A PORTRAIT OF HUMAN RESOURCE NEEDS IN MENTAL HEALTH

Transcription

1 A PORTRAIT OF HUMAN RESOURCE NEEDS IN MENTAL HEALTH

2 ACKNOWLEDGEMENTS The Collective Community Services (CCS) would like to thank all those who have contributed to the production of this report. This document has been prepared at the request of the Networking and Partnership Initiative (NPI) partnered with McGill University through the Training and Retention of Health Professionals Project as a preliminary result of the pilot projects Bus ting the Stigma Tours and Together We Can, under the management of Ursula Nacked Cabral. Research and report writing: Collective Community Services Mary Ann Davis Diane Kipling Dorothy Williams The production of this document has been made possible through a financial contribution from McGill University through a financial contribution from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada. For more information, please contact: Collective Community Services (CCS) 451, Rue de L Eglise, Verdun, QC H4G 2M6 Tel : Web: A production of the Collective Comunity Services (CCS) April of 22

3 Table of Contents Introduction. 2 Methodology... 3 Report Background Global Aspects... 5 Quebec s Healthcare Reform Human Resource Gaps in Five Organizations Offering Mental Health Services Lester B. Pearson School Board Ste. Anne s Hospital Douglas Mental Health University Institute...11 Centre Wellington. 13 Projet PAL Conclusion References Tables Table 1 Number of Trainees per Discipline.. 13 Table 2 Gaps Identified for Potential Internship, Montréal of 22

4 Introduction Collective Community Services (CCS), through its Networking and Partnership Initiative (NPI) partnered with McGill University through the Training and Retention of Health Professionals Project and launched two projects in early 2016 called Bus ting the Stigma Tours and Together We Can. Both projects aim to improve mental health services for the English-speaking community by increasing bilingual employment opportunities in the field of mental health and by battling the issue of mental illness stigma. Though similar, the focus of each project is nuanced. Bus ting the Stigma Tours centers on public perception, particularly those held by student interns in the health field. Stigma-related issues surrounding mental health have an impact on recruitment and retention of students and employees in the field of mental health. Often a misunderstanding or misconstrued notion due to these stigmas will act as a deterrent to those seeking employment. CCS aims to combat the stigmatization of mental illness by introducing students enrolled in health and social services programs in English CEGEPs and universities to the realities of mental health. By helping students demystify mental health issues and their stigmas, they may seriously consider a career in the mental health field upon graduation. Also, CCS aims to increase bilingual employment opportunities by facilitating field study and internship placements for students so that they may potentially lead to job placements at partnering organizations. Together We Can main goal is to develop a collaborative approach between educational institutions and different organizations, including clinical and community partners in the field of mental health, that can serve as a means to these ends. The research brought to bear in this report can give us a clue as to the range of services for the English-speaking population in need of mental health services. To uncover the real issues affecting this sector, health partnerships are essential. Therefore, partnering organizations become key to the success of this report. Together We Can seeks to understand the gaps in the mental health field. The conclusions herein are based upon partners needs and will help CCS to better understand how to select and support mental health internships in the greater Montréal area. 3 of 22

5 METHODOLOGY Initially, CCS identified 22 institutions meeting the criteria for this project. CCS first identified mental health institutions listed in the Southwest sector. Over several weeks, the project contact list expanded to include English-speaking educational institutions, existing community partners of CCS, and institutional partners in the NPI network. Online exploration also uncovered a useful tool that listed a wide-range of mental health, clinical and community support organizations in southwest Montréal: Douglas: Ressources en santé mentale pour les residents du Sud-Ouest de Montréal (Douglas Mental Health University Institute [DMHUI], 2014a). This website became an invaluable resource throughout the project. Though 22 potential institutions were captured, this report will explore the human resource needs of just five organizations that offer mental health services to the English-speaking community. Choosing which five organizations to study presented a challenge. Selecting five organizations required an analysis of services supplied to the English-speaking community. The main criterion identified was the scope of their mental health services within the English-speaking community. The second criterion was the diversity of services offered to a wide range of users with differing mental health needs. For instance, youth services, adult care, geriatric care, services for persons with a physical or intellectual disability, and specialized services like those given to military personnel suffering from operational stress injury (OSI). The third criterion was the extent to which they offered first-line care, second-line care or third-line care. The five organizations that were chosen are Lester B. Pearson School Board (LBPSB), Ste. Anne s Hospital, Douglas Mental Health University Institute, Projet PAL and the Wellington Centre. All five offer bilingual services and have a strong history of serving the English-speaking community. They also offer a full spectrum of services, from prevention strategies, intervention programs and treatment plans to rehabilitation, recovery and outreach programs, to a clientele with a wide range of needs. In addition, all of the organizations offer different levels of care, from first-line to thirdline care and support. One of the first tasks to support this research was the creation of a bibliographic listing. The English-speaking community, thanks to the work of researchers such as Dr. Pocock and others over the years, are growing a body of literature that addresses health services and access in the 4 of 22

