When you walk into Weston Mount Dennis Community Place Hub it is hard to tell what’s going on at first, if anything. The place is one big room and it’s mostly empty. There is a group of tables huddled in the middle, a white board with the daily schedule written on it, a row of desktop computers, and a coffee stand. If you were trying to imaging what an innovative space for managing patients with complex needs looks like, you probably wouldn’t imagine this.
But then you’d be wrong. Or rather, you’d risk missing out on what a place like this can do for vulnerable people on a daily basis.
The Hub is located in the Weston neighbourhood of West Toronto. It serves both the Weston and Mount Dennis communities, and is housed in a small building sandwiched between two, 19-storey apartment towers.
The community is poor, made up of low-income families, recent immigrants, visible minorities, and lone parent families. By all measures, they are some of the worst-off in Toronto: 28% of residents live below the low income line, and the unemployment rate is 13.6% — the highest in the sub-region. They have the highest incidents of Diabetes (13.1%) and very high rates of High Blood Pressure (23.6%). Residents are also disproportionately affected by mental health and addiction issues.
Because of their successful ‘clubhouse model’, Progress Place was tapped to bring their approach to mental health services into the community. Their basic philosophy is that there is no definitive path to recovery for people living with a mental illness, and all programming should be inclusive, responsive, and most importantly, engage clients directly as partners.
At the Hub, Staff and members work side by side. They joke and tease one another, and most importantly, they spend time building trust — a key ingredient to managing ongoing, complex conditions.
A Day in the Life
What began as a solo run community hub with 1.5 full time staff, has slowly grown into a 15+ strong Service Provider Network, providing everything from chronic disease prevention and management, employment and housing services, mental health peer support groups, and senior’s yoga. And although the hub is still only funded for 1.5 FTE, the in-kind support of the Service Provider Network acts as an extended care team, allowing a basket of services to be delivered with a very low overhead.
In many ways Weston Mount Dennis Community Place Hub is the embodiment of a ‘One-Team’ approach: multiple care agencies work intersectorally to deliver seamless wrap around care, under one roof. The organizations are not amalgamated administratively, but rather function as a collective who are able to listen closely to community need and pivot depending on what is being called for by residents.
What follows is a photo essay with both staff and clients that attempts to understand what the Hub means to the them, in their own words.
The Local: What is the Hub?
Niv: “It’s a space for community members to come and access anything under the sun — we have 17 service provider partners that come onsite and provide services to our members. But our focus is really on health and health services. We run on a collaborative model. We have one intake, so that limits barriers.”
The Local: Tell me about the importance of trust building in caring for people with complex needs?
Niv: “For people who have experienced mental illness, trust sometimes is hard because you are dealing with your own issues, and at the same time, you’ve been in a system where everyone controls what you do. They control your medication, how often you take it. Social Services determine how much money you get, when you get it. A lot of things are out of your control. So when you come here, one thing is you have more control over your life. You have choices. You can decide what you want to do with your day or how you engage with society.”
The Local: How is this hub different than other hubs?
Kaltuma: “Here the partners are really connected. We have a service provider network that meets regularly and members are well aware of what we do and what each other does. In some other hubs, they have co-location, but there is no connection. It’s everyone on their own. It’s not collaboration, they don’t come as one. We also don’t duplicate what are partners are doing.”
The Local: What’s the difference between co-location and collaboration?
Kaltuma: “Co-location is when various organizations operate out of one building, provide separate services, and are identified individually. With collaborative model it’s more like walking into one space — one name and one team. We share information about what we are seeing and what services we need to bring in.”
The Local: Tell me about your job here today
Joe: “I’m Joe. One of the things I do here is I handle the sign up sheet where the others sign in by choice, and they pay one dollar. I also make word searches on my laptop. And I’m also the DJ.”
The Local: What does this place mean to you?
Joe: “I think it means a lot. I like helping out.”
The Local: How long have you been in this community?
Jagada: “Almost 26 years.”
The Local: How has the neighbourhood changed over the years?
Jagada: “A lot my dear. They don’t have any shopping centre anymore. We need a shopping centre. Before many many years back, 90s, there was a Kmart. Now there’s just one expensive grocery store. The Bank of Nova Scotia closed. I have to go to Jane and Wilson, on two buses. There’s lots of Money Marts now — people get loans for gambling. They shouldn’t have that. One is ok, but we have ten. They shouldn’t have that. Also guns. Guns and drugs. You heard about that pizza place shooting? One boy died. So sad.”
The Local: Do you feel unsafe here?
Jagada: “Sometimes, not all the time. I wouldn’t say that. I don’t go in the evening anywhere…and too many lonely people in this area. It’s so sad. Rents are expensive. They come to the drop ins. They don’t have food to eat…there’s lots of diabetics, rheumatism, cholesterol. Education is good here [at the hub]. We learn about blood pressure, all those things.”
The Local: What is special about this place?
Mark: “So much, so much. The people that work here, the programs that are offered. The neighbourhood we live in, we really need something like this. This is a very positive space.”
