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Premium member Presentation Transcript Mental Health and AddictionClass -8 : Mental Health and AddictionClass -8 Professor: Dr. Roohullah Shabon Date: March 11 2010 Seneca College, King Campus 1 SESSION OBJECTIVES : Introduction to the concept and approaches of Harm Reduction (HR) - minimization Understanding the Aboriginal Mental Health Introduction to referral site for Mental Health and Addiction SESSION OBJECTIVES 2 Statistics Ontario 2008 : Statistics Ontario 2008 40,000 Injection Drug User –IDU ( 40% of total Canadian number) HIV rate amongst active IDUs: Toronto 5.1%, Ottawa 11% Hepatitis C virus ( HCV) rate amongst active IDUs: Toronto 54 % Ottawa 75% Harm Reduction: History : Harm Reduction: History 1960- social concern about possible public risk linked to alcohol and tobacco 1980- focus was on gay men and their sexual health as well as people injecting substances 1990- On top of needle exchange programmes, safer methods around smoking of crack/cocaine was introduced 2000- Some region implemented Harm Reduction strategies i.e. Toronto’s drug strategy committing $270 millions or Vancouver's four pillar Approach with % of funding ( Prevention (3% ), Treatment ( 14%), Harm Reduction (3%), Enforcement (73%) 2006 – Changing policies of sentencing for drug related crimes, research, crack kit issues, health promotion and education, anonymous HIV testing, Substance use counselling, referrals etc Definition of Harm Reduction : Definition of Harm Reduction Harm Reduction is an umbrella term that sets a framework for the design and delivery of policies, program, and services that work to reduce the health, economic and social harm to individual and community that can cause harmful effects. Harm Reduction focus on any positive changes Goal of Harm Reduction : Goal of Harm Reduction Reduce harms connected to substance use Recognizing the value and dignity of all people Looking at the substance use from a health prospective, not always a criminal justice approach Nonjudgmental, putting our personal biases aside and looking at client’s needs, where they are “at”, not what we may think they need To recognize the need for both substance user and community involvement; we are all impacted i.e. financial cost of incarceration, cost of health care system such as overdoses, visits, ER sites, spread of infection disease, more risk of unsafe sex practice with substance uses Reduce crime rate Understand/ Recognize : Understand/ Recognize Understand that harmful consequences of drug use can be placed on a continuum Understand that goal is to move along this continuum by taking steps to reduce harm Recognize the abstinence is on a continuum of substance using behavior that may not be desirable or achievable for some Recognizes abstinence as an ideal outcome, but accepts other alternatives Recognize that inclusion and input of the clients in design of programs is vital What Harm Reduction Can Do? : What Harm Reduction Can Do? Harm reduction can help move a person from state o crisis/chaos to a state of control over their own life and health Harm reduction can safe lives and improves quality of life by allowing drug user to remain integrated in society Harm Reduction ModelAmsterdam - January 2009 : Harm Reduction ModelAmsterdam - January 2009 Examples: U.K. Model Medicalization Approach Netherlands Normalization Approach Fop Discussion: Social/health approach Pragmatic approach evidence based on public health and human rights Universal Access to all populations at risk Openness, “Normalization” leads to access, control Tolerance vs. Zero-tolerance Public health vs. Criminal justice approach Example of Methods : Example of Methods Safer route of drug administration Alternative, safer substances Reduce frequency of drug use Reduce intensity of drug use Reduce harmful consequences of drug use Harm Reduction Principle and Communication : Harm Reduction Principle and Communication Accept- licit and illicit drug use is part of our world and choose to work to minimize its harmful effect rather then ignore or condemn them. Understand drug use is complex and multifaceted phenomenon that encompasses a continuum of behavior from sever abuse to total abstinence Establish quality of individual and community life and well being – not necessary session of all drug use- as criteria of successful intervention and policies Calls for non judgmental and non coercive provision of services and resource to people who use drug and community where they live in order to assist them in reducing attendant harm Ensure that drug user and those with history of drug use routinely have a real voice in the creation of program and policies designed to sever them Affirms drug user themselves as primary agent of reducing the harms of their drug use and seek to empower user to share information and support each other in strategies which meet their actual condition of use Recognize that the realities of poverty, class, racism, social isolation, past trauma, sex based discrimination, and other social inequalities affect both people vulnerability to and capacity for effective dealing with drug related harm Principle : Principle Seeks to reduce the harms associated with drug and alcohol use to the individual and the community Abstinence is one of a range of strategies and not the only goal Public health approach Offers patients a range of treatment options aimed at minimising harm This is the key to undertaking a quality