RNAO Mental Health and Substance Use Best Practices Program

Our journey: Mental Health and Substance Use Best Practices Program

Mental health and wellbeing are essential to everyday health. Pre-pandemic data suggested that each year, one in five Canadians experienced a mental health concern, highlighting a crisis in Canada. Since the pandemic began, 50 per cent of Canadians have reported worsening mental health, with increases in stress levels, depression, anxiety and, higher rates of substance use and associated deaths related to opioid toxicity.

The need for increased mental health and substance use supports – in an already fragile health-care system in crisis – has never been clearer. Nurses are at the forefront of the system providing mental health supports to people in need of care and healing.

The Registered Nursesʼ Association of Ontarioʼs (RNAO) Mental Health and Substance Use Best Practices Program, established in 2006, drives change by providing leadership to enhance evidence-based care and services.

"As nurses, the single most important thing we can do to support mental health in the community is to nurture the seeds of resilience, connection and hope – both in our clients and in ourselves."

– Dr. Rosie Yoon, NP

I live the reality of accidental drug overdose awareness everyday having lost my 18-year-old son Austin to fentanyl in June 2020. He fell through the cracks of a broken system. Harm reduction involves upstream prevention through a variety of ways: housing and mental health support, education, safe supply for those not ready to stop using, consumption and treatment services, decriminalization for minor possession (to redirect resources to housing and mental health), and appropriate, accessible, evidence-informed treatment available for those ready to recover. We must do better.

Kathy Moreland, RN

Resources for support

If you are in crisis, please call your local distress line (learn more). If you are facing a mental health emergency, please call 911.

RNAO knows that people across Ontario are experiencing tremendous levels of physical and emotional stress at this time. Nurses who are struggling or feeling overwhelmed can reach out to any of the resources listed below. Most are also open to other health-care providers or members of the public.

ConnexOntario provides accurate and up-to-date mental health information 24/7 by telephone, chat and email.
Wellness Together Canada is a free and confidential mental health and substance use support available 24/7 by text or phone.
The Government of Ontario's mental health support page provides links to mental health, wellness and substance use supports for the general public.
FOR NURSES ONLY: Nurses' Health Program is a free, voluntary program for Ontario nurses designed to encourage them to seek treatment for substance use or mental health disorders.

Members leading change

RNAO is committed to working collaboratively to improve the health-care sector, provincially and nationally. Through its collaborations, RNAO provides evidence-based recommendations to governments and organizations to support people with mental health or substance use issues.

Mental Health Nursing Interest Group (MHNIG)

MHNIG, an RNAO interest group, promotes:

the health and wellbeing of people who are at risk of experiencing mental illness and/or emotional distress
mental health services responsive to the needs and wishes of individuals with lived experience and the community
the role of RNs and NPs in serving people with mental health concerns

Members mobilizing change

RNAO resolutions

RNAO members amplify their voices and help to mobilize change by submitting resolutions to RNAO for consideration and discussion at its Annual General Meeting.

2023 resolutions

Improve the working conditions of nurses and build necessary capacity to prevent workplace injuries and provide mental health support to the health-care workforce
Read more

Advocate for an integrated strategy to address the opioid crisis

2022 resolutions

Expand NP scope of practice to include authority to complete forms under the Mental Health Act

Timely access to perinatal mental health services

Accessibility of sharps boxes in patients room

2021 resolutions

Integrated strategy to address substance use disorder (SUD)

Decriminalization of the possession of illegal drugs for personal use

Taking action to facilitate access to mental health supports for Ontario children and youth

Strategy on increasing knowledge and availability of safer opioid supply

Other resolutions

Psychotherapy insurance

It has been seven years this month since my son Bradley John Chapman died after an overdose of toxic drugs. Memories of Brad are with me always and leave me broken on many days still.

He has left siblings, children, grandchildren and friends trying to understand this needless death. It was a needless death as are the many that occurred before and after, from lack of understanding, lack of services and neglect for people suffering from mental health and addictions.

There have been improvements and steps forward including RNAO's Best Practice Guidelines and implementation of Supervised Injection Sites in some jurisdictions. However, the lack of housing, and toxic drug supply continue to exacerbate the problem.

The grief never dies and my life and our family are forever changed by this loss.

Cori Chapman, RN

RNAO’s partnerships and engagement

Your Health Space

Your Health Space supports health care organizations across Ontario to improve mental health in the workplace through live workshops, self-directed modules, and microlearning Wellness Moments. It embraces the holistic view that promoting psychological health and safety in the workplace takes the collective effort of individuals across an entire health care organization.

The Ontario Coalition for Children and Youth Mental Health

The Ontario Coalition for Children and Youth Mental Health (CCYMA) unites education, mental health, community and health sectors to promote the priority of social and emotional wellbeing as a part of healthy child development in Ontario. CCYMA also catalyzes provincewide change for different and more effective approaches to improving supports and services for children and youth wherever they live in Ontario.

