A day in the life of a CMHA Toronto case manager

May 11, 2023

Sabrina Giralico sat down with us to talk about her role as a case manager with CMHA Toronto.  This interview has been condensed and lightly edited for clarity.  

Tell us about your current role at CMHA Toronto. How long have you held this role? 

Sabrina Giralico is a case manager working in Toronto's east end

My role is case manager. When I first started I was doing case management with two teams – an ACT [Assertive Community Treatment] team as well as the team that I’m currently with, the East Case Management team. We're a massive team. I'm a general case manager, but we have language-specific case managers, case managers specific to mental health and justice helping in our court systems, and so on. I'm more general so I get a taste of everything. I've been doing this for four years now.  

What were you doing before this role? 

Before being a case manager, I was still with CMHA Toronto but with another program called SafeBed. It's a crisis program where people get a 30-day crisis stay. We play a case management role and try and help people get back on their feet.  

What is your educational and work background? 

I went to York University for psychology, it feels like forever ago. Mental health has always been a big part of my life and what I wanted to do. So that's what got me into CMHA as an organization. I started out volunteering and ended up in this role. Overall, including my volunteering, I’ve been with CMHA Toronto for about six years. 

So you've been with the agency before and during a global pandemic, which has shaped a lot of change overall. Tell us about some of the changes you've seen in your role and the kind of work you do from when you started to now. 

Gosh, the pandemic definitely has been the biggest change. We weren't able to see people and also we hadn't yet quite figured out the technology piece. Everything was over the phone, which truly is so disconnected. Clients felt that; I know I saw a big difference in my case load in how clients felt [about not being able to have in-person appointments]. Even now, I see most people in person, but there are some people who are still quite comfortable with being at home. So, it's still not quite the same.  

The other change that I would say has occurred in my role is that I'm more versed now in how to manage my time and can get involved in other things like committee work. I'm able to time manage a little better than when I first started out and was still trying to figure out the system. And I’m able to set personal boundaries and be assertive now, which is always difficult as a young, fresh employee.  

What kind of committee work are you involved in? 

CMHA Toronto has many different committees – I couldn't even begin to name them all! But one committee that I sit on is a health and equity committee called Black 365. It's specific to celebrating our Black staff and clients all year round, not just in the month of February [Black History Month]. It makes the work more enjoyable and it does make a difference in terms of our clients and the kind of service that we provide. 

What kinds of supports and services does a CMHA Toronto case manager offer to clients? 

I always describe case management to people as being someone who can put on many different hats. The support is so vast that it really is dependent on what someone needs.  

One of the most common things I do is housing support. If someone's at risk of eviction, I try and help by liaising with building staff. Or sometimes people have issues with hoarding and we’ll support clients through that as well, through different supports or goal setting. The biggest thing is helping clients work with either building managers or property owners to keep them housed. 

The other main area is general system navigation. Clients, especially those who are just starting out or maybe come to us right out of being in the hospital, have to figure out their next moves, maybe getting a doctor, getting whatever therapeutic program they might need, getting financial support if they don't have any income.  

That's a lot and it's difficult for really anyone to navigate that. We provide referrals and support a client through that process. If a client would like to see a therapist, for example, I'll put a referral through for that; if a client needs a psychiatrist and doesn’t have one, which is very common right now, we’ll put that referral through as well. [CMHA Toronto’s Intake, Information and Referral team handles these referrals; learn more here.] 

Another big one is coordinating with different care teams. If a client does have a psychiatrist or a therapist, or they are involved in other programs, we will coordinate with these teams to keep the client well. Honestly, more people in a circle of care is always better. 

Not all clients have family but for those who do, we will coordinate with family and offer family support as well. And we will offer family support as well. Sometimes families are very overwhelmed and we have a family support program that we can refer them to.  

There’s so much more, but those are the main areas of service we provide. 

What's a typical day for you? 

