Foundry With Dr. Steve Mathias, Executive Director

Foundry is more than just revolutionizing mental health care for young people. It’s about creating hope, building resilience, and transforming communities, one heart at a time. In this episode, we have Dr. Steve Mathias, Executive Director of Foundry, to share the story and mission of their organization. He shares the pioneering work of Foundry, a groundbreaking initiative in British Columbia that revolutionizes mental health care for young people. Dr. Mathias reveals it all, from its beginnings and hardships to its triumphs and direction. He also shares his sources of guidance—trustworthy colleagues and a network extending beyond the medical community. Tune in now and learn how Foundry is changing lives.

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Foundry With Dr. Steve Mathias, Executive Director

In this episode, we have Dr. Steve Mathias, Co-Executive Director of Foundry BC. In my conversation with Steve, he shares the magic of an organization that is expanded rapidly to meet the mental health needs of youth across the province of British Columbia, working with community service leaders in different communities to expand the reach of mental health services and transform the way those services are delivered a young people. If you are interested in youth mental health or in what it takes to scale an effective social profit organization, you are going to love this conversation with Dr. Steve Mathias.

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Steve, welcome.

Thanks. It’s great to be on the show.

Steve, we have been looking forward to this conversation for a while in our work here at the show. We work with a number of organizations that partner with Foundry and who are a part of the important work that you do. For the small percentage of our audience and it’s probably vanishingly small that don’t know about your organization, can you tell us a little bit about what Foundry is, who it serves, and your mission?

Foundry is a provincial initiative supported by the BC Government as well as donors from across the province and nonprofit community-based organizations and health authorities. The idea is to create spaces in as many communities as we can where young people can come and access health and social services in a frictionless way.

The reason for this quite honestly, as most folks know that young people have struggled with mental health for a long time in fairly large numbers. We know for instance, that 1 in 4 young people in any given year will struggle with mental health. Often mood and anxiety, but sometimes more serious with substances or with psychosis.

What we found as service providers and I count myself as one as a psychiatrist was that young people and their families were struggling to figure out where to go when they needed help. When you think about it, communities have been set up in ways that make things a little bit more complicated than they need to. We often have community organizations or various services provided by the government or government surrogates that silo the services that folks access.

You might have to go to one door for mental health. Another door for substance and employment. We decided to try to bring all those together in one space. If a young person is coming in for employment, but their challenge and seeking employment or accessing employment is mental health then the ability to get help for that concern is in the same space.

We started this project in 2015 as a program of Providence Health Care. We opened the first Foundry Center on Granville Street in 2015. Since then, we have opened up fifteen centers. On our docket, we have another nineteen that we need to open by 2026-2027. That’s exciting and it’s the work that we do at Foundry.

It’s an incredibly important work and thinking of it from the perspective of leaders in the social profit sector that may be reading this. That scale the growth. It presents a whole host of challenges in terms of program fidelity, meeting needs, and how you order and prioritize where you open. I assume you have got that all figured out.

We don’t know, but that’s why we are doing this, to be honest. Part of the rationale for what we are doing was that young people and their families were all reporting a very large gap in services. Those services or those gaps were inconsistent, depending on the community you were in. It wasn’t necessarily an urban versus rural-based gap or deficit. It was in several of our urban communities.

We are finding that some youth had access to mental health services and substance use services. Some even had access to family doctors, but very rarely would they have access to all of those services. Through this model, we work with communities to do an environmental scan. Identify where their gaps are or where service providers or not.

 

Through the funding that we provide from the government, the Ministry of Health, and the communities we are able to fill the gaps that they have identified. That allows them some flexibility in the model. It allows us to have services that don’t feel like they need to do everything because then they have a partner that is co-located with them in the space or the center that can do a warm hand over then take on a different service provision.

I would imagine in those conversations with communities the idea of pulling that host of services together seems obvious. There’s probably no one saying, “We don’t need to have mental health care and access to a family doctor and connected.” Everyone agrees. What are some of the barriers that you encounter or your communities encounter? Why isn’t this happening on its own?

