DESCRIPTION OF SAMPLE
216 mental health service providers completed the questionnaire. Of this sample, 21 indicated that they were housing providers as well.
While most provinces and territories were represented in the sample, there was no representation from Nunavut or Prince Edward Island (see Table 12 for representation by province).
Most providers had a municipal (32%) or regional mandate (46%), while 11.6% had a provincial mandate and 2.3% a national mandate.
Communities served ranged from large metropolitan communities to rural/remote communities, with 87 mental health service providers serving rural or remote communities18 (see Table 13). Many service providers were from agencies that served more than one community. 25 providers indicated that they served a remote community and/or a community that was situated in the Northern Hinterland.
18 Please note that this is not a group that exclusively services the rural/remote communities. In most cases the mandate also covers rural/remote communities.
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A B C D E F G H I J K L M N O
Agency Gap Regional Gap
The agencies were dedicated to serving a number of different populations including those with mental illness, mental health problems, concurrent disorders, and substance use issues (see Table 14).
Almost 42% of service providers reported that funding was from provincial or territorial governments.
CHALLENGES AND GAPS
Funding levels that do not support the provision of additional support (72%) and the inadequacy of the existing service capacity (59%) were seen as the greatest barriers to assisting people with regards to retaining their housing. Lack of adequate income and/or financial support was also identified as a significant barrier in response to an open-ended item.
Lack of safe, affordable housing (83%), insufficient funding (72%), lack of transitional housing (59%), insufficient staff availability to support individuals in their homes (50%), insufficient outreach teams/off-site services (48%), and supports for individuals aging in place (47%) were identified as the topmost concerns with long-term implications.
Accommodating a transition from one housing context to another based on needs was considered difficult by 47% of service providers. Smaller agencies reported significantly greater rates of difficulty than did larger agencies.
The need for transitional housing was a significant concern in a number of provinces, most notably in Saskatchewan, Québec, Nova Scotia, and Newfoundland and Labrador (χ2 = 20.95, p = .02).
Insufficient outreach teams and off-site services were cited as a concern in Nova Scotia, the Yukon, Saskatchewan, and Québec (χ2 = 30.10, p = .001).
Housing and related mental health support needs identified as crucial by service providers were supports for people with concurrent disorders, holistic determinants of health approach to treatment and support, high support housing, support for people with dual diagnoses, and transition-aged youth services.
Crisis beds, integrated mental health and housing services, housing supports and support for people with concurrent disorders, and 24-hour onsite supports were among the top five support needs reported by mental health service providers as not being met with regards to the clients that they serve (see Table 15 and Figure 9 for complete listing).
Consistent with reports from housing providers, a divide existed between remote and non-remote mental health service providers regarding the need for transition-aged youth services (χ2 = 4.06, p = .04). The issue more frequently resonated with remote providers (48.0%) than non-remote providers (28.3%). Many of the crisis services (i.e., crisis beds, telephone crisis lines, and mobile crisis services) were also reported as not being met at a higher rate among remote providers than among non-remote providers.
Peer support, which was ranked 16th from the 60-item support need list, was significantly associated with provinces and territories (χ2 = 21.78, p = .02). The majority of respondents from New Brunswick (3 of 4 respondents), Québec (3 of 4), Nova Scotia (6 of 10), and Saskatchewan (3 of 5) reported that the need for peer support was not being met. Service providers from British Columbia and Ontario reported the gap at a lesser rate, with 27.0% and 25.7% of respondents from each province, respectively, indicating a gap.
In the assessment of barriers that prevent people from meeting their support needs that assist in the
retention of housing, nearly half the listed barriers were reported significantly more by remote providers than non-remote providers. Issues related to existing service models not meeting aging needs, criminal justice support needs, culture-specific needs, and gender-specific needs; the non-existence of inter-agency partnerships; a lack of sufficient staff training and/or skill level; and the fragmentation of service delivery systems were all more frequently reported as barriers by remote providers (p ≤ .05).
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CULTURE-SPECIFIC CHALLENGES
Only 15% of mental health service providers indicated that they were able to meet the cultural needs of their clients, while 74% indicated that they were able to partially meet cultural needs and 7% reported an inability to meet cultural needs.
22% reported that there were inadequate staff and/or skill levels to provide culturally competent services.
21% reported that their organization is unable to meet the language needs of their clients.
POPULATION-SPECIFIC CHALLENGES
Concurrent Disorders: There was a strong association between agency size and gaps in specific services.
Smaller agencies reported the greatest gaps with regards to their ability to serve people with concurrent disorders (χ2 = 5.94, p = .05).
Forensic Clients: There was a strong association between agency size and gaps in serving forensic clients, with smaller agencies reporting the greatest gaps (χ2 = 6.38, p = .04).
Transitional-Aged Youth: The gap between the needs of transitional youth and mental health services was highest in Nova Scotia (8 of 10 respondents) and Ontario (65%). The provincial association was significant (χ2 = 25.26, p < .01).
