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By Giri Puligandla, Executive Director, Canadian Mental Health Association – Edmonton Region
The Canadian Mental Health Association – Edmonton Region and United Way of the Alberta Capital Region are co-leading the development of a new community mental health strategy for Edmonton in partnership with the City of Edmonton. The strategy will involve a broad range of informants to guide a deep analysis of the current state and design a blueprint for a future system of community care for mental health and interrelated issues. A new governance structure will be established with people with lived experience and other affected community members in the lead. This structure will steward implementation of the strategy while ensuring accountability of service providers and funders to turn the blueprint into a reality.
People are confused and frustrated trying to get mental health supports in the community.
We hear the same stories today from people struggling to get help for their mental health struggles that we have heard for decades. People still do not know where to start the process or what the right thing to do is in a crisis. Many of the ideas that come to mind – like calling 911, going to the hospital, talking to a doctor, or seeing a psychologist – are hit-and-miss at best, harmful at worst, and are too often cause for people to stop trying. For example, some doctors may not adequately understand mental health issues, emergency personnel may not respond appropriately, and hospitals may be too backlogged. Even if by luck or privilege some initial help is received, getting to the next step may take someone right back to square one. A report by the Health Quality Council of Alberta (HQCA, 2020) examining family experiences seeking care for children and youth, captured this snakes-and-ladders view of mental health services:
“It is an absolute nightmare, because you just finish with one service, and you’ve gone through this whole rigmarole. It’s taken months . . . and then you have to start all over again, because there’s no connect between the two services.” (HQCA, 2020, p. 11)
When someone is dealing with the weight of crisis or worry, the last thing anyone needs is a confusing and uncertain array of options, let alone getting an inappropriate response or being dropped from one service to the next. What people need is a clear view of their next steps and a reliable pathway that makes it easy to access support for the first time and get more or less support as needed afterwards.
There is no coordinated system for community-based supports to address mental health, addiction, or related issues.
So why don’t we already have this in place? It is certainly not due to lack of investment or strategic planning: over the years, there have been many strategies, initiatives, and plans accompanied by significant funding to address known gaps and increase services in community. However, these investments are usually not rolled out in a systematic way – there are many funders that each make their own resourcing decisions, and the organizations that receive the funding typically deliver these services on their own. Any coordination among funders or service providers is sporadic or limited. Most funding for key services is usually time-limited and constrained to less than the full amount needed to deliver the service reliably and sustainably. As evident in a Canadian Mental Health Association report (CMHA, 2022) on how the pandemic impacted community mental health organizations across Canada, our problems in Edmonton seem to resonate with other communities nationally:
“It’s these little pockets of money that are never enough to actually provide the service that is expected…you’re reporting on it, and then you’re starting the next round of proposals again because the year is up. And it’s very challenging to retain the quality employees in these programs when you can never promise them stability and it’s really difficult to be strategic in your work and to make plans when you’re year to year…” (CMHA, 2022, p. 17)
What has become evident from talking to many community leaders is that as much as we like to think we have a “mental health system”, there is no system to speak of. A system implies intentional design and thoughtfulness about interconnections among its parts. We couldn’t randomize the way services are distributed throughout the community any better if we meant to do it.
What complicates matters further is that the top-down view of governments, funders, and organizations shape issues through specific policies, initiatives, and programs, artificially disconnecting them (and services and resources) from the way they are experienced by people and communities. This historical pattern of institutional responses has produced a series of initiatives that focus narrowly on one segmented issue after another, layering new resources in communities but in a disorganized way. The irony is that the interconnections are painfully visible from the vantage point of lived experience: people who are struggling with mental health, addiction, suicide, violence, trauma, or social disorder are usually experiencing them as a combination of causes and effects, often compounding and exacerbating each other. Despite the interconnections plainly visible from the vantage point of lived experience, the historical pattern of institutional responses has produced a series of initiatives that focus narrowly on one segmented issue after another. Fortunately, the City of Edmonton’s Community Safety and Well Being Strategy (CSWB, 2022) and the Alberta Mental Health and Addictions Advisory Council’s Alberta Model of Wellness (AMHAAC, 2022) represent approaches that address intersections among this constellation of issues.
Previous strategies have not put enough weight on community perspectives and lived experience.
The CSWB commits to a “a deliberate and concerted effort to put community at the centre” (CSWB, 2022, p. 3). The Alberta Model of Wellness elevates the importance of feeding individual experience into system (re)design:
“The experiences of individuals with lived and living experience of recovery, as well as their families, peers, allies and/or networks, are invaluable in informing the design and implementation of effective recovery-oriented care. Experiences should be inclusive of vulnerable and historically excluded groups.” (AMHAAC, 2022, p. 20)
What will make this new mental health strategy different – and more impactful – is that it will turn the usual power structure upside down: people with lived experience and community members will have the most influence in designing the future system of community care. This is a sharp contrast to the government, institutional, and service provision lenses that typically dominate the definition of both problems and solutions, with minimal involvement of the people who live them. The end result will be a system blueprint designed by community members that embodies how they experience the breadth of mental health and related issues and offers clear, predictable pathways to get support when, how, where, and from whom it makes the most logical sense through their healing journey and lifespan.
While the strategy is being built, the community-led governance structure will be established to bring it to fruition and guide its implementation. This will similarly blaze a new trail for Edmonton, giving direction-setting and decision-making authority to end-users and community members as the new system gets built. Change management will be critical to enabling the governance structure to lead strategy implementation because it depends on repositioning service provider organizations, institutions, funders, and governments as accountable to and in service of its direction.
Fundamentally, if we don’t fix the current situation and do it in the right way, the mental health and related issues that are visibly escalating in our city will have deep and long-lasting consequences on our families, communities, and economy. While we should have designed the system people needed a long time ago, sometimes adversity opens doors for thinking and action that can produce real transformation. That’s the hope, and why so many of us believe we can finally make it happen now.
Note: This is an excerpt from our December 2022 Community Matters, you can read the full publication here
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References:
Alberta Mental Health and Addictions Advisory Council (2022). Toward an Alberta Model of Wellness: Recommendations from the Alberta Mental Health and Addictions Advisory Council. Government of Alberta. Retrieved from https://open.alberta.ca/publications/toward-an-alberta-model-of-wellness.
Canadian Mental Health Association National Office (2022). Running on Empty: How Community Mental Health Organizations Have Fared on the Frontlines of the Pandemic. Retrieved from https://cmha.ca/brochure/running-on-empty-report/.
City of Edmonton (2022). Community Safety and Well Being Strategy. Retrieved from https://www.edmonton.ca/city_government/initiatives_innovation/community-safety-well-being-strategy.
Health Quality Council of Alberta (2020). Parent and Guardian Experiences with Mental Health Services for Children and Youth. Retrieved from https://hqca.ca/mentalhealth.
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