Background

In 2001, 49% of Aboriginal people in Canada lived in cities. This urban population is growing steadily and has unique needs that are often not met by mainstream services. Too often, addictions and mental health issues in urban Aboriginal communities are left untreated, or are treated in culturally inappropriate ways.

Aboriginal community members in Toronto have long felt that there are large gaps in Addictions and Mental health services for Toronto Aboriginal people. There is a need to increase these services at all levels of the community across a wide continuum of care. Front line social service workers have noted a number of alarming areas of need (listed in no particular order):

• Post-traumatic Stress Disorder;
• Depression and Anxiety;
• Substance Abuse and Problem Gambling
• Schizophrenia and other severe mental health conditions
• Self-Harming Behavior and Suicidal Tendencies
• Dementia
• Family Violence
• Fetal Alcohol Syndrome/ Alcohol related Neuro-developmental disorders;
• Unresolved Grief/ Loss and Anger
• Dual Diagnosis (e.g., Bipolar Disorder and Down’s Syndrome)
• Concurrent Disorders (e.g., Schizophrenia and Alcoholism)

The context for addressing these needs has not been adequate. Community workers note an increased need for detoxification and treatment services while the level of service is decreasing. The situation is worsened by social stresses related to trauma, including histories of abuse, poverty and other factors common in the Aboriginal population. The percentage of homeless people in Toronto who are Aboriginal has stayed at 15% or more while overall homeless numbers are rising. Frontline workers also note the urgent need for services to those who are housed and employed and in danger of losing jobs, homes and support networks due to addictions and mental health issues.

Efforts addressing these issues need to be coordinated across agencies. Many people suffer from more than one area of need, and combinations of addictions and mental health issues vary from one client to the next. A client-centered, collaborative multiple-service case management approach to working with clients is essential.

In 2003, various Aboriginal service agencies approached the Ministry of Health with the aim of adding new addictions and mental health services. In 2004, a report on the issue was commissioned outlining the issues (Needs Assessment and Delivery Models to Address Mental Health Needs of the Aboriginal Community of Toronto). Discussions in 2005 explored increasing capacity across the community to address Addictions and Mental Health in a manner that would complement and increase community-wide coordination of services and relate to the development and delivery of various addictions and mental health services to Aboriginal people in Toronto. These discussions resulted in a successful proposal for the Toronto Aboriginal Care Team in 2006-07.