6 greater Montréal area. These reports formed the foundation of our on-the-ground research and in truth were not seminal rather they are rich in detail and analysis about the English-speaking community and health access. Thus the bibliography was indispensable in understanding the demographical makeup of the English-speaking community in Montréal s CSSS (Centre de santé et de services sociaux) territories and identified, for the basis of this report, regional gaps. The data which we report upon here also comes from a series of interviews that were conducted by phone or in person with representatives from three of the five institutions. These were openended conversations, essentially conducted without survey or questionnaire. The rationale for not having a standard form was simply to allow for an open-ended dialogue in order to capture key points in each conversation about their staffing challenges, particularly the impact of the healthcare reform under Bill 10 and the major effect it is having on human resources, from cuts to personnel and hiring freezes to the merging of healthcare institutions. The final source for the data we present here came from two face-to-face meetings held at CCS. These meetings were a culmination of the data collection that had been undertaken during the research phase. On March 22 and 23, 2016, CCS held meetings with most of the educational leaders and mental health partners who had expressed interest in the project. The range of partners attending the face-to-face sessions was impressive and covered clinical, pedagogical, and Englishspeaking community institutions. The educational institutions present were McGill University, School of Physical and Occupational Therapy and School of Social Work; and Concordia University, Department of Applied Human Sciences. The community and mental health organizations present were Lester B. Pearson School Board (LBPSB); Horizon High School; Verdun Elementary School; Projet PAL, an alternative mental health resource; CSSS du Sud- Ouest Verdun; and the Assistance and Referral Centre (ARC). The meetings presented CCS with a trove of textured information that is highlighted in this report. These potential partners engaged in complex and weighty discussions on a broad range of topics: the intern placements HR concerns quotas that impact supervision 5 of 22

7 challenges in managing nonbinding agreements between universities and the Centres intégré universitaire de santé et de services sociaux (CIUSSSes) gaps in mental health Clearly it was of great relevance, for our data collection purpose, that the attendees explored the gaps in mental health. Many of their comments allowed for new avenues of research. Another goal, met with holding these meetings, was the opportunity for these partners to network with each other a critical need for developing CCS s table on mental health. REPORT BACKGROUND: From the beginning of the project, there was a need to understand health access under Quebec s current political environment. Our preliminary research took into account Canadian as well as Quebec-based research where gaps have been previously identified. Global Aspects About 20% of the Canadian and Quebec population, or 1 in 5 people, will experience a mental illness during their lifetime (Ministère de la Santé et des Services sociaux [MSSS], 2015a, Description section, para. 6; Canadian Mental Health Association [CMHA], n.d., Who is affected? section, para. 1). Yet less than half of those who suffer from mental illness seek professional help. The World Health Organization (WHO) estimates that by 2020, depression will be the second leading cause of illness and disability after cardiovascular diseases (MSSS, 2015a, Description section, para. 6). Although mental illness affects all age groups, some groups are more vulnerable than others. According to the CMHA (2014), an estimated 1.5 million Canadian children and youth (aged 0-24) are affected by mental illness and are not receiving access to appropriate supports, treatment or care (Access to Mental Health Care section, para. 1). Statistics show that 50% of mental illnesses occur before the age of 14 and 75%, before the age of 22 (MSSS, 2015b, p. 4). With evidence mounting about the need for early intervention, Quebec responded. First to the table, was the Centre hospitalier universitaire de Sherbrooke along with Quebec's three mental health university institutes: the DMHUI, the Institut Universitaire en santé mentale de Montréal 6 of 22

