What is mental health case management?

Case management services provide intensive long-term support for individuals living with severe and persistent mental illness – some of whom may be homeless or at risk of homelessness. They may have a concurrent disorder (mental health diagnosis and problematic substance use), be in conflict with the criminal justice system, or incur frequent hospitalizations as a result of their mental illness.

Community support workers and clients work together to develop goals and a plan for these individuals with the intent of eventually transitioning out of mental health services. Approximately 1,100 clients receive case management services through the Mental Health Community Support Services (MHCSS) collaborative.

What services do we provide?

Our case management philosophy:

  • Client centered care
  • Family focused
  • Holistic
  • Tailor-made services

Who we serve:

Individuals with a severe and persistent mental illness where the illness is causing significant disruption to functioning i.e.) homeless, or at risk of being homeless, frequent hospitalization, etc.

  • 81 clients 
  • Youth aged 16-24
  • Adults


We annually receive $498,000 of core funding from the Ministry of Health and the Champlain Local Health Integration Network.

Our Youth Program and our Value Added Services (see below) are not covered under our core funding.

What makes our services unique?

Upstream Ottawa provides numerous added value services to our clients that are not provided at other mental health agencies. None of these services are funded – because of generous donors, we are able to continue to provide these services to clients.

This program was developed by women for women. It helps to promote camaraderie, recovery and healthy lifestyles. 

We are the only mental health agency that provides housing supports with newly acquired furnishing.

We currently manage 12 1-bedroom furnished apartments and 2 group living units.

This is a monthly luncheon for our clients that provides a safe environment, that promotes recovery through social networking and recreational/educational activities. We operate this monthly luncheon in conjunction with the Canadian Mental Health Association Ottawa Branch and the First United Church in Westboro.

Clients who are actively engaged in educational or vocational pursuits may apply for funding to support various informational and technological needs

For example, a client who is going back to school may apply for a laptop and internet access OR a client who is re-entering the workplace may apply for a computer in order to help access the job market, apply for positions and keep their IT skills up to date

We try to make these outings inclusive for all our clients as much as possible. An example would be a movie night with popcorn. This provides a social and interactive experience for the clients to help aid their progress towards recovery.

Upstream Psychiatric Assessment Clinic

Our clinic offers a psychiatric assessment service and helps to cut down on wait times to access to mental health services in our community.
That means faster access to support when help is most needed.

The Upstream Psychiatric Assessment Clinic (UPAC) provides indirect psychiatric assessment consultation to referring physicians and appropriate agencies.  This service is provided under contract by Dr. Raj Bhatla, Chief of Psychiatry, of the Royal Ottawa Health Care Group, in addition to a team of youth and adult psychiatrists. For the purpose of the UPAC, the psychiatrists’ scope is limited to participation in case conferences and client-centered consultation.

Referrals must be made by, or in consultation with, a primary care physician as the clinic does not have follow-up capacity.  The UPAC operates with Sessional Funding made available through the Champlain Local Health Integration Network and the Ministry of Health and Long Term Care.

Review our Assessment Clinic Check List here

Download the Assessment Clinic Referral Form

What is Sessional Funding?

Sessional funding accommodates a variety of “indirect” psychiatric services provided by psychiatrists and general practitioners which are not covered as: insured physician services or components of insured physician services; global hospital budgets; or where no other sources of funding have been identified.  Indirect services are divided into seven general areas: participation in case conferences, client-centered consultation, staff-centered consultation, program-centered consultation, program direction, provision of educational services and system coordination.

Many thanks to my wonderful worker and other staff. I honestly don’t know where I would be now without these services. I hope to see Upstream flourish and continue to be in the community for a long time.


Accessing our services

To apply for case management services from Upstream, or any other Mental Health Community Support Service partner agency in Ottawa, an application form must be submitted to the Mental Health Community Support Services (MHCSS) via the Canadian Mental Health Association – Ottawa Branch.

Download an application form

For more information about this centralized access portal please contact:

Canadian Mental Health Association
Ottawa Branch, Intake and Assessment Worker
300-1355 Bank Street
Ottawa, ON K1H 8K7

T: (613) 737-7791
F: (613) 737-7644

Please note that we only accept referrals from the central access portal, as indicated above, and are unable to take referrals directly. Additionally, our housing supports are only accessible through our Mental Health Case Management program.

We would be happy to answer any questions you may have about our programs. Please contact us at:

T: (613) 248-3329 ext 401

Referrals arrive via the Mental Health Services Portal. These include but are not limited to:

  • Hospitals
  • Community care access centres
  • Family physicians
  • Family members
  • Self referrals

Other helpful resources