RANGE OF MENTAL HEALTH AND WELLNESS SERVICES

In 2003, the provincial government transferred most services delivered by the Alberta Mental Health Board to the regional health authorities. From then until its integration with Alberta Health Services (together with the regional health authorities), AMHB provided policy research and direction together with the administration of province-wide mental health programs. Under Alberta Health Services, there are five ‘zones’ – for each zone, there is a Director of Mental Health Services for acute care and community mental health services. Core functions of the current system include:

 Mobile crisis response teams

 Case management

 Assertive community treatment teams

 Outreach services, which are less intensive than ACT, assist the client with appointments, paperwork, and day-to-day chores such as shopping or home maintenance.

 Street outreach for the homeless

 Mental health clinics exist across the province – these clinics provide:

- Intake, assessment and diagnosis

- Individual therapies: brief, short-term and long-term - Group therapies and activities

 Both acute and specialized inpatient services

 Crisis beds house a client short-term (usually no more than five days) – provides 24 hour, seven days a week oversight.

 Transition beds serve clients who have stabilized in hospital but need temporary help before returning to independent living.

 Outpatient services (including group programs that can be specialized in nature such as early intervention in psychosis or eating disorders)

 Specialized services including for people with concurrent disorders, seniors, forensic programs

77 Please note that the 2007/08 inpatient data figures presented in the IHE report are not actuals but are extrapolations based on 2003/04 CIHI data.

Mental health services can be delivered directly by Alberta Health Services, or through contracts with not-for-profit organizations. For housing in particular, AHS engages with not-for-profit organizations, municipalities, and for-profit owners to develop and maintain housing units - mental health services for residents of these housing units are usually provided by the AHS or not-for-profit organizations.

The Provincial Mental Health Plan (2004) organizes services and supports according to three themes: support and treatment, risk reduction and capacity-building. Table 6 provides an overview of the general and population-specific service priorities organized by theme, as outlined in the PMHP. Current initiatives, identified below, support implementation of the Addiction and Mental Health three-year strategic plan:

 Implementation of Community Treatment Orders (for people with serious and persistent mental disorders who pose significant risk to themselves or others and require intensive case management.

 Enhancement of services for people in provincial correctional and remand centres (through a $7.5 million grant from the Solicitor General/Safe Communities initiative)

 The Safe Communities Initiative also funded the opening of 40 addiction treatment beds for young adults (3 month residential treatment), opening of 25 beds at the Centennial Centre in Ponoka with services targeted to clients with Axis IV disorders (psychosocial and environmental factors affecting the person)

 Introduction of Community Health Addiction Counsellors are hospital based and support concurrent disorder programming, consultation and cross training opportunities

 School-based prevention counsellors located in five Alberta communities.

 Expansion of the addiction services and supports for the Provincial Family Violence Treatment Program

 Introduction of mobile/outreach services in Edmonton and Calgary to engage/stabilize people who are street-involved

 During 2009/10, 451 youth were admitted to Protection of Children Abusing Drugs Act safe houses

 Continued implementation of the Children’s Mental Health Action Plan

In its April 2008 report, the Auditor General of Alberta recommended that future provincial mental health plans incorporate four criteria:

1. Responsibility for each priority should be clearly assigned

2. An implementation plan and/or process should be created for each priority 3. Progress should be monitored and periodically reported on

4. Action and progress on the priorities should continue to promote the policy direction, collaboration, and momentum generated by the Provincial Mental Health Plan.

In its 2009/2010 Annual Report, Alberta Health Services identified the following beds available within the mental health and addictions continuum as of March 31, 2010 (p.18):

 862 beds in five psychiatric facilities and 625 acute care psychiatric beds

 1,409 addiction treatment beds

 450 beds in community mental health homes

AHS further reported 15,000 Mental Health Hospital Admissions (Average Stay of 20 Days), 493,000 Outpatient Community Mental Health Visits, and 2,400 Treated for Addiction Problems (Average Stay of 20 Days) in 2009/10.

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General Priorities Population-Specific Priorities

Support And Treatment – Providing assessment, treatment, rehabilitation and community support for individuals and families.