8 (IUSMM), and the Institut Universitaire en santé mentale du Québec (IUSMQ). In January 2014, they had strongly stated, at the provincial consultation on the mental health action plan, that, a global health perspective must go beyond the MSSS framework to become a governmental and interministerial commitment based on a vision of public mental health that incorporates the health status of the general population and accounts for social determinants (Fortin et. al., 2014, para. 7). The province of Quebec followed through and in 2015 recognized this need. It introduced its own mental health action plan titled, Plan d action en santé mentale Faire ensemble et autrement (PASM), (Ministère de la Santé et des Services sociaux [MSSS], 2015b). Three important objectives were stated: increase mental health access and services for youth, fight stigmatization of mental illness, and create a global approach to mental healthcare. These priorities are recognized but have not been treated in an equitable fashion. Studies have confirmed that language barriers affect access and quality of mental health care (Udy, Howarth, Kischuk, & Medeiros, 2013, p. 4), and according to the Canadian Community Health Survey ( ) language is an essential tool in the diagnosis and treatment of mental health problems and the likelihood of impaired communication results in the service being ineffective and simply not pursued (Pocock, 2015, p.10). As early as 2013, according to Udy et. al (2013), availability of and access to mental health services for Quebec s majority and minority language communities is viewed as inadequate (p. 16). Little had changed for even as late as 2015, findings show that the English-speaking population has more difficulty accessing mental health information as well as mental health prevention and treatment services in English (Pocock, 2015, p.10). Quebec s Current Healthcare Reform Bill 100, introduced in 2010, began the downsizing of Quebec s healthcare system because it reduced staff and put in a hiring freeze. The reduction in staff meant beds closed, thereby reducing accessibility to healthcare. This was followed up on April 1, 2015, as Quebec s new healthcare reform, Bill 10, abolished regional agencies. The law replaced them with the CISSS and the CIUSSS. In fact, 28 of these would be created province wide, five in the Montréal region alone ( Bill 10, 2014). Merging and closures of healthcare institutions hit the healthcare system forcing staff to cope with bed closures, fewer jobs and management positions, and the reduction of healthcare professionals ( Quebec close to eliminating 1,300 healthcare jobs, 2016). 7 of 22

9 The gap widened in terms of access and support. Yet we noted in our face-to-face meeting of March 23 that another door has opened in the private sector. A shrinking job pool in greater Montréal now forces recent graduates to look for jobs in the growing private sector, or move to the regions, or leave Quebec altogether for work in other provinces. Cuts to healthcare have a major impact on the services offered to a clientele with mental health issues. These changes formed a major part of our partner discussions, as we tried to determine how the major healthcare reform would affect the project s goals. Because the reform is still in its beginning stages, it is not possible to do a complete analysis of human resource needs at this point in time, yet its impact has already affected these needs across the healthcare system. Nevertheless, this was clearly the aim of the project how can we support the integration of bilingual interns in this environment? Clearly, though the overall gaps in HR were identified as systemic [throughout the healthcare system], the need for additional HR support for mental health appeared to be mitigated by the environment of austerity and change that our public-sector partners are currently facing. Human Resources Gaps in Five Organizations Offering Mental Health Services The project began in this environment of uncertainty. CCS reached out and experienced varying levels of response. CCS looked for partners willing to help it explore some of these issues. Douglas Mental Health University Institute, Projet PAL and the Wellington Centre are mental health organizations. In addition, Lester B. Pearson School Board (LBPSB) and Ste. Anne s Hospital accepted the challenge. Lester B. Pearson School Board (LBPSB) At the educational and community partner meetings of March 22 and 23, 2016, CCS had the pleasure of having three representatives from Lester B. Pearson School Board (LBPSB), one of the largest English school boards in Quebec: Verdun Elementary School where about 45% of the student body has special needs. Their project aims to build the capacity of all staff to provide trauma sensitive education and create a trauma sensitive environment for students; 8 of 22

