Inukjuak (Québec) Nunavik J0M 1M0
Telephone : (819) 254-8738
Fax : (819) 254-8913

DESCRIPTION OF AN INTEGRATED MENTAL HEALTH RESOURCE INTRODUCTION

INTRODUCTION

The Reintegration Centre is a community-based, regional resource, serving the mental health needs of the Nunavik population. It is the only resource of its kind in Nunavik. Situated in Inukjuak, it offers services to both men and women aged 18 years or older.

The Centre provides residential care (24-hours-a-day) and external services to people who have been diagnosed with severe, chronic mental health problems and/or intellectual handicaps. We work with the clients and their families to help identify, understand, and resolve their problems. Services provided at the Centre include vocational training, behavioural management, and training in the activities of daily living. Enhancing clients’ knowledge and practice of traditional skills is a priority.

POPULATION SERVED

We provide services to adults who have been diagnosed as suffering from severe and persistent mental health problems and/or intellectual impairment.

Some examples of mental health problems addressed are:

• mood disorder;
• anxiety disorder;
• bipolar disorder;
• schizophrenia and other psychotic disorders;
• dual diagnoses (coexisting conditions such as mental illness and substance abuse);
• etc.

MISSION STATEMENT

The mission of the Reintegration Centre is to provide quality services that allow adults with severe and persistent mental health problems and/or intellectual impairment to develop the skills necessary to integrate successfully in their communities. We believe that each person has the potential to improve and we make every effort to enhance the quality of life of the individual, the family, and the community.

In providing services to this client group every effort is made to:

• deliver services in a manner that is appropriate to the Inuit culture;
• increase the awareness, the understanding, and the sensitivity of the population at large towards the mentally challenged;
• encourage the public to include and welcome people who are mentally challenged into the life of the community.

ADMISSIONS CRITERIA

The Reintegration Centre was designed to work with mentally challenged individuals who are experiencing difficulties. At times, some clients and their families need temporary separation from one another in order to work effectively on their problems. We work with the client and his/her family toward improving the client’s mental functioning and re-establishing harmonious relationships within the family. Another equally important goal is to improve the client’s level of functioning in the community.

The clients we serve have a variety of needs and are referred to the Centre for a variety of reasons. Some of the reasons that clients may be admitted to the programme may include:

• persistent psychotic relapses/de-compensation;
• regression in cognitive ability;
• non-compliance with the medication regimen;
• difficulty accomplishing the activities of daily living;
• risky behaviours that jeopardise the individual’s safety;
• behaviours that act as barriers to the individual’s successful inclusion in community social life;
• decreased interest in becoming involved in community social life.

All admissions are governed by the Act Respecting Health and Social services and Mental Health Act. We do not force or coerce resistant clients to join or to follow our programme. Entry into the programme is voluntary.

Potential residents must be able to demonstrate following:

• a need, desire, and willingness to join/follow the programme;
• a reasonably stable behaviour pattern (i.e., acting out and aggressive behaviours must be at a level that is not detrimental to the individual, to others, or to the programme);
• an ability to live in a group setting;
• an ability to perform a minimum level of daily self-care (i.e. be able to wash, dress, and feed himself/herself.

Admission is based on the clinical team’s evaluation of referrals.

INTAKE

Requests for services are made by Social Services in the client’s community.

The following information must be provided:

• the history of client’s presenting problems;
• psychological/psychiatric assessments;
• treatment information (in particular, what medication has been prescribed);
• Individual Service Plan.

During the intake process, different people are met or contacted:

• a representative of the referring agency (i.e., community worker, social worker, psychologist);
• nurses and doctors (including the treating psychiatrist, when possible);
• the client;
• members of the client’s family;
• etc.

The purpose of these contacts is twofold:

• to clarify any questions regarding the referral (e.g., the nature of the client’s presenting problems, why the placement was considered to be therapeutic and/or necessary);
• to establish clear expectations of each participant in the intake process.

