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

2. 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)

3. 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

4. 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

5. 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.

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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?

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. Director, Poverty Reduction Poverty Reduction Division
Aisling Gogan
Director, Poverty Reduction
Poverty Reduction Division
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