Request for Proposals
Mapping Connections Between Mental Health and Substance Use
Background
The co-occurrence of mental health problems and illnesses with substance use remains a significant health issue in Canada. Research led by Dr. Rush for CCSA indicates that as many as 50% of those engaged in treatment for substance use are also living with mental illness, and 15-20% of those accessing treatment for mental illness are living with a substance use issue (CCSA, 2009). For people living with schizophrenia, the rate of substance use can be as high as 50% (Buckley, 2009; Rush, 2008).
A recent analysis of data shows that individuals diagnosed with concurrent mental illness and substance use disorders make up close to one-third of admissions to inpatient mental health facilities (CIHI, 2013). Data also shows that people are routinely in contact with multiple service providers from different programs and sectors who typically do not share information, lack clear lines of communication, and operate within different
frameworks for assessing and understanding the challenges faced by the people in need of care and support.
Despite administrative integration and efforts to build bridges between the sectors in recent years, people facing co-occurring mental health and substance use challenges have higher rates of unmet mental health needs in Canada (Statistics Canada, 2017). Effective integration at the client service level remains an ongoing challenge.
People living with a mental health problem or illness and a substance use issue should be able to expect client- centered, integrated and seamless services. Every door into the healthcare system should be the right door to ensure a whole-of-person approach for offering support to people with co-occurring issues.
Furthermore, the current opioid crisis in Canada is taking a devastating toll on individuals, families, front-line workers and communities across the country. The Mental Health Commission of Canada (MHCC) and the Canadian Centre on Substance Use and Addiction (CCSA) recognize that this national public health crisis is a complex health and social issue and share the perspective that current responses need to be comprehensive, collaborative, compassionate and evidence-informed. The current crisis is also a stark reminder that the co- occurrence of mental health and substance use issues remains a significant health issue in Canada.
The Mental Health Strategy for Canada, in making recommendations in Strategic Direction 3, refers to CCSA’s seminal work in 2009 on concurrent disorders authored by Dr. Brian Rush (CCSA, 2009). Subsequently, the MHCC was pleased to partner with the CCSA and the Canadian Executive Council on Addiction (CECA) to investigate and recommend best practices for improving collaboration among service providers across sectors (Addiction and Mental Health Collaborative Project Steering Committee 2014; 2015). This partnership led to the publication of the Collaboration for Addiction and Mental Health Care: Best Advice document. Building from this resource,
MHCC, CCSA and CECA also collaborated to compile examples of successful collaborations between the addiction and mental health sectors in Canada, along with tools and resources to support such collaborations (CCSA, 2016).
Project Scope
The MHCC and CCSA are seeking a consultant to conduct an environmental scan of grey and published, peer reviewed literature that investigates the differences between, and integration of, the fields of mental health and substance use/addiction, and to write a policy briefing paper based on this evidence. We understand that this literature is expansive and are not asking for a full systematic review. Rather, we are seeking a succinct synthesis of some of the most pressing topics to better inform MHCC and CCSA on emerging and ongoing issues. The report will serve as a resource document, should be broken into thematic sections conveying key messages, and should aim to:
• Help MHCC and CCSA effectively respond to issues related to the co-occurrence of mental health and substance use issues, especially in the context of improving collaboration between mental health and substance use/addiction sectors;
• Help MHCC and CCSA better understand the source of the differences between the mental health and substance use/addiction sectors, along with ways of bridging these differences, and approaches for improving collaboration where there is overlap;
• Provide a concise description of central concepts and principles in each sector, where and how
terminology is used differently, and how these link or intersect with MHCC and CCSA’s current projects.
• Help MHCC & CCSA better understand key considerations and current and pressing issues within the substance use and mental health fields.
Preliminary List of Central Concepts and Principles
The contractor will be expected to describe central concepts and principles in the mental health and substance use/addiction sectors including, but not limited to:
- Mental health and wellness
- Prevention and promotion of mental wellness - Harm reduction and abstinence approaches - Substance use and addiction
- Concurrent disorders - Dual diagnosis
- Two-continuum model of mental health and mental illness - Substance use continuum
- Psychosocial and behavioural dimensions of addiction - Social determinants of health
- Trauma and trauma-informed care - Health equity
- Racism - Colonization - Recovery
- Human rights and legal dimensions, e.g., criminalization, - Epistemology of the two domains
- Etiology (causality, risk factors, etc.).
