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Andrew MacFarlane is bridging gaps for vulnerable clients

Andrew MacFarlane, the Provincial Executive Director for both the Regional Forensic Clinics and Correctional Health Services (CHS), knows the importance of supporting clients when they are most vulnerable.
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Having spent the last 25 years working with people with mental health and substance use issues, including people facing multiple health issues in Vancouver's Downtown Eastside, he's seen first-hand how vital it is to improve access to care for clients, and particularly, for those clients who've had contact with the correctional system.

"Before joining PHSA two years ago, I had felt for many years that there were gaps in the system and that, as a province and as a health care system, we should be doing more to support clients to safely transition from correctional settings back into community care," said Andrew.

"That's why, when the opportunity for me to take on this role supporting the 10 provincial correctional centres came up, I jumped at the opportunity. The correctional health team works every day to improve both the quality of care both in the corrections system and for those transitioning back into the community, which is an incredibly vulnerable time for many clients."

CHS has been part of the BC Mental Health & Substance Use Services since October 2017, making B.C. one of the first provinces in Canada to move responsibility for correctional health from a ministry of justice to a ministry of health, something recommended by the College of Family Physicians of Canada and the World Health Organization.

Complex client needs

Due to the nature of the client population in the correctional, forensic, or criminal justice settings – it might be easy for some to be more punitive in their thoughts toward clients, but Andrew's strength is in showing great compassion for clients regardless of any contact with the criminal justice system.

"Clients in corrections, or those involved in other parts of the criminal justice system, often have complex health needs involving mental health, substance use, primary care, and chronic disease management, histories of trauma, and simultaneously face multiple barriers to access to services, not just health care" said Andrew.

"Many people might not realize that clients aren't always in the provincial correctional system for very long, which is why it is integral for our teams to not only provide support while they're with us, but to also support them through the transition period as they move back into the community. If that doesn't happen, they may be met with the same barriers to access that they faced before they came into one of the correctional centres"

The statistics around this population can be startling, for example, people with opioid-use disorder are as much as 12 times more likely to die of a drug overdose shortly after release from a correctional facility – highlighting the need for timely access to substance use services.

Transitioning back into communities

To help bridge this gap for vulnerable clients, Andrew and his team developed an innovative new program this year to help clients connect with the mental health and substance use support services in their home communities. The Community Transition Team project aims to change lives by preventing overdose and helping clients get on a healthier path through connecting them with peers with lived experience of addiction. These peers would work with clients post release to help with connect with a community physician, fill prescriptions and access other recovery supports, including mental health services. This is the first time that correctional health has built peers into communities of care and is supported by working alongside the Forensic Clinic Teams, regional health authorities, First Nations Health Authority and other partners involved with community system of care.

"As we know, care for our clients can't stop when they leave correctional centres," Andrew said. "We also know that there's great evidence that says peers can be an integral part of building trusting relationships with people who use substances. Our social workers can help clients navigate the system, and our community peers bring lived experience with substance use and the criminal justice system. A peer can say, 'I've been where you are, I understand what it is like to face those challenges, I found a way through, and so can you.' That's very powerful."  

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