Leonard Reece used to know where to send his most desperate cases.

As a dedicated youth advocate, the 47-year-old is often contacted by young, black kids in crisis, many of whom are struggling with addiction or mental health: The sexually-abused teenager; The boy whose mother abandoned him in Canada; The girl who needed a ride at 3 a.m. because her stepfather had just tried to rape her.

These are among the many kids Reece has sent over the years to the Centre for Addiction and Mental Health (CAMH), which runs the province’s only publicly-funded clinical program aimed at helping black youth with mental health and substance abuse issues.

The program is called SAPACCY — the Substance Abuse Program for African Canadian and Caribbean Youth — and it was once the only service Reece trusted with helping these kids.

Nowadays, however, he refuses to send them there.

“I was one of the strongest advocates of SAPACCY back in the day,” said Reece, founder of the Young Advocates Youth Organization.

“But I would not send anybody there right now. Nobody.”

Reece isn’t alone in his dismay over the current state of SAPACCY, the tiny program at the heart of a growing dispute over how Canada’s largest mental health institution should be serving black communities.

On one side is a community coalition that says CAMH has allowed an important program to wither and is exhibiting “anti-black racism and poor leadership” in the face of escalating mental health issues within black communities. On the other is a renowned research hospital serving multiple populations, which says it wants to work with communities to find sustainable, evidence-based solutions — both within CAMH and beyond.

Caught in the middle is a program that has become a crucial lifeline for black youth in crisis. And according to the coalition, CAMH has allowed that lifeline to fray to the point of snapping.

Two decades ago, SAPACCY was a small but robust program: it had six employees, a strong community presence, and an advisory council that met with CAMH once a month, according to the coalition, which includes the African Canadian Legal Clinic and Tabono Institute.

Today, the advisory group is gone, the program has no formal presence in the community, and staff levels have withered to just two social workers, one of whom was only hired in March. The program’s Africentric framework has also eroded under CAMH’s watch, according to coalition member Nene Kwasi Kafele, founder of the Tabono Institute, a non-profit that advocates for African Canadians.

But SAPACCY is just a symptom of a larger problem around systemic racism, says Kafele, who served as CAMH’s director of health equity for 11 years.

He asks: Why hasn’t funding for this black youth program been increased in 20 years? Where is CAMH’s strategy for addressing the escalating needs of black populations?

And why, in Canada’s most diverse city, does CAMH only have a single black person on its 16-person board of trustees?

“In 2017, this ought to be inexcusable. Inexcusable that the largest mental health and addiction facility has no clear commitment to the black community, which is the most vulnerable in the province (other than the) aboriginal people when it comes to these issues,” Kafele said. “They have no clear commitment, no clear plan, nothing they can clearly articulate. That is a disgrace and an embarrassment.”

When asked about accusations of anti-black racism and poor leadership, hospital spokesperson Sean O’Malley said in a statement that CAMH agrees African and Caribbean communities have been underserved when it comes to mental health supports. “Addressing this problem will demand a broad-based, systemic approach to very complex issues,” he wrote.

He added that hospital officials, including the president and CEO, have been meeting with community representatives since last June and “corresponding with them extensively.”

“CAMH recognizes the serious nature of the issue and the urgency to address it and has committed to work with the community on sustainable solutions,” he wrote.

Dr. Kwame McKenzie, CAMH’s current director of health equity, also disputes that SAPACCY has been diminished. McKenzie, who is also CEO of the Wellesley Institute, is an international expert on the social causes of mental illness and equitable health systems.

In 2015, SAPACCY — once a standalone program with its own intake processes — was folded into the hospital’s broader child and youth service. The change was part of a hospital-wide shakeup meant to break down silos, he said.

For SAPACCY clients, this was also meant to improve their access to the full menu of services available at CAMH, McKenzie says.

He believes the plan has worked. “SAPACCY is seeing more people than ever,” he said, pointing to CAMH figures that show the program’s clientele more than doubling from 76 in 2015 to 164 last year.

McKenzie says he is part of the African Canadian community and recognizes the enormous and complex challenges faced by black populations when it comes to mental health. He says CAMH is undertaking work to find evidence-based solutions for improving care, including culturally-adapted cognitive behavioural therapy for people of African and Caribbean origin.

But McKenzie emphasizes the solution needs to be more than just SAPACCY, and they need to happen beyond CAMH’s walls. Best practices today indicate that people need to be treated closer to their homes, with only the most extreme cases ending up in hospitals like CAMH, he said.

