatment decisions" ).

Children Family Services Act

The Act may be found at http://nslegislature.ca/legc/statutes/childfam.htm

Amendments to the Act in 2005 may be found at
http://nslegislature.ca/legc/bills/59th_1st/1st_read/b202.htm

The Regulations may be found at http://www.gov.ns.ca/just/regulations/regs/cfsregs.htm

Adult Protection Act

The Act may be found at http://nslegislature.ca/legc/statutes/adultpro.htm

Per section 2 of the Act, the purpose of the Act is stated as;

“…a means whereby adults who lack the ability to care and fend adequately for themselves can be
protected from abuse and neglect by providing them with access to services which will enhance their
ability to care and fend for themselves or which will protect them from abuse or neglect”

Section 12 states the overriding principle of the legislation:

“the welfare of the adult in need of protection is the paramount consideration.”

The Nova Scotia Adult Protection Act, enacted in 1985, was administered by the Department of
Community Services until March 31, 2000, when responsibility for its administration was transferred to
the Minister of Health by Order in Council.

Incompetent Persons Act

The Act may be found at http://nslegislature.ca/legc/statutes/incompet.htm

The Act requires proof of two things to have a guardian appointed; namely

•   that the adult has a mental "infirmity" and
•   that as a result of this "infirmity", the adult is "incapable of managing their affairs".


     78    Mental Health and Addictions Strategy Project – June 24, 2011
The procedure for appointing a guardian involves two court applications:

1. An application to the court seeking a date for the actual guardianship hearing.
2. The actual court hearing in which the court will decide whether or not to grant a guardianship order.

Adult Protection will not normally get involved with clients who meet IPTA criteria. They also focus on
clients who have permanent and irreversible conditions and who are at risk.

Personal Directives Act

The Act may be found at http://nslegislature.ca/legc/bills/60th_2nd/3rd_read/b163.htm

The Regulations may be found at http://www.gov.ns.ca/just/regulations/regs/ptpersdirref.HTM

The Department of Justice describe the Act as follows;

“The Department of Justice is collaborating with the Department of Health, the Department of
Community Services and Office of the Public Trustee to implement the Personal Directives Act.

This Act enables Nova Scotians to document their wishes regarding what personal care decisions
are made for them, and/or who makes them, in the event that they are incapacitated and are
unable to make these decisions themselves. Personal care decisions include those related to
health care, nutrition, hydration, shelter, residence, clothing, hygiene, safety, comfort,
recreation, social activities and support services.

The Act enables three things:

1. It allows individuals to appoint a substitute decision maker to make a personal care decision on their
   behalf should they become incapable of making the decision.
2. It allows individuals to set out instructions or general principles about what or how personal care
   decisions should be made when they are unable to make the decisions themselves.
3. It provides for a hierarchy of statutory substitute decision makers to make decisions regarding health
   care, placement in a continuing care home and home care where the individual has not prepared a
   personal directive in relation to those decisions. The Public Trustee is listed as the last substitute
   decision maker in the hierarchy.

Planning for the future is important. You should think about who you want to make decisions for
you if you are not capable (temporarily or permanently) to make them yourself.”

Ombudsman Act

The Act may be found at http://nslegislature.ca/legc/statutes/ombudsm.htm

The Regulations may be found at http://www.gov.ns.ca/just/regulations/regs/ombdesig.htm

The Ombudsman investigates complaints from individuals who feel they have been treated unfairly by
those who provide provincial or municipal government services.


     79    Mental Health and Addictions Strategy Project – June 24, 2011
Human Rights Act

The Act may be found at http://nslegislature.ca/legc/statutes/humanrt.htm

The NSHR website indicates;

“Human rights are based on the belief that every person is important and valuable and deserves to be
treated with respect. When the United Nations adopted the Universal Declaration of Human Rights in
1948, it declared that all human beings are "free and equal in dignity and rights".

Some human rights are fundamental freedoms like the right to freedom of speech or freedom of religion.
Other human rights protect people from unfair treatment because of personal qualities into which they
were born; these are sometimes called "anti-discrimination" rights.