10 Horizon High School, an alternative school for at-risk youth, offers academic and psychosocial support for at-risk youth who have problems functioning in a more general high school setting (Horizon High School, n.d., Horizon Mission & Vision Statements section); The Centre of Excellence for Mental Health (CEMH) for the ten English School Boards of Quebec including LBPSB. Created in 2011, the CEMH s main focus on prevention and intervention are the building blocks of the trauma sensitive project at Verdun Elementary School and the alternative educational programs at Horizon High School. The school boards have recognized the need to fill a gap so evident in the public health sector. Thus, the CEMH serves as a stopgap, and in some cases, a last-resort for mental health services to English-speaking youth. They describe their raison d être: The Centre s mandate is to develop capacity locally and to serve as a provincial resource to other English school boards in Quebec, assisting schools in the implementation of best practice approaches in prevention, intervention and research in the field of mental health. Thus, a Centre of Excellence for Mental Health requires a focus that is as much oriented toward wellness and prevention as intervention. (Centre of Excellence for Mental Health [CEMH], n.d., Our Mandate and Vision section, para. 1) When speaking of a more global approach to mental health in organizations other than mental health resources, LBPSB s CEMH is a perfect example of this type of approach. Schools have the capacity to work with multidisciplinary teams to help students suffering from mental health issues. For instance, teachers are usually the ones who first observe signs of potential mental health problems and then send their students for their first assessment with a school mental health professional like a school psychologist or guidance counsellor. Therefore, schools in the English language school sector have become the front-line entry into mental health programs and resources. In the partner meetings, these schools identified the need for more funding so their essential programs can support students well-being and be properly equipped with a much needed multidisciplinary professional team. This, we were told, would bring healthcare closer to students and make it more accessible, and it would also increase employment for healthcare professionals. 9 of 22

11 Schools need to be recognized as an important step in front-line mental health services so they can receive the funding for the key role they play. All schools within LBPSB have weekly resource meetings with teachers and a multidisciplinary team which includes psychologist, social worker, resource teacher, occupational therapist, speech and language pathologist, planning room technician, behaviour technician or special education technician, administrator of school to discuss challenging cases. The goal of these meetings is to come up with ideas and interventions for students. It was suggested that CEGEP and university students attend these resource meetings as interns so that they may be introduced to how the multidisciplinary team works in mental health in a school setting, thereby increasing their knowledge-base when looking for eventual employment in schools. In the partner meetings, it was also pointed out that the issues are not only lack of services but also accessibility to external services. The attendees noted that often, students and their families may not seek help outside of school because of the stigma attached to entering a mental health organization like the Douglas Mental Health University Institute, and because of travel time. Also, current wait times at external mental health organizations act as a barrier to students seeking help. Because of the stigma and the difficulty in accessing services, students prefer services in school, whatever the quality offered. The schools struggle to attract recent CEGEP and university graduates from health and services programs. They noted that students have misconceptions about what a mental health professional can do in a school or community setting. Unfortunately, as stated in the partner meetings, because of the prestige associated with working in institutional environments, these budding professionals still prefer to gravitate towards a hospital setting. In reality, they emphasized, that working in a school or community setting can be just as rewarding and professionally stimulating as working in traditional environments. Ste. Anne s Hospital Ste. Anne s Hospital commonly known as the Veterans Hospital was built in 1917 in Ste. Anne de Bellevue located in Montréal s West Island. It was one of nine hospitals established in Canada by the Military Hospitals Commission under the Borden government to respond to a high number 10 of 22

