April Trewhitt, RP, is CMHA Toronto’s Manager, Therapy and Addictions Services and will soon celebrate her 20th anniversary with the agency. She’s passionate about making sure that CMHA Toronto, as one of Canada’s largest community mental health providers, has evidence-based and accessible addiction services that support both mental health and addictions issues.
“All of our staff who work in the addictions program at CMHA Toronto have a comprehensive understanding of the unique connection between mental health and addiction,” April says. CMHA Toronto addiction workers are concurrent disorder specialists, some with lived experience with addictions, mental health, or both.
We think it's really helpful and important for people to be able to get service for both their addictions and their mental health issues. We know that when people feel supported holistically, it’s really a game changer.
Too often, people struggling with substance abuse or other addictions “face a lot of judgment – from family and friends, and from society. Sometimes they face judgment from within themselves. We want to ensure that our services come from a non-judgmental place,” April emphasizes. She adds that when addictions co-occur with mental health issues, the challenges multiply and the stigma that people face can be even greater.
“Our addictions program works from a harm reduction perspective which acknowledges that both harm reduction and abstinence are valid choices. Some people really want to learn new ways to cope, some people want to connect with someone who has been there, and some people want to be able to use in ways that don’t cause as much harm. Our services try to help people where they're at. We work from a non-judgmental perspective,” April says.
The thing that I really appreciated about the groups was the ability to openly talk about my addiction and the issues I had and nobody judged anything.
Increasing Accessibility with a Range of Services
CMHA Toronto works to ensure that clients have multiple options for services and formats for service delivery.
Addictions services are available to current CMHA Toronto clients as well as people living in the Greater Toronto Area. April explains that you don't have to have a formalized diagnosis to take part in programs.
One of our groups is a 12-week dialectical behaviour therapy (DBT) program that helps people learn new skills to manage intense emotions and can support people to manage their addiction more effectively. “We've got many different addiction groups such as structured relapse prevention, Smoke Stoppers, a cannabis skills group, and a ‘talk-it-out' group. We also have therapy specific groups that are skills-focused to help people manage different vulnerability factors like mood and overwhelming emotions,” April explains.
Some groups target depression and anxiety, “both of which can have an impact on whether people might use substances to cope with these experiences,” says April. “We've got an anger management program that helps people learn new skills and strategies to better deal with their anger and we're really excited that we've started a group specifically for people that use cannabis.”
Specialized services are available for individuals with past or current involvement with the justice system. These services, including one-on-one addictions case management and structured psychotherapy, cater specifically to those navigating addiction within the justice system.
There are also more informal drop-in groups where people can attend “just to talk about what's happening,” says April.
In-house services and partnerships for external resources
There is value in being able to provide mental health and addictions services under one roof, and there is a lot of flexibility to make referrals between programs at CMHA Toronto.
“Sometimes your mental health worker, like a will be able to coordinate a connection with staff from the addictions program,” April explains. And in still other circumstances, CMHA Toronto Addictions Services staff can facilitate referrals to external partners who provide other options.
For example, while CMHA Toronto does not have in-house addictions medicine treatment providers, staff are able to connect people to external providers that have RAAM (Rapid Access to Addictions Medicine) programs, such as those offered by hospitals and the Centre for Addictions and Mental Health (CAMH). CMHA Toronto Addictions Services staff can also help people who are interested think about longer-term residential treatment and can make referrals to these resources.
Online groups offer many more people access to services
All CMHA Toronto’s addictions support groups have been running virtually since the start of the pandemic and the agency is looking into offering more in-person options. April notes that the Addictions Services group has seen an uptick in demand since the pandemic, and online options have made it easier to attend. Online groups remain popular for their convenience, and because they alleviate the costs of transportation. There is also a device lending library for those who may not have access to Wi-Fi or a tablet to participate in groups online.
While the pandemic has opened up virtual options for service delivery, it has also driven the need for them. A lack of employment, and fewer activities that feel meaningful or opportunities for connection have driven record rates of loneliness in Toronto, as elsewhere in the world. Toronto Foundation’s Vital Signs survey found that Torontonians are among the loneliest people in Canada with nearly 40 percent feeling lonely at least three days a week. And loneliness is a key driver of mental health issues and addictions.
“When we think about the vulnerability factors that can be drivers of people using or using in ways that are negatively impacting their lives, one of the biggest factors is isolation,” April says. “The addictions program recognizes that we need to do more to combat isolation, do more to help people have a sense of connection and a sense of community.”
CMHA Toronto recently got a grant to run some in-person events and activities that address the level of isolation people are feeling and build community. “Coming up in the new year, we're going to run some events to bring people together, and highlight some positive examples of people who have attended one of our groups or got connected to one of our staff. Many people have been able to achieve some amazing things, things that are really important to them, and we want to celebrate that. There's so much negative; let's focus on some positive stuff. We really need more celebration in this world.”
We really felt like a little family, a little group that has had this shared experience. That’s the biggest thing: hang in there and you’ll get there one day. We’ll get there together.