The Nova Scotia Human Rights Commission is a trusted leader, protector and promoter of human rights.
Through sharing its knowledge and engaging Nova Scotians in discussion on human rights issues, the
NSHRC is committed to affirming and promoting human rights.”

The website also indicates;

“The Nova Scotia Human Rights Commission works to protect people from discrimination in this province
in accordance with the Human Rights Act. It also protects people from retaliation against them for filing
a complaint with the commission or co-operating with a human rights investigation.

The commission's central office is located in Halifax, with regional offices in Sydney and Digby to serve
people across the province.”

Health Act

The Act may be found at http://nslegislature.ca/legc/statutes/health.htm

This Act deals predominantly with Cancer and Drug Dependency.

Note, while the Act speaks to the “Minister’s Substance Abuse Advisory Board”, this has never been
established.

Protection for Persons in Care Act

The Act may be found at http://nslegislature.ca/legc/bills/59th_1st/3rd_read/b110.htm

The Provincial website indicates;

“The Protection for Persons in Care Act came into force on October 1, 2007. This Act is an extra
safe guard for clients and residents 16 years of age and older who are receiving care from Nova
Scotia's hospitals, residential care facilities, nursing homes, homes for the aged or disabled


     80      Mental Health and Addictions Strategy Project – June 24, 2011
persons under the Homes for Special Care Act, or group homes or residential centres under the
Children and Family Services Act.

Under this Act, abuse may be physical, psychological, emotional, sexual, neglect, theft or medical
abuse. It requires health facility administrators and service providers (includes staff and
volunteers) to promptly report all allegations or instances of abuse.”

Mental Health Act

The Act may be found at http://nslegislature.ca/legc/bills/59th_1st/1st_read/b109.htm

 A Provincial press release dated September 29,2004 indicated
(http://www.gov.ns.ca/news/details.asp?id=20040929002 )

“The new Mental Health Act updates 30-year-old legislation, reflects current practices and is consistent
with other mental health legislation across the country.

"This is another building block in improving the mental health of Nova Scotians," said Mr. MacIsaac.
"Most people have the ability to make their own treatment decisions, however, this act speaks
for those who cannot."

The proposed act will provide the legal framework for mental health professionals to intervene on behalf
of individuals who lack the capacity to determine their need for treatment. It will ensure that this is done
without unduly interfering with civil rights and liberties.

The bill introduces substitute decision-makers who will be involved in all treatment decisions when
necessary. In addition, leave certificates are being introduced. These certificates allow clients to be
gradually reintroduced into the community, helping them reintegrate in a planned way.

Also included in the act are community treatment orders (CTOs), for those who have a history of
repeated involuntary admissions. CTOs will be available where assertive treatment teams are in place.
The CTOs will help people maintain wellness and stability and assist in early detection of recurring illness,
thereby resulting in shorter hospital stays.”

Note that this Act was never passed. It was the unsuccessful precursor to IPTA.

Health Authorities Act

The Act may be found at http://nslegislature.ca/legc/bills/58th_1st/3rd_read/b034.htm

The Regulations may be found at http://www.gov.ns.ca/just/regulations/regs/hadistgn.htm

A Health Canada website (http://www.hc-sc.gc.ca/hcs-sss/pubs/cha-lcs/2006-cha-lcs-ar-ra/ns-eng.php )




     81    Mental Health and Addictions Strategy Project – June 24, 2011
“The Health Authorities Act, Chapter 6 of the Acts of 2000, established the province's nine District Health
Authorities (DHAs) and their community-based supports, Community Health Boards (CHBs). DHAs are
responsible for governing, planning, managing, delivering and monitoring health services within each
district and for providing planning support to the CHBs. Services delivered by the DHAs include acute and
tertiary care, mental health, and addictions.