12 of unexpected sick and wounded generated by the First World War (Centre intégré universitaire de santé et de services sociaux de l Ouest-de-l Île-de-Montréal [CIUSSS de l Ouest-de-l Île-de- Montréal], n.d.c, History section, para. 1). Over the years, the hospital began to offer more specialized services in mental health care and geriatric care because of their aging veterans population. In 2015 the newspaper Montreal Gazette gave this overview of Ste. Anne s: There are currently about 350 veterans from the Second World War and the Korean conflict and 10 modern-day veterans staying at the hospital, 75 using the daycare option and around 200 veterans who served in areas of the world, including Bosnia, Afghanistan and Haiti, who regularly use one of the two outpatient clinics to receive treatment for post-traumatic stress disorder and operational stress injuries (OSI) a more complex disorder involving debilitating fallout from multiple traumas. (Greenaway, 2015) Ste. Anne s Hospital specializes in third-line care. With a highly specialized staff, they are able to offer Clinical Services, Operational Stress Injury Clinics and Leading-Edge Clinical Programs (CIUSSS de l Ouest-de-l Île-de-Montréal, n.d.b). The pioneering approach of its interdisciplinary teams, which consist of psychiatrists, psychologists, physicians, nurses, social workers, occupational therapists and other specialists, has enabled Ste. Anne s to develop expertise in the treatment of individuals suffering from operational stress injury (OSI). The hospital also plays a key role with regards to the development and coordination of a network of OSI clinics throughout the country (Government of Canada, 2014, Development of the Network of OSI Clinics section). Over the past forty years, Veterans Affairs Canada began transferring the nine hospitals to the provinces. On April 1, 2016, Ste. Anne s was the last hospital to be transferred. Now part of the CIUSSS de l Ouest-de-l Île-de-Montréal, has led to staff losses; many accepted to be transferred to other federal resources, or decided to just leave or retire. Eventually 40% of the staff had left the hospital. The highly specialized mental health team will continue to offer the same services with more specialized geriatric care not only for veterans and active members of the Canadian Armed Forces and the Royal Canadian Mounted Police but also for the general population. With 40% of the staff gone, an urgent call to the public in early 2016 was made to fill personnel gaps. Following is a current list of the qualified staff that the hospital is still looking for: nurses, 11 of 22

13 candidates for the profession of nursing (CPN), patient care attendants, food services staff, sanitation staff, respiratory therapists, recreation technicians, recreational therapists, psychologists, dietitians, pharmacists, social workers and occupational therapist (CIUSSS de l Ouest-de-l Île-de-Montréal, n.d.a, Staff wanted section). It is clear that Ste. Anne s has important human resource needs that cannot be overlooked. Ste. Anne s is set to become a university learning centre and a potential centre for professional development for students and young graduates, through clinical internships (CIUSSS de l Ouestde-l Île-de-Montréal, n.d.c, Affiliation with McGill University section, para. 2). Due to Ste. Anne s Hospital historic affiliation with McGill University, potential internships, coupled with the expansion of services to the public, could open opportunities for long-term partnerships with HR action plans. Douglas Mental Health University Institute When the Douglas Mental Health University Institute (DMHUI) was first built in 1881 by Alfred Perry, it promised to be the most progressive mental health institution in the province of Quebec. In 1946, the hospital became affiliated with McGill University opening its doors to train students in psychiatry, nursing, psychology, occupational therapy and other disciplines. In 1965, its name was changed to the Douglas Hospital in honour of the work of Dr. James Douglas. (DMHUI, 2014b) The hospital was always a leader in mental health research. In 1967, it was the first psychiatric institute to receive accreditation by the Canadian Council on Health Services Accreditation in recognition of the quality of its services, especially in understanding the brain s biological mechanisms in relation to mental illness. Then in 1979 the Douglas Hospital Research Centre was created. It also became a World Health Organization Collaborating Centre in In 2006, during its 125 th anniversary year, the Douglas Hospital was renamed the Douglas Mental Health University Institute. (DMHUI, 2014b) The Douglas Institute also holds a unique position in the network of Quebec teaching institutions. It is the only psychiatric teaching hospital in the McGill University network, and it is one of only three psychiatric hospitals in Quebec (DMHUI, 2015a, para. 1). 12 of 22

14 The Douglas remains a world-class mental health university institute and has many areas of expertise. Its programs are Child and Adolescent Psychiatry, Geriatric Psychiatry, Mood Disorders, Psychotic Disorders, Prevention and Early Intervention Program for Psychosis, Eating Disorders, Intellectual Handicaps, and Psychosocial Rehabilitation (DMHUI, 2015c). Its vision is The power to recover through some of the following facets: de-stigmatization, global health, population needs, research, teaching, and knowledge exchange and application (DMHUI, 2015e). In 1966 hospitalizations reached 1,840 (DMHUI, 2014b), and today, they reach only 266 because over 100,000 individuals with mental health problems are followed externally through diverse specialized clinics (DMHUI, 2015e). This shift now requires personnel that specialize in psychosocial rehabilitation, adding to the diverse professional specializations that the Douglas attracts. This too is reflected in the Douglas Institute s mandate as a university teaching hospital. In a given year, it accepts over 400 interns in different disciplines: nursing, continuing medical education, psychology, occupational therapy/specialized education, nutrition and social work (DMHUI, 2015a). Interns can apply to work within the hospital or in its external clinics, or they can apply to work in the internationally acclaimed research centre. The Douglas Institute s extensive online career listing underscores its commitment to support internship training: 13 of 22