Partly because of the way our siloing of services has occurred over the years. If you were to start a community from scratch, you would probably open up a Foundry-like center. You would have all the resources in one space, probably offered by one organization. That would be as if you waved a magic wand and you have a new neighborhood. When you think about the history of our service sector, it’s often based on the needs identified by caring individuals by social workers, physicians, or substance use counselors. They often open up at different times.

We have some communities that years ago didn’t have a substance use counselor in the community. We find that a lot of the services are provided in a need-based way and often by organizations set up to provide that single service. Sometimes you have community agencies that provide multiple services but are often reflective of the grants that they may receive of a donor’s interest but not necessarily always reflecting what the community needs holistically.

Our goal here is to say, “On the main, most of the services a young person needs in the community are available but they are tucked away in different places.” Bringing them together and co-locating them, we need something to catalyze that. We need some funding and that’s where we tap into not only our donors or work with our donors for that but we also work with the government to develop or find significant capital funding to find a space and develop a space for young people.

It also needs an organization that is tapped to lead it. We do that process through an expression of interest in the province. Through that work, we identify lead agencies, typically nonprofit organizations who have been tapped on the shoulder by all the other organizations in the community to lead the process of bringing everyone together, creating a leadership table, creating a center, building out a center, co-design with young people and families then starting to think about how services can be integrated when they are working in that space.

It sounds like one of the valuable pieces that working with Foundry brings to a community is that space and time to think about the provision of services differently. The dedicated people who are doing what they are great at and doing it every day don’t necessarily have time to step back and say, “What needs to be added to this picture?” There’s an unending line of people at the door who need that direct service that they provide.

I do think that ultimately what this will show is greater capacity. Some of the services that we have added to this model that didn’t exist before include the development of peer support. This is probably something that we are most proud of at Foundry is the fact that we have trained young people with lived experience to provide services to other young people coming through the door. These are young people in their early 20s and mid-20s who may have had struggles with their mental health or with substance use overcame those struggles and then received training and now working as navigators in the centers. As well as folks in the community that young people can come to rely on and have conversations with. That was something new and built capacity.

 

Another component of what we have done is added solution-focused brief therapy or walk-in counseling. Single sessions so that young people don’t have to wait months to see someone. If they are struggling with a more significant mental illness or substance use, we invite them back to connect with a clinician or a therapist.

For many young people, they are looking to talk to someone. They are not looking to go to the emergency room and be told that they can come back six months from now to see someone. They are not looking to go to their family doctor and in six minutes, try to say everything they need to say. That’s a service that hasn’t existed and we have included it in our model in Foundry. We are trying to do as much capacity building as possible. That’s one of the things that we are pleased with.

That’s a powerful story and work that you are doing. I want to shift away from the work of Foundry and talk about you. Let’s talk about you. You are the Executive Director. You started as a psychiatrist. You have fellowships and addictions medicine and child and adolescent psychiatry. What led you to psychiatry in the first place?

Probably what drew me to work with young people is the question I would more easily answer. I was a hockey coach from my early days as a teenager then when I came to UBC as a student, I started doing some peer support in the student residences and enjoyed that work. When I applied to medical school, I might have some experiences working with marginalized communities and came to understand that social determinants of health were key issues of trauma in the lives of folks that we are struggling with addiction.

When you think about young people, mental health and substance use are far and away the greatest health obstacles that a young person is going to have when you look at the population in general. They are typically otherwise healthy. If you are trying to work with young people or are interested in working with young people and you want to make a difference and you are a physician, then being a child adolescent psychiatrist makes a lot of sense.

Mental health and substance use are far and away the greatest health obstacles that a young person is going to have. Click To Tweet

In our sector, we talk a lot about how very few people went to the career day in grade three and said, “I went to work in the social profit sector one day. I want to be an executive director one day.” How did your career evolve from being that practicing psychiatrist to executive director at Foundry?

It’s a privilege to wake up every day and have a purpose and have a meaningful role. I’m comfortable being vulnerable here. I started with my fellowships being interested in working with homeless young people. I was lucky to have colleagues at Saint Paul’s Hospital who were interested in supporting homeless youth. This is around the 2007 and 2008 time.

