Across Ontario and at CAMH, oppression of and disadvantage against Black communities is evidenced by ongoing racial disparities in mental health and well-being. Specifically at CAMH, in 2020, data showed the rate of restraint use was significantly higher with Black patients compared with white patients. With these concerns in mind and a desire to fundamentally change the way our hospital operates, in February 2021, CAMH launched Dismantling Anti- Black Racism, a landmark strategy that includes 22 actions to decrease anti-Black racism by the end of fiscal year 2022/23. CAMH’s Dismantling Anti-Black Racism strategy became a key focus of the hospital-wide initiative Fair & Just CAMH, outlining a plan to accomplish the following:
- ensure safe, accessible and equitable care for Black patients and families;
- build an equitable working environment for Black staff; and,
- eliminate unfair treatment for Black populations within CAMH and across the mental health system
Since its launch many facets of CAMH have worked together, with the support of important community partners, to make meaningful progress on our goals. We are happy to share two examples from each category of the strategy to demonstrate our progress.
For Black patients and families:
A disproportionate number of Black patients are represented in CAMH’s forensic units. 217 employees in these units took part in an Equity-Based Response Training program focused on addressing root causes of disparities in the health outcomes of Black patients through examining anti-Black racism at the intersections of mental health and justice systems. These teams have now introduced an equity, diversity and inclusion framework and implementation of new tools such as the Cultural Formulation Interview and the Adverse Childhood Experience Tool to support the provision of equitable care. The forensic unit teams have also introduced a multi-staged approach of implementing Culturally-adapted CBT (CA-CBT) designed specifically for English-speaking Caribbean and African populations in Canada. There are two offerings coming up in summer 2023 to continue to train more CAMH staff in CA-CBT as part of the broader Health Equity Certificate Program. In order to scale and spread this approach, CAMH is now determining ways in which this training program can be adapted for the unique needs of different clinical units, starting with the Geriatric Service, Adult Neurodevelopment and Social Support Services, Psychosis Recovery and Treatment units. This work will be supported by a new Health Equity Coaching Service that is now providing coaching and implementation to support this work.
Oftentimes Black patients and families are negatively impacted by policies that are inadvertently biased against them. For example, most health care policies were originally designed around an expectation of European cultural norms that may look different in some Black communities. To address this, CAMH has started a review of all clinical policies with an equity lens to check that they do not introduce a possibility of bias. This is a major undertaking and is a first of its kind initiative in Canada. Over 175 CAMH staff have been engaged in the process, which has included training sessions through the Health Equity Coaching service and the use of the Ontario Ministry of Health’s Health Equity Impact Assessment (HEIA) Tool. To date, 26 CAMH policies have been reviewed and many strategies for improvement have been identified. As new policies continue to come up for review in the policy review cycle, this lens will continue to be applied.
To better support an equitable working environment for Black staff, CAMH can point to some simple but powerful internal incident reporting adjustments that have been made. STRIDES – a learning and incident reporting system – was recently updated and now includes an opportunity for the inclusion of new fields to officially report incidents of racism. In parallel with this change, the complaints resolution process was also revised to provide different options for addressing and resolving complaints. Both of these changes are reflected in CAMH’s new Anti-Racism, Harassment and Discrimination Policy developed in consultation with the Anti-Black Racism subcommittee of the Horizontal Violence, Anti-Racism, Anti- Oppression Working Group. It is now mandatory for all managers to be trained in this policy, with over 300 managers trained so far.
In 2021, CAMH launched Foundational knowledge on anti-Black racism: An Introductory course for CAMH staff. This training is specific to the Canadian context, and includes real-life case scenarios experienced by Black staff, patients and families at CAMH. The course consists of three self-led modules offered through CAMH’s e-learning platform. The training was made mandatory for leaders in 2022. Over 3,000 staff, physicians and learners have completed the course to date.
For CAMH and the mental health system:
The Substance Abuse Program for African Canadian and Caribbean Youth (SAPACCY) provides accessible, Africentric and racial trauma-informed support to Black youth who are dealing with mental health and substance use concerns. To improve access to appropriate care for Black youth, CAMH is helping to build a network of community based services across Ontario built on the SAPACCY model. This model now includes seven community satellite sites across Ontario and is the first-ever Canadian hospital and community partnership focused on offering care to Black youth. To support new and ongoing work, SAPACCY has convened a provincial Black Youth Advisory Panel (BYAP), comprised of diverse Black youth throughout the province, which provides guidance on program design, implementation, evaluation, knowledge exchange and the strategic direction of the service.
SAPACCY has also established a new partnership with the Ministry of the Attorney General to develop a new service that will provide culturally responsive assessments and mental health care for Black and racialized youth involved in the youth justice system. This service marks a significant step towards addressing the ongoing systemic problem of the overrepresentation of young Black and racialized youth in the justice system.
CAMH has made meaningful progress on all 22 actions outlined in the Dismantling Anti-Black Racism strategy but we recognize this is only the beginning of a long journey for our organization. Conversations are taking place about the next iteration of this work, which will continue to include strong engagement with CAMH staff, patients, families, and our wider community.
We would like to thank everybody who is taking part in the delivery of this important work, including the over three thousand people who have completed the Foundational Knowledge in Anti-Black Racism training, the clinical teams who are changing the way they deliver care and the committee members who are diligently assessing hospital-wide processes and policies with an equity lens. We especially recognize members of the Anti-Black Racism and Mental Health Advisory Committee for their dedication and partnership, and the Black health care leaders who have contributed to our learning along the way.
Read the full report, including a list of the 22 action items and our progress here: