Together We Can - Nova Scotia
The plan to improve mental health and addictions care for Nova Scotians.5 Key Priority Areas2012/13 2013/14 2014/15Intervening and treating early for better results18-month developmental screening for all childrenProvince-wide telephone coaching for familiesMental health clinicians in schoolsSchool policies related to mental health, substance use, and gamblingCollaborative care among primary health, mental health, and addictions providersEnhanced education for EHS paramedics333333Shorter waits, better careReduced mental health wait times to meet standards through new approachesExpanded peer support for mentally ill33Skills training and support for familiesExpanded opioid replacement treatmentProvince-wide toll-free crisis line333Review location of mental health, addictions beds333More specialty care networksConcurrent disorder training for care providersGreater awareness of Problem Gambling Helpline, DHA, IWK gambling services3Better information system for mental health, addictions3Information-sharing guidelines3Aboriginal and diverse communitiesDiversity group(s) for mental health, addictions3More collaborative treatment services for First Nations, cultural safety trainingfor care providers3Gay Straight Alliances for students3Sex, gender, and diversity review of servicesTogether We Can333Undertake work to increase diversity in the addictions, mental health workforceRecruit French speaking professionalsEducation on seniors’ mental health, addictions needs for care providers3Working together differentlySafe, affordable housing optionsFunding process for community agencies, projectsSupport municipalities to reduce alcohol harms333Collect and monitor alcohol, drug, gambling data33Mental health, addictions care for incarcerated adultsReducing stigmaAnti-stigma initiativesShare reporting guidelines with mediaAwareness of healthy and safe workplacesEmployer awareness of workplace programs3333* Checkmarks (3) indicate when work on each action will start. While this is a five-year plan, the work will get underway within the first three years.The plan to improve mental health andaddictions care for Nova Scotians
Together We CanThe plan to improve mental health andaddictions care for Nova Scotians
ContentsMinister’s Message.1Introduction.3Our Vision.5Our Actions to Date.7Five Priority Areas:1. Intervening and Treating Early for Better Results. 112. Shorter Waits, Better Care. 153. Aboriginal and Diverse Communities. 224. Working Together Differently. 265. Reducing Stigma. 29Evaluation of the Plan. 31Conclusion. 35Together We CanAppendix 1: The Development of the Strategy. 37iii
Minister’s MessageIt’s my great pleasure to release Nova Scotia’s first mentalhealth and addictions strategy, which outlines ourgovernment’s plan to improve the mental health andwell-being of our province’s citizens over the coming years.This strategy is the culmination of efforts of manydedicated, informed, and passionate people, from a varietyof vantage points; from the lived experiences of mentalillnesses and addictions, to working on the front lines toaddress the needs of children, adolescents, families, adults,seniors, and diverse populations who struggle to live withand recover from mental illness and/or addictions. Although they are too many toacknowledge by name, I sincerely want to thank them all for their commitment,courage, and the significant contribution they’ve made to improving mental healthand addictions services throughout Nova Scotia.This strategy is focused on health promotion, early intervention, closing gaps in thesystem, improved cultural and other competencies, peer and community supports,and reducing stigma through greater public awareness. It is based on our currentunderstanding of what works, and what will have a significant impact and can beaccomplished within the context of declining resources and competing needs.To borrow from the Mental Health Commission of Canada, mental illness has emergedfrom the shadows, and having done so we can now move forward to a world that’smore understanding and accepting of mental illness. This strategy assures NovaScotians that better care sooner will be available for those experiencing mental healthand addictions issues and that not only will the health-care system be more responsive,it will be more integrated and coordinated with other important areas of public service,including justice, housing, social security, education, training, and employment.As Minister of Health and Wellness, I look forward with enthusiasm to the positiveresults this strategy will have on mental health and addictions care in our province.Together We CanAs someone who has been in and around the mental health field for many years, atno other time have I felt so optimistic that change is possible, and indeed is happening.1Health and Wellness Minister, Maureen MacDonald
IntroductionWe are committed to improving mental health and addictions care for Nova Scotians.Most people have been touched by mental health and addictions issues—whether theyhave had an illness or addiction themselves, or been impacted by the illness or addictionof someone else—a family member, friend, co-worker, or others in their lives.Research tells us that one in five Nova Scotians will be impacted by a mental illness. Onein seven will experience a problem with alcohol or drug use. We know that many morewill be affected by mental illnesses and addictions of others. Most, if not all, Nova Scotianswill be affected by these issues in their lifetime.BackgroundIn March 2010, we announced the development of a Mental Health and AddictionsStrategy, Nova Scotia’s first ever, to improve these services for Nova Scotians who needthem now and in the future.In the fall of 2010, we appointed an Advisory Committee made up of people withpersonal and professional experience in mental health and addictions.Based on what they learned, they made recommendations for improving mental healthand addictions services in their report Come Together, which was released on April 23,2012. Their recommendations set out a road map for this plan. Their priorities—investingin health promotion, earlier intervention, and faster access to services; fixing gaps withinthe systems of care; creating supportive communities; and strengthening collaboration—are reflected in this plan. Their thoughtful, well-researched advice will set our course forthe next five years.Come Together offers excellent context for this plan, as well as stories of peoplewho have first-hand experience with mental illness and addictions. For additionalcontext, readers can read this report and the accompanying summary, whichare available on the Department of Health and Wellness’ iction-strategy.asp).Together We CanThe Advisory Committee was given the task of developing recommendations forimproving mental health and addictions services. To do this, they embarked on a oneand-a-half-year process to learn from Nova Scotians and gather facts to create a completepicture of the mental health and addictions systems in Nova Scotia. They heard frommore than 1,200 Nova Scotians during consultations between January and June 2011,and reviewed best practices and research.3