assessment, understanding the person’s major issues, & managing drug & alcohol-related problems Primary service providers, nurses & midwives often provide the link between the person, other members of the multidisciplinary team, the person’s family, & other service providers Be clear and straightforward about who you are, your role, what your are asking about and why Attend to the person’s immediate concerns before addressing sensitive issues that may be unimportant to the person Build rapport and a sense of trust by listening to what the person wants, why they may be worried, and what they believe will help them Show your concern about the person’s drug & alcohol use problems without prejudice Harm minimisation strategies beneficial : Harm minimisation strategies beneficial Providing clean injecting equipment – disposal units, needles, syringes, swabs Providing access to drug and alcohol withdrawal services & rehabilitation services Introducing legislative measures – restricting tobacco advertising Health promotion campaigns – preventing young people taking up smoking, risks of drink spiking in pubs and clubs, promoting light beer Methadone (opioids), Acamprosate (alcohol) and NRT (nicotine) New@health Improving cross-cultural communication : Improving cross-cultural communication Different cultural groups may misinterpret your requests for information or have different expectation of the service Responding requires flexibility in approach and creativity that services are appropriate for the person and family Complying with rigid guidelines maybe inappropriate This flexibility will foster rapport and a greater willingness for the person to participate and cooperate Always use approved interpreter services Always follow the guidelines for how to use interpreter services Allow sufficient time to interpret the situation from the person’s and their family’s cultural perspective Provide ongoing evaluation of assessment and care Be clear, concrete and specific Respond with respect, immediacy and timeliness Be sensitive to embarrassment Examine your own expectations Co-existing mental health disorders and substance misuse : Co-existing mental health disorders and substance misuse People with a mental illness are at an increased risk of developing problematic drug or alcohol use 30 to 80% of patients in mental health settings have drug use issues More than 50% of people who use substances have experienced psychiatric symptoms The prevalence of people with co-existing mental health and drug use problems may be increasing These co-existing disorders are associated with: increased symptoms and suicide behaviours greater non compliance with treatment more hostile and aggressive behaviours increased risk of violence to others higher rates of offending, imprisonment and homelessness longer psychiatric admissions New@health What kind of the following activities encompass harm reduction? : What kind of the following activities encompass harm reduction? Using seat belt Safety locks on cupboards for kid Suntan lotion Menthol cigarettes instead of regular Methadone Birth Control Condoms Dieting- depend on individual Sharing razors or toothbrush Harm Reduction: : Harm Reduction: Behavior Change: Individual Environment Policy Who needs harm reduction? : Who needs harm reduction? 15.9m IDUs, most in low and middle income Other drug and alcohol users vulnerable 158 countries and territories with IDUs New countries vulnerable Up to 10% of global HIV infections linked with injecting How it helps the Community : How it helps the Community Decreases crime on the streets Increases business for downtown businesses Increases tourism bringing in more money to the city Decreases tax payer money being paid for hospital, jail and detox stays Promoting Recovery : Promoting Recovery DO: Focus on individual strengths rather than illness or addiction Treat individuals with respect Normalize their experience Express optimism and hope Speak directly to people, adult to adult Ask individuals for their opinion Ask what has worked in the past Work from a motivational perspective: what do they want for themselves? What are they willing to do to get it? *University of Kansas, School of Social Welfare Strengths Model National Harm Reduction Response : National Harm Reduction Response 84 countries support or tolerate harm reduction, 71 explicitly in national policy documents 77 countries have needle exchange 74 countries with IDU have nothing! Challenges : Challenges In some places there is violation of Fundamental Rights of Drug User Right to Autonomy, Privacy, Information, Equality and Non-Discrimination, Consensual Treatment Lack of (or) misinformation on substance use In some countries treatment is compulsory (Torture) Reduction interventions are reaching only a small percent of the persons who need them (South Asia less than 2%) Some countries criminalize drug use. Motto is Punishment not Treatment. Death penalty to drug users, Human Rights defenders also detained and arrested Aboriginal Addiction : Aboriginal Addiction Context - Mental Wellness Issues Facing First Nations and Inuit : Context - Mental Wellness Issues Facing First Nations and Inuit Suicide Rates: 3-6 times higher in First Nations communities compared to non-Aboriginal Canadians 11 times higher among Inuit youth Addictions: Higher rates of binge drinking & alcohol-related hospitalization Almost double the number of alcohol-related deaths Violence: Rates of domestic violence are up to 5 times higher than average