15 Table #1 Number of Trainees per Discipline Professional disciplines Number of trainees Nursing 196 Special Education 4 Occupational therapy 13 Nutrition 11 Psychology 47 Social Work 28 Externs 44 Residents 25 Fellows 4 Pharmacy 27 Administration 9 Douglas Mental Health University Institute, 2015a In keeping with societal changes, the Douglas Mental Health University Institute has developed the Social Psychiatry Research and Interest Group (SPRING), an interdisciplinary division. These professional researchers collaborate together to develop best practices in the struggle against mental health stigma. They too see the need to sensitize professionals and heighten awareness, thus SPRING incorporates and supports internship training. (DMHUI, 2015b) Wellington Centre The reach of the Douglas Institute is evidenced in its relationship to the Wellington Centre in Verdun. The Centre is an off-site psycho-social rehabilitation program run by the Douglas Mental Health University Institute. It helps individuals with severe mental health disorders reintegrate into the community. Its mandate aims to: Develop social and community opportunities that allow people to take on concrete and meaningful roles in society 14 of 22

16 Demystify mental illness and raise awareness about recovery and social inclusion of people mental health disorders (DMHUI, 2015d) Interestingly, the Wellington Centre stands apart from the Douglas Hospital in the critical types of services it offers. Wellington offers a number of recovery support services including Wellness Services, Work Integration Services, Educational Services, Therapeutic and Personal Growth Groups, and Peer Helper Service. Its Wellness Services offers integration activities to help individuals regain healthy habits that promote recovery (DMHUI, 2015d). Their Work Integration Services program includes Individual Placement and Support (IPS) program for clients referred by the Douglas Institute, and Social Assistance and Support Program (PAAS-Action) positions (DMHUI, 2015d). The Educational Services link clients with adult education, various social integration services offered by the school boards and even high-school matriculation (DMHUI, 2015d). Complementing these labour-market skills are the soft-skills training given through Wellington s Therapeutic and Personal Growth Groups. Individuals are coached through sessions on selfesteem and awareness; relaxation; recovery, health and well-being orientation; and budget management (DMHUI, 2015d). Rounding out this holistic support, the Centre also offers a Peer Helper Service, providing counselling and coaching services to increase awareness of their rights while supporting individuals on their personal path to recovery (DMHUI, 2015d). The Wellington Centre employs a social worker, an occupational therapist and a nurse clinician along with experts coordinating each program. Aligned with the Douglas Mental Health University Institute, Wellington too, finds itself in need of many internship positions like nursing, occupational therapy and social work. Projet PAL Projet PAL (Projet Programme Aide au Logement) is an alternative resource in mental health, founded in 1975 by Verdun ex-psychiatric patients and a social worker from the Douglas Mental 15 of 22