Our VisionThis plan is for and about Nova Scotians.Better care sooner for Nova Scotians is the only outcome we will accept. NovaScotians living with mental illness and addictions and their families deserve it and,as a province, we have waited too long.Nova Scotians deserve to be healthier and to live in communities that support andrespect people living with mental health and addictions issues.Because of our commitment to the actions laid out in this plan, Nova Scotia’smental health and addictions systems will look and feel different for the peoplewho need them and for their families. Nova Scotians have their mental health and addictions concerns identifiedearly. Children and youth are a priority. Because 70 per cent of mentalillnesses begin before the age of 25, it is essential that they be addressed earlywhen the impact is greatest and before they become bigger problems. Nova Scotians are able to get the care, treatment, and supports they need moreeasily and in a timely manner, regardless of where in the province they live. Theimpact of mental illness and addictions will be reduced. The unique needs, traditions, and ways of First Nations citizens, diversecommunities, and specific groups within our province will be respected andmet to ensure that there is dignity and respect for all, and barriers to careare removed. The care, treatment, and supports needed by Nova Scotians living with mentalhealth and addictions issues will be centred on their needs and those of theirfamilies, through greater collaboration within the mental health and addictionscare systems, across government, and in communities. We will help close the gaps to ease the transition from one program or serviceto another for individuals and families. Care, treatment, and services will be improved to help people living withmental illness and addictions issues stay well, to help others cope with theseissues, to provide the most intensive level of services to those who are criticallyill, and to support people on the road to recovery.Together We CanThrough this five-year plan, we are working to ensure that:5
The stigma and discrimination faced by Nova Scotians living with theseillnesses will be reduced, and there will be greater respect, compassion, andunderstanding of these issues throughout our province.Together We CanGuiding Principles6 Be accessible—responsive to the needs of Nova Scotians experiencing mentalhealth, substance use and gambling problems Offer health equity—opportunity for health for all, regardless of age, gender,ethnicity, religion, sexual orientation, or socioeconomic status Respect individuals and collaborate—“nothing for you, without you” Ensure dignity—relationship-based, recovery-focused Be sustainable—fiscally responsible, with supports in the communityand enough health-care professionals
Our Actions to Date Nova Scotians living with autism and their families have access to better programsand services so they can get the best possible treatment, support, and care. Thisincludes expanding the Early Intensive Behavioural Intervention (EIBI) program so allchildren who need it can get in the program, rather than relying on a random draw. Youth on remand by the court for a mental health assessment, and those determinedto be unfit to stand trial or not criminally responsible are now being cared for at a newsix-bed secure care unit at the Nova Scotia Youth Facility in Waterville, resulting inthese young people receiving better mental health care, programming, and support. The province’s Domestic Violence Action Plan is building stronger, safer communitiesby preventing and reducing domestic violence while offering better services forvictims and offenders. A Psychiatric Intensive Care Unit is now open at the East Coast Forensic Hospital toprovide treatment and stabilization for people with severe mental illness who arehighly aggressive and have been involuntarily admitted to mental health units acrossNova Scotia. Through this, these individuals have a safe and comfortable place to gettreatment that is better suited to their needs. Care in custody is being improved for people who are living with mental illnessthrough Building Bridges, the province’s response to Judge Anne Derrick’s reportinto the death of Howard Hyde. Improvements include better training, strongerpartnerships, and information-sharing between the criminal justice and health-caresystems. The Mental Health Court, the first of its kind in Nova Scotia, now hears cases involvingadults who have been charged with a criminal offence and have a mental illness butare competent to participate in the criminal justice system. The goal is to treat theseindividuals fairly and compassionately, and help them improve their mental health toreduce the risk to public safety. The Prescription Drug Overdoses in Nova Scotia Working Group was established tosuggest ways the system could respond more effectively to the negative impactsof prescription drug abuse, including overdose and death. The group released itsrecommendations in summer 2011, and considerable progress has been madesince then.Together We CanWe have made many improvements over the last few years that help people withmental health and addictions issues. These improvements include:7