If things are going as per schedule, a typical day would be starting out with going through any voicemails (sometimes clients call in the middle of the night and leave voicemails) and emails. That’s how I start my day, and then I usually have scheduled community visits – three to four visits a day on average, and those are set up on a weekly basis. If there's no cancellations, or if someone isn't sick, or if there's no crisis, then I'll go through those visits and it's a good day.  

What if your day doesn't go as planned? What usually disrupts your day? 

The biggest thing that would disrupt our day is any kind of crisis. That can look like a lot of things, for example getting calls from a building manager that our client is not doing well, that they're being disruptive and it's just evident that they're not doing well. That has to be prioritized, intervention would have to take place. When we know that clients are unwell or maybe even a safety risk, we coordinate with doctors, if there's a doctor in place, and sometimes bring them into hospital on a form [the process that initiates a community treatment order] – that can take some time. And sometimes it's even going to the client, too. We’ll often meet the client where they are and if there is no doctor we’ll call mobile crisis; whatever we can do to get the person safe. 

What do you bring to your job that makes you a great case manager? What previous life or professional experiences, skills or talents, have been most useful to you in your role? 

I'm awful at tooting my own horn but the biggest thing for me is that I've always been passionate about equity and I've always been involved in different kinds of advocacy work. So that’s big in this role because a lot of our client base are very vulnerable people in Toronto. Being able to look at someone through a completely open and empathetic and non-judgmental lens is the foundation of being able to work with people.  

People come to us from different walks of life, and some people, naturally, come to us at the lowest point in their life. Being able to empathize is important. I look at a lot of what I do as leveling the playing field. I think that has played a big role in why I do what I do, and why I continue to do what I do. 

Is there something that would surprise people about the kind of work you do? 

Most people, when I tell them about what I do, are surprised that I meet clients wherever they are. They are surprised by the outreach involved in the role. Whether it's people's homes, or anywhere in the community that’s safe, that’s where I’ll go. If clients want to come to the office they can, but it doesn't usually happen. 

People are shocked to know I'm not just sitting in an office all day. My office is my car. 

I think also that the level of support we provide to people can be surprising. For example, I've had clients who have had nothing in the fridge so I have gone and picked up some groceries for them. It's not necessarily in our job description, but I know I'm not the only person who would do that for a client. We really take a holistic approach, you know, because how can we expect people to get better if they don't have their basic needs met?  

Although we do tend to work nine-to-five, we can be flexible if a client's needs are outside those hours. So, I've had clients who have had important appointments or needed support after hours, for example to make a police report, and I can flex my day so that I can do that. That might also surprise people that we really try to accommodate people’s needs that way. 

You mentioned earlier that the ability to set your own boundaries is an important skill you’ve learned. Tell me a little bit about how you navigate that when you're going above and beyond. How do you take time to make sure you're okay in that process? 

That's an ongoing journey! The biggest thing is leaning on your team. A lot of this work is so individual. We have a team meeting once a week and that’s sometimes the only time I see my team; everything else I do is individual. But I know that I can call a co-worker any time, or I can call my manager any time. They are all supportive. I think leaning on your team when you are feeling overwhelmed helps a lot. It's so easy to feel you're not doing enough because people are going through so much. But leaning on your team can help reset that. 

What’s your greatest satisfaction in your job? 

Helping people. We see people come in at their very lowest, and to see someone transition to becoming more independent, more confident, and just more well, in general – there's no better feeling than that. 

What advice would you give to someone who's considering a role like yours? 

I think to make sure they make time for self-care in this role. It is such a rewarding job, but it can be a very taxing job. I think anyone working in mental health can appreciate that it can be emotionally draining. Compassion fatigue is a very real thing. That said, this job is still extremely rewarding. And I think that you must make sure to take the time for self-care – having that family time, doing things that you enjoy, disconnecting when you're done for the day (that's a big one). That's the best advice I could give and that'll help so much. 

In anything, right, almost anything?

Yeah, for sure! 

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