CMHA Niagara Short Term and Crisis Support,

Mental health crises rarely start as an “emergency” and that’s exactly why people need clear options before things hit the breaking point. Kristen Diel, Clinical Director of Operations at Canadian Mental Health Association Niagara, talks about what supports  CMHA offers, from no charge same day counselling to the Mobile Crisis Rapid  Response Team, which pairs a police officer and a social worker to respond to emergency calls.

Transcript

Mental Health Week And The Theme

SPEAKER_01 0:00

This week starts the beginning of Mental Health Awareness Week, which is in May every year. And the theme this year is Come Together Canada, but also that strong connections lead to better mental health. And Canadian Mental Health Association Niagara is holding its 15th annual wellness for all event on next week on May 7th. I have on the show today Kristen Diel from CMHA Niagara, and she is the clinical director of operations. Hi Kristen, thanks for coming on the show to talk about this.

SPEAKER_00 0:39

Hi Janice, thank you so much for having me.

SPEAKER_01 0:42

Can you give me, we'll just start with an overview of what Canadian Mental Health Association Niagara does, what the activities are in general, because I think that Canadian Mental Health Association almost in a way flies a little bit under the radar and but provides so many valuable services. So let's start with just a description of what Canadian Mental Health Association is.

SPEAKER_00 1:10

Yeah, thank you. And you're right. It's we're an organization that offers a lot more than I think what some people realize at times. So the Canadian Mental Health Association, Niagara branch, has been providing services that are mental health specific to individuals who are 16 years of age or older. And that's been happening for over 50 years in our community. We offer both short-term and long-term mental health support. And the intention of our services is that it's offered based on a continuum. So it's not necessarily all high intensity, it's not necessarily all low intensity because we recognize that mental health is on a continuum and we want to be able to support people no matter where they are on that continuum or where they are in their own mental health journey. From our lens, we separate things a little bit. We describe it as immediate and brief services and longer term services. But at the end of the day, we definitely don't want that to be a barrier to someone reaching out, not understanding where they're going to fit best or where they're going to receive the most appropriate support. So really anyone who's struggling with their mental health connecting to CMHA Niagara is a great place to start because we do offer such a range of mental health services in Niagara, and we are a leader within the community for mental health services, evidence-based practice, and quality client care.

Same-Day Counseling Explained

SPEAKER_01 2:33

Just so that people understand what the continuum is, it's uh you can use this for your mental health, your physical health. Um so it goes from green to red, green being, hey, I'm healthy and I feel good, um, and then sort of moves into the yellow and orange as your mental health may be declining, and then into red where it's you're in a situation where you really do need to seek medical help. And it's a great thing that you can use uh and every day just to sort of track how you're feeling, because we all have some level of anxiety or fatigue, or you know, so it's it's good to stay on top of uh of your mental health that way. Let's talk about the crisis services because I think that um you do some really interesting work in crisis services. So could we start with, let's start with same same day counseling.

SPEAKER_00 3:28

Okay. Uh so our same day counseling program is a program that individuals, again, who are 16 years of age or older can access when they're having any sort of mental health concern and they would find it helpful to have a conversation with a mental health counselor. The benefit of that service is services almost always provided same day. It is a single session model. So what that means for clients is it's not ongoing counseling. It's not meeting with the same counselor weekly for eight to 12 sessions, let's say. It is really, I'm in need of support from someone or a conversation focused on my mental health would be helpful today. I'm gonna reach out and I'm gonna be able to get that appointment same day. Folks are then connected with a counselor and they can either do that by phone or in person. We currently operate that service from our St. Catharines location at Well and Ave and our Morrison Street location in Niagara Falls, Monday through Friday, 11:30 a.m. to 5.30 p.m. And all individuals have to do is call our main reception line first to connect. Those workers, depending on why someone's coming in, can do brief supportive counseling, solution-focused work. They might do some crisis intervention where there's risk assessment and safety planning conversations that are at the forefront. But what I love about that program is it's really living the empowerment philosophy that clients have the best skills and resources and understanding of their situation within themselves. So that power and balance of the counselor having all the information and all the knowledge, that's not it with same-day counseling. Yes, there is the opportunity to do some additional strategy education, to connect to a resource that someone might not be familiar with. But the power of those sessions is really how do we facilitate a conversation in a way that's a listening the strengths that are already existing for that client so that they feel equipped to move forward and deal with whatever brought them to that session. So it's a really exciting session. While it isn't an ongoing support, folks can return. So just because you've accessed the same-day counseling session once doesn't mean that you can't call again and get another session. And so it is not guaranteed that you would get the same counselor, but that you can access the service again.