It's an absolute privilege to wake up every day and have purpose and have a really meaningful role. Click To Tweet

We were seeing hundreds of young people who were coming through the doors of Saint Paul’s Hospital in the emergency room being discharged with no follow-up plan. No ability to follow up. This may shock some folks, but it was at a time when if you didn’t have an address, you could not go to a mental health team. You needed an address to be able to get service from a mental health team.

You can imagine how difficult that is if you are a homeless young person. We started a partnership with Covenant House. It was an amazing partnership with Saint Paul’s, then eventually BC Housing, Coast Mental Health, and PCRS. A lot of other nonprofit organizations. We started doing outreach to youth and working with them to house them and start to address all of their social determinants.

At that point in time for me was a relatively new experience. As a psychiatrist, I understood the role of social determinants in health because that wasn’t part of my training. As I started to get it, I also understood that as a medical community, we weren’t partnering enough with our nonprofit sector. We started to see what the power of partnership could look like. I became an advocate for that. I became an advocate for services writ large for young people.

At a time when I had estimated, we needed between $80 million and $100 million from the Ministry of Health to help young people meet the demand when it came to mental health and substance use for young people in this province. We could only identify around $8 million to $10 million in the province that was being spent. There was a huge gap. Through that advocacy work and proposing a Foundry model, government and providence tapped me on the shoulder to lead this initiative back in 2015. I started in an acting role and several years later, I’m still here.

You have done so much advocacy and you talked about the problem so much. They are like, “Steve, you got to solve this now. It’s over you.” You fix it.

It’s a big learning curve. I’m still unlearning in terms of the relationships that we need to have with First Nations communities with urban indigenous young people and organizations. I’m learning a lot about equity, diversity, and inclusion as a White male psychiatrist, which was not part of our training. That’s something that I continue as much as possible every day to learn a little bit more and unlearn as well. Growing a workforce during COVID, with everything that came with it was a big challenge. I find a rewarding part of my career to be in this role.

Having been in the role for several years with such remarkable growth and the challenges you are dealing with in youth, mental health seemingly hasn’t gotten worse certainly over the pandemic period. If you could go back to 2015, what advice would you give to yourself as the newly minted interim executive director of Foundry?

I want to acknowledge that at this point, I am a Co-Executive director at Foundry and my partner in crime is Dr. Karen Tee a psychologist. If I was employee one, she was employee number three when we started Foundry as the BC integrated youth services initiative back in 2015. We have had a lot of thinking about that. It’s difficult to undo what’s happened. Where we are now is so different than how we started. Many of the lessons along the way have made me stronger.

Going back to 2015, at that point in time, we only had three years of funding. This was one-time money. We didn’t know how far we would get with this model. We knew there’d be huge demand. We had no idea how we were going to meet it. There was an urgency to try to get some services up and running and showcase what this looked like on the ground.

There’s a lot of impatience probably for me because of feeling that urgency. I would go back and probably say, “Bare with this. Be patient and see it through but also communicate more clearly what your expectations are. Ensure that people understand what the direction is what’s in the Foundry box and what’s not. Let’s be clear about that early.”

It’s interesting that you say that because the urgency of the issue and the work in 2015 or 2023 requires a loud voice to say, “We need to do better for these kids. We need to do better for these youth.” Patience pays off and so does so does a loud voice at times. How do you balance those two? You seem to be doing the right things.

There are days where I’m not. Those are days where I’m grateful when my team says, “We have got to back off here.” I never thought in my career that the number one risk of death to my three teenage kids would be a fentanyl overdose. Especially not given where the statistics were going on significantly decreasing the risk of substance use harm. Young people using less, drinking less, and smoking less never thought that this is where we would be and where we have been for several years.

There’s a reason why I had to step away from clinical work because I had experienced a lot of trauma from the death of young people whom I was caring for. It’s difficult. You have to be careful when you bring that urgency up because it’s so overwhelming, especially for an organization that’s not necessarily made up of a lot of clinicians.