on First Nations reserves Rates of sexual assault are estimated to be triple the Canadian avera Aboriginal people Requires critical attention : Aboriginal people Requires critical attention First Nations (390) – diabetes, substance abuse, mental health, diet & nutrition. Inuit (227)- mental health, cancer, substance. abuse Métis (386)– diabetes, substance abuse, diet & nutrition, cancer. NAHO Professional Issues Forum: First Nation, Metis & Inuit Peoples’ Health & Community Development : Professional Issues Forum: First Nation, Metis & Inuit Peoples’ Health & Community Development Alison Gerlach, MSc, OT(C) CAOT Conference Whitehorse, June 2008 Where am ‘I Speaking From’? ~Transforming My Occupational Therapy Practice….. : Where am ‘I Speaking From’? ~Transforming My Occupational Therapy Practice….. Post- Colonialism Diversity ~ ‘many different paths’ : Diversity ~ ‘many different paths’ Aboriginal peoples “do not see themselves as a pan-Aboriginal population - they come from diverse Nations, heterogeneous cultures, linguistic groups and geographies where there is no ‘One Perspective’ (Monture-Angus 1999 in NAHO, 2001b). “Models of health care must reflect and be adapted to the realities of different communities. This may involve taking many different paths” (NAHO, 2001a). Slide 33: “Program delivery models which reflect predominately western European concepts of health and illness have been identified as largely ineffective in responding to the needs of First Nation’s people” (Smye & Browne, 2002). “A simple invocation of a return to culture” is not enough” (Adelson, 2005) : “A simple invocation of a return to culture” is not enough” (Adelson, 2005) Traditional Discourse in Health: Cultural Sensitivity/Competency (Adapted from Black, 2005). Colonialism: A Determinant of Health for Aboriginal Peoples…. (NAHO, 2001a) : Colonialism: A Determinant of Health for Aboriginal Peoples…. (NAHO, 2001a) Colonialism Health & Social Justice in Community Development… : Health & Social Justice in Community Development… “A commitment to equity, social justice, participation and empowerment that enables people to identify common concerns and that supports them in taking action related to them” (WHO, 1999). “Common good or communal well-being is a fundamental tenet of Aboriginal world views ..This translates into a requirement that the community participate in decisions concerning the health system” (NAHO, 2001a,b). An ‘enabling occupational’ perspective promotes and guides greater engagement in social change (Townsend & Polatajko, 2007). Occupational Therapy Enablement Skills…. : Occupational Therapy Enablement Skills…. Specific factors/hints for communication with Aboriginal are: DO & Don’ts : Specific factors/hints for communication with Aboriginal are: DO & Don’ts Understanding of cultural values, knowledge and practices of diverse Aboriginal populations Cultural teaching as part of a healing process for effective addictions prevention/intervention Use of positive Aboriginal role models Be polite, respectful, and treat the person as equal to yourself Be very careful about non-verbal signals – use a friendly tone of voice, smile; take some time to show your interest in the patient and their family or other visitors Ensure privacy when talking about substance issues Be aware that separation from family can be very frightening for Aboriginal people Try to accommodate the patient’s wishes for a relative or other trusted person to be with them if they wish for it Don’t assume anything. Do not base your responses to a patient on any assumptions about their illness, their Aboriginality or their behaviour. Don’t use stereotypes. Relying on stereotypes (e.g. ‘Aborigines all have drinking problems’) is not only offensive but dangerous – it can lead to other health problems being ignored or misdiagnosed Don’t be pushy or confrontational when giving health advice Don’t give the impression that you are too busy to talk to the patient properly National Aboriginal Health Organisation : National Aboriginal Health Organisation NAHO is a knowledge-based organization that excels in the advancement and promotion of the health and well-being of all First Nations, Inuit and Métis individuals, families and communities NAHO advances and promotes the health and well-being of all First Nations, Inuit and Métis through collaborative research, Indigenous Traditional Knowledge, building capacity and community led initiatives.. Three Centres of NAHO : Three Centres of NAHO 40 Regional Health Survey Wellness Model : Regional Health Survey Wellness Model NAHO, Understanding Health Indicators, 2007, page 10. 41 Determinants of Inuit Community WellnessAdapted from Inuit Tapiriit Kanatami : Determinants of Inuit Community WellnessAdapted from Inuit Tapiriit Kanatami Mental Health and Addiction Referral Sites : Mental Health and Addiction Referral Sites Canadian Mental Health and Addiction (CMHA) : Canadian Mental Health and Addiction (CMHA) Looking for Mental Health Services? Mental Health Service Information Ontario (MHSIO) can provide you with information about mental health services and supports in your community and across Ontario. Call 1-866-531-2600 Free. Confidential. Anonymous.Available 24 hours. E-mail MHSIO or search the directory of services. NEW! Webchat with an Information and Referral Specialist. Please note that clinical services are not available from CAMH Provincial Services offices. Contact ConnexOntario for information about alcohol and drug, gambling