SafeBeds As A Hospital Alternative

SPEAKER_01 5:56

I think that one of the things that really jumps out is that you're not spending your entire uh appointment talking about your past history. What's your medical history? You know, it's generally what happens when you go to a doctor is what's your medical history? Are you on any medications? Um, when was the last time you sought medical help, that kind of thing? That could take up your entire appointment time. So so this is this is a way that it's sort of low barrier access to a therapist who can help walk you through that. And as you said, it doesn't have to be a crisis, it can be uh closer to the green if we think about the continuum. And uh um, but that can so it really, really fills a gap where it's difficult for some people, it's just financially um not possible to go to a psychologist and start on a program like that. Um, and and uh for some people, um like you said, and I just said, you know, they may just need someone to help them and lift them up and get through that day. But you can go on to some longer-term counseling, which which CNHA also offers. Let's move into the more crisis situations. So the the three that I was thinking about, and and you can you know tell me if there's more we need to add, but one is your safe beds program at um which is at your office in St. Catharines, and explain to me what safe beds are because it's I think it's again, it's not something people know a lot about. And um people might wonder, like, well, I what is a safe bed? I don't quite understand.

SPEAKER_00 7:51

Yes, yeah, it's a great question. And you're not wrong, there's not a ton of understanding and clarifying how it's different from other services that might appear to be similar. And so when I say that, I think about um people asking us, well, what would it be different than going to the hospital, or what would it be different than going to shelter? And it is a really unique service, um, and it's not to say that folks who meet either of those other criteria can't access at some point, but it's looking at how do we leverage the existing beds that we have. So we have 12 beds that operate from our St. Catharines Street office or our Well and Ave office in St. Catharines, and safe beds is really intended as an alternative for hospitalization for individuals who are experiencing a mental health crisis. That is a self-identified mental health crisis, so it's not like our team is screening to say, do you meet this criteria? Is this the type of crisis you're happening? It is really what is your identification of a current mental health crisis? And are you not currently at imminent risk of harming yourself, someone else, or having a medical need that requires a higher level of care? At which point it might be, is hospital or a different system most appropriate for you? But a lot of our folks can benefit from the safety of a short-term residential stay and having staff available to them 24-7 without needing hospitalization, without needing intervention from the medical system. So it's a community-based program. Individuals that get referred to us complete a short intake when they come into program, and then they have the opportunity to have their own room. They have the ability to shower, meals are prepped for them, and they're able to focus on those basic needs that maybe whatever was presenting for them as the crisis was impacting their ability just to take care of those basic needs as a starting point. The other piece that we do within SafeBeds is we really do an overarching assessment that understands what are your current unmet needs and how do we do some work together to set goals and ensure that supports and planning is put into place to help resolve the current crisis and then safety planning work that's really looking at what led to this current crisis, how do we prevent that from happening again, and how do we set up skills and resources and supports so that when you notice those early warning signs of stress or distress, you can start implementing those strategies earlier. And maybe folks are going into crisis less often because they now have a stronger awareness of what their own kind of stress, distress, and crisis pathway looks like, and they know what skills to implement at each of those stages. But really important that we're building that relationship so that folks understand if crisis happens again because we're on a continuum, and just because we've addressed something once doesn't mean it won't show up for us again, that they know what supports are out there for them. I think it really aligns with the theme of mental health week and coming together and the importance of social connection. Within SafeBeds, it really just isn't about connecting with the crisis workers in program and the clients. It's the clients connecting with each other too. So we have up to 12 individuals in program at a time. There are groups that are run where clients get to learn from each other as well. They have time where they're able to engage with each other in the common areas if they're wanting to do that. And so it really demonstrates that importance of having opportunity to connect with others because often when we experience mental health struggles, we might have that urge to isolate, even though that's not what's going to be most effective for us long term.

SPEAKER_01 11:44

And you're not signing on to have to stay there. So that's the other thing. And again, it's another low barrier. I don't know if I want to use the word crisis, but one step up from same-day counseling where you feel like you need a little bit more of uh structured and potentially longer term help.

