Substance Use and Mental Health

On Wednesday, March 11, 2020, the World Health Organization announced a global pandemic. On the following Monday, March 16, 2020, one day before the Ford government declared a state of emergency, the world as we knew it shifted and the way in which clients were able to access services at South Riverdale changed dramatically. For those most affected by health inequities, social injustices and systemic oppression, such as community members/service users connected to the Substance Use and Mental Health (SUMH) programs, the added impact of COVID has been complicated.

In the face of adversity, our commitment to innovative care, cutting-edge approaches and health equity only deepened with the alignment and expansion of our services. Committed to offering dignified, meaningful and relevant care, the newly-formed SUMH team offers a continuum of service and support for individuals impacted by substance use. Many are also impacted by other challenges including mental health concerns, poverty, discrimination, criminalization and homelessness. Programs under this team’s umbrella include: consumption and treatment services (keepSIX and Moss Park), the Hepatitis C program, COUNTERfit harm reduction programming (mobile delivery, east Toronto outreach project, Common Ground group programming, and women’s harm reduction) and, most recently, the safer supply program.

With the emergence of COVID, services disappeared that had previously provided a modicum of dignity, safety, respite and refuge for people who are street-involved or unhoused. Community drop-ins, food programs, shower and laundry programs, washroom facilities and libraries across the city closed their doors. Deemed “essential services” by the organization and adept at staying responsive, we suited up in gowns, masks and face shields, and quickly adapted to provide safe and supportive care in a rapidly changing environment that demanded physical distancing and social isolation.

Over the course of this year, our two sites for consumption and treatment services (CTS), keepSIX and Moss Park, have worked tirelessly to try to save lives by reversing an unprecedented number of overdoses and by offering client-centred care, reducing the burden of stigma and promoting dignity for individuals who use drugs. The CTS teams, including service users, have been unrelenting and fearless advocates for local and systemic change: providing deputations to decision-makers, showing up at encampment sites to offer support, providing onsite drug checking to identify tainted supplies, mobilizing teams to respond to community overdoses, and participating in a range of community partnerships and research initiatives.

For people in the shelter system, the burden of COVID has also been disproportionately high. Many people who are unhoused choose to avoid the cramped and unsafe shelter system, and homeless encampments have popped up all over the city. We are opposed to the dismantling of the encampments and will continue to advocate for people’s right to live in tents as long as permanent housing is not available. We lobbied for the use of hotel rooms, sitting empty, as a safer alternative to shelters and homelessness and will continue to advocate for permanent housing – not warehousing – that prioritizes people’s health and safety. Through the shelter hotel program, service users have access to an interim housing option with a range of services, including harm reduction supports and overdose response services offered by members of our harm reduction team who continue to advocate for the expansion of these services throughout the city-wide program.

While in-person group programming for Hepatitis C ground to a halt with COVID, the program moved to a virtual platform to maintain connections between community members and continued to offer individual support. Despite the barriers, this year saw 55 treatment starts. And the safer supply program, the newest addition to the SUMH team, launched in 2020 in response to the national overdose epidemic. The program connects people who use opiates to prescribing clinicians, case management support and nursing services with the goal of improving health outcomes and reducing risks associated with a toxic drug supply.

Prior to COVID, service users were facing a host of challenges and barriers including devastating losses and harm from an opioid epidemic that has caused skyrocketing increases in preventable death. Our service users and staff have been dealing with unending trauma and grief, and COVID added another layer of complexity to an already difficult situation. The pandemic has made social inequities much more apparent. Yet, community continues to come together to share space, to make noise, to demand change, to show solidarity, and to grieve the tremendous toll that the dual pandemics have taken on us. Despite it all, we are still hopeful for positive change and are committed to working towards that.