We have a lot of folks who are filling or working in key areas of our Foundry team who aren’t clinicians and may not have that connection to the work. At the same time, it’s important for us to try to encourage any group working in this area to do iterative work. One of my colleagues has this expression where they say, “Perfect is the enemy of good enough.” I think that’s true and that’s where I’m trying to find that balance of supporting my team to understand that what we might get out the door isn’t going to be what it looks like several years from now, but let’s learn from it and continue to improve. We feel that way more.

You are in such an interesting position in society and the health system. You are an advocate for change and service delivery, and you partner with many people that you listed out earlier in the conversation. As co-executive director, how do you balance that need to be an effective advocate with the reality of delivering service in a very rapidly expanding organization?

Funded by the government.

You are advocating to your funder.

It is a balance. One of our core values is learning and evolving. Also, the work that we do is nuanced and if you try to make this Black and White all the time, you are going to lose and piss off people. In a small town and a community, the size of 5,000 or 7,000, they don’t want the big city people telling them how they need to do their work. It’s critical that you spend a lot of time listening, co-designing, and co-developing your model. We came in saying, “We want to transform access.”

If you try to make this black and white all the time, you're going to lose and you're going to piss off people. Click To Tweet

That’s a pretty significant vision. It’s not like, “We want to do a little bit better.” It’s like, “We want to do it in a way that’s never been done before.” If you are going to do that, you need everybody rowing in the same direction. You need to listen to as many people as you can. What’s exciting for us is that two of our next centers will be led by indigenous-led organizations. That will make a huge difference in terms of our understanding of how we work with each other, with our First Nations partners, and with young people who self-identify as indigenous but also as equity-seeking populations.

We aren’t on a 2 or 3-year journey. We are on a 15 to 20-year journey. When we are looking at our strategy and horizon, we need to know that we are going to take time with this. We will provide better care and better services. For sure, young people will access care and a dramatically different way. As challenges come up, as we fulfill our mission, we need to continue to innovate and understand how we can do things better.

With the growth the organization has seen, I assume there’s a feedback loop as things are better in some communities that you take from what you learned in one location, you can apply to others. Keeping in mind that you are partnering with the people in each community. One of the things I have learned about working across BC is that every community is different, just ask them.

It’s true. Like Homosapien DNA, we are 97% to 98% the same but that 2% to 3% is what sets us apart and makes us different. We embrace those differences because they are so amazing. These are the homes of our clients. These are the homes of the folks or the communities where we are trying to provide better care.

We need to understand the differences and to embrace them. At the same time, recognize that if you are a young person, there’s still probably 85% to 90% of the things you need to flourish are going to be similar to someone who is in a large urban center or setting. We have to keep that in mind. This is why when we first opened Vancouver Granville, Downtown Vancouver had a highly marginalized homeless population.

The second center that we opened was in Campbell River. A much smaller. Historically, a fishing community and a resource-rich community with 5 or 6 indigenous communities surrounding it. A very different community, yet the model works there too. We were clear about what our principles were, the idea of the organization coming together, working together, and caring for young people together. If you are principal-driven then a model like this one can transfer. I’m proud of the fact that it has.

You and your colleagues have done a lot of work on the self-awareness you have in moving into the community and you have been sharing that with us. What have you learned about what to look for in the partners you are working with as you are working in different communities?

We all recognize that. Most communities in the province would put their hand up and say, “We would love a Foundry.” What we also recognize is that we need a strong nonprofit lead agency or a strong program at the health authority to be able to lead something like Foundry. From the day we award a Foundry to a community to the day they open their doors, usually 2 to 4 years.

 

Once the doors are open, probably be another year and a half to work on getting to a fidelity or to a place where a lot of the guidance that we provide in terms of standardization of what we are trying to do with Foundry is observed. It takes time. That lead agency or that nonprofit community organization needs to have the troughs and be able to have a history of doing capital project planning. It’s not an insignificant capital project to build a Foundry Center.

We are talking about 6,000 to 12,000 square feet co-designed with young people. It’s not an insignificant capital initiative, but it also requires a lead agency that has relationships with other community organizations that can bring them to the table and work through some of the challenges that they are going to have to address potentially past tensions and also validate concerns while bringing the youth’s voice and creating a safe space for young people and families to be heard.

