By Dr. CHRISTOPHER J. MORGAN
What does the future hold for the Substance Abuse Program for African Canadian and Caribbean Youth (SAPACCY) at the Centre for Addiction and Mental Health (CAMH)?
Dozens of community members, stakeholders from the Black Health Alliance, the African Canadian Legal Clinic, the Tabono Institute, Zero Gun Violence Movement, Toronto Public Health, TAIBU Community Health Centre, Across Boundaries, Queen West Central Toronto Community Health Centre, Black Daddies, Mount Sinai Hospital, existing and former SAPACCY staff, community media and most important, SAPACCY program participants, participated recently in a community stakeholders meeting at Toronto City Hall with representatives from CAMH to answer this question.
“I was on a path of ruin and destruction, now its healing and recovery.” These are the words of Paul (not his real name) who spoke courageously of his changed life dealing with the horrors of Post-Traumatic Stress Disorder (PTSD) since the age of 15. For eight years, between the age of 15 and 23, Paul bounced around seeking therapy to help him cope with PTSD, including the mainstream counselling services at the CAMH, Canada’s largest and best known mental health hospital. But it was not until he found SAPACCY did he find the help he so desperately was seeking.
Sonya (not her real name) grew up and became a young mother while in the foster care system. She admittedly had addiction problems and was battling suicidal thoughts for many years. Like Paul, Sonya found hope, guidance and strength to turn her life around through the therapists and services of SAPACCY. In terms of substance abuse and mental health services, SAPACCY is unique. It has an Africentric orientation, it is anti-oppression, anti-racist and culturally appropriate for the African Canadian community and it is housed within CAMH.
In its nearly 20-year existence, SAPACCY has undergone significant changes. In the former years it had no less than two full-time clinical therapists, a community outreach worker, program manager and an active community advisory committee. Over the years many of these positions and services have been stripped away. Gone is the community outreach worker, the community advisory committee and only one clinical therapist remains. Yet, the designated budget for SAPACCY has essentially remained unchanged over the years and the need for mental and addictions services for African Canadian youth and young adults has escalated to crisis proportions.
The proverbial straw that broke the camel’s back was the most recent elimination of the sole Black male therapist, leaving one female therapist to carry out SAPACCY’s mandate – alone. When program participants, community members and partners learned of this latest development, questions and concern regarding the future of SAPACCY at CAMH reached a tipping point. In her comments, Sonya could not imagine “seeking out for help and help (the SAPACCY program) not being there”.
Neil Edwards, former investigator and negotiator with the Ontario Human Rights Commission, was the moderator and smoothly navigated the presentations, questions and responses throughout the nearly three-hour meeting.
As an original member of the SAPACCY Community Advisory Committee alongside Nene Kwasi Kafele, former Director of Equity at CAMH, Margaret Parsons, Executive Director of the African Canadian Legal Clinic, reminded the group of the historical context of SAPACCY’s origins and the importance of its founding principles and culturally specific focus on Black youth. Because of the strong link between substance use, mental health and the criminal justice system, Parsons recounted the critical role the SAPACCY community outreach worker played in conducting substance use workshops in the community. In very strong terms she communicated the systematic decisions that have been made that effectively amount to closing the program.
The decisions could be considered racist in nature.
Louis March, founding member of the Zero Gun Violence Movement, walks around with a pack of playing cards in his pocket. The cards are a constant reminder of the 52 young Black lives lost in one year to gun violence not long ago. He shares with the group daily struggles of these young adults and the pervasiveness of drug use in their lives.
“Many will smoke for breakfast, smoke for lunch and smoke for dinner,” he says.
He adds, mainstream mental health and addiction services are open 9am – 5pm, the critical part of these young men’s lives is “from 5 pm to 9 am. Who’s open then to help them?”
March wonders how many of the 52 lost lives could have been saved if there were more, not less, SAPACCY programs available to them. His comments reminded me of Paul’s profound statement that SAPACCY “gave me a second chance and a mother got her son back”.
There were several other real-life examples demonstrating both the need for and the positive impact of SAPACCY. The Black Health Alliance and its partners presented a number of recommendations to CAMH for SAPACCY including (in part): Restoring the full funding complement of African Canadian clinical therapists and community workers; Restore the Community Advisory Committee; Ensure SAPACCY funding is protected and expanded and Perform regular program evaluations and reports.