Youth Mental Health and Addiction Champion Initiative

YMHAC, a youth-led, peer-based model founded by RNAO in 2014, aims to promote mental health, reduce stigma, and improve knowledge and awareness concerning substance use and its prevention, supporting the creation of a resilient and supportive school environment.

The Nursesʼ Health Program

The Nursesʼ Health Program was developed by RNAO in partnership with the College of Nurses of Ontario (CNO), the Ontario Nursesʼ Association (ONA) and the Registered Practical Nurses Association of Ontario (WeRPN). The program provides an effective channel for nurses with substance use and/or mental health disorders to receive support to recover and practise nursing safely.

International Overdose Awareness Day

International Overdose Awareness Day (Aug. 31) is a time to remember the lives lost and individuals left behind due to drug overdose. RNAO continues to call on the provincial government to respond to the opioid crisis to decrease the toxic drug supply and prevent deaths. Opioid overdose knows no bounds and leads to tragic, preventable deaths.

Brad Chapman coroner's inquest recommendations

Brad Chapman coronerʼs inquest recommendations

An inquest into the death of Brad Chapman, a 43-year-old father who experienced homelessness and struggled with substance use, was completed in December 2018. RNAO was a party to the inquest, which allowed representatives from the association to ask questions and make submissions. The inquest resulted in 55 recommendations to better safeguard vulnerable people who use substances.

Insite - Nurses support harm reduction model

RNAO has been a strong advocate of a harm reduction approach to drug use for over a decade. In 2011, RNAO along with the Canadian Nurses Association (CNA) and the Association of Registered Nurses of British Columbia (ARNBC) was granted intervener status before the high court to defend Insite, Canadaʼs first safe injection site located in Vancouver. Insite continues to reduce health risks from drug use, and connect clients to health and social services.

#DecriminalizeNow

The criminalization of simple drug possession in cities across Ontario is costing lives. Toronto is no exception. On May 15, RNAO wrote to candidates in Toronto’s 2023 by-election for mayor asking them to sign a pledge to support decriminalizing simple drug possession in Toronto. Find out which candidates signed the pledge.

Queen's Park on the Road (QPOR)

It allows RNAO members to meet their MPPs within their local constituency to discuss key nursing, health, and health-care issues that matter to them and that affect their day-to-day practice.

RNAO's provincial election platform 2022

Nurses know what factors influence and shape people’s health. That’s why RNAO has developed a set of recommendations that cover the environment, the social determinants of health, nursing, care delivery and fiscal capacity.

Federal Election 2021: Nurses vote for a healthy recovery for all Canadians

Our economic and social circumstances affect our health. The environment also affects our health. These are important issues at stake in the election. Vote for your health.

RNAO submission to the Controlled Substances Directorate of Health Canada (2020)

RNAO provided feedback in response to a federal government consultation on the intent to develop new regulations under the Controlled Drugs and Substances Act with respect to supervised consumption sites and services.

Fund supervised consumption sites immediately, premier

Call on Premier Ford to fund supervised consumption sites immediately, bring an end to the toxic drug crisis and save lives.

Action Alerts

Action alerts are a political advocacy tool used by RNAO to engage our 50,400+ members, and the public related to critical issues pertaining to mental health and substance use.

Capacity building

Best practice guidelines (BPG)

BPGs are systematically developed, evidence-based documents that include recommendations for nurses and the interprofessional team, educators, leaders and policy-makers, persons and their chosen families on specific clinical and healthy work environment topics. RNAO has about 50 BPGs covering four themes: foundational, clinical, system and healthy work environment, and population and public health.

**Assessment and Interventions for Perinatal Depression**

**Implementing Supervised Injection Services**

**Crisis Intervention for Adults Using a Trauma-Informed Approach: Initial Four Weeks of Management Third Edition**

Integrating Tobacco Interventions into Daily Practice — Integrating Tobacco Interventions into
Daily Practice

Enhancing Healthy Adolescent Development — Enhancing Healthy Adolescent
Development

What is stigma?

The video features an NP and a person with lived experience discussing stigma, how it impacts nurses and other health-care providers, and ways to reduce stigma.

E-Learning modules

These free e-Learning modules help broaden nursesʼ knowledge and skills to better support individuals experiencing mental health and/or substance use issues.

Engaging Clients Who Use Substances
Nursing Towards Equity: Applying the Social Determinants of Health in Practice
Integrating Tobacco Interventions into Daily Practice
Tobacco Use and Cessation with Youth and Young Adults

Toolkits

Nurse Educator Mental Health and Addiction Resource Toolkit

This resource supports undergraduate educators in integrating mental health and substance use knowledge and skills into nursing curriculums.

Youth Mental Health and Addiction Champion (YMHAC) Toolkit

This toolkit supports the implementation of evidence-based, youth-led mental health promotion and substance use prevention initiatives in school settings. It provides users with a comprehensive step-by-step understanding of the YMHAC initiative and all of its components.