Once a client is accepted into the programme, the Reintegration Centre staff co-ordinates a multidisciplinary team meeting in which the client and the family participate. The purpose of the meeting is to develop an Intervention Plan for the client. This plan is re-evaluated weekly throughout the course of the client’s participation in the programme.

FAMILY INTERVENTION

After the client is admitted, the Reintegration Centre staff stays in touch with the family. The staff keeps the family apprised of the client’s progress and encourages the maximum involvement of family members in any decision concerning their loved one.

The goal of family work is to help the family understand the mental health problems of their relative and to assist family members in learning new ways to interact with this person in order to prevent crises, to enhance functioning, and to restore harmony. Staff members will also be available to support family members.

Family visits to the Centre are welcomed at any time. Advance notice by phone is appreciated so that the visits can be synchronised with the activities of the Centre.

After any family meeting held at the Centre, members are invited to stay for meals. Families are encouraged to spend time at the Centre so that they can become familiar with the programme. At the same time, they will have the opportunity to observe, and learn from, the methods employed by educators when working with their loved ones.

TREATMENT PHILOSOPHY

The Reintegration Centre is committed to a bio-psycho-social model of intervention that takes into account all aspects of the client’s life (e.g., the individual’s physical, emotional, cultural and spiritual life, the family and the community, the environment, etc.). The Reintegration Centre recognises that each client’s mental and emotional challenges are unique and thus services must be tailored to meet each client’s specific needs.

Our treatment objectives are geared towards assisting and supporting mentally challenged individuals with the following:

• basic life skills (to help clients develop or improve personal autonomy in areas of money management, meal preparation, housekeeping, personal hygiene, etc.);
• personal development (to help clients enhance their awareness of their strengths and weaknesses, develop satisfactory and supportive interpersonal relationship, learn how to communicate with others, bolster self-esteem, etc.);
• occupational skills (traditional activities such as hunting, fishing, carving, and sewing; job training, etc.);
• psychological stability (to support clients and to help them develop the skills and equilibrium essential to prevent de-compensation and/or hospitalisation);
• reintegration in the community (to encourage increased participation in community activities, recreational activities, and social interaction).

INTERVENTION OPTIONS

The innovative programmes offered at this Centre are designed to assist users to remain in the community and maintain family and social ties while they receive appropriate psychosocial/psychotherapeutic treatment services.

The Reintegration Centre offers both residential services and external services. Following is a description of programmes we offer:

1. RESIDENTIAL SERVICES

Short term and long-term placement: Short (3-6 months) and long term residential (1-2 years) services are available for individuals who are having difficulties remaining in the family environment. The Centre offers a supervised structured and supportive milieu, tailored to meet client’s individual needs. The residential programme gives clients an opportunity to learn personal care, household management, money management, shopping, and meal preparation as well as a chance to participate in leisure activities that provide an opening for enhancement of social skills. Through the group life of the Centre, residents further develop skills such as negotiation, conflict resolution, etc. Clients who acquire these skills have a better chance to participate fully in the live of their communities.

Short-term crisis intervention: Individuals who are in crisis may be admitted to the Centre, when beds are available, for a maximum of one week. Only clients whose conditions are stable enough to permit them to function adequately in an open, residential setting would be admitted; those who are experiencing severe de-compensation and who require hospitalisation cannot be accommodated at the Centre.

The goal of this short-term placement is two-fold:

• to offer intense, short-term support to clients in crisis in order that they stabilise as quickly as possible;
• to offer a secure environment to clients who are awaiting alternative living arrangements.

Placement for short-term, crisis intervention would be possible for:

• clients whose families are in crisis because of unusual stressors (e. g., illness in the family, death of a family member, marital conflict, etc.);
• clients who make repeated, non-lethal suicidal gestures;
• clients who self-mutilate;
• clients who are awaiting transfer to another facility or to another community;
• etc.

