Our purpose

The Central West Concurrent Disorders Network's purpose is to build capacity in the Central West LHIN to better respond to the multiple needs of people living with what are called concurrent disorders - co-occurring mental health and substance use needs or problems. Network members work together to develop and implement more integrative and collaborative approaches to care and to monitor and report on their progress in building the system's capacity in this area over time.

The CW CDN also works together to exchange knowledge and to develop and continuously improve a system of mental health, addiction and concurrent disorders-specific services and supports so that consumers and families in the Central West LHIN experiencing both mental health and substance use needs are: welcomed; identified quickly; provided with the best combination of services and supports given their unique needs; and are supported in their recovery.

The CW CDN's vision is of a true "no wrong door" access system in which mental health, addiction, health and social services programs all have the ability to welcome and accurately screen for and assess the mental health and substance use needs of the individual served and their families. All service providers have the ability to seamlessly provide or link needed services in a fluid manner that does not place the burden on the individual or their family to navigate different service systems separately.

Service providers within the Central West LHIN seek to operate within a collaborative culture where all service providers, funders and stakeholders join together in partnership to share responsibility for meeting the multiple and complex needs of individuals with any combination of mental health and substance use problems that present in any setting, to collaboratively prioritize resources to meet their needs most effectively, and to create a framework for universal concurrent disorders capability and mutual support across the service-providing system.

The CW CDN believes in the following values and principles [1] and works to adhere to them in all that the Network does:

• Expectation, not exception: The presence of both mental health and substance use problems (i.e., concurrent disorders) is an expectation, not an exception within the Central West LHIN's mental health, addiction, health and social services system. The whole system, at every level, must be designed so as to be able to identify and respond to the needs of people with both mental health and substance use needs no matter where they enter the system.
• Integrative assessment, service and follow-up: Mental health and substance use problems, regardless of severity, tend to be persistent and recurrent. These problems co-occur frequently and complicate each other, necessitating a continuous and integrative approach to assessment, service delivery and recovery. Assessments must be inclusive of both kinds of problems and must include understanding the individual within the context of his/her environment and personal lived experience. Regardless of where a person first seeks help within the system, integrated services and follow-up must be available to anyone who would benefit from them.
• Holistic, determinants of health-based approach to recovery: The Central West LHIN's mental health, addiction, health and social services system must take a holistic, determinants of health-based approach to supporting a person in his/her recovery process. The system must see and work with individuals as whole people, supporting them to address their full range of health-impacting needs (e.g., including their housing, employment, income support, social connections and other needs).
• Use of existing services and programs: A comprehensive, integrated system for people with both mental health and substance use needs should be created by building on the existing strengths of current services, supports and the system. When needed, new services and supports should be created that are evidence-based or are innovations with high likelihoods of success.
• Accessibility (i.e., inclusive, no wrong door): Individuals with both mental health and substance use needs should be able to enter the mental health, addiction, health and social services system through any door and expect to be welcomed, identified as having co-occurring mental health and substance use problems, and supported to access the array of services and supports that will best meet their unique needs.
• Comprehensiveness and continuity of care (i.e., no cracks in the system): The Central West LHIN's mental health, addiction, health and social services system must provide early and easy access to a comprehensive continuum of integrated services and supports and to integrated treatment and support relationships which are maintained over time and across service settings as needed to respond to people's varying needs. In essence, there should be no cracks in the system through which people with co-occurring mental health and substance use needs are able to fall.
• Concurrent primary service and support: When mental health and substance use problems coexist, both should be considered primary, and addressed through integrated concurrent needs-specific service and support. Using such an approach:
• Each individual receives needs-specific, evidence-based, phase-specific and appropriately intensive services and supports that takes into account and works with people where they are in relation to their problems (e.g., the level of severity and engagement for each problem, and any complications resulting from the co-occurring problems)
  • Each individual has a primary service relationship with an individual who coordinates on-going service and support interventions for the co-occurring problems (initiating service agreements as appropriate when other service providers become actively involved)
  • Each individual receives service for concurrent disorders in the setting or service system that is most appropriate to the self-defined needs of the individual
  • Each individual has access to needed clinicians and/or workers who have expertise in both mental health and addiction treatment as well as expertise in concurrent disorders
  • When the individual has a serious mental illness and a co-occurring severe substance use problem, integrated treatment and support planning for both problems will be provided by the same clinicians and workers or teams of clinicians and workers (from the same or different organizations), providing both mental health and addiction interventions in a coordinated fashion
  • Each individual is encouraged to include family members or significant others in the service and support planning and delivery process.
• Caring, supportive, and empathic relationships: One of the most important factors for recovery from both mental health and substance use problems is the development and sustaining of a caring, supportive, and empathic service relationship in which the individual is considered to be able to recover and experiences the hope of this belief. All clinicians and workers must work to create this kind of relationship with the people with whom they work.
• Individualization and flexibility of approach: Individuals with both mental health and substance use needs may be at different phases of acceptance and recovery for each problem and should receive phase-specific service and support for each of their needs. People with concurrent disorders should receive a judicious combination of supportive case management, other health and social services as needed, and empathic detachment and empowerment, the exact balance of which should vary based on the specific needs of each individual. Basic needs meeting, harm reduction, determinants of health-based, self-management, and health recovery strategies should all be used as appropriate.
• Shared system responsibility and commitment: The Central West LHIN mental health and addiction system, through its constituent service providers and workers, must make a long-term commitment to individuals with both mental health and substance use needs. Individuals with concurrent disorders, no matter how complex their needs, must be welcomed into the system at any point and supported to access the services and supports most appropriate to their needs. This welcoming, supportive environment must be sustained throughout the care and support delivery process even as individuals' needs, behaviours and levels of engagement change. The system must always offer options for and support people to access services and supports that will meet and work with them where they are.
• Welcoming and inclusive of all diversity, culturally competent and taking of a multi-lens perspective: People with both mental health and substance use needs must receive culturally competent care that welcomes, addresses and respects diversity in all its forms (e.g., language, customs, values, sexual orientation, gender, faith/beliefs). Services and the system must have the capacity to work from an anti-oppression and trauma-informed framework and respond to individuals' unique families, cultures, traditions, and strengths. People and their specific needs and situations must be viewed through multiple lens' including, for example, their various diversities, families and experiences.
• Effectiveness and outcome evaluation: Services and supports must be outcome-based, with the key outcomes that are monitored being selected and defined with consumer input and involvement. Services and supports must provide evidence of effectiveness through the appropriate use of periodic outcome evaluations and consumer satisfaction assessments.
• Consumer and family engagement, involvement, education and empowerment: Consumers and families (however defined by the consumer) must be encouraged, educated, empowered and actively supported to be engaged and involved in service, support and system development and delivery over time.
• Advocacy: Services and supports must work together to advocate to government, the Central West Local Health Integration Network (LHIN) and other funders for the resources needed to adequately and appropriately meet the needs of people with both mental health and substance use needs and their families living in the Central West LHIN.