COVID-19 Pandemic Guidelines for Mental Health Support of Racialized Women At Risk of Gender Based Violence

COVID19 Guidelines for mental health support of racialized women at risk of Gender Based Violence – Synthesis Report

Multidisciplinary Team: Nazilla Khanlou (Principal Investigator) and Dr. Andrew Ssawe (Principal Knowledge User) with Co-Investigators:  Yvonne Bohr, Jennifer Connolly, Iris Epstein, Thumeka Mgwigwi, Soheila Pashang, and Collaborators: Farah Ahmad, Negar Alamdar and Sajedeh Zahraei

Project Coordinator: Luz Maria Vazquez

Funding Source:  Canadian Institutes of Health Research (CIHR) Operating Grant: Knowledge Synthesis: COVID-19 in Mental Health & Substance Use

The COVID-19 pandemic has exacerbated gender-based violence against women and girls.  Statistics from across the world show a drastic increase in violence against women and girls during the current COVID-19 pandemic.  The United Nations has referred to this significant social and public health issue as the “shadow pandemic”. We know that violence against women results in high rates of mortality and morbidity and that is also associated with mental health problems – psychological distress, depression, anxiety disorders, substance use disorders.

The social determinants of health factors place racialized women and girls at an increased disadvantage during the pandemic. Practice and policy must address the structural determinants of the mental health of racialized women at risk of gender-based violence during COVID-19 pandemic.

In Spring of this year we received funding from the Canadian Institutes of Health Research (CIHR) to conduct a rapid knowledge synthesis for our project titled “COVID-19 pandemic guidelines for mental health support of racialized women at risk of gender-based violence.” This was an academic-community collaboration between Principal Investigator Dr. Nazilla Khanlou (York University) and Principal Knowledge User Dr. Andrew Ssawe (South Riverdale Community Health Centre).

Our project has multiple outcomes* that knowledge users can utilize to support trauma informed mental health care program planning, delivery, and evaluation during the COVID19 pandemic’s response and recovery phase.

We present multi-level recommendations and best practices for equity informed mental health promotion and care. These include individual, psychological and situational (micro); institutional, organizational and agency-based (meso); and structural, systemic (macro) levels.  We emphasize an upstream approach to public mental health support, presenting the recommendations from macro to meso to micro levels.

Using information from our project’s tools, decision-makers can assess potential venues to re-direct funding and programming to address inequities in the social determinants of mental health and related health disparities.

* Project Outcomes:

  1. Knowledge Synthesis Report: Click here
  2. Information Brief: Click here
  3. Infographic: Click here
  4. Toolkit: Click here
  5. Policy Brief: Click here

For more information visit:  York University

 

Harmony Community Food Centre Launch

The Harmony Community Food Centre is Launched!

The seed was planted and we saw the first blossoms of Harmony Community Food Centre emerge. A partner site of Community Food Centres (CFC) Canada, the program’s focus is on addressing food insecurity in the neighbourhoods surrounding 2 Gower St. The CFC is designed to be a place to grow, cook, share and advocate for good food for all.

September 1 was the official launch as the thirteenth community food centre partner site in Canada. We are  proud to be part of this national movement which works toward equitable, dignified access to good food for all. Thank you to our fearless partners at Community Food Centres Canada, all local partners, funders and the community of East York for welcoming us. Special thanks to MP Julie Dabrusin, MP Nathaniel Erskine-Smith, the P. & L. Odette Charitable Foundation and Community Food Centres Canada for celebrating with us.

We’re making connections

Over the past year, we conducted a community consultation to get to know our neighbourhoods and fellow advocates in the O’Connor-Parkview, Taylor-Massey and Oakridge areas. We talked to residents, local schools, parents, seniors, librarians, youth workers, settlement workers, service providers, health providers, church leaders and more.