17 Health University Institute. It was established in the early days of deinstitutionalization when the need for an ex-patients rights group was more and more apparent. Projet PAL became one of the first vocal patients rights group in Verdun. (Projet PAL, n.d.c) In addition to advocacy, PAL addressed the mental health challenges of living on the outside. The need to accompany ex-patients and help them rebuild their lives was critical. Services are based on the needs of their members. The following programs are offered at Projet PAL: The Drop-in Center: offers educational and occupational activities ranging from yoga, writing, and art to music (Projet PAL, n.d.b). Housing Services: have been a driving force since PAL s inception in 1975, because in their own words regarding recovery, A roof over one s head is simply the first and essential step (Projet PAL, n.d.d, para. 5). Collective Community Action Program: encapsulates the human rights fight concerning mental health, fighting stigma, housing rights and anti-poverty rights, (Projet PAL, n.d.a) Individual Aide and Accompaniment Program: offers members help in accessing health services, filing a complaint against their landlord, breaking isolation and dealing with poverty. (Projet PAL, n.d.e, Logi PAL section, para. 2) Projet PAL has unique hiring practices in the community alternative mental health sector. During CCS s partner meetings, PAL members take a front role when hiring staff, accompanied by the coordinator. PAL does not necessarily look at the diploma of the person applying; or rather, this type of bona fides ranks very low on their priority list when interviewing applicants. What PAL looks at most is the candidate s experience working with individuals suffering from mental health problems. Projet PAL is a well-respected resource and has laid the groundwork for other alternative resources in mental health. PAL employees come from different psychosocial-educational backgrounds ranging from social work, special care counselling, and social services to recreational therapies. Notwithstanding PAL s experiential criteria for staffing they acknowledge the need for more psychologists, occupational therapists, and staff from other disciplines to assist them in their 16 of 22

18 integration activities (Projet PAL, personal communication, February 15, 2016). Outreach through the project, Together We Can has afforded PAL an opportunity to seriously revisit the possibility of working with interns in these areas. Conclusion Despite the effects of the recent provincial healthcare reform, the five organizations mentioned above continue to work to reduce risk factors, to mitigate the effects of mental health, to enhance the positive factors and better support their communities. During CCS s community meetings, the numerous face-to-face and telephone conversations, every effort was made to understand the level of commitment, factors of resistance and the obstacles faced in the mental health sector today. These five institutions give us a glimpse of the complexities they face in serving their clientele. From direct front-line and clinical to ancillary services in community centers and education, work is being done to support bilingual, mental health needs in diverse populations: youth, seniors, families and adults. Unknowingly, the project, Together We Can, created an opportunity for project partners to come together around mental health care in the community. Participants at various levels were invited to share their thoughts and ideas concerning the difficulties they encountered placing interns at a time when Quebec s healthcare system is undergoing a major reform due to Bill 10. Still, staffing continues to challenge their service mandates though clearly the fiscal reality has had an impact. In summary then, specifically we have identified, through these first, second, and third-line services institutions, the following gaps. 17 of 22

19 Table #2 Gaps Identified for Potential Internship, Montréal Institution Clientele Services Gaps Lester B. Pearson School Board (LBPSB), Centre of Excellence for Mental Health (CEMH) Public schools: children, youth, adults Prevention, on-site intervention, mental health education, staff training Guidance counsellor, psychologist, social worker, resource teacher, occupational therapist, speech and language pathologist, planning room technician, behaviour technician, special education technician Ste. Anne s Hospital Veterans, elderly, general public Geriatrics, Operational Stress Injury (OSI), physical and mental rehabilitation Nurses, recreation technicians, recreational therapists, psychologists, dietitians, pharmacists, social workers, occupational therapist Douglas Mental Health University Institute Adult, youth, elderly Clinical treatment; child, adolescent and geriatric psychiatry; mood and psychotic disorders; PEPP; eating disorders; intellectual handicaps; psychosocial rehabilitation; emergency; anti-stigma research group (SPRING) Nurse, Special Education, Occupational therapy, Nutrition, Psychology, Social Work, Externs, Residents, Fellows, Pharmacy, Administration Wellington Centre Adults Holistic services: employment, peer support, rehabilitation, education, personal edification Occupational therapist, social worker, nurse Projet PAL Adults Housing, drop-in, advocacy, aid and accompaniment Social worker, special care counsellor, recreational counsellor, social service intervention worker 18 of 22

20 Together We Can has verified several assumptions. First, the work has shown that there is a need for groups in the mental health sector to network, to share ideas, best practices and concerns. Second, there is significant resilience amongst workers in the field, for despite their assertions about reduction in resources, everyone showed a willingness to engage in new initiatives and explore ways in which collaboration can help them achieve their mandates. Third, these institutions have not fully lost the desire or need for internships. Though supervision is more challenging, it is still considered a valued tool to re-energize staff and current practices. Bringing educational partners and community/institutional partners together has enabled CCS s project, Together We Can, to benefit from gathering of a wealth of new knowledge, to create enduring partnerships and create the environment whereby its partners can adapt to each other and therefore learn from each other. 19 of 22

