# of Beds per 10,000 pop 19+
2001 2006 2001 2006 2001 2006
Vancouver
Coastal
5.6 5.3 12.9 15.3 .26 .27
Vancouver Island
3.7 3.6 11.1 14.4 ---- ----
Interior Health
3.6 3.2 5.8 8.9 .77 1.3
Northern Health
1.7 1.9 7.0 8.7 .24 .04
Fraser Health
7.0 5.7 5.7 7.9 .18 .11
*
Date calculated using information from the Ministry of Health -Survey of Mental Health Housing Capacity – January 2006Appendix E
Members of the Housing Plan Task Group Harold Bumann - Family representative
Linda Denny - Community residential co-ordinator, Langley Mental Health
Becky Doherty - Community residential co-ordinator, North / South Delta Mental Health Simon Faber - Community residential co-ordinator, Tri-Cities Mental Health
Dorothy Jennings - Manager, Mission Mental Health / CRESST / Contracted Services Andrew Kellett - Consumer representative
Frank King - Case manager, Hope Mental Health
Dan Kipper (Chair) - Mental health housing leader, Fraser Health
Ken Lerner - Community residential co-ordinator, Surrey Mental Health Kate Lister - Family representative
Alison Luke - Manager, New Westminster Mental Health Meryl McDowell - Manager, White Rock Mental Health Mike Medford - Health Care Worker, Mission Mental Health Rom Petri - Case manager, Abbotsford Mental Health
Rosanne Rothenberg - Community residential co-ordinator, Burnaby Mental Health Barney Usborne - Community residential co-ordinator, Maple Ridge Mental Health
Appendix F
Consultation Day Feedback October 24, 2005
On October 24, 2005 more than 120 people met at the Sheraton Guildford Hotel in Surrey, B.C. to provide feedback on the draft housing plan. The invitees included consumers, family
members, contracted service providers, residential operators, Fraser Health staff, other community partners and physicians. Below is a summary of the feedback obtained from this event. Statements in bold type indicate priority of importance for participants.
Group One – Specialized Populations
What do I like?
• New residential and housing resources that will be developed for specialized
populations (harder to house, youth and adolescents, eating disorders, aging in place)
• Addresses all client populations • Its proactive with a plan to 2011 • Increase in rehabilitation specialists
• Increased number of subsidized housing (SIL) units with support • Increased involvement of consumers and family members What do I dislike?
• Need to revisit benchmarks as they don’t seem to reflect demographics
• Change language from describing the “harder to house” to be “inclusive housing” – less negative connotations.
What is missing? Gaps?
• Need to develop a continuum of care for harder to house clients and need to break
down barriers that limits access to residential and housing resources. Need minimal barrier housing resources in each community that are owned by Fraser Health.
• Need more residential facilities that are flexible in working with concurrently
disordered clients. Need for “safe housing” for concurrently disordered (mental illness and substance use) clients.
• Need more knowledge around concurrent disorders
• Enhancement of interdisciplinary teams. Need to prioritize skill set of staff. • Staffing issues in relation to case management. . Need adequate staffing levels
that reflect the needs of clients (24/7).
• Currently gaps in housing for specialized populations of clients with have a dual
diagnosis of a mental illness and developmental disabilities, FASD, Organic Brain syndrome, or Acquired brain injury.
• Specialized staffing skill set and programming for young mental health clients (18-
30). Need new approach for youth
• Need to educate inpatient staff, emergency staff, police on available resources and
how to access them.
• Need to work closer with municipalities in developing resources for “harder to house”. • Need to have youth SIL available / developed for transitioning youth between 17-21.
Consider increasing age cap to 24.
• Lack of after hours resources (midnight to 0800)
• Access to unregistered clients of Mental Health have a problem accessing housing • Need a specific plan for eating disorders authority wide, can draw on Fraser South plan
• Additional resources for education and training. Enhance education for Support workers. • Need clearer definitions for each category. Description of step down, dual disorder /
concurrent disorder and consumer involvement too vague. Other suggestions from “walk about”
• Need to develop culturally appropriate programs and services including training (education) for staff.
• Needs to be a mechanism / formula for the downsizing / reshaping of existing resources at the local level.
