Supporting Individuals with Complex Needs Poverty Reduction Division April 25, 2018

What do we mean by “Individuals with Complex Needs”? Adults with severe and persistent mental health issues as well as other multiple and complex issues, such as: addictions brain injury (acquired/birth) disability (intellectual and/or physical) violent behaviours that lead to high risk to self, service staff, and/or community involvement with the criminal justice system difficulty finding and maintaining housing and/or periods of homelessness limited or no relationships with family, friends, community chronic or episodic behaviours and health conditions that require long term service responses Note: Above definition adapted from the NAVNET (January 2013)

Individuals with Complex Needs Chronically excluded (from government and/or community services and society in general) Finding and maintaining appropriate and affordable housing is a central issue Government often spends large amounts per client with poor outcomes Past engagement process have highlighted significant issues with the range of services available, service delivery approaches and policy issues

The Way Forward The Way Forward: Realizing Our Potential – commitment to improve support to individuals with complex health and social issues (handout) First phase complete – need to ensure we are on the right track and fill in gaps Focused engagement with community is essential: Individuals with lived experience Front line service providers and advocates

Considerations Diverse group of individuals with diverse needs and diverse experiences trying to access services Often struggle with homelessness and self-care Often have experience with the criminal justice system Our current system can be difficult to navigate, particularly if an individual is in crisis Individuals with complex needs are often left relying on emergency services in the medium and long-term Purpose of this initiative is to address systemic challenges, issues and barriers Individuals with complex needs have varying needs and experiences and interact with government departments, agencies, and community service providers differently.

Approach and Goals Internal steering committee established– CSSD, NLHC, AESL, HCS, JPS and Eastern Health (NAVNET) Reviewed past engagement processes and feedback from community Worked to understand, document and consider solutions to service delivery, program and policy-related gaps, and barriers faced by adults with complex needs Overall goals: Better support individuals receiving services from multiple departments, agencies and service providers Improve program coordination and address policy barriers Create more efficient and client-focused systems

Actions Implemented in 2017/18 Related to Towards Recovery: The Mental Health and Addictions Action Plan Expanding access to psychiatry services throughout Labrador through locum visits by Eastern Health psychiatrists and telehealth sessions for those in remote communities Increasing training and awareness with a specific focus on the needs and concerns of LGBTQI2S youth, in partnership with Egale Canada Establishing a Wait Time Reduction Team to address wait times for access to mental health and addictions services Key focus on Towards Recovery: The Mental Health and Addictions Action Plan and the review of the Newfoundland and Labrador Housing Corporation

Actions Implemented in 2017/18 Related to the review of the Newfoundland and Labrador Housing Corporation: Providing stable funding for housing support workers through a two-year commitment of funding for 2018/19 and 2019/20 Improving support to community centres by funding two social worker positions to work directly with the five community centres in the St. John’s area Other: Increased understanding of Duty to Warn policies through completion of a review Improving supports for individuals as they transition from receiving Income Support to seniors’ benefits

Ongoing Actions Implementing a “housing first” approach to service delivery in general with specific consideration for individuals with complex needs Developing an eviction prevention framework Establishing a portable rent supplement pilot program Developing a comprehensive Provincial Housing and Homelessness Plan Ensuring individuals discharged from correctional facilities have proper identification

Issues and Solutions The 32 key issues and solutions identified fit under seven broad areas: Mental Health and Addiction Housing and Homelessness Communications and Privacy Financial Youth Home and Community Supports Other Focus here on Housing and Homelessness related issues – welcome feedback on all areas

Discussion Questions Are there specific considerations around identified issues that are not recognized in the discussion guide? Are there any other key issues impacting individuals with complex needs? What changes, besides those identified, could be undertaken to improve services to individuals with complex needs? What should be our key considerations moving forward?

Issues : Housing and Homelessness Boarding homes (bedsitters) and board and lodging houses are not covered by the Residential Tenancies Act. Lack of ability for rent supplement clients to move between landlords means that it is difficult for clients to move if their living arrangements are not working for them. Individuals with complex needs have challenges with providing damage deposits Lack of access to/availability of shelters : (i) they need a new damage deposit before moving into a new apartment but often do not get their current/ previous damage deposit returned until after moving, and (ii) complex needs clients often do not have their damage deposit returned to them

Issues : Housing and Homelessness (continued) Lack of housing for at-risk and homeless youth Persons with complex needs do not always have the supports they need or an advocate Too few supportive housing options to assist individuals with significant mental health issues Lack of a full range of housing options, including supportive housing options, throughout the province Limited coordination of services and ability to prioritize services across systems for individuals with complex needs

Issues : Mental Health and Addictions Limited medical services and case management for individuals with complex needs (e.g. ACT teams, crisis and psychiatric services for youth, etc.) who will rely otherwise upon general emergency services Improve coordination between the mental health and addictions and the behavioural supports related programs and services Lack of a harm reduction approach in services for individuals with complex needs

Issues: Other Areas Limited supportive options for individuals with barriers to apply for or make changes to Income Support No broad-based approach to enable information sharing between government service providers, as well as between government service providers and community-based service providers, that serve individuals with complex needs (e.g. the NAVNET model) Health Authority policies around scheduling of appointments and no-shows can create barriers to individuals with complex needs receiving health care

Issues: Other Areas Difficulty getting and maintaining a bank account Limited ability to manage money, or access support for decision-making, causing problems with payment for housing, access to necessities, and other relevant issues Individuals with complex needs often do not regularly file tax returns Housing affordability issues for individuals with complex needs, particularly in light of higher rents charged by private landlords for this group Youth with complex needs find supports are reduced or removed when they turn 18

Issues: Other Areas Need for more pro-active programs and services for youth transitioning into adulthood (16-25 years old) Eligibility criteria for Home Support geared more to seniors than to individuals with mental health issues Home support hours assessment approach geared more to seniors than to individuals with mental health issues Struggle to find and afford transportation to medical and wellness appointment

Director, Poverty Reduction Poverty Reduction Division Aisling Gogan Director, Poverty Reduction 709-729-1287 aislinggogan@gov.nl.ca Poverty Reduction Division Toll Free: 1-866-883-6600 povertyreduction@gov.nl.ca