SPEAKER_00 12:05

There might be something presenting at home that makes it difficult for that individual to stay safe in their own environment or to start activating or practicing skills that are introduced. Um, being in a more structured setting can be helpful for someone. And I love that you highlighted, because I didn't touch on that, it's a voluntary program. So it's non-medical, it's voluntary. Folks can choose to leave the program earlier. Generally, our length of stay is anywhere from three to seven days that someone can stay in our program and receive that support with staff there 24-7 to be supportive, redirect to coping skills, provide education on other resources that might be helpful. And um they're able to work with staff to say what's working and what's not. So again, it's that collaborative, client-led what's helpful for you, and what do you see being important for us to work on during the time we have together?

SPEAKER_01 13:02

Coast, crisis outreach and support team, known as COAST, and that's what most people talk about. But I'm connected in with people in the mental health uh not-for-profit services world. And we talk about COST. I'm not sure how well COST is known, and I'm not sure if people really know the acronym COST. But again, it's sort of another step in the in the potential for crisis counseling. And uh, and so how does how does COST work and where does it fit into kind of I think the continuum of counseling that that you offer?

SPEAKER_00 13:45

Yeah, so COAST, which stands for the Crisis Outreach and Support Team, uh, COST would be uh a primary access point for folks who are looking for telephone crisis support. So that's the bulk of where service is initiated within COAST. It operates a 24-7 crisis line where individuals can call in and receive crisis counseling from a crisis worker. They're not volunteers, they are trained mental health professional crisis workers, and they're able to connect with individuals when folks are experiencing a crisis situation and looking for some support to talk through that situation. Those crisis workers would be able to engage in telephone support, crisis de-escalation, they would do a risk assessment and have safety planning conversations with individuals by phone. They can also make referrals or provide psychoeducation on skills and resources within that call. There are opportunities for follow-up. So if something's not resolved in a crisis call, there could be the potential for an additional follow-up call. There could be the potential for a call or an individual to start with COAST and then be booked with a same-day counseling appointment so that they can actually connect with someone in person and have a further conversation. They could be referred from COST to our safe bed program. And the other piece that I think a lot of folks don't know about COAST, if they are familiar with the crisis line, is that the O in COST also stands for outreach. So we have a trained mental health professional that can go out with an ununiformed police officer, or if that ununiformed police officer is unavailable, then it would be two mental health workers that go out. And that is something that's scheduled as a follow-up from an initial phone call, either a phone call from an individual themselves calling in crisis, or someone in the community calling out of concern for someone who's in crisis. And that looks like in-person follow-up risk assessment and safety planning in the community. It's not an emergency service, but it is a crisis service. So those appointments, if the individual meets criteria and depending on our team's capacity, those visits would happen within up to 48 hours, but other referrals can take place in between as well. And that's in partnership with Niagara Regional Police Services.

SPEAKER_01 16:16

And you can access COST. Um the phone number for COAST is on cmiagra.ca, so you can access it that way, or you could also call Access Line Niagara and be referred to Coast that way. Is it also a 911 but non-emergency? So they call 911 and hey, it's not an emergency crisis call and it's referred to COAST, or is it uh done directly through through uh CMHA Niagara?

SPEAKER_00 16:51

Uh so we don't divert calls directly from 911 in partnership with Niagara Regional Police Services. Uh, there are times where maybe someone on dispatch may feel that the call would benefit from COAST and they could support a warm transfer, but it's not a call diversion from uh 911 when that need isn't there. So it is a bit different than some services that are operating across Ontario, but certainly those warm transfers can take place. The other piece that's great is uh the COST and access line number is actually the same phone number. And if you are in crisis, you press one. And if you are looking for information and referrals, you press two. So you just have to know that one number or program that one number into your phone, and it's pretty much no wrong door. One way or the other, you're gonna be able to connect to get some crisis support, or you're going to be able to connect with someone to get further information on community resources.

Mobile Rapid Response With Police

SPEAKER_01 17:51

Let's move another step up in crisis response. Um, and there's the mobile crisis rapid response team, also known as MCERT. And that does put a mental health worker in a car with a police officer who's also got some mental health training. And you that that car does respond to 911 calls.