and mental health services in your area. CAMH Main switchboard (416) 535-8501 For a mental health or addiction concern (416) 595-6111 (within Toronto) or 1-800-463-6273 (toll free) Canadian Mental Health Association : Canadian Mental Health Association The Centre for Addiction and Mental Health (CAMH) is the largest mental health and addiction organization in Canada and is fully affiliated with the University of Toronto. The Centre for Addiction and Mental Health is committed to providing comprehensive, well-coordinated, accessible care for people who are struggling with mental health problems or addiction. Web site: http://www.camh.net/Telephone: (416) 535-8501 ext. 6128 or (416) 535-8501 ext. 7064 Addiction Assessment,33 Russell Street or 175 Brentcliffe RoadToronto, Ontario The Mainline The Mainline deals with issues related to harm reduction, injection drug use, and needle exchange programs. For more information, please call theri toll-free number or visit their web site. Telephone: 1 (800) 686-7544Web site: http://www.toronto.ca/health/ai_index.htm Community Health Services : Community Health Services Referrals to all programs including: Individual, family, group and day treatments can be made by calling the office at 416-234-1942 and speaking with their intake worker. Web site: http://www.breakawayyouth.org/Telephone: (416) 234-1942 2 Billingham Road,4th Floor,Toronto, Ontario,M9B 6E1 Black Creek Community Health Centre Web site: http://www.bcchc.com/Telephone: (416) 249-8000 2202 Jane St.Unit 5Toronto, Ontario,M3M 1A4 Planned Parenthood: The House Community Health Centre Website: http://www.ppt.on.ca/community.aspTelephone: (416) 927-7171 The House36B Prince Arthur Avenue,Toronto , Ontario,M5R 1A9 Body Image & Disordered Eating : Body Image & Disordered Eating Sheena's Place provides free programs and support to individuals who may be experiencing disordered eating or body image challenges. Web site: www.sheenasplace.org/Telephone: (416) 927-8900 Alcoholics Anonymous : Alcoholics Anonymous Alcoholics Anonymous is a fellowship of men and women who share their experience, strength, and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or fees for A.A. membership. Web site: http://www.aatoronto.org/Telephone: (416) 487-5591 (between 9:00am – 10:00pm) 234 Eglinton Avenue East, Suite 202Toronto, Ontario,M4P 1K5 Narcotics Anonymous : Narcotics Anonymous Narcotics Anonymous is an international, community-based association of recovering drug addicts with more than 28,000 weekly meetings in 113 countries. There are no dues or fees to access support. Web site: http://www.torontona.org/Telephone: (416) 236-8956 Toronto Area of Narcotics AnonymousP.O. Box # 5700, Depot A,Toronto, Ontario,M5W 1N8 DART (Drug and Alcohol Treatment Infoline) : DART (Drug and Alcohol Treatment Infoline) DART is a free, confidential, anonymous referral service. It is designed to link callers with suitable treatment options tailored to their individual needs. Web site: www.dart.on.caTelephone: 1 (800) 565-8603 24 hours, 7 days a week Centre for Addiction and Mental Health (CAMH) : Centre for Addiction and Mental Health (CAMH) For mental health emergencies or times of crisis, present yourself at the CAMH Emergency Room located at 250 College St. They are open 24 hours a day, 7 days a week. Web site: www.camh.netTelephone: (416) 535-8501 ext. 6885 (24 hours) Toronto Distress Centres : Toronto Distress Centres The mission of the Distress Centres of Toronto is to provide emotional support, crisis intervention and suicide prevention to those who request their services. They provide a confidential telephone service available 24 hours a day to persons in distress. Web site: http://www.torontodistresscentre.com/Telephone: 416-408-HELP (4357)Email: Info@TorontoDistressCentre.com P.O. Box 243,Adelaide P.O.Toronto, Ontario,M5C 2J4 R. Samuel McLaughlin Addiction and Mental Health Information Centre : R. Samuel McLaughlin Addiction and Mental Health Information Centre This information centre provides up to date information on mental health and addiction problems, trends, facts, programs, treatment, and prevention strategies. Call the Automated Response Line 24 hours/ 7 days a week. To obtain help through the support line, call Tuesday – Saturday 3:00pm – 9:00pm. Web site: www.camh.net/McLaughlinTelephone: 416- 595-6111 219 Suite 3B,Dufferin StreetToronto, Ontario The PRIME Clinic : The PRIME Clinic The PRIME Clinic is dedicated to early identification and treatment of people ages 14-30 who are at risk of developing psychosis. They help people who become distressed by changes in their thoughts, perceptions, and feelings; changes that may be difficult to describe to others. Web site: http://www.camh.net/prime_clinicTelephone: 416-260-4188 250 College Street,Toronto, OntarioM5T 1R8 Smoking Cessation : Smoking Cessation The Canadian Cancer Society – Smoker's Helpline The Canadian Cancer Society offers this valuable online tool to help you whether you have already quit smoking or are thinking about quitting smoking. Feel free to call the toll free number to get access and support. You do not have to purchase any products to use this free program. Website: http://ccs.stopsmokingcentre.net/Telephone: 1 (877) 513-5333 Review and takeaway : True or False Review and takeaway 56 Questions???????? : Questions???????? Comments!!!!!!!!! NOTHING ABOUT US WITHOUT US!! You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Class 8 Harm Reduction final Roohullah Shabon March 18 