Substance use, mental health and RNAO

Our journey

Mental health and wellbeing are essential to everyday health. Data suggests one in five Canadians experienced a mental health concern each year, 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. In 2023 alone, more than 3,800 people across Ontario died from the unregulated drug supply. Across Ontario, an average of 10 people per day are dying from tainted drugs.

Nurses are at the forefront of the system providing mental health supports to people in need of care and healing. The need for this – in an already fragile health-care system in crisis – has never been clearer. Nurses know that saving lives requires an integrated approach to substance use, not just a focus on treatment. This includes providing supervised consumption services sites and other harm reduction approaches to meet people where they’re at.

RNAO’s leadership has focused on the toxic drug crisis. RNAO exemplary leadership continues to advocate for healthy public policy, supporting the integration of evidence-based practice in clinical health settings and advocating for the person wherever they are in their journey. The Ontario government’s plan to gut and prohibit harm reduction programming places ideology over health care. People will continue to die without these critical 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.
9-8-8: Suicide Crisis Helpline is a national three-digit number for suicide prevention and emotional distress, available across Canada 24/7 by text or phone in English and French.
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.

Substance use policy and advocacy

RNAO continues to fight to save lives in Ontario through multi-pronged policy and advocacy work grounded in social determinants of health. For example, people with mental health and substance use issues need adequate income supports and affordable housing. RNAO policy and advocacy works supports people who use drugs wherever they are at in their care trajectory.

While we wait for government action, we tirelessly assert the need for the harm reduction needed to best support people with mental health or substance use issues. In the short term, this requires supervised consumption services (SCS) sites and other harm reduction services. RNAO demands funding of SCS sites in every community in need and decriminalizing simple drug possession across Ontario.

Opioid overdose crisis

For over a decade, Canadians have been dying at an increasing rate from opioid overdoses. Between January 2016 and December 2021, nearly 30,000 Canadians died from an opioid overdose. Ontario is not immune to this tragedy.

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.

#DecriminalizeNow

The criminalization of simple drug possession in cities across Ontario is costing lives. Toronto is no exception. On May 15, 2023, 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.

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

Improve nursing working conditions to prevent workplace injuries

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

Advocate for a strategy to address the opioid crisis

Advocate for an integrated strategy to address the opioid crisis

2022

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

Advocating for NP scope of practice expansion to include the ability to initiate and complete all forms under the Mental Health Act.

Timely Access to Perinatal Mental Health Services

Advocating municipal, provincial and federal governments for funding to increase timely access to perinatal mental health services.

Accessibility of Sharps Boxes in Patients Room

Promote education and information regarding appropriate organization policies and client centered assessment to ensure individuals who use substances have access to appropriate harm reduction tools.

2021

Integrated Strategy to Address Substance Use Disorder

Advocate for the Ministry of Health and its allies to: 1. Accelerate and augment the Road to Wellness (2020) initiatives and by implementing a province-wide, integrated strategy for substance use disorder (SUD) that will address prevention; and 2. Create and fund roles for trauma-informed SUD coordinators to support and educate those working with this population and those they serve.

Decriminalization of drug possession for personal use

Advocate for municipal, provincial and federal governments to take all actions within their power to decriminalize the possession of drugs for personal use, in order to reduce the harms of the opioid crisis.

Access to mental health supports for Ontario children and youth

Lobby the government for designated funds to ensure equitable access to mental health services within 30 days of presenting mental health related concerns, so that children and youth, up to and including eighteen years of age, do not suffer long term consequences related to delayed assessments, diagnoses, and interventions.

Increasing knowledge of safer opioid supply

Advocate for the increased knowledge and accessibility of safer supply prescribing programs and practices among Ontario health-care and social service professionals.

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

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Toxic Drug Supply: The lived experience of those affected and a call to action

RNAO organized a media conference to highlight how Ontario's toxic drug crisis is now killing an average of 10 Ontarians every day, to close Nursing Week.