The province's thirty-seven CHBs develop community health plans with primary health care and health
promotion as their foundation. DHAs draw two thirds of their board nominations from CHBs. Their
community health plans are part of the DHAs annual business planning process. In addition to the nine
DHAs, the IWK Health Centre continues to have separate board, administrative and service delivery
structures.

The Department of Health is responsible for setting the strategic direction and standards for health
services, ensuring availability of quality health care, monitoring, evaluating and reporting on
performance and outcomes and funding health services. The Department of Health is directly responsible
for physician and pharmaceutical services, emergency health, continuing care, and many other insured
and publicly funded health programs and services.

Under the Health Authorities Act, the DHAs are required to provide the Minister of Health with monthly
and quarterly financial statements and audited year-end financial statements. They are also required to
submit annual reports, which provide updates on implementing DHA business plans. These provisions
ensure greater financial accountability. The sections of the Health Authorities Act related to financial
reporting and business planning came into effect on April 1, 2001.”

Hospitals Act

The Act may be found at http://nslegislature.ca/legc/statutes/hosptls.htm

Personal Health Information Act

The Provincial website indicates;

“For the past several years the Department of Health has been working with health sector
partners on initiatives related to the protection and use of personal health information. As part
of the evolution of standards, policy and law on these issues, the Department has developed a
Personal Health Information Act for the province.

The Personal Health Information Act (Bill 64) was introduced in the House of Assembly on
November 4th, 2009. The Bill did not go forward to Second Reading when the House rose, but the
Department intends to proceed with the Bill in the Fall 2010 session.”

Health Protection Act

The Act may be found at www.gov.ns.ca/legisalture/legc



     82    Mental Health and Addictions Strategy Project – June 24, 2011
As noted in a Health Canada website (http://www.hc-sc.gc.ca/hcs-sss/pubs/cha-lcs/2006-cha-lcs-ar-
ra/ns-eng.php )

“In February 2006, the Government of Nova Scotia created a new Department of Health Promotion and
Protection that brought together two areas from the Department of Health, the Office of the Chief
Medical Officer of Health and Public Health branch, with Nova Scotia Health Promotion.”

The Health Protection Act is legislation designed to protect the health of the public. It came into effect
November 1, 2005. The Provincial website also indicates; “provides the legal framework enabling public
health officials to protect the public and to prevent, detect, manage, and contain health threats without
unduly interfering with civil rights and liberties deals with notifiable diseases or conditions,
communicable diseases, health hazards, public health emergencies and food safety lays out the duties
and responsibilities of public health officials and of the Ministers responsible “

The Act may or may not have any direct relevance to mental illness or addictions.

Mental Health Court Act

The Act may be found at http://nslegislature.ca/legc/bills/60th_2nd/1st_read/b021.htm

Section 4 of the legislation indicates;

”4 (1) The Mental Health Court shall facilitate appropriate proceedings and hearings to identify those
persons who suffer from a mental disorder or intellectual disability that makes them unfit to stand trial
or not criminally responsible for their actions.

(2) For those accused who suffer from a mental disorder or intellectual disability but to whom subsection
(1) does not apply, the Mental Health Court shall facilitate appropriate proceedings and hearings to

(a) effectively deal with accused persons who have a mental disorder or intellectual disability within the
provisions of the Criminal Code (Canada);

(b) provide accused persons who have a mental disorder or intellectual disability with effective treatment
that involves the least restrictive intervention that is reasonable in the circumstances in the least
restrictive environment that is appropriate;

(c) protect the rights of the public, the rights of accused persons and the integrity of the criminal justice
system; and

(d) hold accused persons who are found to be guilty of offences accountable for their behavior.”

Inebriates Guardianship Act, & Narcotic Drug Addict Act

These acts may be found at;

http://nslegislature.ca/legc//statutes/inebriat.htm and


     83    Mental Health and Addictions Strategy Project – June 24, 2011
http://nslegislature.ca/legc/statutes/narcotic.htm

Preliminary research suggests these Acts are no longer in active use.




     84    Mental Health and Addictions Strategy Project – June 24, 2011

				
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