2010 aSGuest53899 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 105 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: July 10, 2010 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript Mental Health and AddictionClass -8 : Mental Health and AddictionClass -8 Professor: Dr. Roohullah Shabon Date: March 11 2010 Seneca College, King Campus 1 SESSION OBJECTIVES : Introduction to the concept and approaches of Harm Reduction (HR) - minimization Understanding the Aboriginal Mental Health Introduction to referral site for Mental Health and Addiction SESSION OBJECTIVES 2 Statistics Ontario 2008 : Statistics Ontario 2008 40,000 Injection Drug User –IDU ( 40% of total Canadian number) HIV rate amongst active IDUs: Toronto 5.1%, Ottawa 11% Hepatitis C virus ( HCV) rate amongst active IDUs: Toronto 54 % Ottawa 75% Harm Reduction: History : Harm Reduction: History 1960- social concern about possible public risk linked to alcohol and tobacco 1980- focus was on gay men and their sexual health as well as people injecting substances 1990- On top of needle exchange programmes, safer methods around smoking of crack/cocaine was introduced 2000- Some region implemented Harm Reduction strategies i.e. Toronto’s drug strategy committing $270 millions or Vancouver's four pillar Approach with % of funding ( Prevention (3% ), Treatment ( 14%), Harm Reduction (3%), Enforcement (73%) 2006 – Changing policies of sentencing for drug related crimes, research, crack kit issues, health promotion and education, anonymous HIV testing, Substance use counselling, referrals etc Definition of Harm Reduction : Definition of Harm Reduction Harm Reduction is an umbrella term that sets a framework for the design and delivery of policies, program, and services that work to reduce the health, economic and social harm to individual and community that can cause harmful effects. Harm Reduction focus on any positive changes Goal of Harm Reduction : Goal of Harm Reduction Reduce harms connected to substance use Recognizing the value and dignity of all people Looking at the substance use from a health prospective, not always a criminal justice approach Nonjudgmental, putting our personal biases aside and looking at client’s needs, where they are “at”, not what we may think they need To recognize the need for both substance user and community involvement; we are all impacted i.e. financial cost of incarceration, cost of health care system such as overdoses, visits, ER sites, spread of infection disease, more risk of unsafe sex practice with substance uses Reduce crime rate Understand/ Recognize : Understand/ Recognize Understand that harmful consequences of drug use can be placed on a continuum Understand that goal is to move along this continuum by taking steps to reduce harm Recognize the abstinence is on a continuum of substance using behavior that may not be desirable or achievable for some Recognizes abstinence as an ideal outcome, but accepts other alternatives Recognize that inclusion and input of the clients in design of programs is vital What Harm Reduction Can Do? : What Harm Reduction Can Do? Harm reduction can help move a person from state o crisis/chaos to a state of control over their own life and health Harm reduction can safe lives and improves quality of life by allowing drug user to remain integrated in society Harm Reduction ModelAmsterdam - January 2009 : Harm Reduction ModelAmsterdam - January 2009 Examples: U.K. Model Medicalization Approach Netherlands Normalization Approach Fop Discussion: Social/health approach Pragmatic approach evidence based on public health and human rights Universal Access to all populations at risk Openness, “Normalization” leads to access, control Tolerance vs. Zero-tolerance Public health vs. Criminal justice approach Example of Methods : Example of Methods Safer route of drug administration Alternative, safer substances Reduce frequency of drug use Reduce intensity of drug use Reduce harmful consequences of drug use Harm Reduction Principle and Communication : Harm Reduction Principle and Communication Accept- licit and illicit drug use is part of our world and choose to work to minimize its harmful effect rather then ignore or condemn them. Understand drug use is complex and multifaceted phenomenon that encompasses a continuum of behavior from sever abuse to total abstinence Establish quality of individual and community life and well being – not necessary session of all drug use- as criteria of successful intervention and policies Calls for non judgmental and non coercive provision of services and resource to people who use drug and community where they live in order to assist them in reducing attendant harm Ensure that drug user and those with history of drug use routinely have a real voice in the creation of program and policies designed to sever them Affirms drug user themselves as primary agent of reducing the harms of their drug use and seek to empower user to share information and support each other in strategies which meet their actual condition of use Recognize that the realities of poverty, class, racism, social isolation, past trauma, sex based discrimination, and other social inequalities affect both people vulnerability to and capacity for effective dealing with drug related harm Principle : Principle Seeks to reduce the harms associated with drug and alcohol use to the individual and the community Abstinence is one of a range of strategies and not the only goal Public health approach Offers