Every so often when things go wrong or as they tend to in the social service sector or where there’s a tragedy, we need a lead agency that can step up and say, “We got this.” We will do good or do well by the community and ensure that either this mistake doesn’t happen again or we support the community to grieve or find a solution so that whatever happened doesn’t happen again.

That lead partner in the subject before we started our conversation was a number of the organizations you work with do view Foundry as a badge of honor or a symbol of their credibility in the community that they have been able to partner with Foundry to deliver services in their community. I would imagine you have got a very long list of people lined up to work with you. Prioritizing that must be a real challenge.

It is a real challenge, but going back to your comment. I can’t tell you how inspiring it’s been to meet some of these organizations. All of the organizations we work with are incredible organizations led by some amazing people staffed by incredibly passionate and well-intentioned individuals. It leaves you with an appreciation of the strength of our communities in BC. Also, when you see organizations able to work together the way they do, it leaves you with a great deal of hope. As we continue to move forward with the Foundry model or as organizations people come together and work together, several years from now, we will have a very different landscape when it comes to this sector.

It’s something exciting to look forward to. I have a question. As we have been having this conversation and getting ready for the interview, I was thinking a lot about the role that you have played in your career trajectory. A lot of times when we talk to executive directors or CEOs in the social profit sector, they are like, “I didn’t expect to end up here. It wasn’t the first choice.” It wasn’t what they set out to do.

You are with Foundry. You are operating an organization that hasn’t existed like this before. There’s not another Foundry where you can look at what’s happening in Ontario, New Brunswick, or Alberta and say, “We will bring that here.” This is a very unique entity in the British Columbia environment. As you and your colleagues have grown this organization when it’s a tough day and there are hard challenges, who do you turn to for advice? Who do you call when you are like, “I don’t know what to do about this?”

Seven of us are directors on this team and it’s an amazing group of people to have those conversations with. Karen and I have been working together for several years. There’s a great of deal trust between the two of us. Every once in a while, we blow off some steam in those conversations. One of the changes or shifts that have happened for me is early in my career I was mentored by psychiatrists and physicians. Mid-career that shift has been to other executive directors of nonprofit organizations and even folks who have run businesses.

One of the people that I consider my mentor is Paul Hollins who is the CEO of A&W Canada and has been incredibly generous with his time. Helping me understand what it’s like to lead a much smaller, but significant organization, and also what the relationship needs to be with the lead agencies in our network.

I have been invigorated by the conversations with folks who are outside the medical community because they take such a different perspective than we have in healthcare. I valued being able to sit down with them every once in a while and say, “Can you help me through this one? I’m not sure what to do here.” It’s been fun.

As we come to the end of our conversation, I want to ask you my favorite question to ask our guests. What are you looking forward to?

2023 was an interesting year and a lot going on not only at home but internationally. I hope 2024 will be a more hopeful year. For us in BC, specifically, we continue to recognize the concerns young people have over climate change. We continue to be concerned about the risk of overdose and we will be opening up a couple of more centers in 2024, which is exciting.

We are about to announce another ten communities with the goal of opening up centers and those communities by 2026. The work continues, but I look forward to us continuing to serve more young people every year. We are starting to make a difference to stem the flow or stem the tide where young people are aware of our brand and where they can go for help. The friction and challenges of accessing support start to feel like they are coming down. I’m looking forward to my sixteen-year-old getting her driver’s license and spending time with the family at some point in the summer and taking a nice warm break from work.

We are all looking forward to that. Before I let you go, could you tell our audience how they can learn more about the Foundry?

The easiest way is probably to go online, FoundryBC.ca. Anyone who is a parent of a teenager or young adult or if you are a teenager or young adult yourself or a service provider, young people can download our app out of both stores or go online. Through that app, they can access free services, whether it’s counseling or therapy, those services are available. They can download the app and get some help. The information is all on the website.

Thank you so much for making time and for all the work that you and your colleagues do in our communities across BC.

Thank you very much. I appreciate it.

 

Important Links

• Foundry BC
• Dr. Karen Tee
• App – Foundry BC