From our conversations, we developed a framework for program design: a focus on low-income and marginalized communities; addressing barriers to access; inviting participants and those with lived experience to co-design; using a team approach to enable cross-organizational resources; and building partnership with community members and organizations for greater impact. We began the work of building relationships and trust within the community and, at SRCHC, we began the work of building creative collaborations across the organization.

Inviting the community into our kitchen

A beautiful thing about the new Harmony Community Food Centre is that the location at 2 Gower St. opened its doors to the community beyond the existing seniors programs. We welcomed neighbours of all ages into our space and kitchen through nutrition and food skill workshops, community kitchens, kids’ cooking programs, garden design and special events. Our kitchen became a new hub for knowledge exchange, social connection and delicious food to share!

Food access during a pandemic and beyond

The COVID-19 pandemic intensified existing gaps in our system and vulnerable populations found themselves in greater distress and uncertainty around food access. We sprang into immediate action. With emergency funding from Community Food Centres Canada and United Way, we were able to quickly expand our existing food security work and redeploy staff to plan and distribute grocery gift cards, home delivered meals, takeaway meals and produce boxes. Those we served were able to access supports in a dignified manner with few barriers.

The pandemic food access response could not have happened without strong partnerships with funders, local businesses and local networks. The challenges facing priority populations will not disappear, and we are keeping our sleeves rolled up. We will continue to serve and amplify the voices of the marginalized until all are safely housed, economically secure, socially empowered, healthy, and can nourish themselves with joy and abundance. And this feedback tells us that the work is vitally important.

“I found the program and support very helpful due to being non-status and health issues that make it very difficult to work. I have no income and would like online training to get regular work. The gift cards helped manage what I needed for my baby and myself.” – Rose (34 years old, new single mother, non-status, immunocompromised)

“I had something to eat guaranteed, at least one hot meal a day. Bottom line this thing helped me a lot it put me over the fence (of happiness). Before if I did not have food I did not know if I could make it.” – Theo (62 years old, lives alone, on ODSP, living with a disability).

Our Community Is Your Community

I’d like to comment on my observations as a new harm reduction worker at South Riverdale CHC and its surrounding community.

Harm Reduction is a philosophy about the human rights of people who use drugs. It says that people who use drugs deserve all the same things that everyone else enjoys: safe housing, health care, food security, and employment.

The work we do is not just for those who access SRCHC programs, but also for the larger community. Often, and especially in neighbourhoods where there is a sharp divide between people who have privilege and those who don’t, there tends to be an “us and them” mentality. When you don’t live on the streets without shelter or food, it can be hard to understand what that experience is like. But many of our service users have been living in this area for decades. In fact, South Riverdale CHC has been serving this community for over 40 years and has been providing resources and programming to people who use drugs for over 20 years. Our service users share the same sidewalks and air as folks who are well-resourced. Our clients are humans just like you.

In harm reduction, some practical strategies include educating our clients, other service providers and the local residents about safer drug use, overdose prevention, and preventing HIV and Hep C transmission. The harm reduction kits we give out are not only for distribution of sterile needles or pipes and the associated equipment to use drugs more safely, but also a way to help engage with folks who are regularly excluded from mainstream health services and housing, and who are overrepresented in child welfare, prison and other systems.

Having said that, part of the safety of the community is people properly disposing of their equipment. We facilitate that with daily needle patrols throughout the neighbourhood and by providing a yellow secure-disposal bin at the west side of the building. Pre-COVID, we organized several annual community clean-ups during which staff and volunteers cleaned up garbage, as well as drug use equipment, from local parks and laneways.

If you have any questions about harm reduction, please call The Fixed Site at (416) 461-1925, ext. 235. If you have any concerns or suggestions, please call the COUNTERfit program coordinator at ext. 388.

And please remember that “our community is your community!

(These impressions are offered by a new SRCHC staff member.)