21 REFERENCES Bill 10: An Act to modify the organization and governance of the health and social services network, in particular by abolishing the regional agencies. (2014). Introduced September 25, 2014, 41 st Legislature, 1 st Session. Retrieved from Assemblée nationale du Québec: Canadian Mental Health Association. (n.d.). Fast facts about mental illness. Retrieved from Canadian Mental Health Association. (2014). CMHA public policy position: Child and youth Access to mental health promotion and mental health care. Retrieved from Centre intégré universitaire de santé et de services sociaux de l Ouest-de-l Île-de-Montréal. (n.d.a). Recruitment campaign - Ste. Anne s hospital. Retrieved from Centre intégré universitaire de santé et de services sociaux de l Ouest-de-l Île-de-Montréal. (n.d.b). Ste. Anne s hospital: Care and services. Retrieved from Centre intégré universitaire de santé et de services sociaux de l Ouest-de-l Île-de-Montréal. (n.d.c). Ste. Anne s hospital: History. Retrieved from Centre of Excellence for Mental Health. (n.d.) Centre of Excellence for Mental Health (CEMH): About us. Retrieved from Douglas Mental Health University Institute. (2014a). Ressources en santé mentale pour les résidents du Sud-Ouest de Montréal [Brochure]. Retrieved from Douglas Mental Health University Institute. (2014b, November 11). The Douglas: History. Retrieved from Douglas Mental Health University Institute. (2015a, March 25). The Douglas: Internships. Retrieved from Douglas Mental Health University Institute. Social Psychiatry Research and Interest Group (SPRING). (2015b, April 13). Social Psychiatry Research and Interest Group (SPRING): About. Retrieved from 20 of 22

22 Douglas Mental Health University Institute. (2015c, May 8). The Douglas: Access to care. Retrieved from Douglas Mental Health University Institute. (2015d, May 19). The Douglas: Psychosocial Rehabilitation. Retrieved from Douglas Mental Health University Institute. (2015e, August 14). The Douglas: About. Retrieved from Fortin, D., McVey, L., Racine, S., Luyet, A. J., Israël, M., Villeneuve, E.,... Fortier, L. (2014). Réflexions et recommandations des Instituts universitaires en santé mentale du Québec sur le document de consultation du Forum national sur le plan d action en santé mentale [Reflections and recommendations from Quebec mental health university institutes on the working paper of the provincial forum for the Mental Health Action Plan] [Abstract]. Santé mentale au Québec,39(1), Retrieved from Government of Canada. Veterans Affairs Canada. (2014, December 12). Evaluation of the operational stress injury (OSI) clinic network - October Retrieved from evaluation-osi-clinic-network Greenaway, Kathryn. (2015, February 24). Staff, veterans remain wary of transfer plans for veterans hospital. Montreal Gazette. Retrieved from Horizon High School. Lester B. Pearson School Board. (n.d.) Horizon High School. Retrieved from Ministère de la Santé et des Services sociaux. (2015a, June 11). Mental health (Mental illness). Retrieved from Ministère de la Santé et des Services sociaux. (2015b). Plan d action en santé mentale Faire ensemble et autrement. Retrieved from /?&date=DESC&type=plan-d-action&critere=type Pocock, J. (2015). Canadian community health survey ( ). Findings related to the mental and emotional health of Quebec s English-speaking communities. Retrieved from Projet PAL. (n.d.a). Projet PAL: Collective community action program. Retrieved from Projet PAL. (n.d.b). Projet PAL: Drop-in center. Retrieved from Projet PAL. (n.d.c). Projet PAL: History. Retrieved from Projet PAL. (n.d.d). Projet PAL: Housing services. Retrieved from 21 of 22

23 Projet PAL. (n.d.e). Projet PAL: Individual aid & accompaniment program. Retrieved from Quebec close to eliminating 1,300 healthcare jobs. (2016, March 16). CBC News. Retrieved from Udy, M., Howarth, K., Kischuk, N., & Medeiros, CMA. (2013). Improving access to health and social services for Quebec s English-speaking population. Development priorities Retrieved from 22 of 22