SPEAKER_00 18:17

Yes. Yeah. So this is another partnership that we have with Niagara Regional Police Services. Uh, it's a really great partnership to have both from a system level and for a client's experience level. So it is directly referred through 911. So that program cannot respond to calls outside of when they are a 911 dispatch call, and there's an identified need for a mental health worker to be on scene. And so that mental health worker can provide immediate connection, be part of the conversation in risk assessment, um, de-escalation, talking about what other community resources or supports might be appropriate. And the benefit of that service is it's really decreasing the need for police to have involvement in mental health situations that don't need a heavy police presence. And the hope is that we're diverting from the criminal justice system whenever possible. We're diverting from hospital and keeping individuals who are safe to be in the community in the community and connected with community-based supports. And we do an incredible job. Our team is phenomenal and they are successful at diverting a good chunk of the calls that come through and being able to connect individuals with appropriate supports. So they again can refer to our safe bed program, they can refer to our same-day counseling program, they facilitate referrals to COST. So maybe someone doesn't need to go to safe beds but would benefit from a follow-up call once that emergency situation has de-escalated. COST can follow up the next day and say, hey, we heard that you were experiencing some challenges yesterday. How's that going? Do you need any additional support? And so it's really that wraparound to ensure individuals don't fall between the gaps, but that they're also not involved in systems that they don't need to be involved with if they're not at that level.

SPEAKER_01 20:17

I I really think that this the AMCERT program is so important because so many people don't think that the police have any um involvement in any kind of mental health. They're just going to go in and arrest the person and throw them in jail, or they're gonna take the person to hospital where there is no bed and and and just leave them there. And um I know that CNHA has been doing this for quite a number of years, and I think probably it's one of the leaders in the province. I know there are some other um uh rapid response teams, but it um it's so important for people to understand that the police are not just going in and arresting people and throwing them in jail where they do not get the mental health treatment that they might need. And um I and I don't know if this is part of what MCRT does or CMHA does, I was um driving out of the city one day of St. Catharines on St. Paul West, and I was just sort of at first. And I saw a car had stopped, and there was a gentleman who was had just come from the hospital, you know, up the road because he was wearing a hospital gown, standing at the side of the road. And uh so this van stopped. So I did, and all of these cars are driving right past. It was at eight o'clock in the morning that all of these people are driving to work, and they're just driving right past this uh person who is standing on the side of the road, clearly visible, uh, which was shocking to me in itself. But so we called 911 and um and a police car came and and they, you know. They talked to him and they found out kind of what was going on, but they were also waiting for a mental health car to come. So trained officers trained in mental health to come. And I don't think that they were answered or coast, I'm not sure. But the but police officers do have other training. They have, you know, sort of basic mental health training. So they knew that this person needed a professional. I mean, he he was mad about something that had happened at the hospital. And so he walked out. He wasn't dangerous. He wasn't doing anything. He was just standing at the side of the road. So I was happy to see that this car came. Like the police actually said, because I hadn't seen it in action.

SPEAKER_00 22:45

Yeah.

SPEAKER_01 22:46

So the police actually did say, you know what, we're going to chat with him for a while while we wait for the mental health team to come.

Real-World Crisis Response Story

SPEAKER_00 22:53

Well, and that's a really neat neat example to speak to. And I think when people hear about our MCRT team, it is something that if people are needing emergency services, they certainly want that mental health involvement if that's the nature of their call. And the challenge is we have two districts, so two areas, St. Catharines and Niagara Falls, that are funded to have MCRT workers, but only for 12 hours a day, seven days a week. So that means calls outside of the window unfortunately don't have that response. But the really great aspect of our partnership is that our mobile crisis mental health workers also do crisis intervention training with Niagara Regional Police Services. So that's part of our partnership is it's a week-long training where officers are able to participate in training related to mental health, responding to individuals in mental health. And they also do a community tour where they get to see programs that they can refer to. So even if that mental health worker isn't on shift, the expertise and knowledge of officers to know where to refer to, so that it's not just about going to hospital. Officers don't want to do that either. They want people to be able to stay in community whenever they can.

SPEAKER_01 24:08

Kristen, thanks for coming on and talking about the crisis services. It's really important that people know what CNHA Niagara does and know that it's a place that they can reach out to.

SPEAKER_00 24:21

Thank you so much for having me. It's great to hear about it. And I look forward to hearing you as our keynote speaker next week at the Wellness for All event.