Geriatric Mental Health Outreach Program
Serving Halton & Northwest Mississauga

A unique and innovative program designed to provide specialized service to older adults with complex mental health needs.

Crisis Support

If you are in a mental health crisis, please contact crisis services in your area.

    Halton Crisis Outreach and Support Team (COAST)
  • Halton Crisis Line 24 hours: 1-877-825-9011 or for more information visit their website
    Mobile Crisis Peel/COAST Peel Crisis Line 24 hours: 905-278-9036 or for more information visit their website.
  • For all other emergencies call 911 or go to your nearest hospital emergency department.


Answers to your most asked questions

Do I need a doctor's referral?

Yes. We work in partnership with family physicians in a 'shared-care' model of service. All referrals need the approval of the family physician (primary care provider). Under the 'shared-care' model, we make treatment recommendations to the family physician to consider and implement.

What does outreach mean?

Outreach means that we come to your home, whether in the community, retirement home or long term care, to do the assessments and follow up visits. Outreach services are for those high risk seniors who cannot (e.g. poor physical health, limited mobility, at risk for falls, limited or no family support etc.) or will not seek traditional or office-based services (e.g. senior may be very reluctant and lack insight into their problems due to illness).

Outreach also includes providing education on seniors' mental health, addiction and/or behavioural issues to caregivers, healthcare providers and family members. Seniors with mental health difficulties often benefit greatly when they, their family members, caregivers and/or healthcare providers are well-informed about mental health and available services, treatments and supports.

How long will I be seen?

We are considered short term case management however length in the program is based on individual need. The average length of involvement with our program is approximately 8-9 months. Once the client has been assessed by the case manager and program physician and treatment recommendations are made to the family physician, the client will be supported and monitored by our program until stabilized.

What is the difference between you and CCAC?

CCAC (Community Care Access Centre) completes assessments for a person's need for:

We have a strong partnership with CCAC case managers and their contracted agencies and work together to serve and support seniors and their families residing in the community or in Long Term care Homes. The geriatric mental health outreach program does specialized geriatric psychiatry assessments to help others better understand the presenting mental health, addiction or behavioural problems and makes recommendations for treatment, management strategies, community services and/or supports that may improve the situation. We often will link seniors and their families to the services coordinated by CCAC.

For more information about CCAC:

What happens when a referral is made?

Once a referral is made, we will try to complete a telephone risk screen within 2 working days of receiving the referral. Based on risk and safety issues and current supports, referrals are prioritized to be seen by a case manager for the initial assessment. The program physician will do a further assessment and make treatment recommendations to the family physician to consider and implement. The client and their family/caregivers will be supported and followed on our program until stabilized and then discharged. Please refer to our services for more information on our program's services.

How do I get my family member to agree to your program? They won't let any service in or go to their family physician and don't think anything is wrong.

We do need client consent however being an outreach team we do recognize that there are times a high risk senior may be reluctant to receive help and/or lack insight into their problems due to their illness. We work in non-threatening, creative and supportive ways to try and establish rapport and relationship with the senior. Support from the family physician, family or existing community programs can help to bridge the way for our program to become involved.

It is important that referral services make efforts to inform the client and the family of the concerns triggering the referral and the role they hope the outreach team can play.

How long will I wait for service?

Waiting for service is based on need and priority. We receive approximately 80-100 referrals per month for seniors residing in community and/or long term care homes. Within 2 working days of receiving the referral, we try to complete an initial telephone risk screen to determine the nature of the presenting problem, program eligibility and prioritize a service response based on safety and risk factors and current supports. We are not a crisis service but referrals defined as being of an urgent nature could be seen within two weeks of the completed screen.

Who do I call if there is a mental health crisis?

Crisis response services provide individuals with timely access to a variety of crisis service options such as:

These services reduce avoidable emergency department visits, unnecessary hospitalization and improve quality of life for individuals experiencing a mental health crisis through symptom relief and access to on-going support to prevent future crises.

If you feel there is a mental health crisis, please contact:

Halton COAST
Telephone: 1-877-825-9011

Telephone: 905-278-9036

What are you going to do about the behaviours?

Our case managers and Psychogeriatric Resource Consultants work with care partners to clinically screen and observe behaviours to understand, assess and collaborate to share solution finding. We understand behaviour as a means of communication and will try to get a sense "from whose perspective" is the behaviour a problem. Behaviours are assessed systematically in the context of the 'whole person'. We will refer to and resource the P.I.E.C.E.S. framework or approach to help guide the assessment and provide a shared understanding of the often multiple causes and associated risks so that care planning recognizes areas of need and builds on the person's remaining strengths. The P.I.E.C.E.S. holistic approach provides an understanding of the meaning behind a person's behaviour which comes from considering the person's; Physical, Emotional, and Intellectual health, supportive strategies to maximize Capabilities, the individual's social and physical Environment, and his/her Social self (cultural, spiritual, Life Story).

More information about P.I.E.C.E.S. can be found at:

What are some common behaviour interventions?

Behaviour interventions are developed unique to each person's needs, abilities, limitations, and background. Interventions are varied so that staff and families have options to choose from. The same strategy will not always be effective. Behavioural interventions look at what the person, their environment, family, staff and the community can offer. The underlying causes of the behaviour and the associated risks will contribute to what therapeutic approaches, both non-pharmacological and pharmacological, are suggested to best address the person's needs.

The local Alzheimer Society Chapters of Peel and Hamilton and Halton provide individual counseling, educational groups and a wide range written and audio-visual resources to help seniors, families and service providers better understand, manage and cope with common behaviours associated with dementia.

Peel Alzheimer Society:
Alzheimer Society of Hamilton and Halton: