Windsor's complex mental health care system not getting fixed fast enough, says CMHA

People seeking mental health help in Windsor-Essex may encounter a complex system — a problem local service providers have been trying to fix for at least three years. 

One change community partners have been working on is creating a more coordinated approach to mental health care. In an ideal world, it shouldn't matter which agency someone calls first as long as they get to the most appropriate service, according to Sonja Grbevski, CEO of the Canadian Mental Health Association (CMHA) Windsor-Essex Branch.

"What we're trying to do is avoid people having to keep re-telling their story because that in itself is traumatizing," said Grbevski.

"Historically, you would have to maybe go to two or three different agencies before you land on what is the service for you. So what we want to do is get in the front of that," she said, adding a person may have previously told their story six or seven times before getting the support they needed.

A coroner's inquest into the death of Matthew Mahoney concluded earlier this month, highlighting gaps in mental health care for those most vulnerable and suffering severe illness. The jury's nine recommendations draws attention to the need for "very serious discussions" about changes to how services are delivered, according to Bill Marra, CEO of Hotel-Dieu Grace Healthcare (HDGH).

One of those suggestions stemming from the inquest is the creation of a mental health advocate to help people navigate the system. Had this been in place when Mahoney was alive, his brother Michael said it may have changed the outcome.

On March 21, 2018, Mahoney was shot and killed by two Windsor police officers. The 33-year-old, off his schizophrenia medication at the time, was carrying a butcher block of knives in downtown Windsor. Prior to his death, he had many encounters with health professionals trying to help.

"It's heartbreaking," said Grbevski, who acknowledged there's still a lot of work to do to improve mental health care.

Windsor-Essex lags behind other Ontario communities that already have this type of coordination in place, she said.

Within the next six to eight months, or possibly sooner, Grbevski hopes to have a coordinated community approach to mental health care. She said the pandemic can be blamed for much of the delay over the last few years.

During the inquest, Jonathan Foster, VP of emergency services and mental health for Windsor Regional Hospital (WRH), testified about the struggle to find timely care for people with severe mental illness once discharged. Foster said the solution isn't always about money, but also suggested community partners need to look at how they allocate resources to eliminate overlap and improve efficiencies.

The hospital's mental health unit is full most days, he said. At the same time, WRH is treating an increasing number of people for mental illness and those issues have become more severe, Foster added.

Barriers, gaps exist for those with severe mental illness

Wait times for people seeking community services for severe mental illness can range from two to six months. However, the initial intake is immediate. It's after the first meeting people may start encountering "barriers," said Grbevski.

"We could definitely, absolutely use and have more intensive support to clients who have Intensive issues like psychosis, very strong addictions," said Jean Laforge, executive director of Mental Health Connections.

Laforge, her team of 10 full-time staff members and other employees provide support to 800 people with mild to moderate mental illness who are 16 and older. Currently, there aren't any waits for those services.

However, Laforge said she does get calls about accessing help for people with a severe mental illness. Those people are referred to other organizations funded with intensive supports.

Ontario Health provides oversight for all community partners that offer mental health supports. In 2019, the province began consolidating 14 Local Health Integration Networks into this new super agency to reportedly save $350 million each year.

To mitigate pressures from an increasing number of people seeking mental health support, an Ontario Health spokesperson told CBC News in an email that they're offering incentive programs for health care professionals. Those include temporary nurse retention funds and a personal support worker wage enhancement.

However, the solution isn't always about adding additional resources, according to HDGH's Marra. 

"The partners also have to come together. It's not always about writing a cheque, it's about re-visiting service delivery models," Marra said. "Are we doing things consistent with what the needs are today and if not, let's have a conversation around changing the models."

Staff and services are already linked between HDGH and the CMHA, but the organizations want that integration between all providers that offer mental health supports.

New Zero Suicide partnership

A recent example is a partnership between Family Services Windsor-Essex (FSWE) and WRH that began roughly six months ago called the Zero Suicide program.

Staff at Family Services are at the hospital three times a week interacting with people who are having thoughts of suicide or made an attempt to end their life.

FSWE clinical supervisor Beth Turnovan said it's critical that her staff establish that relationship before they're discharged so the care continues in a seamless way. Once they're out of hospital, FSWE provides suicide prevention programs and services for as long as they need it.

"In between every appointment, every single day, these individuals who have now come into our pathway, will receive what's called an on-demand care and contact," said Turnovan.

"Our staff literally reach out to them every single day to check on their welfare, how they are doing with any of their therapeutic homework, that we are anticipating their return for their next session and that we are excited to see them for their next session."

There aren't any waits for this program as FSWE has been able to keep up with the demand. The hospital has made 37 referrals since the Zero Suicide program began in March.

A need for 24-hour mental health support

Windsor police, the CMHA and the Mahoney inquest jury have all said there's a need for 24-hour services in the community specific to mental health that aren't currently available.

Jurors recommended expanding the Community Outreach and Support Team (COAST) to be an around-the-clock service. It's a partnership between police and HDGH that puts a front-line officer with a crisis social worker. Together they work to assist people with mental illness during the week from 8 a.m. until 4 p.m.

In a statement to CBC News, acting police chief Jason Bellaire said they'll review the recommendations to see if any changes can be made.

"I've often said the Windsor Police Service doesn't have the resources to take the lead on mental health calls and that far-reaching changes are needed to ensure that people in crisis can get the help they need and deserve," Bellaire said.

Grbevski with the local CMHA agrees expanding mental health services beyond the usual weekday hours would fill a gap.

"I know we've been chipping away to start opening our doors, various services more so into the evening. There's already services that are moving into the evening, so we have to make that shift," said Grbevski.

"Little by little we are, but again from my perspective, just not fast enough," she added.

Organizations named by the jury in the inquest recommendations are required to respond in writing within six months, but aren't obligated to implement any of the changes.