patients a range of treatment options aimed at minimising harm This is the key to undertaking a quality assessment, understanding the person’s major issues, & managing drug & alcohol-related problems Primary service providers, nurses & midwives often provide the link between the person, other members of the multidisciplinary team, the person’s family, & other service providers Be clear and straightforward about who you are, your role, what your are asking about and why Attend to the person’s immediate concerns before addressing sensitive issues that may be unimportant to the person Build rapport and a sense of trust by listening to what the person wants, why they may be worried, and what they believe will help them Show your concern about the person’s drug & alcohol use problems without prejudice Harm minimisation strategies beneficial : Harm minimisation strategies beneficial Providing clean injecting equipment – disposal units, needles, syringes, swabs Providing access to drug and alcohol withdrawal services & rehabilitation services Introducing legislative measures – restricting tobacco advertising Health promotion campaigns – preventing young people taking up smoking, risks of drink spiking in pubs and clubs, promoting light beer Methadone (opioids), Acamprosate (alcohol) and NRT (nicotine) New@health Improving cross-cultural communication : Improving cross-cultural communication Different cultural groups may misinterpret your requests for information or have different expectation of the service Responding requires flexibility in approach and creativity that services are appropriate for the person and family Complying with rigid guidelines maybe inappropriate This flexibility will foster rapport and a greater willingness for the person to participate and cooperate Always use approved interpreter services Always follow the guidelines for how to use interpreter services Allow sufficient time to interpret the situation from the person’s and their family’s cultural perspective Provide ongoing evaluation of assessment and care Be clear, concrete and specific Respond with respect, immediacy and timeliness Be sensitive to embarrassment Examine your own expectations Co-existing mental health disorders and substance misuse : Co-existing mental health disorders and substance misuse People with a mental illness are at an increased risk of developing problematic drug or alcohol use 30 to 80% of patients in mental health settings have drug use issues More than 50% of people who use substances have experienced psychiatric symptoms The prevalence of people with co-existing mental health and drug use problems may be increasing These co-existing disorders are associated with: increased symptoms and suicide behaviours greater non compliance with treatment more hostile and aggressive behaviours increased risk of violence to others higher rates of offending, imprisonment and homelessness longer psychiatric admissions New@health What kind of the following activities encompass harm reduction? : What kind of the following activities encompass harm reduction? Using seat belt Safety locks on cupboards for kid Suntan lotion Menthol cigarettes instead of regular Methadone Birth Control Condoms Dieting- depend on individual Sharing razors or toothbrush Harm Reduction: : Harm Reduction: Behavior Change: Individual Environment Policy Who needs harm reduction? : Who needs harm reduction? 15.9m IDUs, most in low and middle income Other drug and alcohol users vulnerable 158 countries and territories with IDUs New countries vulnerable Up to 10% of global HIV infections linked with injecting How it helps the Community : How it helps the Community Decreases crime on the streets Increases business for downtown businesses Increases tourism bringing in more money to the city Decreases tax payer money being paid for hospital, jail and detox stays Promoting Recovery : Promoting Recovery DO: Focus on individual strengths rather than illness or addiction Treat individuals with respect Normalize their experience Express optimism and hope Speak directly to people, adult to adult Ask individuals for their opinion Ask what has worked in the past Work from a motivational perspective: what do they want for themselves? What are they willing to do to get it? *University of Kansas, School of Social Welfare Strengths Model National Harm Reduction Response : National Harm Reduction Response 84 countries support or tolerate harm reduction, 71 explicitly in national policy documents 77 countries have needle exchange 74 countries with IDU have nothing! Challenges : Challenges In some places there is violation of Fundamental Rights of Drug User Right to Autonomy, Privacy, Information, Equality and Non-Discrimination, Consensual Treatment Lack of (or) misinformation on substance use In some countries treatment is compulsory (Torture) Reduction interventions are reaching only a small percent of the persons who need them (South Asia less than 2%) Some countries criminalize drug use. Motto is Punishment not Treatment. Death penalty to drug users, Human Rights defenders also detained and arrested Aboriginal Addiction : Aboriginal Addiction Context - Mental Wellness Issues Facing First Nations and Inuit : Context - Mental Wellness Issues Facing First Nations and Inuit Suicide Rates: 3-6 times higher in First Nations communities compared to non-Aboriginal Canadians 11 times higher among Inuit youth Addictions: Higher rates of binge drinking & alcohol-related hospitalization Almost double