 Crisis services

 Care/case coordination: Tailor services to meet the needs of individual clients and their families.

 Shared care: Position mental health services as an integral part of all primary health care reform initiatives.

 Planning and follow-up

 Concurrent diagnosis/co-morbidity: Increase the capacity to respond to the needs of clients with more complex mental health problems including concurrent diagnosis/co-morbidities.

 Substance abuse and addictions: Collaboratively develop a provincial strategy for increasing investment and addressing the needs of mentally ill clients with addiction and substance abuse problems.

 Forensic services

 Tele-mental health services: Expand the utilization of tele-mental health to support service delivery.

 Brain injury: Develop a province-wide strategy for brain injury services through a process that effectively engages regional health authorities, Alberta Community Development (Brain Injury Network), key service providers and consumers.

 Assessment and treatment services for children and youth

 Alberta Children and Youth Initiative (ACYI): Use the organizational framework and management infrastructure of the ACYI to advance

initiatives that have implications for the children’s and youth mental health services.

 Services for children in care: Ensure that the needs of children in care are proactively and collaboratively addressed by regional health authorities, relevant ministries and related authorities.

 Adult Early Onset Dementia

 Psycho-geriatric services: Increase investment in psycho-geriatric services to accommodate increasing demand as a result of demographic trends.

 Treatment and support for vulnerable populations

 Programs for homeless people: Provide access to on-site mental health programs and referral services for homeless people who access shelters or drop-in centers.

 Access to culturally sensitive Aboriginal mental health programming Risk Reduction – Reducing the risk of mental illness and optimizing mental health by decreasing factors that negatively affect well-being including physical illness, poverty, abuse or chronic neglect, violence, addictions, trauma, or harsh social conditions.

 Prevention, promotion and public awareness

 Suicide prevention: Develop and implement an effective suicide prevention strategy designed to substantially reduce rates of suicide and suicidal behaviour in the province.

 Affordable housing: Create incentives to encourage private, public and voluntary providers to expand the supply of affordable housing across the province

 Children and youth – early intervention, prevention and education

 Seniors’ community wellness programs:

 Services for expectant women and new mothers: Work cooperatively with women’s and children’s health services in each region to ensure that prenatal education, screening and pre- and postnatal counselling are provided to all expectant mothers.

Capacity building – Identifying, maintaining and strengthening factors that promote mental health and wellbeing across government, in communities, and with individuals and their families

 Safe and supportive housing: Improve access to an appropriate range of supportive housing/living options for clients with severe and persistent mental health problems.

 Funded homes: Ensure compliance with the provisions of the Protection of Persons In-Care Act.

 Community capacity building and inclusion

 Individual family and community supports: Increase the resources for individuals, families and community-based support programs designed to: address the socio-economic factors that influence mental health, increase the ability of clients to cope with mental health issues,

 Youth in transition: Build bridges and supports to assist youth with mental health problems to transition from adolescent to adult programs and services.

 Community supports for seniors

 Aboriginal community-based strategies: Use integrated community-based service delivery strategies to address the determinants of health and ensure that services are available and accessible in the communities where

Aboriginal people reside.

General Priorities Population-Specific Priorities increase the capacity of families and communities to care for clients with mental illnesses,

and increase the capacity of clients and families to participate in their communities.

 Income supports and supportive employment

 Consumer support groups: Provide greater support for consumer owned and led supports and services, including the expansion of support for self-help groups, club houses, etc.

 Ethnic groups: Develop community-based support systems and culturally sensitive programming to reach high risk members of immigrant and ethnic populations.

 Developmental disabilities: Improve the coordination and integration of services for people with developmental disabilities with mental health services provided by regional health authorities.

 Aboriginal mental health service providers: Ensure that service providers have the training required to increase their capacity to become culturally competent to serve Aboriginal people.