“I really think that we need to be thinking a lot bigger than SAPACCY,” he said. “There’s a whole system out there that needs to be involved in producing better care and at CAMH, we’re not able to sort out all of these problems by itself. It’s just not possible to work that way.”

The coalition wholeheartedly agrees that the societal problems are massive. Black people are over-represented in jails, welfare programs and children’s aid systems, while facing barriers to good health care, employment and education — all social factors known to increase the risk of mental health and addiction problems.

Studies — including those done by CAMH researchers — have also revealed barriers to accessing care. In a 2015 study led by McKenzie, researchers looked at 171 patients with psychosis in Toronto and Hamilton and how long it took for them to access treatment. For black Caribbeans, the median was 16 months; for white Europeans, it was only seven.

But SAPACCY was created in the first place to try to make a dent in the face of such massive issues, said Ginelle Skerritt, who sat on SAPACCY’s community advisory council before it was dismantled in the mid-2000s.

It was a new tool in a nearly-empty toolbox — and now, Skerritt feels, it’s been taken away.

“Nobody is saying solve anti-black racism for the community,” Skerritt said. “We’re saying when it comes to mental health, can we create a little program that specifically addresses the needs of this community? And the answer has been ‘yes’ for X number of years, and all of a sudden now it’s ‘Oh well, that’s not possible.’”

Skerritt points out that SAPACCY only exists in the first place because of community advocacy.

In the mid-’90s, grassroots organizations lobbied for a program to address rising addictions amongst black youth, said Margaret Parsons with the African Canadian Legal Clinic. The result was a small community-based program funded by the province, which was absorbed into CAMH in 1999.

What made the program unique was its Africentric approach — the provision of mental health and addiction services using an anti-racism lens that centres on African values and experiences.

There is growing evidence that culturally-sensitive approaches to mental health can improve outcomes. A 2016 report by the Mental Health Commission of Canada — which McKenzie co-authored — found that specific culturally-adapted treatments for racialized youth are effective, especially when it comes to substance misuse.

At SAPACCY, an Africentric approach meant including family members in a person’s recovery, meeting clients at their homes and safe spaces, and building links with community. Back in the day, it wasn’t uncommon to see staff playing basketball with black youth or dropping into the African Canadian Legal Clinic to provide counseling, Parsons says.

It also meant black clinicians helping black youth. “When it was strong, it was an amazingly effective program,” said Shannon Ryan, executive director of the Black Coalition for AIDS Prevention. “This Africentric approach really works for these folks — sitting down with another black person, who really understands where you’re coming from.”

But the coalition says the program has withered under CAMH’s watch. While the hospital provides in-kind support, they question why no efforts have been made to expand the program or advocate for more funding; over the last decade, SAPACCY has received less than $290,000 per year, according to figures from the ministry of health and long-term care.

“That’s less than 1 per cent of CAMH’s budget,” Ryan said. “It’s really kind of sad that we’re seeing disinterest from CAMH to maintain and adequately sustain this program.”

The Africentric approach has also been eroded as the program — originally intended as an alternative to mainstream approaches — became mainstreamed.

This is a common pattern with grassroots efforts that get absorbed by large, powerful institutions, said David Lewis-Peart, who worked as a SAPACCY program assistant in 2006.

“There’s almost a whitewashing of — or watering down around — some of the ways in which this program shows up,” said Lewis-Peart, a college lecturer in child and youth care. “And while the intent may be well-meaning, its impact can be really disruptive.”

While SAPACCY’s numbers have more than doubled over the last two years, the coalition is skeptical that this is actually translating to improved or culturally-relevant care, especially since staffing levels have remained unchanged.

Moving the program into a central intake system has also reintroduced a barrier that SAPACCY was supposed to break down. Reece used to call the program office directly, where staff was skilled at understanding the coded language often used by black youth to describe their mental health problems.

Nowadays, kids are getting turned away by CAMH staff who can’t necessarily identify when a young, black person is describing a mental health issue, he said. “African Canadian youth identify mental health differently than the average youth,” he said. “Before I could have called (SAPACCY) directly and said, ‘I have a kid here, I need you to see him now.’ And they would say, ‘Okay, Leo, can he come here tomorrow?’”

Nearly a year after the coalition first sounded the alarm with CAMH, both sides feel they have reached a kind of impasse. McKenzie says the hospital did propose expanding SAPACCY by adding four staff to community-based facilities in the west and east end, but the idea was rejected by the coalition.