Respite care: The Centre provides short-term respite care (3 months). Conditions for which families may require respite service range from unexpected family crisis, burnout of caregivers, to the evaluation of a person’s skills for future community residence placement. An additional goal of this programme is to afford caregivers temporary relief from their daily responsibilities to their family member who is mentally challenged.

2. EXTERNAL SERVICES

Day Program: Participants in the day programme can take advantage of the same therapeutic programme as residents. These individuals come to the Centre for a portion of each day (10 a.m. to 7 p.m.) and return home at night. Interaction among clients helps to create a sense of belonging and offers an opportunity to establish and develop a personal support network.

Community follow up / support: This aspect of the Centre’s work has two aspects. It is the philosophy of the Reintegration Centre that treatment does not end with discharge from the programme. After discharge, staff follows up on clients in their communities of origin. The role of the staff of the Centre is to ensure continuity of services so that the client can function without problems within his/her community of origin. Support to the local Social Services workers is offered, as is outreach to the client and the family, crisis intervention, referral to community resources, and information about medication management, etc.

THERAPEUTIC PROGRAMMES

The therapeutic programmes offered at the Centre are open to residents as well as clients who are involved in the day programme.

Different therapeutic programmes are being developed.

1. JOB SKILLS/PLACEMENT

The work programme is designed to serve as a therapeutic tool to accelerate client improvement and development. The programme is designed with following objectives:

• to equip clients with marketable labour skills;
• to improve their functional skills;
• to raise their self-esteem;
• to develop good work habits;
• to learn to accept direction;
• to learn to stay on task and complete work assignments;
• to develop healthy interpersonal relationships;
• to develop social skills.

2. ART THERAPY

Working in collaboration with the organisation Fondation pour l’art thérapeutique et l’art brut au Québec and local artists in Inukjuak, the staff will work with programme participants on developing their creative expression. Using various media such as soapstone, oils, pastels, crayons and other materials, participants will work on projects ranging from traditional carvings, drawings to paintings to producing gift cards. Art will be used as a tool to help participants understand their thoughts and feelings, to enhance creativity and imagination, and to build confidence.

3. TRADITIONAL INUIT HEALING APPROACHES

Inuit methods of resolving conflict and healing pain are used as much as possible. Sharing in group sessions, confiding and confession, spending time on the land, prayer, dealing with errors of the past through apology are used as therapeutic tools.

Elders will be sought to offer healing sessions on a regular basis for residents and participants in the day programme.

AWARENESS PROGRAMMES

The Centre is also involved in developing community awareness programmes. Information about mental health issues will be disseminated to the population at large with the goal of sensitising community members, as well as service providers and employers, to the special characteristics and needs of this population.

Awareness programmes may also contribute to early detection and treatment of mental health problems.

STAFF

The Reintegration Centre has a team of two full time psycho-educators, four part time educators, six on-call educators, two night guards and a co-ordinator.

The duties of psycho-educators include clinical supervision of educators, assessment of psychosocial needs of clients, arranging for periodic evaluation of client medication, assisting in the development and implementation of client treatment plans, and acting as liaison between the client, family and the multidisciplinary team to ensure effective treatment outcome.

The role of the educators is to encourage each client to learn daily activities (such as housework, cooking) and, where necessary, teach skills. They help to resolve conflicts among clients, escort users to the nursing station and to government services, support clients in complying with their medication, and supervise the administration of prescribed medication.

The night guards are responsible for the safety and security of the clients and the facility during the overnight period.

The co-ordinator oversees the overall functioning of the Centre, ensuring supervision of staff members, effective treatment planning, programme development, and maintenance of the physical plant.

Inukjuak Reintegration Centre
General Delivery, Inukjuak (Quebec) Nunavik J0M 1M0
Telephone (819) 254-8738 — Fax (819) 254-8913

Prepared by Beethoven Asante, Coordinator