While Nursing Week (May 6-12) is mainly regarded as a time of celebration, RNAO took the opportunity to shine a light on this crisis, share solutions, and renew its demand that the provincial government take the steps needed to stop a tragedy that is ravaging communities across Ontario.

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Friends of Ontario SCS invites all members of the media to attend rally: FUND ONTARIO SCS

Together with community members, frontline workers, and advocates, RNAO members gathered from across the province, including Timmins, Sudbury, Barrie, and Windsor, for a rally in Toronto to demand the Ontario government immediately fund and adequately support lifesaving supervised consumption services (SCS) amidst the worsening toxic drug crisis.

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International Overdose Awareness Day

Saturday, Aug. 31, 2024 marks International Overdose Awareness Day. It is a day to remember and honour the lives lost due to accidental overdose. Recently, the Ontario government announced it was withdrawing support for supervised consumption sites. These sites provide a lifeline for people who use substances. RNAO will continue its advocacy for those who need support.

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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.

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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.

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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.

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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.

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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.

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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.

Capacity building

RNAO’s Mental Health and Substance Use (MHSU) Program enhances evidence-based care and services related to mental health and substance use across all health-care settings. We also produce educational toolkits and education guides for practitioners.

Do you want to access webinars, events, e-learn modules, educational videos? Visit the program web page: Mental Health and Substance Use Program

Best practice guidelines

RNAO Best Practice Guidelines (BPG) 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**

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

RNAO programs for nurses

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

Speaking out is part of nursing

As the son of a teacher, Simon Donato-Woodger knew from a very young age the importance of being politically active. Seeing his mother participate in walk-outs, call for increased education funding and advocate for her students instilled in him a sense of pride and drive for change that defined his impressionable years as a young man. When his mother passed away when he was 12 years old, that passion for advocacy didn’t leave him.

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.

Media hits

Windsor Star

It is deeply troubling that Mayor Drew Dilkens and 12 other Ontario “Big City Mayors” have embraced Premier Doug Ford’s suggestion to invoke the notwithstanding clause to dismantle homeless encampments and impose involuntary treatment for individuals struggling with substance use disorder.

CBC Power & Politics

The Registered Nurses' Association of Ontario is calling the province’s move to ban supervised drug consumption sites near schools and child-care centres “a death sentence for people that use substances.” The new rules will force more than half of the supervised injection sites in Ontario to either transition into treatment centres or close down.

Brockville Recorder & Times

The crosses lining the ground may have caught some by surprise, but to Andrea Keller they were all too sadly familiar. The Kingston resident was among the members of the public attending a Community Forum at Armagh Sifton Price Park bringing together agencies dealing with mental illness and addictions.

CBC News

Ontario has banned supervised drug consumption sites within 200 metres of schools and child-care centres. Ten facilities across the province will be forced to stop providing safe consumption services by March 2025, and they will be given the option to transition into "treatment hubs."

The Hamilton Spectator

The operator of a supervised drug-consumption service facing closure in downtown Hamilton says it’s “well positioned” to take on a new hub model the province plans to roll out to tackle homelessness and addiction. Hamilton Urban Core Community Health Centre must close its consumption and treatment services (CTS) site at St. Paul’s Presbyterian Church by next March under new provincial restrictions.

QP Briefing

Health Minister Sylvia Jones on Tuesday announced new restrictions that will lead to the closure of 10 supervised consumption sites across Ontario. As first reported by the Toronto Sun, the province is planning on closing sites that are located within 200 metres of schools or childcare centres. The Ford government on Tuesday confirmed that the change will see sites in Ottawa, Guelph, Hamilton, Thunder Bay, Kitchener and Toronto close by March 31, 2025.

CP24

Ontario is banning consumption and treatment services sites within 200 metres of schools and child care centres, which will lead to the closure of 10 facilities.

CBC News

Advocates and people who use drugs are demanding the Ontario government step up its support for supervised consumption sites, which they say must go hand in hand with treatment programs.