Mental Health and Addictions

Current State BMHC

Future State BMHC

Improvement Goals Provincial and Regional Breakthrough Initiative: To improve access, by March 31, 2016, meet triage benchmarks for waits to see contract and salaried psychiatrists 50% of the time, and triage benchmarks for outpatient mental health and addiction services 85% of the time.

By March 30, 2016: Reduce number of patients readmitted within 30 days from last admission by 20% Reduce the number of patients who stay on the Inpatient unit longer than 60 days by 20% Further, reduce the length of stay of those patients by 20% 100% of staff will have Part and Wave training

Quality

Readmissions after recent discharge Established baseline for readmissions Examined individual cases for root cause Establish what a normal readmission rate might look like (standard deviation)

Detox Remains a challenge for Initially visited other sites in the province to see how they manage Detox.

Review of Clozaril nurse/ Depo clinic PDSA determined service was necessary but not efficient. Just DO IT- relocated clinic and nurse, incorporated into community nurses group, expanded roles for all

CBO Contracts Revisit the CBO contracts and update language in the contracts to meet current day demands Explore amalgamation under Canadian Mental Health assoc.

Cost

Are services for inpatients timely /appropriate ? Realigned services for sub- groups who waited several days Child & Youth, addictions, First Nation liaison attend rounds daily and see new admissions/patients that day Will continue to monitor in 16/17

Length of stay Reduce long stays by 20% review data to set realistic improvement goals

No admission Criteria Discussions with Psychiatry has alleviated some of the issues Ongoing work on this for 16-17

Delivery

Community connections shared management of patient care with family physicians Partnering with problem solving court- timely access for individuals with substance abuse problems Working with Primary Care councilors

Wait times Consistently met our benchmarks – including 80% for our Psychiatrists from 50% as defined by the Ministry. Prepare for 100% benchmark in next year.

Is individual treatment necessary Running new groups to accommodate more patients. Inpatient addictions group, social wellness group explore outpatient groups in both mental health and in addictions.

Intake Walk-in system issues Intake system allowed walk-in for mild and moderate to jump the que creating longer wait lists. The brief questionnaire allows intake to triage care options in a more appropriate way reducing bottlenecks and being fair.

Delivery

Psychiatry recruitment Chief Psychiatrist assumed larger role with SLT in interviewing and screening candidates. Working with new Psychiatrists to consider new ideas for programing

Reallocation of resources to meet demand Analyzing all positions as vacancies occur to shift to other areas according to the data and service demands. Senior’s mental Health nurse in ML to support LTC More groups/ intake call-out procedure. Increase in Psychiatric clinics to the North, Meadow Lake and KYHR

Other accomplishments Suicide Prevention Protocol Inpatient and Outpatient Mental Health programs – Facilitated with LTC to roll out Health records developed electronic data entry and schedule system ++ time savings 2 RPIWs –Discharge Planning and BMHC therapies programing

Corrective Action- BMHC Work on the triaging of mild and moderate cases to shared care and other providers as PHC councilors- will take a while to adjust stats. – Monitor the Mild to Moderate and work on issues in the shared care model- physicians having trouble being the first line of Mental Health.

Current Challenges 3 new Psychiatrists starting about the same time Family physicians adapting to change in MH&A services to a shared care/stepped care model where they are the first line prior to the psychiatrist or specialty service 20% increase in referrals and service requests – Economic down turn resulting in stress, poverty and addictions issues

Opportunities New ideas with new Psychiatrists- question the status quo Evaluate effective use of staff and look at best evidence practice for services in Mental Health and Addictions Work in different ways – more on line; group work… Deep dive the data and respond to issues in innovative ways.

Opportunities Continued strengthening of the stepped care/shared care management and Mental Health Primary Care – Work with family physicians in consultative way to facilitate improved mental health for their patients. – Closer relationship with PHC councilors to enhance care at the Primary care point of contact Right Provider at the right time in the right amount!

Current State SHNB

Safety

Corrective Action SHNB Refocus on the priority training of PART and WAVE- – Training delayed due to TLR training priority and shortage of staff to replace for training Continue to review and discuss each and every incidence of violence – ensure learnings are in place through out the hospital.

Current Challenges Managing the facility in light of the sustained and significant workload of developing a new program and building a new facility Reviewing the programing in light of IT needs – Very low tech at the moment creates need to introduce IT processes before the move Changing challenges of mental health needs in the community – Difficult treatments are not always agreed upon and challenge resources

Opportunities Review current programming- update and improve best evidence practice Build in evaluation processes to ensure we are delivering the best programing – Create dynamic programming that reflects a younger population Build stronger teams’ – Discuss how to manage the most difficult patients especially the more violent behaviors