• Smaller resources are more approachable, facilitates community inclusion and support • Recognize shared housing as an affordable alternative for mental health community
living.
• Tailor the number of supports for the elderly and disabled to fit the physical as well as the Mental Health need.
• Reconsider family care home usage – cost effective and may be suitable for some individuals. e.g.) Alberta – Home health program
Group Two – Supported Housing & SIL
What do I like?
• SIL review to look at areas of standardization, portability, market housing,
clarification of the roles between SIL support worker and FH Health Care worker, rent subsidy rates matching local community rent rates
• Increase in After hours client supports especially in the evening and weekends • Increase in support staff
• Increase in Harder to house resources • Increase in rehabilitation specialists
• Hopeful that the housing model is the priority as there will be more opportunity for people to live independently.
• Recognition of values such as autonomy, privacy, independence. What do I dislike?
• Estimate of SIL need too low
• Need for clearer formula for allocation of SIL What is missing? Gaps?
• Rent subsidy program for clients not needing ongoing support. More rent
subsidies not connected to Mental Health Services. “No strings attached” rent supplements
• Need to have a continuum of rent subsidy, gradually weaning off support.
Currently disincentive to get well because loss of subsidy.
• Need for clear leadership in the SIL program
• Pressure to reintroduce / re emphasize BC Housing Rent supplement program • Opportunities for education e.g.) PSR focused recovery model so all on the same
page
• Need OT Assessment for SIL participants.
• Need for flexible supports for staff , $$$, whatever is needed
• Need a more comprehensive plan for the development of Bridging. Have a housing specialist to assist with Bridging development.
• Process should have begun with wider consultation around current housing inventory (non profit / rent supplements)
• Need to provide more supports for SIL without creating a dependence e.g.) meal preparation, house keeping
• Need flexible rehab support. (professional in addition to support worker) • Need for more peer support workers
• Greater emphasis on “rehab and recovery” throughout document • End of year SIL subsidy surplus should be able to be used creatively • Government policy link missing (impact on funding)
• Improved partnership between FH and contracted agencies
• Representative form each agency to provide overview report on SIL when the SIL program is reviewed
• More youth SIL
• Inclusion of Riverview population appropriate for SIL in the plan
• Education and skill development for support staff around psycho geriatrics • Need to have representation from BC Housing (rent supp program) involved in
consultation / planning
• Service provider representatives and municipal planners should have been on the task group.
Other suggestions from “walk about”
• Need for local areas (FN, FS, FE) to review the study and how it addresses the local growth / issues
• Do a study on inpatient eating disorder admissions and where they live
• Need to have confidential pt information around safety issues shared with contracted agencies providing services
• Move SIL administration to CRP teams across the authority
• Reference to youth programs – no youth in population estimates or needs • Local leaders of SIL
• Consistency in care teams
• More rent supplements that are portable with clients and housing need • Ongoing consultation process to include municipalities
• Education opportunities on recover for consumers in recovery • Consider family care homes as a specialized resource Ways to include consumer & family
• Ensure that individuals actually want the plan • Family and consumer education
• Focus groups in evenings (flexible times)
• SIL review done by family, consumers and line staff • Fair compensation for participation
• More consumer and family representation on task groups • Local level family and consumer involvement
• More ongoing supports for family members • Greater communication to families
• Employing a stakeholder consultant e.g.) Riverview redesign
Group Three – Housing Program & Licensed Residential Facilities
What do I like?
• Rehabilitation specialists – great idea
• Capital funding for facility upgrades. Some concerns expressed as some owners
have spent own money to date to keep facilities upgraded.
• Update MH residential policy and procedure manual – must be universal / realistic /
attainable. Manual should have a PSR focus
• A level of commitment and increased opportunities for collaboration
• Standing committee for residential and housing - with broad representation and considering local needs.
• Quality improvement / Risk management – support for this recommendation but will there be expectations that will cost facilities more
Questions for clarification:
• Complex care beds – Are these beds included in the 12 – 15 bed specialized residential or additional? (The complex care beds could potentially be developed in a current licensed facility if the physical building could accommodate a program such as this) • Is the $110 / per diem for clinical costs or other costs as well? (The $110/ per diem would
be inclusive of all costs)
• Would funding be congruent with care needs e.g.) increase as needs increase?
