African Canadian Coalition Concerned about Inadequate Mental Health and Addiction Services

By Neil Armstrong

Nene Kwasi Kafele, who is also a member of the African Canadian Mental Health Coalition, speaking at the opening of A Different Booklist Cultural Centre on April 7.

A coalition of concerned members of the African Canadian community is calling on the Centre of Addiction and Mental Health (CAMH) to “stabilize, expand and fully resource” the Substance Abuse Program for African Canadian and Caribbean Youth (SAPACCY) inside the institution.

It also wants CAMH to build a strong strategy and plan to address mental health and addiction issues facing members of the African Canadian community, to build  respectful and transparent partnerships with the community, and to establish a representative African Canadian consultative body to assist in guiding this work and to bring credibility to the process.

On April 27, the coalition held a town hall meeting at Scarborough Civic Centre Council Chambers in Toronto to discuss its concerns.

“CAMH’s mission is to serve the most marginalized and stigmatized people in our community and our society. It’s in our DNA. If any members of our community are not receiving the mental health treatment they need, it’s part of our organization’s duty to address it,” says CAMH in response to the matters raised by the coalition.

The coalition is concerned about the diminution of SAPACCY, Canada’s only public funded ethno-specific mental health and addictions program for African-Canadian Youth.

Among its concerns are: the “over-representation of African-Canadian clients in clinical programs at CAMH, the lack of leadership and appropriate response to address anti-Black racism at CAMH, serious gaps regarding CAMH’s clinical environment, and poor treatment of African-Canadian clients in CAMH’s clinical care.”

The coalition also pointed to the “lack of African-Canadian representation on the board of trustees and senior leadership at CAMH, and deaths and over-restraint of African-Canadian men in the care of CAMH.”

CAMH says it is keenly aware of the way that the social determinants of health impact different groups in the society.

“There is no question that the health needs of the African and Caribbean origin population across the province are not being met. In Toronto, these communities have been particularly underserved when it comes to mental health care and supportive services. Systemic and institutionalized anti-black racism is a very important component of the prejudice and discrimination experienced by these communities.”

CAMH says it is dedicated to advancing health equity at CAMH – “recognizing the fact that anti-black racism has led to a disproportionate burden of discrimination toward our African and Caribbean origin communities.”

“To do this, CAMH is working to bolster our understanding of the clients we serve. We can’t fully address the issues of unequal access to health care on our own, but we’re firmly committed to working in partnership with the African and Caribbean origin communities and health service providers, among others, on sustainable solutions. Some aspects of the solutions will be delivered through CAMH, many others will require system enhancements and support from all levels of government.”

CAMH says since June of 2016, a number of its leaders and board of trustees have been meeting with representatives of organizations from the African and Caribbean communities and have been corresponding with them on an ongoing basis about the SAPACCY program.

The coalition says SAPACCY has gone from a 6-person staff team with strong internal leadership and championing, prevention and community engagement programs, collaborative partnerships and utilising an Africentric, anti-racist framework, to a one-person team with no formal presence or partnership in the community

However, CAMH says the staffing and resources at the SAPACCY program are not being reduced, but instead they have actually increased the number of clients seen in it.

CAMH says SAPACCY arrived in CAMH in 1999 and has had stable funding and staffing for many years.

In 2015, CAMH made changes to its Child, Youth and Emerging Adult Program “to better link SAPACCY with the other CAMH youth addictions and mental health services, providing youth with more options for care and support. The result has been a two-fold increase in the number of youth served by SAPPACY. In addition, CAMH serves this population through our Urgent Care Service, Emergency Department, and our partnerships with walk in youth clinics in the community.”

Regarding enhancing diversity at the board and senior leadership level, CAMH said this is an important area of focus for it.

“The Board of Trustees has a formal process for identifying new members, and diversity is a priority for recruitment. In the past we have engaged organizations like DiverseCity to support the search and we are working hard to enhance our process.”

It said with regard to claims of over-representation in its inpatient community or specific outcomes, “the state of socio-demographic data in hospitals is still emerging, and the current state of reliable data is weak.”

“CAMH is working to shift this situation. We do not have demographic data that supports claims of poorer treatment outcomes for black patients at CAMH, but we take seriously the concerns of the community and we are always trying to improve. Health equity research studies have indicated that black and other racialized groups tend to access services at a later stage, when symptoms may be more acute, and there is a need for better access to community-based services.”

The institution said together with community members it worked on a funding proposal that could have allowed then to acquire additional SAPACCY staff who would work at two community based health clinics in underserved areas of the city.

“This would have augmented the existing SAPACCY services at CAMH. While the proposal was supported by some community partners, others had a different vision with a desire to expand SAPACCY within CAMH.

“We are disappointed that we weren’t able to reach an agreement on a common path forward, but we remain dedicated to advancing health equity at CAMH for all those we serve. At the same time, we recognize the fact that anti-black racism has led to a disproportionate burden of discrimination toward our African and Caribbean origin communities and are committed to an enhanced focus in this area,” it said.

However, the coalition says this is not accurate and that its advocacy triggered a number of suggestions.

“CAMH’s director of health equity decided on his own to develop a proposal that would essentially “off-load” SAPACCY to the community in a very troubling manner. He developed a draft proposal document that ignored input and concerns from the coalition, arbitrarily selected two agencies with no transparent process, had no process for determining critical priority service needs to be addressed and sought to submit this as representative of our needs. Contrary to information provided, the funders indicated that no commitment to anything had been made so there was actually no agreement to fund.”

The coalition said what was more troubling was that at that time CAMH “made it very clear that there would be no expansion of SAPACCY inside the hospital and no changes to their approach, despite the fact that more and more African Canadian youth clients in the community needed psychiatric, clinical and case management supports and despite the concerns about racism and program neglect concerning SAPACCY at CAMH.”

“CAMH agreed then seemed to refuse our request to bring together a group of community members (clinicians, advocates, researchers, planners, funders, policy folks, etc) to build a fully considered, comprehensive mental health and addictions strategy and plan for the African Canadian. The coalition has been told that this is “not a simple thing” because system and policy issues need to be considered,” the coalition said.

It believes that all of this is “a stalling tactic (in the hopes that our advocacy will subside) and that the hospital has no real interest in meaningfully addressing this issue; that they will provide a piecemeal, superficial and innocuous carrot (under the amorphous guise of “Health Equity”) to the community, given their recent track record, clear discomfort and aversion to directly and clearly addressing Anti-Black racism. Although this exposure of CAMH requires in our view, bold and assertive leadership, transparency and full engagement, the strategy of containment, avoidance and corporate-speak seems to prevail.”

The coalition said CAMH refuses to clearly address calls for information about deaths of African Canadian men in their forensic care and over-representation of African Canadians in their clinical programs.

It also asserts that CAMH has no strong, credible or progressive internal leadership on this issue.

[An abbreviated version of this story was published in the North American Weekly Gleaner.]