The Local: What has been helpful for you in your mental health recovery?
Mark: “Community. A place to go to. A purpose. Once you become productive and part of the community, that helps with the recovery of self.”
The Local: What makes the staff here good?
Mark: “I think they are sensitive — to peoples needs, to people’s uniqueness or quirks. This is the Mental Health Foundations program, so it caters to a lot of people who are psychiatric survivors. It’s providing an accepting environment, so everyone feels welcome.
Kaltuma: “ I love connecting with new people. I love the community. There are a lot of people that don’t even know we exist.”
Kaltuma: “Lately people are saying they want ESL classes and senior’s classes. One of our partner agencies does ESL and they are right across the street, so we refer people there. But with a warm transfer.”
The Local: How much of a draw is the food?
Kaltuma: “The one thing that draws people in that I know from working in various agencies is food. If you’re doing anything and there is no food, nobody shows up. If you are having a meeting, and there is no food, nobody shows up. Even just having something simple — tea, a cup of coffee. Food is very essential, especially this neighbourhood. It’s the second poorest neighbourhood in the country. People are living below the poverty line.”
The Local: Why do you come to the Hub?
Dave: “I find it helps, socializing stuff like that. It’s very friendly. They teach you to have respect. They go out of their way to help you. They keep phoning me to make sure I’m coming, so I come. I also clean the Hub now. Every Saturday. I did volunteer but then they said it was paid. They like my cleaning. ”
The Local: Do you live nearby?
Dave: “I live in the building right next door. I don’t have far to go. Regeneration is in the building on the top floor. They have an office there. They’re for people that need help. They help me with stress,…and if you’re in crisis they’ll spend time with you. They’ll get you a doctor.”
The Local: Is it helpful that they are services right in your building?
Dave: “I find it is. If I have problems or bad days, I just go up and talk to staff, and they try to bring you back to level. It’s very nice of them to do that. The doors always open. They give our medication at nighttime. They monitor it.”
The Local: Why did you come here today?
Khadijat: “I was a fashion designer before, but I can’t do it anymore. I had a kidney transplant. I can’t sit down for a long time anymore. They told me I’m at risk for Diabetes. So I came here today for the diabetes program.”
The Local: How did you hear about it?
Khadijat: “One day I was passing by here and someone gave me a sign for computer learning. I registered here so I could learn things. Everywhere you go, if you have to apply for something, you have to go online. Too bad if you don’t know. So the more the world is changing, you have to change, but we never got. Old people too. They have to learn knew things.”
The Local: Why is having someplace to go important for mental health recovery?
Niv: “I think when people start to disengage with society that’s when health go does hill. Even things like going to see a doctor – if you aren’t in the habit of waking up every day, that’s a big hurdle. This place gets them in the habit of taking care of themselves.”
The Local: What are some ways you connect people to the health system?
Niv: “I think it’s a very direct thing we do. As we work with people, doing intake or just through casual conversations, we may find out that they do not have a primary care doctor. They may have Diabetes that’s gone unchecked. So just being able to make those referrals through our service provider network is a quick phone call.”
The Local: How hard is it to find out what’s really going on?
Niv: “They may not come in on their first day and tell us that they don’t have a primary care doctor. Over time they might disclose that. And sometime’s they won’t tell us, but they’ll tell a community member and that community member will come and say ‘Hey you need to talk to that person”.
The Local: Is the Hub connected with larger health system?
Niv: “Hospitals are a place we need to do more connections, to make sure the continuum is there. If we were able to make stronger connections, people could more easily integrate back into the community with local services. We are young, but we’re working on it.”
Is it Working?
From what I could observe, there were two major components to the model Progress Place has been developing, both here and at their Church Street location:
The Secret Sauce: Part I
It is clear from spending the day there that the hub has become a one-stop shop that many residents with complex needs have come to rely on for ongoing support.
One of the most notable aspects of WMDPH is the integration of clients into every aspect of the hub’s operation. With only 2 staff members coordinating all activities, this strategy is partial designed to keep the place sustainable. But it’s not only that — the Hub sees this as a way for people to take ownership of the space, and in so doing, to find a sense of purpose.
By involving them, they are more likely to attend. The more they attend, the the more likely they are to combat the costly effects of social isolation on mental health and addictions. There is also a higher chance of staff connecting them to the services, education and training they need to thrive.
The Secret Sauce: Part II
The second major ingredient in their ‘secret sauce’ is the value they place on forming relationships with members. People with complex needs are vulnerable. They have often been neglected through traditional services, and there can be shame. As a result, they can be hesitant about disclosing their real needs. By placing priority on relationship and trust building, they increase the likelihood that they’ll learn about core needs for particular clients, and plan more appropriate care for the community as a whole.
Many of the residents I spoke with who use the Hub on a weekly, if not daily, basis, consistently referred to it as a ‘godsend’. This was partially attributed to fact that it is a no-cost, neighbourhood space that simply gives them “somewhere to go outside the four walls of my apartment”. But more importantly, it was because the Hub instills a sense of ownership: in the space; in their community; and in their lives.