Preliminary List of Key Considerations and Dimensions of the Issues
The contractor will be expected to address key considerations and dimensions of the issues within the mental health and substance use/addiction systems, including but not limited to:
- How are terms used and in what contexts, and what is informing this terminology?
- Shared risk factors (biological, psychological, social) - History of Trauma
- Dimensions across populations and intersectionalities o Life stage
▪ Youth
▪ Emerging adults
▪ Aging
▪ Adults
▪ Older adults
▪ Pregnant and parenting women o Co-occurring conditions
▪ Mild and moderate mental health problems and illnesses
▪ Substance use and addiction
▪ Serious mental illnesses
▪ Developmental disabilities (e.g. autism, intellectual disabilities, FASD, etc.)
▪ Acquired brain injuries
▪ Physical health problems (only when present in concurrent disorders) o Populations
▪ Immigrant, refugee, ethnocultural, and racialized (IRER)
▪ First Nations
▪ Inuit
▪ Métis
▪ 2SLGBTQ+
▪ Gender differences
▪ Uniquely marginalized: incarcerated, homeless, survival sex-workers, etc.
- Prevention and intervention
o Prevention, promotion of mental wellness, and early intervention o Current treatment and after care approaches
o Social determinants of health o Service systems challenges
▪ Systemic
▪ Integration, collaborative care
▪ Unique/uneven funding structures between systems
▪ Ongoing unresolved issues and challenges
▪ Criminal justice system - PWLE and caregiving
o Stigma and discrimination o Priorities
o Peer organizations
- E-mental health and the use of technology in treating mental health problems and illnesses and substance use issues
- Current issues o Opioid crisis
o Legalization of cannabis
Deliverables
1. Proposed scope for the scan and search parameters for the literature review (due no later than November 20, 2017)
2. Environmental scan and literature review (due no later than January 15, 2018) 3. Annotated outline for policy briefing paper (due no later than January 15, 2018)
4. Draft policy briefing paper for MHCC & CCSA’s use only and proposed topics for the two or three short issue briefs (due no later than March 1, 2018)
5. Final policy briefing paper for MHCC and CCSA’s use only and final drafts of two or three smaller issues briefs (one to two pages) for MHCC, CCSA and external use (due no later than March 23, 2018)
Proposals and Budget
Proposals to complete the deliverables will be accepted until 5PM ET on Sunday October 15, 2017 and should include the following:
1. A statement of how the project will be undertaken (no more than 5 pages);
2. A list of names, CVs, and roles of project team member(s);
3. A proposed timeline for deliverables;
4. A detailed budget and cost proposal.
The budget shall not exceed $40,000 (including GST, PST, and HST, where applicable). The contract will be issued by the Mental Health Commission of Canada.
Evaluation Criteria
1. Strong academic background in mental health and substance use policy, epidemiology, and/or service and program development.
2. Demonstrated history of writing and publishing on mental health and substance use systems and services in Canada.
3. Adequate human resource capacity to meet identified timelines.
4. Ability to complete the project within the available budget.
Please send proposals to Christopher Canning, Manager, Policy and Research:
ccanning@mentalhealthcommission.ca
Preliminary List of Key Documents
Adair, C.E. (2009). Concurrent substance use and mental disorders in adolescents: A review of the literature on current science and practice. The Alberta Centre for Child Family and Community Research.
Addiction and Mental Health Collaborative Project Steering Committee. (2014/2015). Collaboration for addiction and mental health care: Best advice. Ottawa, Ont.: Canadian Centre on Substance Abuse.
Buckley et al. (2009). Psychiatric comorbidities and schizophrenia. Schizophrenia Bulletin, 35: 383-402.
Buckley, J. (2017). Responding to the Opioid Crisis: Leading Practices, Challenges, and Opportunities: A Summary of the Ministerial Roundtable on Opioids.
British Columbia Centre of Excellence for Women’s Health (2015). Harm reduction and pregnancy: Community- based approaches to prenatal substance use in western Canada. Retrieved from http://bccewh.bc.ca/wp- content/uploads/2015/02/HReduction-and-Preg-Booklet.2015_web.pdf
Brousselle, A. et al. (2010). Integrating services for patients with mental and substance use disorders: What matters? Health Care Manage Rev. 35(3): 212-223.
Canadian Centre on Substance Abuse. (2007). National Alcohol Strategy: Reducing alcohol-related harm in Canada: Toward a culture of moderation — Recommendations for a National Alcohol Strategy. Ottawa, ON: Author.
