From Crisis to Community
Community mental health alliance reduces hospital burden
Emergency departments across Ontario are overwhelmed. Psychiatric beds remain full. Individuals with severe mental illness cycle through crisis services, caught in a revolving door of hospitalization, homelessness, and emergency intervention. The human cost is devastating. The financial burden on the healthcare system is unsustainable.
But evidence-based, collaborative care, and integrated community support can dramatically reduce reliance on hospitals while improving lives. Summit Housing and Outreach Programs' Assertive Community Treatment (ACT) Team serves as a powerful example of what alliance collaboration makes possible: a 30-40% reduction in emergency room visits, 40-50% fewer hospital admissions, and over 80% housing stability after one year.
These aren't aspirational targets. These are documented outcomes achieved through a model that prioritizes coordination over silos, expertise over duplication, and sustained relationships over short-term interventions.
When Traditional Outpatient Care Isn't Enough
For individuals living with persistent mental health challenges—schizophrenia, schizoaffective disorder, bipolar disorder, major depression—traditional outpatient mental health services often fall short. Attending appointments at a clinic requires stability that many simply don't have. Managing daily activities like meals, budgeting, medication, and safe housing becomes impossible without intensive support.
The result? Repeated hospitalizations. Frequent emergency department visits. Homelessness or precarious housing. Involvement with the justice system.
The fragmented nature of healthcare exacerbates these challenges. A person might see a psychiatrist at one location, access addictions support elsewhere, and struggle to find stable housing through yet another system—assuming they can navigate referral processes, waitlists, and eligibility criteria while managing acute mental health symptoms.
This fragmentation doesn't just fail individuals. It places enormous pressure on emergency departments, acute care beds, and crisis services that were never designed to serve as ongoing mental health supports. The costs accumulate across the system while outcomes remain poor.
Holistic Care Through Strategic Collaboration
The Mental Health +Addictions Alliance operates on the principle that complex needs require coordinated expertise, not competing services. As a member of this Alliance, Summit's ACT Team exemplifies this philosophy in action. The team's multidisciplinary structure—psychiatrist, registered nurses, peer support specialist, addictions specialist, social worker, dual diagnosis specialist, vocational specialist—mirrors the alliance's collaborative approach at an organizational level.
This isn't about agencies working in parallel. It's about intentional integration.
When Summit's ACT Team identifies that a client needs after-hours crisis support, they connect with the Crisis Outreach And Service Team at CMHA Halton. When vocational support exceeds ACT Team capacity, STRIDE's specialized employment team steps in with expertise designed to help individuals with mental health challenges find and maintain meaningful work.
When clients need housing through ADAPT's Alternative Supportive Housing (ASH) program, Summit works collaboratively to secure placements, combining ADAPT's housing resources with Summit's clinical supports.
When Support House's mobile outreach team encounters someone who could benefit from intensive ACT services, they facilitate warm referrals, leveraging established relationships rather than navigating bureaucratic intake processes.
"By knowing who to reach out to and eliminating the bureaucratic approach, we can move mountains," explains Alban Joxhe, Executive Director of Summit Housing and Outreach Programs. "It's about optimizing our resources within the alliance. Sometimes you can do more through smart partnerships than through additional funding alone."
This resource optimization matters immensely. Rather than each agency building capacity in every service area—an approach that leads to duplication, inefficiency, and gaps—alliance members maintain specialized expertise while creating pathways between organizations. The result is more comprehensive care delivered more efficiently.
Measurable Impact: Diverting Crisis, Building Stability
Summit's ACT Team data from Halton Region demonstrates significant reductions in emergency department use and hospitalizations. Clients who previously cycled through crisis services experience a 30-40% reduction in ER visits and 40-50% fewer hospital admissions after enrolling in ACT services. These results align with provincial evidence showing that Ontario ACT teams achieve a 62% reduction in hospital admissions after one year, increasing to 83% after six years of sustained support.
Perhaps more importantly, over 80% of Summit ACT clients maintain stable housing after one year—a stark contrast to the unstable, crisis-driven existence many experienced before accessing services.
These aren't short-term fixes. ACT Team relationships typically span three to four years, with some clients receiving support for 10 to 15 years. This sustained engagement allows for genuine recovery, not just crisis stabilization. Medications are carefully adjusted and monitored. Peer support helps rebuild routines and confidence. Housing specialists ensure clients don't just have shelter, but homes they can maintain. Vocational specialists support employment goals that seemed impossible during acute crisis.
The diversion implications are substantial. Provincial data from 2005-06 showed that 2,412 of 4,048 ACT clients across Ontario had zero hospital admissions — demonstrating large-scale success in stabilizing individuals who previously relied heavily on inpatient psychiatric care. Multiple cost-effectiveness analyses confirm that ACT services either save money or operate at cost-neutral levels despite providing intensive supports, making them a high-value investment for the healthcare system.
This directly supports Ontario's operational priorities for 2025, which emphasize keeping people in their homes and communities, reducing Alternate Level of Care (ALC) pressures, and diverting low-acuity emergency department visits. Summit's ACT Team, enabled by alliance collaboration, delivers precisely the connected community care that provincial strategy calls for.
A Journey from Crisis to Stability
The data tells one story. Mark's experience tells another—one that illustrates what those statistics mean in human terms.
When Mark first connected with Summit's ACT Team, he was trapped in a relentless cycle. Multiple emergency department visits. Housing on the verge of collapse. Unable to manage meals, budgeting, or medication consistently. Previous outpatient services hadn't worked, and Mark struggled to attend appointments or engage in traditional clinic settings.
The ACT Team met him where he was—literally. Mobile outreach brought psychiatric care, nursing support, medication management, and peer connection directly to Mark's home and community. The team's psychiatrist provided consistent follow-ups and crisis intervention, adjusting medications and monitoring closely. Nursing staff offered health assessments, injections, and coaching. The housing specialist worked to secure stable accommodation, something Mark hadn't achieved in years.
Within months, Mark's hospital admissions dropped dramatically. He maintained stable housing. He joined a wellness programme at Summit's Milton location. He began setting personal goals—employment, reconnecting with family—milestones that had seemed impossibly distant during the crisis cycle.
Today, Mark's life reflects what integrated community mental health collaboration achieves: fewer hospital visits, stronger community integration, safe housing, and hope built on recovery rather than crisis management.
The Alliance Advantage: Why Collaboration Outperforms
The MH+A Alliance’s structure ensures member agencies maintain distinct identities while operating as coordinated partners.
"Creating this 'Amazon Prime approach' for human beings isn't successful in the long term," Joxhe notes. "What works is maintaining specialized expertise while building the connections that eliminate silos."
Each Alliance member brings unique strengths: supportive housing, mobile outreach, crisis management, clinical care, peer support, addictions treatment and recovery, employment. The Alliance model preserves this expertise while creating pathways between them.
The benefits extend beyond service delivery. Alliance members share lessons learned and develop shared training to build consistent capacity across agencies. They present a unified voice for advocacy—stronger together when addressing funding bodies, policymakers, and community stakeholders.
"Mental health and addictions support isn't a warm and fuzzy cause," Joxhe acknowledges. "But I’d argue it makes the biggest impact in terms of overall community wellness. When we speak as an Alliance, that voice carries more weight than any of us could achieve individually."
Sources:
Summit Housing and Outreach Programs ACT Team data, Halton Region (2024-2025)
Ontario Association of ACT and Early Intervention Services
"Implementing and Evaluating an ACT-like Model in a Canadian Context," Psychiatric Services (2005)
Ontario Health operational priorities (2025)