STAFF TRAINING NEEDS
Mental Health Service Providers prioritized the following training and learning needs:
1. Support for concurrent disorders (61.6%)
2. Community-based management of mental illness (53.7%) 3. Behaviour management and modification (46.3%) 4. Better practice models (43.5%)
Remote service providers (68.0%) more frequently reported the need for behaviour management and modification training than did non-remote providers (43.5%); χ2 = 5.36, p = .02.
Community-based management of mental illness was significantly associated with province, with the need being most reported in Nova Scotia, Québec, New Brunswick, Newfoundland and Labrador, British Columbia, and Alberta.
KEY FEATURES OF HOUSING AND RELATED SUPPORT MODELS THAT FACILITATE ACCESSING AND MAINTAINING HOUSING
Subsidized/rent-geared to income housing (62.0%)
Continuum of housing options (61.6%)
Flexible and adaptable supports (57.4%)
24/7 high support housing (55.1%)
Transitional housing (50.9%)
Harm reduction housing models (48.6%)
Off-site supports (33.3%)
Low barrier (on-site substance use allowed within housing) (29.6%)
Also, certain practices currently being undertaken by mental health service providers facilitate accessing and maintaining housing:
Partnerships between mental health services and housing providers (60.6%)
Off-site housing supports (53.7%)
On-site housing supports (e.g., hygiene support, crisis services, eviction prevention programs, etc.) (51.9%)
Development of relationships with landlords (48.1%) RECOMMENDATIONS
The following recommendations were most endorsed by the housing providers:
1. Adequate funding of a full continuum of housing and supports (76%)
2. Change government policy of how existing funds can be used to increase flexibility (74%) 3. Development of a Housing Strategy (68.5%)
4. Funding for community-based services (65.7%) 5. Increase subsidized housing stock (65.7%)
6. Cross-ministerial partnerships for planning and funding purposes (53.2%) 7. Adequate training of staff (49.5%)
8. High degree of consumer involvement in decision-making (49.1%) 9. Development of supports for the aging population (47.7%)
The high level of support for the recommendation of funding a full continuum of housing and supports was strongly backed by remote service providers (92.0%). Nearly 75% of non-remote providers also endorsed this recommendation.
Table 12. Mental Health Service Provider responses by province/territory.
Province Frequency (n) Percentage
(%)
Alberta 8 3.7
British Columbia 37 17.1
Manitoba 13 6.0
New Brunswick 4 1.9
Newfoundland and Labrador 26 12.0
Northwest Territories 1 0.5
Nova Scotia 10 4.6
Ontario 105 48.6
Quebec 4 1.9
Saskatchewan 5 2.3
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Table 13. Communities served by the agencies of mental health service providers.
Community Frequency (n) Percentage
(%)
Large metropolitan (1,000,000+) 42 19.4
Medium metropolitan (250,000 – 999,999) 39 18.1
Small metropolitan (50,000 – 249,999) 60 27.8
Small city (20,000 – 49,999) adjacent to metropolitan area 23 10.6 Small city (20,000 – 49,999) not adjacent to metropolitan area 29 13.4 Small town (2,500 – 19,999) adjacent to metropolitan area 21 9.7 Small town (2,500 – 19,999) not adjacent to metropolitan area 41 19.0 Rural (less than 2,500) adjacent to metropolitan area 22 10.2 Rural (less than 2,500) not adjacent to metropolitan area 27 12.5 Predominantly rural (no urban settlements in area) 10 4.6 Remote (less than 2,500 with minimal or no road access) 13 6.0
Northern Hinterland 15 6.9
Table 14. Type of provider and populations served.
People with mental illness (%)
People with concurrent disorders (%)
People with mental health problems (%)
People with substance use issues (%)
Dedicated 47.7 16.2 35.6 9.7
Mixed (most or some services dedicated)
47.7 75.5 56.5 44.9
Social 3.2 6.5 5.1 43.1
Table 15. The ten most important support needs not being met by the service providers19 (n = 216).
Support Need Score Number of “most
important” selections
1 Crisis beds/Safe beds/Respite beds 67 31
2 Integrated mental health and housing services 57 22
3 Housing support 53 18
4 Treatment/support for people with concurrent
disorders 50 13
5 24-hour on-site support 45 8
6 Drug or alcohol treatment – residential model 37 3 6 Treatment/support for people with dual
diagnosis 37 6
8 Drug or alcohol treatment – community-based 27 10
10 Housing 25 6
10 Intensive Case Management (ICM) 25 3
10 Intensive mental health treatment (i.e., options
instead of ACT teams) 25 2
19 The score indicates the number of times an item was selected as one of the five most important support needs not being met
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Figure 9. The most important support needs not being met by the service providers20 (n = 216).
A – crisis beds/safe beds/respite beds; B – integrated mental health and housing services; C – housing support; D – treatment/support for people with concurrent disorders; E – 24-hour on-site support; F – drug or alcohol
treatment: residential model; G – treatment/support for people with dual diagnosis; H – drug or alcohol
treatment: community-based; I - assertive community treatment; J – housing; K – intensive case management; L – intensive mental health treatment (i.e., options instead of ACT teams)
20 Scores indicate the percentage of participants that selected the item as one of the five most important support needs not being met
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