“When CAMH came forward with a viable plan of increasing SAPACCY closer to where people needed, they didn’t want it,” he said. “I’d push back and say it’s a little bit unfair.”

But Kafele says the proposal failed to gain support because it was developed unilaterally by CAMH and ignored concerns from coalition members. It would also be pointless to expand without first addressing problems with the hospital program, where the most serious cases will still end up, he added.

“We have no problems with SAPACCY being expanded into the community, but that expansion can’t be an empty shell,” he said. “We say first you build internally and then you build outward.”

McKenzie says CAMH is developing a strategy for people of African and Caribbean origin, but these things take time. He said it would also be good to build an evidence base for SAPACCY— and while the coalition represents “serious players,” there is a need to consult thoroughly with other voices in the community as well, he added.

But these explanations rankle for those who work in anti-racism. The coalition points out that CAMH had 20 years to study the program and find evidence for whether it works or not. Choosing to evaluate the program now — when it’s at its weakest — is “part of the covert way that institutional racism can show up,” said Lewis-Peart.

“You set a situation up that makes it very easy for that individual, person, organization, or service to fail. And then you use their failure as an example of why they shouldn’t exist.”

Dismissing one coalition’s concerns in the name of broader consultation is also “partially how anti-black racism operates,” said Idil Abdillahi, board member with Across Boundaries, the city’s only other provincially-funded mental health and addiction program specifically for racialized communities.

“Whether it’s this coalition alone or 85 black coalitions, we need to take seriously that someone is telling us that something is wrong,” said Abdillahi, who isn’t formally involved with the coalition but supports its efforts. “To say they’re not representative of everybody — well, nobody is representative of everybody. The government isn’t representative of everybody.”

Skerritt said the coalition isn’t against CAMH, which has done excellent work in the mental health space. What they want is for CAMH, a taxpayer-funded institution, to address an obvious need and take black communities into consideration when making decisions that affect them.

“The nature of systemic racism is that it’s sometimes unintentional. It’s not about whether or not someone’s going to call you a racial slur,” she said. “But when you are not considered in a decision that affects you, deeply and greatly, that’s a systemic barrier to access and to control.”

Zachary Khan: ‘They make a big difference’

When Zachary Khan moved to Toronto in Grade 9, he noticed that people started to see him differently.

Back home in Guyana, Khan looked like every other kid; in Toronto, he was one of two black students in his grade.

He could never shake the feeling that his teachers liked him less — Khan was suspended eight times for “tiny things” he says other kids got away with — and when someone he knew was mugged by a black person, Khan was baffled to find himself suddenly accused.

By the end of high school, Khan was struggling with anger issues, depression, marijuana addiction and a brush with the law. His mother worried he was spiraling.

But today, the 26-year-old is studying tourism and hospitality at George Brown College and he feels healthier and more productive than ever before.

He knows exactly who to thank. One is his family; the other is SAPACCY, where staff not only worked with him to overcome his addiction and anger issues, they supported him in court, helped his family members with their own struggles, and provided a space where Khan felt seen and heard.

“I’m going to be more comfortable with someone I can relate to,” he said. “Just the atmosphere, you feel much more comfortable and (with other programs) certain things are just lost in translation.

“My mother couldn’t have dealt with me without SAPACCY. I don’t think anyone in my family would be where they are right now,” he continued. “They make a big difference.”

Tiffany Burton: ‘She has opened my eyes a lot’

Tiffany Burton first realized something was deeply wrong when she noticed that she was always crying. The tears came during many sleepless nights.

She had an unhappy family life as a young child, either holing up in her room or avoiding home altogether. When she started self-harming and attempting suicide, her mother sent her to counseling but it wasn’t always helpful; one of her counselors was a white man, who she felt uncomfortable speaking with candidly, especially about her sexual orientation.

But at SAPACCY, she found help. Burton, now 20, says her social worker, a black woman, helped her dismantle her own stigmatizing of mental health.

“We always have a stereotypical way of saying, ‘Black people don’t need help from therapy. We don’t deal with psychologists,’” Burton said. “She made me look at it in a different perspective.”

The program also focused on culturally-specific issues around body image and self-hatred.

“Sometimes black youth can be racist to other black youth, saying things like, ‘Oh, that girl’s darker than me, she’s not as pretty,’” Burton said.

But Burton says SAPACCY has made the most difference in helping her find her future, connecting her with scholarships and educational opportunities.

“She’s opened up more motivation for me, especially as a black woman going to university,” she said. “She has opened my eyes a lot.”