the number of alcohol-related deaths Violence: Rates of domestic violence are up to 5 times higher than average on First Nations reserves Rates of sexual assault are estimated to be triple the Canadian avera Aboriginal people Requires critical attention : Aboriginal people Requires critical attention First Nations (390) – diabetes, substance abuse, mental health, diet & nutrition. Inuit (227)- mental health, cancer, substance. abuse Métis (386)– diabetes, substance abuse, diet & nutrition, cancer. NAHO Professional Issues Forum: First Nation, Metis & Inuit Peoples’ Health & Community Development : Professional Issues Forum: First Nation, Metis & Inuit Peoples’ Health & Community Development Alison Gerlach, MSc, OT(C) CAOT Conference Whitehorse, June 2008 Where am ‘I Speaking From’? ~Transforming My Occupational Therapy Practice….. : Where am ‘I Speaking From’? ~Transforming My Occupational Therapy Practice….. Post- Colonialism Diversity ~ ‘many different paths’ : Diversity ~ ‘many different paths’ Aboriginal peoples “do not see themselves as a pan-Aboriginal population - they come from diverse Nations, heterogeneous cultures, linguistic groups and geographies where there is no ‘One Perspective’ (Monture-Angus 1999 in NAHO, 2001b). “Models of health care must reflect and be adapted to the realities of different communities. This may involve taking many different paths” (NAHO, 2001a). Slide 33: “Program delivery models which reflect predominately western European concepts of health and illness have been identified as largely ineffective in responding to the needs of First Nation’s people” (Smye & Browne, 2002). “A simple invocation of a return to culture” is not enough” (Adelson, 2005) : “A simple invocation of a return to culture” is not enough” (Adelson, 2005) Traditional Discourse in Health: Cultural Sensitivity/Competency (Adapted from Black, 2005). Colonialism: A Determinant of Health for Aboriginal Peoples…. (NAHO, 2001a) : Colonialism: A Determinant of Health for Aboriginal Peoples…. (NAHO, 2001a) Colonialism Health & Social Justice in Community Development… : Health & Social Justice in Community Development… “A commitment to equity, social justice, participation and empowerment that enables people to identify common concerns and that supports them in taking action related to them” (WHO, 1999). “Common good or communal well-being is a fundamental tenet of Aboriginal world views ..This translates into a requirement that the community participate in decisions concerning the health system” (NAHO, 2001a,b). An ‘enabling occupational’ perspective promotes and guides greater engagement in social change (Townsend & Polatajko, 2007). Occupational Therapy Enablement Skills…. : Occupational Therapy Enablement Skills…. Specific factors/hints for communication with Aboriginal are: DO & Don’ts : Specific factors/hints for communication with Aboriginal are: DO & Don’ts Understanding of cultural values, knowledge and practices of diverse Aboriginal populations Cultural teaching as part of a healing process for effective addictions prevention/intervention Use of positive Aboriginal role models Be polite, respectful, and treat the person as equal to yourself Be very careful about non-verbal signals – use a friendly tone of voice, smile; take some time to show your interest in the patient and their family or other visitors Ensure privacy when talking about substance issues Be aware that separation from family can be very frightening for Aboriginal people Try to accommodate the patient’s wishes for a relative or other trusted person to be with them if they wish for it Don’t assume anything. Do not base your responses to a patient on any assumptions about their illness, their Aboriginality or their behaviour. Don’t use stereotypes. Relying on stereotypes (e.g. ‘Aborigines all have drinking problems’) is not only offensive but dangerous – it can lead to other health problems being ignored or misdiagnosed Don’t be pushy or confrontational when giving health advice Don’t give the impression that you are too busy to talk to the patient properly National Aboriginal Health Organisation : National Aboriginal Health Organisation NAHO is a knowledge-based organization that excels in the advancement and promotion of the health and well-being of all First Nations, Inuit and Métis individuals, families and communities NAHO advances and promotes the health and well-being of all First Nations, Inuit and Métis through collaborative research, Indigenous Traditional Knowledge, building capacity and community led initiatives.. Three Centres of NAHO : Three Centres of NAHO 40 Regional Health Survey Wellness Model : Regional Health Survey Wellness Model NAHO, Understanding Health Indicators, 2007, page 10. 