Community-Based Mental Health and Substance Use Services for People Leaving Prison: Equity and Inclusion Strengths and Limitations in Specialized Service Inventory Development.

Community reentry from prison is a challenging process, especially for persons with lived and living experience of mental health concerns. Access to appropriate community-based care for those leaving prison is a key part of improving health equity for this population. Our work to develop a cross-Canada inventory of active community mental health and substance use services for criminal justice-involved persons represents a valuable example for others hoping to conduct projects that are similar in nature and scope. We describe the strengths and limitations of our health equity-informed, multi-pronged approach to service inventory development, highlighting the importance of considering and addressing search- and stakeholder-related biases. Investment of time and resources is critical to ensuring comprehensive and inclusive identification of community-based mental health services and meaningful resource development.

Advancing Curriculum Development and Design in Health Professions Education: A Health Equity and Inclusion Framework for Education Programs.

ABSTRACT: The COVID-19 pandemic has exacerbated pre-existing health inequities in vulnerable and marginalized patient populations. Continuing professional development (CPD) can be a critical driver of change to improve quality of care, health inequities, and system change. In order for CPD to address these disparities in care for patient populations most affected in the health care system, CPD programs must first address issues of equity and inclusion in their education development and delivery. Despite the need for equitable and inclusive CPD programs, there remains a paucity of tools and frameworks available in the literature to guide CPD and broader education providers on how best to develop and deliver equitable and inclusive education programs. In this article, we describe the development and application of a Health Equity and Inclusion (HEI) Framework for education and training grounded in the Analyze, Design, Develop, Implement, and Evaluate model for instructional design. Using a case example, specifically a hospital-wide trauma-informed de-escalation for safety program, we demonstrate how the HEI Framework can be applied practically to CPD programs to support equity and inclusion in the planning, development, implementation, and evaluation phases of education program delivery. The case example illustrates how the HEI Framework can be used by CPD providers to respect learner diversity, improve accessibility for all learners, foster inclusion, and address biases and stereotypes. We suggest that the HEI Framework can serve as an educational resource for CPD providers and health professions educators aiming to create equitable and inclusive CPD programs.

Addressing the complex substance use and mental health needs of people leaving prison: Insights from developing a national inventory of services in Canada.

Internationally, transitions from prison to the community are often precarious experiences for people who are living with substance use and mental health concerns. In Canada, a continuing opioid overdose crisis and overlapping challenges related to the COVID-19 pandemic have generated urgency for scaling up community-based services that can meet the complex substance use and mental health needs of people leaving prison. In this commentary, we reflect on our experience with and knowledge gained by developing a national inventory of substance use and mental health services for criminal justice-involved persons who are re-entering the community. We learned that there is a scarcity of such community-based services specific to criminal justice-involved populations and a glaring lack of information about culturally safe and appropriate supports. Stakeholders from organisations across Canada identified that communities need a comprehensive array of low-barrier services, inclusive of harm reduction and substance use treatment services, to meet the diverse needs of people leaving prison. We recommend building greater investment in and awareness of community-driven, local programs, as well as enhancing efforts to engage people with lived and living experience in service design and provision. We also briefly describe a few programs to highlight examples of how to operationalise the themes that we observed to emerge while developing a national inventory of community-based substance use and mental health services for criminal justice-involved persons.

Collaborating with Families: Exploring Family Member and Health Care Provider Perspectives on Engaging Families Within Medical Education.

OBJECTIVE: With 40 to 65% of mental health patients being cared for by family members, nearly 500,000 Canadians are serving as caregivers. Yet family members are often excluded from daily clinical interactions and the development of mental health continuing medical education (CME). This qualitative study aimed to understand how best to involve families in mental health CME and how to advance their meaningful and equitable engagement in such initiatives. METHODS: Semi-structured interviews were conducted with two samples: mental health care providers (n = 8) and family members of individuals diagnosed with a co-occurring addiction and mental health problems (n = 12) to explore barriers, facilitators, and strategies for family engagement. RESULTS: Several themes related to the perception of expertise emerged from the interviews, including the tension between the validity of knowledge based on education/credentials and knowledge based on lived experience, as well as expressions of "voice." Participants also identified barriers to, and ethical considerations related to, family engagement, including stigma and confidentiality, and recommended strategies and supports to meaningfully include the family perspective within mental health CME. CONCLUSIONS: Aligning with the movement to improve collaboration between mental health professionals and service users requires developing relationships with family members. Identifying strategies to involve families in the development of CME is crucial to initiating and maintaining family engagement.