(Currently the funding model is a standardized model and does not formally increase as care needs increase)
• Are the specialized residential beds new or downsizing of present facilities? (The proposal is to add specialized residential beds)
• What form will the capital development fund be? Grant, loan, shared costs ? (The details of this have not yet been worked out)
What do I dislike?
• Standardized funding formula “ is like fitting a square peg in a round hole” How
will this be addressed
• Increase per diem rate to $110 / day. May not be enough as formula needs to be
based on needs of person rather than set amount
• Contract review – want input / negotiation with contracts as currently no
negotiation
• Contract Language review – should have attainable outcomes /expectations e.g.) current PSR expectations in contract may be unattainable for all clients
What is missing? Gaps?
• Need for greater consumer and family involvement. Rehab specialist and PSR would assist this process.
• Need to upgrade current facilities. Other suggestions from “walk about”
• How would the “assisted living” designation help as a middle ground between the licensed facilities and SIL type apartments.
• Need for local areas (FN, FE, FS) to review plan to see how it impacts locally
• Recognition that non profit organizations may want to and be able to develop specialized facilities. Many of these organizations have a consumer and family component.
• Separate money dedicated for rehabilitation and other activities from the general food and supplies budget in current contracts. Rehabilitation should have a separate budget line.
• Could large facilities be downsized to offer more individual care • Good to downsize beds in facilities to diminish institutionalization • Consumers need own bedroom if wanted.
• No significant changes to the residential contracts in 12 years but costs have gone up i.e.) gas
• Contracts need to be preceded by a budget negotiation process to inform health authority of actual costs
• Care plans and activities need to be more individualized with more accountability
Group Four – Partnerships
What do I like?
• Support for a permanent housing committee What do I dislike?
• Change language to reflect partnership goals
• Change language from “beds” (medical model) to “homes” (PSR orientation) What is missing? Gaps?
• Need for non profits to be represented on steering committees • Consumer Involvement in transition planning
• More rehab staff to promote PSR with stakeholders
• Partnerships should use expertise of associations such as BC non profit housing assoc, Association of MH service providers, PSR Canada
• Private apartments – purchase outright and not put money in landlord pocket • Increase community / municipal awareness
• Develop a planning mechanism with municipalities – who to do this? • Become part of the OCP
• Who could be partners? BC Housing, Business Associations, Apt owners, non profits, HRDC, consumer advisory boards, municipalities, provincial / federal govt.
• Definition of “partnership”
• Consultation with advocacy / developers • Educate
• Information technology expensive – investments should be coordinated across health authority – same software/platform
• How to support / not ostracize • Collaboration between stakeholders Other suggestions from “walk about”
• Compensation programs for family and consumers who participate in planning and or facilitation at all levels
• 3 month contract to an individual who would meet with individual families to complete questionnaire to collect information for planning. Same with persons in recovery
Group Five – Other
What is missing? Gaps?
• Facilities for harder to house with higher tolerance for A & D issues e.g.) Cliff
Block – New West
• Outcome measures should relate specifically to homeless mentally ill • Downsizing should occur in already existing facilities
• Staffing with backfill (relief) for the levels suggested
• Need a section on emergency housing specific to catchment area • Consider greater relationship with room and board operators
• Fraser Health should budget for training, education and development for non-profit and contract “partners”
• Need to include consumers not “attached” to mental health • Specialized housing for mental health consumers with families
• Need to investigate other funding sources e.g.) SCPI / foundations/ fund raising
• Need to focus on the integration through the various levels of housing support and clinical support.
• Housing task group must include the non profit sector
• Need for funding for start up for client’s initially entering SIL e.g.) sofa, bedding • More recognition and support for family care providers e.g.) easy access to respite • Family support is not allowed in the subsidization of housing
• Number of other successful models in other countries – HUD
• Ministry of Employment and Income assistance should be involved in planning. Need to address low shelter allowance and difficulty in accessing disability benefits.
• City planners also need to be involved in planning.
• Housing resource for the aboriginal population and having an aboriginal partner on the steering committee.
Appendix G
Consumer and Family Focus Groups