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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Michelle Patterson, PhD. RPsych

Reprinted from "Criminal Justice" issue of Visions Journal, 2005, 2 (8), p. 26-27

With an estimated one in five Canadians experiencing a mental disorder in the course of a year, effective treatment and support networks are needed in every community. Successful community integration and treatment have been achieved for many clients who use the mental health system, and many people with active or past diagnoses of mental illness live and work successfully in communities across the country. However, a general lack of resources (e.g., affordable housing, employment training, etc.) make it difficult for many people with mental illness to receive the help they need. When people with serious mental illness (including substance abuse) do not receive sufficient treatment and are homeless and in crisis, the resulting disruptive behaviour often brings these people to the attention of law enforcement agencies.

In order to address gaps in the existing service system, many advocates have voiced the need for mental health programs and services for individuals with longterm, serious mental illness that incorporate multiple systems and stakeholders. A strategic action plan is required that involves collaboration between federal, provincial and municipal government agencies as well as the community.

The Vancouver Intensive Supervision Unit (VISU)

The Vancouver Intensive Supervision Unit (VISU) and its predecessor, the Inter-­Ministerial Project, are examples of programs funded, administered and staffed by multiple stakeholders at the regional district and provincial levels (i.e., Forensic Psychiatric Services Commission, BC Corrections Branch and the Vancouver Coastal Health Authority).

VISU opened its doors in April 2003 in response to a growing need in the Downtown Eastside for services that address the complex needs of individuals who have severe mental illness and frequently come into contact with the justice system. These “multi-­problem offenders” typically present with a combination of chronic mental illness, severe interpersonal and behavioural problems, poly­-substance abuse and multiple encounters with the criminal justice system. The lives of these individuals are characterized by a repeated series of crises, which lead to cycling through various parts of the legal, health and social service systems. There is often little benefit to the individual and staggering costs to the multiple service systems and institutions with which they come into contact. Creating and implementing programs that are effective in serving this population, while still remaining flexible and sustainable, has been a challenging endeavour.

Traditional office­ based interventions, which require adherence to scheduled appointments, have generally failed to maintain these individuals in the community. Few multi-­problem offenders are likely to take advantage of these services on their own initiative. Furthermore, multi-­problem offenders have often experienced multiple barriers to accessing services and/or have had very negative experiences with various social service systems, such that trust is very hard to establish with these clients. Finally, the different systems involved may have no history of, or interest in, cooperating or coordinating services—thus, the client is always “somebody else’s problem.”

At VISU, a small group of dedicated staff with backgrounds in probation, health and occupational therapy work from an assertive case management model, building relationships with clients in their own community. A primary focus of the work is building trust, a difficult task for reasons noted above. Once clients have engaged with a caseworker, the team works to stabilize clients by connecting them to services and supports in the community (e.g., housing, employment, obtaining identification, navigating the welfare/disability and health care systems, money management, etc.). This work requires an enormous amount of patience, persistence and skill in negotiating and building trust, and in repairing trust when it is broken.

An evaluation of VISU is currently underway through the Centre for Applied Research in Mental Health and Addiction (CARMHA) in the Faculty of Health Sciences at Simon Fraser University.1 The evaluation is looking at VISU’s ability to increase the community tenure of its clients, including effectiveness in reducing re­offending and admissions to psychiatric and correctional institutions.

CARMHA is also interested in investigating the active ingredients of change, from the perspective of both VISU staff and clients, and other community agencies. This research will further our understanding of VISU’s niche in the Downtown Eastside community, as well as our understanding of assertive case management in general, and will thus inform future program changes and refinements.

About the Author

Michelle is a clinical psychologist who works at the Centre for Applied Research in Mental Health and Addiction (CARMHA), an interdisciplinary research group in the Faculty of Health Sciences at Simon Fraser University. She is currently working on several projects that examine overlap among corrections, mental health and human resources systems

  1. The Centre for Applied Research in Mental Health and Addiction (CARMHA) at Simon Fraser University came into being in January 2006 under the leadership of Dr. Elliot Goldner, Dr. Julian Somers and Dr. Paul Waraich. Formerly part of the Mental Health Evaluation and Community Consultation Unit (Mheccu) at UBC, CARMHA works with provincial, federal and international organizations interested in conducting research on mental health policy

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