Photos by HSIMS Recycling bottles at Mill Lane.

By Sharon Gray
One of the important ways that the Faculty of Medicine meets the health needs of the community is through the Health Research Unit (HRU). A project nearing completion is a report evaluating the outcomes and cost effectiveness of the Waterford Foundation’s Mill Lane Enterprises program, and the report’s recommendations may have important implications for the program’s expansion.

Mill Lane Enterprises and the Ever Green Recycling programs began in 1991 in downtown St. John’s to provide work opportunities for mental health clients, and help them adapt to the community. To find out how effective the program is, HRU researchers Ann Ryan and Linda Longerich organized a survey of people working at Mill Lane and people waiting to be hired, and followed this up with focus groups on specific issues.

Ms. Longerich said the study found Mill Lane employment led to better mental health outcomes. “Participants scored higher for general positive well-being while those on the wait list showed more severe levels of distress and depression."

The Mill Lane program also results in health care cost savings.

“We found that the clients of the program had significantly less utilization of health care including things like hospital visits, hospital stays and visits to emergency rooms,” said Ms. Ryan. “We speculate that this is because Mill Lane provides a supportive environment – people in the program are productive and have less time to think about their illness. We also found that Mill Lane clients tend to use case managers and social workers more than wait list people.

“What we believe is happening is that they, unlike the wait list people, know or are directed – by staff and other clients – to these intermediaries when stressful issues or events are bothering them, thus preventing overuse of doctors and hospitals.”

Added Ms. Longerich, “Another difference between the two groups is that people participating in the program enjoy more socialization. And it’s a big plus that the work they are doing is valued by the community; it’s not just busy work.”

Mill Lane employs about 140 people and there are usually about 40 people waiting to get into the program. The waiting time can be a year or more – people tend to stay in the program, and those interviewed in the HRU study had been at Mill Lane for at least two years.

Interviews with the Mill Lane clients and the wait list clients were done face to face by trained interviewers, and followed by in-depth discussion of some issues through focus groups. Interviews were also done with “graduates” of Mill Lane, — people who had worked there and then gone on to find jobs in the community.

“One of the major issues that came out is that right now Mill Lane doesn’t have a way to transition people into the community. There should be resources available to help clients with resumés and provide support even after they are in a community job,” said Ms. Ryan.

There is an international program called Clubhouse, a place where people who have had mental illness come to rebuild their lives. Clubhouse members work there, and receive help in securing housing, advancing their education, obtaining good psychiatric and medical care and maintaining government benefits.

“The Clubhouse model came up many time during our discussions,” said Ms. Ryan. “It is a successful worldwide model. There are three on Prince Edward Island and there is no reason the model wouldn’t work here. It’s a way to pool resources that are now scattered through the community and provide 24 hour-a-day support.”

Ms. Longerich noted that one of the main difficulties of transition to a community job is financial. Employees at Mill Lane are funded through social assistance and the Waterford Foundation and receive coverage for their medication, which can be very expensive. “There’s no way a person with those medical costs can survive on minimum wage.”

Although not directly related to the services of Mill Lane, the issue of housing was frequently brought up in the interviews as a major problem. “Housing is totally inadequate – hard to find, not affordable and often unhealthy and even dangerous,” said Ms. Ryan.

The next step in the HRU evaluation of the Mill Lane program will be to put some dollar figures on what the program saves the health care system. By coming up with an estimate of the utilization of health care by clients of Mill Lane compared to those on the wait list, the report will provide financial incentive for government to consider expanding the program.

The Mill Lane program and its evaluation recently attracted the attention of Global TV. An interview featuring Ms. Ryan and Ms. Longerich and Mill Lane will be aired this fall on the show Body and Health.