The opioid replacement program in the Annapolis Valley was expanded, increasingthe number of Nova Scotians getting this treatment for prescription drug addiction. We are working with partners in law enforcement and the district health authoritiesto address abuse of prescription drugs. We are working with shelters to find short- and long-term solutions tohomelessness.–– A supportive housing pilot project was created in 2011 to help people inshelters move to long-term, affordable housing. During the first year (2011),more than 200 individuals were moved into safe housing.–– Investments have been made to help find solutions for homelessness throughfunding for emergency shelters, transition housing, supportive and supportedhousing, rent supplement subsidies, recovery housing, and more. SchoolsPlus, part of Nova Scotia’s Child and Youth Strategy, is now available inall school boards in the province. This program sees professionals and programsprovide social work, health, justice, and addictions services for students and familiesin a convenient, familiar setting—a school in their community. Suicide and attempted suicide is a complex problem and is the tragic outcome ofmultiple factors and causes. Our work to prevent suicides includes:Together We Can–– providing funding to the Canadian Mental Health Association for theCommunities Addressing Suicide Together (CAST) initiative, which supportssuicide-prevention community coalitions in the province8–– providing funding for the Youth Project, which enables them to providesupports to lesbian, gay, bi-sexual, transgendered and intersex youth—apopulation at significant risk of suicide–– working with the Chief Medical Examiner to improve data collection processesfor suicide deaths, which will better inform future policy and interventions–– providing funding to the Sun Life Financial Chair in Adolescent Mental Health(IWK and Dalhousie University) in partnership with the Canadian MentalHealth Association’s Nova Scotia Division to develop an evidence-basedguide to addressing suicide for clinicians, institutions, and community-basedorganizations
What’s Working WellWhile we often hear about the problems and challenges encountered in NovaScotia’s mental health and addictions systems, there are many things that areworking well.There are many dedicated, highly skilled people who work with those living withmental illness and addictions in Nova Scotia. They work tirelessly and are verycommitted to the people for whom they provide care and services. They includehealth-care professionals (family doctors, psychiatrists, psychologists, social workers,nurses, occupational therapists, recreational therapists, dietitians, and others);principals, teachers, guidance counselors, and others in the education system;and people working in the justice and child-care systems and other workplaces.Their efforts are supported by community and non-governmental organizationscommitted to helping Nova Scotians who are dealing with these issues.There are some good programs and services in place now that are providinghigh-quality care and meeting the needs of Nova Scotians with mental health andaddictions issues, as well as working to reduce stigma and other barriers to peopleseeking out the care they need.The Advisory Committee confirmed that many people are waiting too long forcare—or for the treatment best suited to their needs. Long wait-times for childrenand youth with symptoms of mental illness are of particular concern, as researchtells us that intervening early with young people can have the greatest impact ontheir lives. Sadly, some Nova Scotians do not seek treatment at all, either becauseof the stigma attached to these illnesses or because they do not know where toturn for help.During their consultations across the province, the committee heard that familiesoften find it difficult to navigate the maze of trying to get assessment, treatment,and care, making it frustrating and overwhelming for them. People—especiallythose in rural areas of the province—are sometimes not sure where to turn onweekends or at night. Services are not always easily obtainable or equally availablein all areas of the province.Together We CanWhat Needs to Change9
The committee also heard that government departments, mental health andaddictions care systems, and related programs and services need to work togetherbetter than they do now. We have heard that there are too many uncoordinatedservices, too many silos facing people who need mental health and addictions careand supports. This can make it difficult for Nova Scotians to navigate the systemand to get the care and supports they need.Nova Scotians want and need to be able to get services in a simple way that allowsthem to enter through a variety of places—so every door is the right door. This willallow for a smooth and efficient transition from one service to another. There aresome gaps at key points where individuals and families make these transitions.Sometimes all or some of their information is not transferred from one programto another, which can have a negative impact on their care. We need to supportpeople with mental illness and addictions, not just treat them.Together We CanWe all need to work together to reduce the stigma and discrimination often facedby people living with mental health and addictions issues. Stigma happens inmany places—in workplaces, schools, hospitals, clinics, and the media. Mentalillnesses and addictions are disorders of the brain and can be treated. Stigma is areal and significant barrier to people seeking care, treatment, and support.10
Five Priority Areas1) Intervening and Treating Early for BetterResults—With a Focus on Children and YouthTo have the greatest impact on the lives of children, youth, and their families, weneed to identify potential mental health and addictions problems and interveneearly to achieve better outcomes and to prevent these problems from getting worse.Promoting the healthy development of children can significantly reduce thedevelopment of mental health, substance use and gambling problems later in life.Birth and the Early YearsProblems can start very early
Together We Can 5 This plan is for and about Nova Scotians. Better care sooner for Nova Scotians is the only outcome we will accept. Nova Scotians living with mental
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