In 2008, the Mental Health Commission of Canada started the At Home/Chez Soi project, a $110 million initiative to provide housing to more than 1,000 Canadians in five cities, including Vancouver. But in March 2013, this federally funded project wrapped up, leaving a myriad of questions regarding how Vancouver Coastal Health and the multiple partners involved in the lives of the 240 Vancouver participants would continue to engage clients in care and insure that clinical gains that were made were sustained and enhanced. With no more funding, VCH was given the responsibility of helping this client cohort, many of whom with co-occurring mental health and substance abuse problems.

“It caused a fair amount of strife. People were panicking, thinking they were going to lose their housing,” says Sheila Scotton, a project manager with VCH Mental Health and Addiction Services. “But we stepped in, with our BC Housing and non-profit partners, and continued to support the housing for these people and connected them to the services they needed.”

Challenges and skepticism

During the project, housing and services were provided by non-profits around the city. When At Home/Chez Soi ended, there was some skepticism around how this client population would transition to VCH services.

“There were some challenges when we transferred over, but we all worked together for the clients,” says Sheila who worked (and continues to work) with the non-profits and the clients and their families.  “There was a big concern with the non-profits that these people would fall between the cracks and end up back on the street again.”

“VCH picked this up and took the lead, doing something new and challenging and helping the clients,” she adds.

“There was some doubt that we wouldn’t be successful,” says Andrew MacFarlane, Director of Mental Health and Addiction Services, Vancouver Community. “Sheila has done an amazing job of bringing the teams together for the clients – the non-profits, the teams and our internal service providers. Client by client, she was involved with the transition, making sure they got what they needed and she continues to make sure they’re getting what they need. Clinical care is only one part of a systemic response that involves multiple stakeholders and Sheila pulled all of these groups, with the client at the centre of the plan”

Adaptive approach

Instead of providing services to people according to a strict list of guidelines, VCH has become more adaptive and creative, trying to accommodate each person’s mental health and addictions care needs on a case-by-case basis, across the community of care, through various points around the system – through Mental Health and Addictions as well as primary care, home health and housing. People who didn’t fit into a specific box were still helped regardless.

“Some of these people may not have conditions deemed by the current system as critical,” Sheila explains. “They may not have schizophrenia or bipolar disorder but they might have other psychiatric issues that historically we haven’t provided care for. This speaks to the practice of matching client need to appropriate service and aligns with VCH service goals. These people still need help and our teams have opened up the doors.”