Dr. Kwame McKenzie, Director of Health Equity at CAMH, with support from Christina Bartha, Executive Director of the Child Youth Emerging Adult Program and Lori Spadorcia, Vice President Communications and Partnerships at CAMH, presented CAMH’s vision for SAPACCY and responded to questions. Dr. McKenzie described the clinical transformation that CAMH has been undergoing the last few years. The hospital is “trying to see more people while increasing quality of service and increasing access to those services”. This has led to structural and organizational changes which include the merging of some programs to form the new Child, Youth and Emerging Adult Program which SAPACCY now falls within.
The intent is that SAPACCY clients would have better and faster access to specialized (or any other services) of the hospital, improving their health outcomes.
“We are breaking down the silos the different programs and departments once had…if is far easier now to refer or transfer someone from a youth program into an adult program,” said McKenzie.
He presented a slide on recent data collected from the hospital’s new Access CAMH intake system that showed a near doubling of SAPACCY registrants within the last two years.
The rise in SAPACCY participants is not surprising to community members and stakeholders. It is the simultaneous decline in staffing and programs that is troubling. Christina Bartha informed the group that the subsequent transformational changes had staffing implications that led to the relocation of the unionized SAPACCY therapist to another area of the hospital. A big part of the organization’s clinical transformation decision making is centred on “having the right skill set (Masters or PhD) to deal effectively with the often complex cases seen”.
With respect to funding, the group was informed that dedicated SAPACCY funding is less than $300,000. It is funded by the Ministry of Health and Long-Term Care and it has experienced “marginal” changes over the years and it is often subsidized (or added to) by CAMH.
Questions regarding a short timeline for replacing the full-time therapist and commitment to hire someone from the African Canadian community for this culturally specific program were among concerns expressed in addition to proficiency in cultural sensitivity or competency of CAMH staff in other departments and programs beyond SAPACCY to ensure respectful and appropriate communication and interactions with members of the community. In addition, several complaints of significant difficulty accessing the SAPACCY program via Access CAMH with CAMH staff that were either not knowledgeable of or unaware of the program were made.
Due to time, some questions around funding such as efforts made (or not made) by SAPACCY management to advocate and apply for additional funding and what is being done with the SAPACCY funds allocated to pay for the relocated therapist have yet to be answered.
Whereas some concerns and questions have not yet been answered or resolved, there was consensus on some big picture issues. There is no debate on the critical, life-changing need and impact of a culturally specific program such as SAPACCY. CAMH’s own recent SAPACCY intake data and community lived experiences builds and confirms the case. Yet, SAPACCY is one program in a large hospital, alone; it does not have the capacity to make the population-based change in mental health and addiction services desperately needed for Black youth and young adults.
McKenzie shared with the group that in the UK, where he has worked extensively in developing and building mental health programs and policies, the politicians’ debate over mental health funding making up 11 or 13 per cent of the global health budget. Here in Ontario mental health services barley make up 6.2 per cent of health care spending.
In Ontario, under Patients First, health care administration and funding will become more localized. We should be working collaboratively to apply pressure to ensure mental health and specifically, mental health services for the African Canadian Community, is on the agenda when decisions are being made.
We will need multiple SAPACCY-like programs imbedded within the community in places like TAIBU and Queen West Central Toronto, or Black Creek Community Health Centres, with strong clinical and community partners such as the CAMH, Toronto Public Health, Black Health Alliance, Tabono Institute and others. We must continue the work that has been and is being done on a mental health strategy for the Black community. It may likely be a part of a larger Black Health Strategy we have spoken of before.
There were some very encouraging signs coming out of last week’s community stakeholders meeting on the future of SAPACCY at CAMH. There was commitment on all parties to continue the conversation as it relates to SAPACCY specifically but to also broaden the discussion on strategies and approaches to address mental health at public policy level.
On behalf of the Black Health Alliance we thank all our partners and everyone who assisted in the planning and execution of the community stakeholders meeting. We thank CAMH and especially our brothers and sisters who were (and are) participants in the SAPACCY program – everyone’s voice was critical. As a community we share some responsibility and accountability in ensuring that we are central in the development, implementation and evaluation of programs and services that are there to advance our health and well-being.
Dr. Christopher J. Morgan is the director of Morgan Chiropractic & Wellness, an interdisciplinary health centre in Toronto; the founder and former president of the Black Health Alliance, a network of community organizations, health professionals and community members working in partnership to advance the health and well-being of the Black community. He can be reached at 416-447-7600 or email@example.com.