For Jacqualine, a community treatment order started her on a road to recovery that took her life in directions she could barely have imagined.
With the steady support of the CMHA Toronto community treatment order team, and with her own active engagement and growing confidence, Jacqualine now serves as a beacon of hope and inspiration for those who are taking a similar journey.
“In the beginning, I was so fuzzy from being in the hospital that I don't recall probably the first two or three months of meeting with my [CMHA Toronto case workers]. I remember bits and pieces of it. But once I got stabilized that's when the haze started to lift.”
Jacqualine doesn’t remember the precise date she came to be supported by CMHA Toronto, but she does know what triggered her decline: “I lost a sister to suicide. She had a long battle with severe mental health concerns, and then she lost her life. After that, I went to a very dark place. My sister and I were very, very close. She was close with my children. I turned to alcohol to self-medicate and almost died because of the alcoholism.”
Jacqualine enrolled in a hospital day program for addictions. As she started her recovery for sobriety, though, “all my mental health concerns started to surface. I went through many years of being unstable with my mental health. Not being diagnosed properly. Medications not working because I wasn't diagnosed properly. In and out of the hospital in efforts to try and stabilize my mental health.”
A series of hospitalizations in a short period led Jacqualine to the community treatment order (CTO) – a provision under the Ontario Mental Health Act that allows a physician to mandate supervised treatment when someone is discharged from hospital.
While CTO’s have a reputation of forcing people into care that they may not want, this was not Jacqualine’s experience and it is not the way CMHA Toronto approaches the work.
“I had the wherewithal to know that I was unstable. I needed somebody to help me. It was welcoming to me. I can't think of a negative.”
For Jacqualine, the CTO was lifesaving. She was finally properly diagnosed and prescribed the right medications. Jacqualine believes that “what really helped me was meeting with my [CMHA Toronto case managers].” Early on, she met with them often twice weekly, but the schedule was flexible and geared to her interests. Beyond the concrete resources she was provided, Jacqualine says it was the CTO team’s collaborative approach that made all the difference.
“They were collaborative with me and I felt like I was making the decisions with them. They offered me the supports that worked for me, or offered supports that they thought might work for me saying, you know, try it out, it might not work for you. And if it doesn't, we'll look for something else,” Jacqualine explained.
Collaborative and client-centred
Maria Boada, program manager of CMHA Toronto’s Community Treatment Order Program and Hospital to Home Program, explains that when she first learned about CTOs she viewed it as an opportunity to employ a strong recovery focus, consistent with CMHA Toronto’s values.
“Community treatment orders can be seen as coercive, but that’s not how we work,” Maria explains. She and her team apply a collaborative, trauma-informed and client-centred process to their work with clients. Maria emphasizes that they are "transparent with the person about how we will work with them and their support system, and provide information to them about the CTO process, expectations, and how to appeal it.” She adds that the team must think creatively and find ways to connect with the individual. “Often, we work on other goals with them such as employment or housing while also assisting them with the obligations of the CTO, like taking medications and attending appointments with their psychiatrist,” she explains.
“I have met many people throughout the organization and regardless of whether they’re case managers or executives or community members, everyone has always made me feel that I mattered, that I was not ‘less than’. It's the culture at CMHA Toronto that really resonates with me.”
Maria believes that close communication between physicians or psychiatrists and her staff is the key to making CTOs work well in the full service of the client. She goes so far as to say that if that communication happens, CTOs might not be needed in many cases.
“When a referral comes in, we connect with the individual first. If the person says no to our services, we’ll connect with the referral source and the substitute decision-maker to see if there’s a way we can be involved. Sometimes, we’ll ask the doctor to invite us to a meeting with the client so we can share what we do. Sometimes this is effective,” Maria said.
For Jacqualine, even though she was mandated through a CTO to engage in treatment, she welcomed it. “I did not like being unstable. I had the wherewithal to know that I was unstable and my behaviors and my actions were because my mental health wasn't being treated appropriately. I needed support and I needed somebody to help me,” Jacqualine said. “It was welcoming to me. I can't think of a negative,” she added.
Seeing the whole person
Another important element in CMHA Toronto’s work – within the CTO program and in all its programs – is that they take a long-term, holistic view.
While Jacqualine’s CTO expired six months after it was initiated, she continued to be a CMHA Toronto client and has benefitted from many different kinds of support. “I've had multiple community support workers along the way who’ve helped me tremendously,” Jacqualine said.
One of her earliest case managers, Maria Kalogridis, was of special importance to her: “She got to know me and my past before my alcoholism. We talked about when I used to work in corporate many years ago, before I had children, before I got married. I was a manager of a call centre. I interviewed people and I hired people. She got to know my life before I got sick.”