41 Determinants of Inuit Community WellnessAdapted from Inuit Tapiriit Kanatami : Determinants of Inuit Community WellnessAdapted from Inuit Tapiriit Kanatami Mental Health and Addiction Referral Sites : Mental Health and Addiction Referral Sites Canadian Mental Health and Addiction (CMHA) : Canadian Mental Health and Addiction (CMHA) Looking for Mental Health Services? Mental Health Service Information Ontario (MHSIO) can provide you with information about mental health services and supports in your community and across Ontario. Call 1-866-531-2600 Free. Confidential. Anonymous.Available 24 hours. E-mail MHSIO or search the directory of services. NEW! Webchat with an Information and Referral Specialist. Please note that clinical services are not available from CAMH Provincial Services offices. Contact ConnexOntario for information about alcohol and drug, gambling and mental health services in your area. CAMH Main switchboard (416) 535-8501 For a mental health or addiction concern (416) 595-6111 (within Toronto) or 1-800-463-6273 (toll free) Canadian Mental Health Association : Canadian Mental Health Association The Centre for Addiction and Mental Health (CAMH) is the largest mental health and addiction organization in Canada and is fully affiliated with the University of Toronto. The Centre for Addiction and Mental Health is committed to providing comprehensive, well-coordinated, accessible care for people who are struggling with mental health problems or addiction. Web site: http://www.camh.net/Telephone: (416) 535-8501 ext. 6128 or (416) 535-8501 ext. 7064 Addiction Assessment,33 Russell Street or 175 Brentcliffe RoadToronto, Ontario The Mainline The Mainline deals with issues related to harm reduction, injection drug use, and needle exchange programs. For more information, please call theri toll-free number or visit their web site. Telephone: 1 (800) 686-7544Web site: http://www.toronto.ca/health/ai_index.htm Community Health Services : Community Health Services Referrals to all programs including: Individual, family, group and day treatments can be made by calling the office at 416-234-1942 and speaking with their intake worker. Web site: http://www.breakawayyouth.org/Telephone: (416) 234-1942 2 Billingham Road,4th Floor,Toronto, Ontario,M9B 6E1 Black Creek Community Health Centre Web site: http://www.bcchc.com/Telephone: (416) 249-8000 2202 Jane St.Unit 5Toronto, Ontario,M3M 1A4 Planned Parenthood: The House Community Health Centre Website: http://www.ppt.on.ca/community.aspTelephone: (416) 927-7171 The House36B Prince Arthur Avenue,Toronto , Ontario,M5R 1A9 Body Image & Disordered Eating : Body Image & Disordered Eating Sheena's Place provides free programs and support to individuals who may be experiencing disordered eating or body image challenges. Web site: www.sheenasplace.org/Telephone: (416) 927-8900 Alcoholics Anonymous : Alcoholics Anonymous Alcoholics Anonymous is a fellowship of men and women who share their experience, strength, and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or fees for A.A. membership. Web site: http://www.aatoronto.org/Telephone: (416) 487-5591 (between 9:00am – 10:00pm) 234 Eglinton Avenue East, Suite 202Toronto, Ontario,M4P 1K5 Narcotics Anonymous : Narcotics Anonymous Narcotics Anonymous is an international, community-based association of recovering drug addicts with more than 28,000 weekly meetings in 113 countries. There are no dues or fees to access support. Web site: http://www.torontona.org/Telephone: (416) 236-8956 Toronto Area of Narcotics AnonymousP.O. Box # 5700, Depot A,Toronto, Ontario,M5W 1N8 DART (Drug and Alcohol Treatment Infoline) : DART (Drug and Alcohol Treatment Infoline) DART is a free, confidential, anonymous referral service. It is designed to link callers with suitable treatment options tailored to their individual needs. Web site: www.dart.on.caTelephone: 1 (800) 565-8603 24 hours, 7 days a week Centre for Addiction and Mental Health (CAMH) : Centre for Addiction and Mental Health (CAMH) For mental health emergencies or times of crisis, present yourself at the CAMH Emergency Room located at 250 College St. They are open 24 hours a day, 7 days a week. Web site: www.camh.netTelephone: (416) 535-8501 ext. 6885 (24 hours) Toronto Distress Centres : Toronto Distress Centres The mission of the Distress Centres of Toronto is to provide emotional support, crisis intervention and suicide prevention to those who request their services. They provide a confidential telephone service available 24 hours a day to persons in distress. Web site: http://www.torontodistresscentre.com/Telephone: 416-408-HELP (4357)Email: Info@TorontoDistressCentre.com P.O. Box 243,Adelaide P.O.Toronto, Ontario,M5C 2J4 R. Samuel McLaughlin Addiction and Mental Health Information Centre : R. Samuel McLaughlin Addiction and Mental Health Information Centre This information centre provides up to date information on mental health and addiction problems, trends, facts, programs, treatment, and prevention strategies. Call the Automated Response Line 24 hours/ 7 days a week. To obtain help through the support line, call Tuesday – Saturday 3:00pm – 9:00pm. Web site: www.camh.net/McLaughlinTelephone: 416- 595-6111 219 Suite 3B,Dufferin StreetToronto, Ontario The PRIME Clinic : The PRIME Clinic The PRIME Clinic is dedicated to early identification and treatment of people ages 14-30 who are at risk of developing psychosis. They help people who become distressed by changes in their thoughts, perceptions, and feelings; changes that may be difficult to describe to others. Web site: http://www.camh.net/prime_clinicTelephone: 416-260-4188 250 College Street,Toronto, OntarioM5T 1R8 Smoking Cessation : Smoking Cessation The Canadian Cancer Society – Smoker's Helpline The Canadian Cancer Society offers this valuable online tool to help you whether you have already quit smoking or are thinking about quitting smoking. Feel free to call the toll free number to get access and support. You do not have to purchase any products to use this free program. Website: http://ccs.stopsmokingcentre.net/Telephone: 1 (877) 513-5333 Review and takeaway : True or False Review and takeaway 56 Questions???????? : Questions???????? Comments!!!!!!!!! NOTHING ABOUT US WITHOUT US!!