 

Our commitment and actions to address Anti-Black Racism

We stand in solidarity with Black Communities and Black leaders in Toronto and across North America, we will not be silent about the continued discrimination, systemic racism and disproportionate harm faced by Black people. White supremacy and the legacies of colonization, slavery, structural inequality and systemic discrimination profoundly impact the lives of Black people. Black people have long talked about disproportionate violence and deaths as a result of policing. In 2018, an Ontario Human Rights Commission study found that Black people are 20 times more likely than other races to face lethal force, and as a result, be injured or die at the hands of Police. Not only are we no longer remaining silent; we are now urging our allies to join us in taking immediate action.

The Toronto Board of Health unanimously voted to declare Anti-Black Racism a public health crisis. Our action plan on beginning to address Anti-Black Racism will include:

  • Calling for the defunding the Police and re-prioritizing the City’s budget to address the roots of violence and Anti-Black racism
  • Finding training and capacity-building supports to assist individuals and organizations in learning about Anti-Black Racism
  • Developing and implementing an anti-bias policy for SRCHC, which will be shared
  • Collaborating with partners on communications  to help amplify messages and actions
  • Collecting race-based health data and identifying health outcomes for Black populations
  • Building common accountability measurements for management/boards in support of Black leadership

Building a Harm Reduction and Substance Use Continuum of Care

We are in the midst of increased overdose fatalities and the restructuring of services for folks using the homeless shelter and services systems with the call for the embedding of harm reduction services everywhere.  This moment was used to request that the Toronto Region enable us to release this review report as it holds great insights on strategies for the work we are currently doing. To view the report and the full press release, please click the links below:

REPORT RELEASE Building Harm Reduction Substance Use Continuum of Care Review

Harm Reduction Continuum of Care TCLHIN March 2018

South Riverdale CHC launches program to connect clients with cell phones during COVID-19 crisis

Leslieville-based organization working to ‘bridge the digital divide’ and help 1,500 get a fully functional phone or tablet

BY JOANNA LAVOIE   //  TORONTO.COM
Not being able to afford a mobile device shouldn’t be a reason why someone can’t access healthcare and other vital supports and services during the COVID-19 pandemic.

With more than half of its clients living on less than $25,000 a year, the South Riverdale Community Health Centre (SRCHC) experienced this reality first-hand recently when one under housed individual who makes use of the community-based organization’s harm reduction services at Moss Park exhibited symptoms of COVID-19 and was sent for testing at a nearby assessment centre at St. Michael’s Hospital.

But without a cell phone, there was no direct way for the hospital to contact this individual to discuss their test results. Fortunately, staff at SRCHC had a good relationship with this person and were able to locate the individual to discuss healthcare needs.

This all-too-common situation is what inspired SRCHC, which serves those living in an area roughly bounded by Lake Shore Boulevard East to O’Connor Drive and from Coxwell Avenue to the Don Valley Parkway, to recently reach out to technology partner QoC Health for some cell phone donations. That organization’s CEO, Sarah Sharpe, suggested SRCHC launch a device drive and offered their expertise to staff members so they can scrub any information from donated devices.

Launched just over two weeks ago, the #DeviceDrive is aiming to immediately collect and distribute 1,500 new or used activated cell phones/tablets with chargers for its highest-priority clients, those who are most at risk for complications from COVID-19. These devices will allow marginalized and socially disconnected clients to attend virtual medical appointments, receive COVID test results, access group-based programs, get information on available resources, and connect with their loved ones.

Ideally, the centre would like to give 5,000 of its most vulnerable clients a fully functional mobile device.

So far, SRCHC has only received 61 phones and 68 SIM cards and is appealing for donations.

“This project really came about because we needed to find a way to get devices to our clients. … We want to at least give them an option to pick up the phone and call someone,” said Surkhab Peerzada, SRCHC’s regional manager of chronic disease.

“We needed to do something and we needed to do it as soon as possible.”

