As Ontario restricts supervised consumption, can 'HART Hubs' fill the gap?

Ontario's decision to ban supervised drug consumption sites near schools and child-care centres came with a commitment to fund a different approach.

The province is calling them Homelessness and Addiction Recovery Treatment (HART) Hubs, a new acronym that's nonetheless modelled on examples that already exist in Ontario. 

Last week, when Health Minister Sylvia Jones announced $378 million to support 19 of the hubs across the province, she singled out London, Ont. On Monday, Premier Doug Ford commended that city's Mayor Josh Morgan as a pioneer for bringing the idea to reality.

In an interview with CBC News, Morgan said London has been building out the model for more than a year and now has two hubs. 

"What we've designed is an integrated approach that brings different models of care together under the same roof," he said.

Morgan said the hubs have a "more intense" level of service and lower staff ratios than homeless shelters, with the ultimate goal of getting people into stable housing. 

Though they do not provide residential addictions treatment on site, he said the hubs offer "pathways" to recovery through counselling and referrals.

He said the lack of provincial operating funds has always been a "limiting factor" with the model — until now.

"We have access to some capital here, but without health-care-related provincial operating dollars it is very difficult to bring these things to fruition," Morgan said.

Model could work anywhere, says hub operator

The Ministry of Health said the hubs will reflect community needs and could offer shelter beds, addiction care, primary care, supportive housing, employment support and more. It said more detail will come through a request for proposals, expected later this month.

In addition to London, the ministry provided four examples of existing hubs: the House of Friendship in Kitchener-Waterloo, Kingston's Integrated Care Hub, Mission United in Oshawa and Youth Wellness Hubs located across the province.

Nathan Gardner is executive director of Oshawa's Back Door Mission, which runs Mission United along with Durham's chapter of the Canadian Mental Health Association. He said the fundamentals of the model — low-barrier access based on partnerships and a continuum of care — can work just about anywhere.

He called Mission United an "integrated care hub" that offers everything from housing outreach to crisis intervention. It also caters to such basic needs as meals and showers. 

Its addiction services include withdrawal management plans and almost daily access to addictions physicians, though not on-site residential treatment. Mission United also offers a needle supply program.

Gardner explained the decision to offer harm reduction services in simple terms: "It's a better health outcome for our clients."

Investment in residential treatment would fill vital need

In her announcement, Jones said HART Hubs won't offer supervised consumption services, safer drug supply or needle exchange programs. Needle return or collection "may be considered," according to the news release.

The province says HART Hubs will add 375 supportive housing units, but also addiction recovery and treatment beds that many say are in desperately short supply. 

Gardner said it can sometimes take months to get clients into addictions treatment. Addiction experts who spoke to CBC agreed: wait lists for addiction treatment programs in Ontario are unacceptably long.

Mike Souilliere, director of patient care services for the substance use and concurrent disorders program at the Royal Ottawa Mental Health Centre, said it can take days or weeks to get someone into a short-term treatment bed. It can take weeks or months to find longer-term residential treatment. 

"It's very difficult, because when someone gets that motivation to make those changes, if there's not a space for them to go, that motivation wanes," he said.

"If this hub creates more space... I think that's great," he added. "How that rolls out, I'll wait to see."

Soulliere questioned why the money has to come with a restriction against supervised consumption services or needle supply. In his view, harm reduction programs can support patients until they're ready for treatment, and then help them take that step.

"What you're doing when you put those constraints, you eliminate people that aren't at that point," he said.

Province creating 'false dichotomy,' say experts

Dan Werb, chair in mental health and substance use disorders at Saint Michael's Hospital and the University of Toronto, said the provincial investment in HART Hubs is positive in itself, though late in coming. In his view, though, it makes little sense to close 10 supervised injection sites at the same time.

He said the kind of patients HART Hubs aim to help are exceptionally difficult to reach. The best way to connect with them, he said, is through harm reduction.

"On the one hand you're making this massive investment, and then on the other hand you're shutting down the best gateway that you have to get people connected with that system," Werb said. "It's like investing in a brand new, state-of-the-art hospital and then not putting in doors."

Carole Sinclair, interim executive director of Ottawa's Rideauwood Addiction and Family Services, said the province is creating a false dichotomy between treatment and harm reduction.

"It gives the impression that these two types of care are mutually exclusive, or that it's one against the other," she said. "And that couldn't be further from the truth."