Canadian Centre on Substance Use and Addiction. (2009). Substance abuse in Canada: Concurrent disorders.
Ottawa, ON: Author.
Canadian Centre on Substance Use and Addiction. (2010). Competencies for Canada’s substance abuse workforce.
Ottawa, ON: Author.
Canadian Centre on Substance Use and Addiction. (2016). Addiction and Mental Health Care: Resources to Support Collaboration. Ottawa, ON: Author. http://www.ccsa.ca/Resource%20Library/CCSA-Addiction- Mental-Health-Collaborations-Summary-2016-en.pdf
Canadian Institute on Health Information. (2013). Hospital Mental Health Services for Concurrent Mental Illness and Substance Use Disorders in Canada.
CDFF-FADC. (2017, April 4-5). Canada’s Drug Futures Forum. A summary of proceedings and final recommendations. Retrieved from
https://static1.squarespace.com/static/573a874cf85082b32ba55c15/t/59686921d482e947979d4695/1
500014889362/Canada%E2%80%99s+Drug+Futures+Forum_Summary+of+Proceedings+and+Final+Reco mmendations+%28FULL+REPORT%29_July14.pdf
Greaves, L, N. Poole, E. Boyle (eds). (2015) Transforming Addiction: gender, trauma transdisciplinarity. Routledge, New York.
Health Canada. Best Practices: Concurrent Mental Health and Substance Use Disorders (2002). Ottawa, ON:
Author.
Impact. (n.d.). Transdisciplinarity and Addiction. Factsheet. Retrieved from
http://addictionsresearchtraining.ca/wp-content/uploads/2016/03/infosheet-transdiciplinarity02.pdf
Kates, N., Mazowita, G., Lemire, F., Jayabarathan, A., Bland, R., Selby, S. Audet, D. (2011). The evolution of
collaborative mental health care in Canada: A shared vision for the future. Canadian Journal of Psychiatry, 56(5), 1–10.
McQuaid, R.J., Malik, A., Moussouni, K., Baydack, N., Stargardter, M., & Morrisey, M. (2017). Life in Recovery from Addiction in Canada. Ottawa, Ont.: Canadian Centre on Substance Use and Addiction.
Mental Health Commission of Canada (2012). Changing Directions, Changing Lives: The Mental Health Strategy for Canada. Ottawa, ON: Author.
Mental Health Commission of Canada (2014). National Final Report: Cross-Site At Home/Chez Soi Project. Ottawa, ON: Author.
Mental Health Commission of Canada (2015). Guidelines for Recovery-Oriented Practice. Ottawa, ON: Author.
National institute on Drug Abuse. (2010). Research Report Series. Comorbidity: Addiction and other mental illnesses. US Department of Health and Human Resources. National Institutes of Health.
National Treatment Strategy Working Group. (2008). A Systems Approach to Substance
Use in Canada: Recommendations for a National Treatment Strategy. Ottawa: National Framework for Action to Reduce the Harms Associated with Alcohol and Other Drugs and Substances in Canada
Ontario Centre of Excellence on Child and Youth Mental Health. (2014). Pathways to care for youth with concurrent mental health and substance use disorders.
Ontario. Office of the Auditor General. (2008). Annual Report 2008, chapter 3, section 3.01 – Addiction Programs.
Perreault, M., Perreault, N., Withaeuper, D, & Malai, D. (2009). Le défi du traitement et de la prévention des troubles concomitants sur la base de données probantes. Criminologie, 42(1), 91-114.
http://www.erudit.org/revue/crimino/2009/v42/n1/029809ar.pdf
Rush et al. (2008). Prevalence of co-occurring substance use and other mental disorders in the Canadian population. Canadian Journal of Psychiatry, 53: 800-9.
Rush, B. (2010). Tiered frameworks for planning substance use service delivery systems: Origins and key principles. Nordic Studies on Alcohol and Drugs, 27, 617–636.
Rush, B. (2014). Evaluating the complex: Alternative models and measures for evaluating collaboration among substance use services with mental health, primary care and other services and sectors. Nordic Studies on Alcohol and Drugs, 31(1), 27–44.
Statistics Canada (2017). Concurrent mental and substance use disorders in Canada.
http://www.statcan.gc.ca/pub/82-003-x/2017008/article/54853-eng.pdf