Out of this deep connection, Maria K. was able to support Jacqualine’s recovery and growth in ways that were uniquely suited to her. Maria suggested that Jacqualine join a hiring panel for organizations that seek representation of people with lived experience of mental health issues in their recruitment process. This opportunity led Jacqualine to meet CMHA Toronto program manager Laura Monastero, who has become another key connection and mentor.
“I felt like a human being. I felt like I was contributing to society again. It reminded me that I do still have skills and I still have something to give despite everything that I've gone through.”
Having been out of the workforce for so long, Jacqualine didn’t feel confident that she could do the role, but with Maria K. and Laura’s encouragement, it was transformative.
“I felt like a human being. I felt like I was contributing to society again. The encouragement that I received from the other managers and staff on the panel was very uplifting. It reminded me that I do still have skills and I still have something to give despite everything that I've gone through.” Or maybe, Jacqualine agrees, because of it.
Jacqualine joins CMHA Toronto as a volunteer
From there, Jacqualine has had numerous other opportunities to lend her voice and share her experience with others. She volunteered to be on CMHA Toronto’s Client and Family Advisory Committee, which brings the client voice to program decisions and issues that involve the families of those with mental health issues.
Then, in the first year of the pandemic, Jacqualine was approached to conduct quality assurance surveys to gather information about how CMHA Toronto could better support its clients during COVID-19. For Jacqualine, this was another life-altering experience. “Working with Laura on the Client and Family Advisory Committee and on the quality assurance surveys was amazing. I felt like I was giving back. Laura was able to recognize my growth even when I could not,” Jacqualine said.
“I remember so clearly one call,” Jacqualine reports. “I started the interview saying that I am a [CMHA Toronto] client just like you are. That’s how we positioned it. After the survey was done, [the participant asked me] ‘how are you able to do what you're doing?’ When I explained, she said ‘wow, maybe one day when I start to feel better, I can do what you're doing’.”
“It was like I gave somebody hope, just by doing a survey. And it reminded me how far I had come. Sometimes I lose sight of where I was and where I am now. It was another affirmation to me that I'm doing well.”
Jacqualine’s eyes brim with tears as she recounts this experience and what it meant to her. “It was like I just gave somebody hope, just by doing a survey. And it reminded me how far I had come. Sometimes I lose sight of where I was and where I am now. It was another affirmation to me that I'm doing well.”
And she continues to do well. Jacqualine has now had “11 years of continuous sobriety. From the minute I stopped drinking I've never picked up,” she said. And now, in another milestone on her road to recovery, she’s returned to school to train as an addiction and mental health worker.
The two-year program at Centennial College has tapped into the deep connections Jacqualine has forged with CMHA Toronto. This semester she completed her second of two work placements, both of which have been with CMHA Toronto programs.*
“Sometimes I could see a little bit of myself in people … this is where I was. But I used that as an opportunity just to sit with them, and just meet them where they're at. I think that's really all you can do: meet them where they're at and go from there.”
It was a full-circle moment when Jacqualine found her first placement: “I ended up being on Maria Boada’s team, working with two community support workers on the CTO team. It was really, really good,” Jacqualine said.
Reflecting on her overall experience, she adds: “I have met many people throughout the organization and regardless of whether they’re case managers or executives or community members, everyone's treated equally. Everyone has always made me feel that I mattered, that I was not ‘less than’. It's the culture at CMHA Toronto that really resonates with me.”
Taking care of her own mental health
Jacqualine knows that she brings unique strengths to the work and, as a person in recovery herself, may have to confront unique challenges. “One of my challenges was sometimes I could see a little bit of myself in people. Not that I was triggered, but there were some reminders there, like, I recognize this because this is where I was. But I used that as an opportunity just to sit with them, and just meet them where they're at. I think that's really all you can do: meet them where they're at and go from there.”
She is taking extra steps to make sure she prioritizes her own mental health, including finding ways to leave work at work. “We talk about burnout and resiliency and self-care a lot. I need to decompress more. I've been doing more mindfulness meditation just to clear my thoughts,” Jacqualine said.
My recovery is a lifelong journey, right? At the end of the day, I can't let all of this affect my mental health.”
Jacqualine continues to have the support of many people at CMHA Toronto: her current case manager and former CMHA Toronto case and program managers, including Maria Boada who first met Jacqualine when she was under CTO care and now connects with her to offer guidance and check-ins on Jacqualine’s own case work.
“I remember being told that I would have to be on [the community treatment order] for six months and here I am, over a decade later,” Jacqualine said. From CTO client to CMHA Toronto volunteer to case worker in training, Jacqualine is staying well and giving hope and inspiration to others who are travelling a similar road.