This article presents the results of a needs assessment of family physicians and residents concerning the provision of mental health care and an implementation evaluation of a multidisciplinary mental health service demonstration project, linking 2 family practices with mental health services of a general hospital. Family physicians and residents reported that collaborative mental health care provision would enhance but not replace their management of patients with mental health problems. The implementation evaluation found that collaborative care provided by a multidisciplinary mental health team co-located with family physicians was accepted by patients and valued by family physicians. Because of a shortage of family physicians, few patients from the mental health system who lacked family physicians were able to gain access to primary care through this project.

This article describes recent work to support recommendations for improving Ontario's system of housing for people with serious mental illness. This multifaceted project engaged stakeholders in discussions concerning strategies for improving the system based on (a) values that underlie housing programs, (b) evidence of effective housing practices, (c) the current status of the system, and (d) international practices for monitoring community mental health systems. Stakeholders reviewed summaries of the work and discussed implications for improving the provincial system of housing and supports. Recommendations are made for improving the system, focusing on both regional and provincial level actions. Housing is an essential component of an effective community mental health system for people with serious mental illness. Without accessible, good quality housing and support, successful community living and recovery are not possible. Ontario has provided housing dedicated to people with serious mental illness since the onset of deinstitutionalization. Since the 1960s, the system has grown substantially to encompass a variety of forms of housing and to become a cornerstone of the community mental health system. Despite its growth and importance, this housing system faces a number of significant challenges. It remains inadequate for meeting consumer demand, with very long waiting lists reported by most programs in the province. There is a lack of good data on the system, documenting who is being served and how they are being served, as well as on the needs of those who cannot access the system. This lack of information makes it difficult to effectively manage the system and to plan for its future.In 2003, the Ontario Ministry of Health and Long-Term Care funded a research project to examine the province's dedicated housing system and to make recommendations for improving it. This paper describes the multifaceted project that was conducted to develop a foundation for planning system improvements. The project developed three foundations for system planning: (a) a vision for the system by identifying values that should guide the delivery of services, (b) research evidence about the status of the system and effective practices, and (c) consultations with stakeholders from across the province about directions for system improvement.

Housing First (HF) effectively houses the majority of homeless individuals suffering from mental illness; however, a small subset continues to struggle with unstable housing. This paper describes a supportive housing pilot program developed at the Moncton site of the At Home / Chez Soi demonstration project for HF participants who have experienced difficulty achieving housing stability while receiving HF services. Specifically, Peer Supportive Housing (PSH) was created for participants demonstrating ongoing unstable housing in the HF program. Results from structured interviews with five program staff and nine tenants of PSH describe the successes, challenges, and perceived outcomes of the early implementation of the program. PSH can supplement HF, and may help to meet the needs of some tenants who are unable to achieve stable housing after a trial of receiving HF services.

This paper describes the implementation of Housing First in a small Canadian city. Given that the majority of Housing First research has been conducted in large American cities, providing a Canadian context in a small city contributes significant insights for similarly sized areas. The main objectives were to determine the adaptations made to the Housing First model and the contextual realities that affected implementation. Data were collected from two sources: (a) a fidelity assessment by an external team of experts; and (b) key informant interviews and focus groups with program staff and consumers. Results demonstrate that Housing First can be successfully implemented in a small city but with certain constraints and adaptations, notably more limited consumer choice of housing, challenges related to consumer access to transportation, and adaptations to program staffing. Implications for practice are discussed.

AbSTrACTthe at Home / chez soi project, funded by Health canada through the mental Health commission of canada, involves evaluating the implementation and effectiveness of the Housing First (HF) approach, a complex community-based intervention that addresses homelessness in people with severe and persistent mental illness. this paper examines the perspectives of community partners on the implementation of HF in moncton, new Brunswick. engagement varied, but overall, HF was seen as fitting well within the network of existing community resources and filling a long-standing gap in services. community will for sustaining HF was present, though concerns were expressed about sources for ongoing funding.