Since the onset of the COVID-19 pandemic nine weeks ago, the South Riverdale Community Health Centre has moved most of its programs and services online, however a high percentage of the people that have typically accessed them are homeless, under-housed, and on a fixed income and don’t have a functional cell phone, tablet, or computer.

“We really want to bridge that digital gap,” said Peersada, who is co-chairing the device drive with Andrea Laing, the organization’s communications manager.

“Unfortunately, these cracks in the system are much more evident since the outbreak.”

Anyone able to donate either a new or used device with a charger can drop drop it off at 2 Gower St., just off Dawes Road, or 955 Queen St. E., just east of Carlaw Avenue. Don’t forget to factory reset your device, especially if it’s an Android or Apple product.

Broken devices including those with cracked screens or frayed wires, devices that are more than five years old, devices with poor battery life like those that need to be plugged into power to work, and SIM locked devices that cannot be factory reset are not being accepted.

Monetary donations, which will be used to buy SIM cards and short-term data plans to activate the devices, are also greatly needed.

Visit www.srchc.ca/devicedrive or email at devicedrive@srchc.com for more details.

Joanna Lavoie

by Joanna Lavoie

Joanna Lavoie is an award-winning, bilingual journalist with more than a decade of diverse experience. A graduate of Ryerson University’s Journalism Program, she is a breaking news reporter for toronto.com.

Email: jlavoie@toronto.com Facebook Twitter

Hepatitis C Treatment Program at Moss Park Consumption and Treatment Service

Integrating hepatitis C care into an overdose prevention service

We are happy to announce that CATIE has published an article on the Hepatitis C Program at Moss Park.

Thank you everyone for the team effort in helping us put this article together. We’re happy with how it turned out, and it will be a great model for other programs around the country to learn about integrating hepatitis C and harm reduction services.

Hepatitis C Treatment Program at Moss Park Consumption and Treatment Service

“Since Covid began, we’ve seen the highest number of overdoses since 2017”: What happens when the opioid epidemic meets a global pandemic?

“Since Covid began, we’ve seen the highest number of overdoses since 2017”: What happens when the opioid epidemic meets a global pandemic? – Jason Altenberg, April 14, 2020

I’ve worked at the South Riverdale Community Health Centre for 15 years, and I just took over as CEO in January. It’s a heck of a time to be starting a new job. We offer health services to the city’s most vulnerable people: newcomers to Toronto, people who living in poverty and who use drugs, and the homeless community. More than half of the people who come to us are low-income, and two-thirds are living with mental illness. On an average week, more than 500 people come here for communal meals.

We’ve also been in a sustained crisis for years: our job is to keep people alive through the opioid epidemic. We provide a safe place where people can use drugs under the supervision of nurses and doctors, where they can access medical advice free from judgment, and where they can access naloxone kits, safe disposal supplies and clean syringes and pipes, and that work keeps them alive. We usual deliver harm-reduction supplies, too, in unmarked cars to people’s homes or coffee shops anywhere from Lake Ontario to Eglinton Avenue East, and from Victoria Park Avenue to the Don Valley Parkway. I have a long history with my staff: some of us have been through other outbreaks together, like H1N1 and SARS. I don’t know that I’ve had time to absorb it yet. We’re just trying to keep moving.

We’ve been watching Covid-19 since January, and making plans with an infectious disease specialist, focusing on implementing measures that would help keep people out of the hospitals. We have a respiratory therapist who is running a primary-care asthma program and getting people access to nicotine replacements. Our diabetes program is still running, because those are people at high risk for Covid-19 complications. We’re doing insulin initiation and adjustment over phone and video, and we’re still doing wound care in-person. For homeless people who don’t have phones, we’re accepting in-person drop-ins at the health centre for medical and social support. And we’re doing everything we can to keep our safe-consumption sites fully operational. It’s our job to keep people who are using drugs alive and ensure they don’t get Covid-19. Somehow we have to do both at the same time.