Advanced Clinical Practice Fellowships

RNAO established the new ACPF Health and Wellness Stream in the Spring of 2022 in response to chronic shortages of nurses within the system and increases in nurse fatigue and burnout associated with the COVID-19 pandemic. If pursuing a fellowship in this stream, you can focus on promoting wellbeing and creating a healthy work environment, improving retention or recruitment of nurses, or providing mentorship or support for new staff.

Nursesʼ health and wellbeing In Focus page

The global pandemic has clearly demonstrated the importance of healthy work environments for nurses. This RNAO In Focus page is a one-stop shop outlining our research, advocacy, partnerships, resources, tools and other work in this area.

Mental health and substance use in the media

RNJ

Redefining mental health

Rosanra (Rosie) Yoon’s earliest childhood memories harken back to her days accompanying her mother on the streetcar for monthly visits to Toronto’s St. Michael’s Hospital. From the age of four to eight, she was scared and nervous on these outings, but as soon as she saw her mother’s nurse, she felt safe.

“Nobody can go to treatment if they’re dead”: RNAO members take action to address Ontario’s opioid overdose crisis

Nurses throughout Ontario are working to provide help to those affected by this crisis.

Saving lives and salvaging hope

Family and community come together to reduce harm and build a healthier future for those battling substance-use disorder.

On the streets during COVID-19

In downtown Toronto, street nurse Roxie Danielson is meeting with new clients at a shelter.

Media hits

The city of Hamilton says it is working with partners to 'explore different models of decriminalization.' (Briar Stewart/CBC)

CBC News

Almost a year after Hamilton city councillors voted to decriminalize the possession of small amounts of illegal drugs, CBC Hamilton has learned city officials still haven't submitted that request for exemption to Health Canada. Researchers and advocates have mixed feelings about whether the delay is "inexcusable" or part of "good faith" efforts.

Opioid crisis kills nearly 10 Ontarians a day: Nursing Association urges PCs to change course and support overdose prevention sites (Alexis Wright/The Pointer)

The Pointer

The opioid crisis—at its root—is an epidemic of an endless search for relief. More than eight people are dying per day in Ontario due to opioid overdoses. In Canada, there were nearly 20 deaths a day between the months of January and June 2022. As many as 98 percent of these overdoses are classified as accidental.

More powerful drugs and pandemic-related mental health issues contributed to a sharp rise in opioid-related deaths confirmed by provincial police in Southwestern Ontario last year. (File photo/Postmedia Network SunMedia)

Chatham Daily News

The upcoming municipal election has prompted the Registered Nurses’ Association of Ontario to call on mayoral candidates across Ontario to support the decriminalization of simple drug possession.

CBC News

'It can happen to anybody,' says Kitchener mom ahead of Overdose Awareness Day

Sioux Bulletin

Members of the community joined local healthcare organizations in participating in an FASD Awareness Family Walk on September 9.

White cross crosses for change opioid memorial Sudbury

Sudbury.com

Sudbury opioid deaths cited as an example of why a harm reduction approach is needed to prevent overdose deaths connected to substance abuse

Brock Clinic Mission Peterborough Examiner

The Peterborough Examiner

Nurse practitioner-led clinic operating for two days a week out of the Brock Mission.

Toronto Star

ʻHelp is hereʼ: Mobile outreach unit brings treatment to opioid addicts in Norfolk County

The Globe and Mail

Homelessness is most visceral in our local communities. But it demands an ambitious national perspective

Social media

Get involved. Use the following hashtags on X (formerly Twitter), Facebook and Instagram to participate in the ongoing dialogue:

#MentalHealth #MentalIllness #SubstanceUse #HarmReduction #OpioidOverdoseCrisis

RNAO Mental Health and Substance Use Best Practices Program

Our journey: Mental Health and Substance Use Best Practices Program

Resources for support

Members leading change

Members mobilizing change

RNAO’s partnerships and engagement

RNAO policy

#DecriminalizeNow

Queen's Park on the Road (QPOR)

RNAO's provincial election platform 2022

Federal Election 2021: Nurses vote for a healthy recovery for all Canadians

RNAO submission to the Controlled Substances Directorate of Health Canada (2020)

Fund supervised consumption sites immediately, premier

Action Alerts

Capacity building

What is stigma?

E-Learning modules

Toolkits

Nurse Educator Mental Health and Addiction Resource Toolkit

Youth Mental Health and Addiction Champion (YMHAC) Toolkit

RNAO programs for nurses

Advanced Clinical Practice Fellowships

Nursesʼ health and wellbeing In Focus page

Mental health and substance use in the media

Redefining mental health

“Nobody can go to treatment if they’re dead”: RNAO members take action to address Ontario’s opioid overdose crisis

Saving lives and salvaging hope

On the streets during COVID-19

CBC News

The Pointer

Chatham Daily News

CBC News

Sioux Bulletin

Sudbury.com

The Peterborough Examiner

Toronto Star

The Globe and Mail

Social media