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INCOME SUPPORTS

The provincial social assistance program in Alberta is named ‘Alberta Works – Income Supports’. Alberta Employment Immigration and Industry is responsible for the delivery of the program. Key legislation includes the Income and Employment Supports Act, and the Income Supports Health and Training Benefits Regulations guides the administration of the program. Benefits include a core essential benefit (e.g., cost of food, clothing, household and personal needs, telephone installation, and laundry and transportation) and a core shelter benefit (e.g., rent, mortgage, utilities, heating, fuel, municipal taxes, insurance, condominium fees, lot rental, homeowner’s maintenance and damage deposit).

The provincial assistance program for adults with severe and permanent disability is known as ‘Assured Income for the Severely Handicapped’ (AISH). Alberta Seniors and Community Supports administers the program. This assistance program is governed by the Assured Income fore the Severely Handicapped Regulation, the Facilities, Institutions, Health Benefits Regulation and the Income and Employment Supports Act. The program provides monthly living allowance, health related assistance (e.g., prescription drugs, optical, dental and emergency ambulance available to recipient, partner and dependent children under 18 years), a child benefit, and personal benefit.

The level of benefits that a recipient receives from AISH depends on the type and amount of income of the recipient and his/her cohabiting partner. Under AISH, income is classified into four categories: fully exempt (e.g., income tax refunds, an education or training grant, a goods and service tax credit), partially exempt (e.g., Chapter 11 – Alberta – Assured Income for the Severely Handicapped interest/investment, rental income), non-exempt (e.g. Canada Pension Plan Disability Benefits, Employment Insurance) and employment income. Recipients who live in facilities designated by the Facilities, Institutions, Health Benefits Regulation receive Modified AISH benefits (includes the facility daily accommodation rate plus a personal allowance).

Rapid reinstatement of AISH benefits is also available for those eligible former AISH recipients who need to come back onto AISH within 2 years due to a reduction in their employment earnings.

Clients of the Alberta Works – Income Supports social assistance program are placed in one of three client groups:

1. ‘Expected to Work’

- Individuals and families within this category include: those that are working (full or part-time) whose income is less than the financial benefits provided under the social assistance program; are able to work but unable to find employment; or, those that are temporarily unavailable for work due to reasons such as short-term illness 2. ‘Not Expected to Work’

- Individuals and families within this category include: those who have a permanent disability (defined by the AISH program); or, have multiple barriers or suffer from a ‘chronic medical condition that inhibits their ability to seek and accept employment’

3. ‘Learners’

- Individuals and families in this category include those that are participating in occupational training or attending classes or courses to improve their employability

According to the Social Assistance Statistical Report, 2007 (Federal-Provincial-Territorial Directors of Income Support, May 2010, pp. 92-98),

 There were a reported 48,100 recipients (25, 100 cases) of Alberta Works-Income Support - Approximately 17% of all cases (4,300 of 25,100 cases) were due to a short-term disability

- Approximately 46% of all cases were due to long-term disability (may include AISH clients who have been transferred to the Alberta Works - Income Support program to access supplemental benefits which are not available through AISH)

- Approximately 57% of all disability-related cases had been receiving assistance for over one year - Approximately 19% of all disability-related cases had been receiving assistance for over five years

 There were a reported 36,100 recipients of AISH

- Of all recipients receiving AISH, 32% were due to mental illness disorders.

 Social assistance clients of the Alberta Works – Income Supports program are eligible for the following monthly earnings exemptions: singles may retain $115 per month plus 25% of additional earnings; single parent families may retain $230 per month plus 25% of additional earnings; couples (with or without children) may retain $115 per month plus 25% of additional earnings for each working adult

 Clients of the AISH are eligible for the following earnings exemptions: $400 of employment income plus 50% of net remainder (maximum of $1,000 per month) for singles/childless couple; $975 of employment income plus 50% of the net remainder (maximum of $2000 per month) for single parents, childless couple (one AISH), couple with children

 Total income for a single person with a disability receiving Alberta Works – Income Support is $8773 (includes basic social assistance, other provincial/territorial benefits and GST credit)⁷⁸

 Total income for a single person with a disability receiving AISH is $14,256 as of April 1, 2009 (includes basis social assistance and GST credit)⁷⁹