We run two safe consumption sites: one in Moss Park and the other in South Riverdale. Along with supervised injection services, we provide harm-reduction supplies like naloxone kits, drop-in nurse practitioner services and a hepatitis C clinic. We’ve had to cut down our hours, and we’re seeing people more slowly because of social-distancing rules. Before, these spaces were built by our members and decorated with paintings by the community. Two weeks ago, we turned the sites into scenes from a science-fiction movie. We had to. We separated the booths and taped up plastic tarps everywhere, to keep people safe and distant from one another. Our staff are wearing full protective gear. It looks like a field hospital. People are freaked out and distrustful: these are people who have been criminalized and stigmatized for years, so when the services start to feel like policing, that’s hard for them to take. And it’s hard for our staff, too. Some people are grateful, and thank us for giving out cloth masks and bagged meals. Others have told us it’s weird, that the space doesn’t feel like theirs anymore.

Every day, we approach each client in scrubs and masks to take their temperature. We have screeners asking questions at the door now, and every time someone shows up, we have to ask whether they’ve travelled out of the country, even if we asked them the same question the day before, and even though it’s utterly unlikely based on their life circumstances. To the clients, it feels like discrimination. To be able to socially distance is a privilege, but I know people are trying to respect the rules as much as their circumstances allow. One man is camping near a pavilion on Lakeshore Boulevard, and set himself up just outside the caution tape so he wouldn’t violate the bylaw, instead of setting up underneath the shelter. Another man tested positive for the virus and refused to go back to his shelter so he wouldn’t infect his friends; he slept on the streets instead.

The spaces that create any kind of normalcy in our clients’ lives have disappeared overnight. The libraries are closed, the drop-in centres are closed. The spaces they would go for a cup of coffee or a sandwich or to use the bathroom are closed. The things that would allow them some semblance of basic dignity are just not available. People are more desperate. People are hungry. We’ve seen more fights breaking out between clients. Two weeks after those closures, on March 31, the city had the highest number of opioid overdose responses since the crisis started in 2017. I wasn’t surprised at all. This is the new normal. The needs in the community are the same, but resources are scarcer. Drugs are harder to find right now, and they’re more expensive. Some of our clients are buying from new dealers, and the potency is incredibly unreliable. Just last week, there was a strange overdose warning: four people ended up in the hospital with opiate overdoses after using what they thought was crack cocaine. That’s very unusual. Covid-19 hasn’t hit the homeless and street-involved community with full force yet; this is not a community that travels, so it will emerge later. When it does, it will hit hard.

We’ve had to explain to people that we’re making these changes—adjusting and reducing our hours, changing our spaces—because we love them and we want them to be here in three months. We know that if we could offer people a predictable safe supply, overdoses would go down dramatically, overnight. We’re hoping to get funding to offer an individualized safe-supply care plan for anyone who is eligible. That may involve picking up a prescription for high-potency hydromorphone at a pharmacy on a daily basis, or supervision by a consumption site. On the Downtown Eastside in Vancouver, they’re moving on this. It’s a solution that makes self-isolation possible. We’ve seen the system respond with incredible speed, recognizing where the rules we have in place don’t make sense. There has been resistance, but innovation always has resistors. We have a proposal in to Health Canada right now, and I’m optimistic.

I’m worried about the compounded nature of the epidemic and the pandemic. I worry that we will lose people that we otherwise wouldn’t have. It’s in my head all the time. We’ve been hearing about other deaths in the community, people dying in stairwells who would normally be somewhere else, like at one of the city’s nine safe consumption sites. The horrible thing we’re trying to reconcile is that if we don’t continue to re-engineer how we’re offering our services, we could spread Covid-19 through the community, which would be horrific. We’re doing this crazy balancing act. As we pivot to prevent this virus, the social isolation and distancing are creating other harms. They’re necessary and they’re predictable. They’re also brutal, and we need to be ready to respond to them, too.

As I go to work every day, I stop at the drug user’s memorial project. It’s a monument on Queen Street East, an eight-foot copper flame, where people come to honour the memory of their friends who have died. I start every day there, stopping to see what someone has put in front of the memorial the night before. And now, every day, I have a lump in my throat about how many people we are going to lose because we aren’t able to be there for them.

ETHP announces new role to bridge mental health services between hospital and community

ETHP announces new role to bridge mental health services between hospital and community

With more than 25 years of experience working in mental health and addictions services, Raj Sohi is well positioned to take on East Toronto Health Partners’ (ETHP) first shared directorship role. On April 27, Raj began his new role as Director of Mental Health and Substance Use at Michael Garron Hospital (MGH) and South Riverdale Community Health Centre. Previously, Sohi served as the director of mental health and addictions services at MGH.

The new position supports ETHP’s vision of creating a system without discharges and providing more seamless access to services for those living with mental health and substance use challenges in East Toronto.

“There are so many opportunities for us to work better together,” says Sohi, who spent 12 years leading mental health services at the Centre for Addiction and Mental Health. “By integrating patient pathways between hospital and community, we eliminate unnecessary barriers that so many of our clients face when navigating a complex health and community care system.”

East Toronto is comprised of approximately 300,000 people living in 21 diverse neighbourhoods, with five Neighbourhood Improvement Areas, including: Thorncliffe Park, Victoria Village, Oakridge, Flemingdon Park and Taylor-Massey. East Toronto has higher mental health and addictions needs than the Toronto average. Taylor Massey has one of the highest youth mental health Emergency Department utilization rates in the city.

For the past several months, Sohi has helped propel integrated mental health and addictions services forward in East Toronto by serving as the lead for two ETHP workstreams including: Youth mental health and addictions and adults with needs related to substance use and addictions. Sohi also supported the development of the Oakridge Health and Harm Reduction Hub, a three month pilot project that ran from February to April.

The goal of ETHP is to better connect health care sectors, including hospitals, community, home and primary care, in addition to other health care providers, to make it easier for clients and families to receive more integrated care close to home.

“This shared directorship role represents the next important step in our journey to create an integrated health care system that places patients at the centre of their care,” says Mark Fam, Vice President, Clinical Programs at MGH.

“SRCHC is excited to expand Raj’s shared directorship role to include operational oversight and support of SRCHC’s teams, strengthening the collaborative approach between SRCHC and MGH. This work is a natural progression of the partnerships being built as part of the East Toronto Health Partners and will drive deeper integration of services to our most marginalized clients in their communities,” says Jason Altenberg, Chief Executive Officer, South Riverdale Community Health Centre.

This article is brought to you by ETHP Communications Staff

Bridging the Digital Divide

There is no denying that the pandemic has made all of our lives more challenging. Please imagine surviving this pandemic without a phone or a device that keeps you connected to the news, resources, health care and your loved ones; this is the reality for many marginalized clients. Based on a 2019 client survey results, more than 50% of SRCHC clients have an income of less than $25,000/year.

South Riverdale Community Health Centre (SRCHC) is putting out this call to action for donations of used cell phones and chargers. They will give these cell phones to clients in need and support their connections. Clients need phones to attend medical appointments, receive COVID test results, participate in group-based programs to promote social connections, as well as access information and support. “Clients need a way of connecting to holistic health and social services virtually to increase positive health outcomes”, says Jason Altenberg, CEO of South Riverdale Community Health Centre.

SRCHC is in need of used cell phones, SIM cards and chargers in working condition; please visit the website for more information www.srchc.ca/devicedrive. Donation bins are located outside our 2 Gower St. and 955 Queen St. East locations. For people who want to help, but do not have a used cell phone, we are looking for monetary donations to connect the phones to plans; please visit the SRCHC Canada Helps website.

Pregnant woman in pink tshirt using a cell phone