Collaboration to Calm the Crisis – The London & Middlesex Experience of Creating a Walk-in Crisis Service Pam Hill, Director of Clinical Services, Addiction Services Thames Valley Bill Chantler, Inspector London Police Services Bere Tekel, Connect for Mental Health Yvonne Lammers, Manager Crisis Services, CMHA Lori Hassall, Director, Crisis and Short Term Interventions

Overview  Evolution of crisis services in London and Middlesex  Mental Health and Addictions Crisis Centre  Police Partnership  Lessons Learned  Moving Forward  Questions

What is crisis?

Context /Why Now?  SWLHIN Report, The Time is Now: A Plan for Enhancing Community-based Mental Health and Addiction Services, 2011  London stakeholders identified mental health crisis response as a priority concern.  To address this concern a Crisis Mental Health Response System Working Group was created

Crisis Mental Health Working Group Agency representation from: CMHA, London Middlesex Branch London Health Sciences Centre Parkwood Institute London Police Service Mission Services of London St. Leonard’s Community Services Search Community Mental Health Services Southwest Ontario Aboriginal Health Access Centre South West Local Health Integration Network

Ideal Model Person Experiencing a Mental Health Crisis Effective Phone Service & Supports Expanded Crisis Mobile Team Non-medical Crisis/Relief Beds Crisis Service Centre (in time near ED) Specialized Crisis Services (for hard to reach populations)

Anticipated Benefits Better response for those experiencing a mental health crisis More effective use of community resources Better working relationship between Crisis Services and Police Services Improved and timely response by the right provider Assisting with backlog in the Emergency Department Available to all residents in the City of London and Middlesex

What was in place?

Many agencies and services addressing crisis in the moment

How can we improve things?  Enhanced Crisis Committee  Crisis Centre Project Team

Step 1 Enhanced Mobile Crisis Service  London and District Distress Centre  London Police Service  24/7 on site support

Step 2:  Transitional Case Managers and Addictions Transitional Case Managers in the Emergency Department and Inpatient Unit at LHSC

Step 3  5 Crisis Stabilization beds in the community  Provides linkages to other community services  Assessment every 12 hours  Low-Medium Risk Individuals  2 staff 24/7

Next Step:

Governance Model Project Delivery Team Decision Makers Steering Committee Project Team Clinical or Business LeadProject Manager Project Sponsor Other workgroups TBD ED Triaging Group Space Planning Group Executive Sponsor

Crisis Centre  Partnership between CMHA and Addiction Services Thames Valley  24/7 Walk-in  No referrals necessary  Warm and welcoming  Crisis support  Connection to services  16 years +

Crisis Centre Mental Health Workers Crisis Assessment Team Crisis Mobile Team Crisis Stabilization Space

Stats from the Crisis Centre Dec-15Jan-16Feb-16Mar-16Apr-16Total Number of Clients Indigenous Heritage French First Language First Visit to Crisis Centre Wait Time 6 min14 min23 min22 min 19 min Length of Engagement 83 min70 min66 min65 min64 min67 min

Referral Source Dec-15Jan-16Feb-16Mar-16Apr-16Total Mobile Response Team London CAReS London Police Services Self-Referral London Distress Centre Family/Support

Emergency Department Contact

Referral Destination Dec-15Jan-16Feb-16Mar-16Apr-16Total Stabilization CMHA Programs ADSTV Community Programs Emergency Department

Feedback about the Crisis Centre “Made me feel empowered through my crisis to move forward. It was the best decision I made to come here and felt so hopeful after seeing Jordan” “I did not want to go to the hospital but needed immediate intervention/help. This has been the most comfortable way to reach out.” “Extremely knowledgeable, helpful and respectful. Easy access. I have already recommended.” “Warm and receptive environment”

BERE TEKLE Valuing the lived experience perspective in the development of crisis services

London Police Services – Partnership Unique model for Police Response to Mental Health and Addictions BENEFITS BENEFITS Appropriate Response - Destigmatize Mental Illness and Addictions Economics - Police Time Economics - Police Time Reducing Apprehensions Reducing Mental Health Patient Volume at Emergency Department

London Police Services Statistics Although, LPS responded to 1,028 more mental health occurrences in 2015 than in 2012, significant effectiveness and efficiency has been achieved through the crisis response strategy including:  LPS utilization of the MRT in 984 mental Health occurrences in 2015 compared to 0 in 2012  The reduction in apprehensions under S.17 of the MHA by 100 in 2015 compared to 2014  The reduction in the average time spent on mental health occurrences by 2.58 hours in 2015 compared to 2012 (efficiency of 6, hours spent on mental health crisis calls in 2015 compared to 2012) Cost savings: 6, hours = 3.3 FTE – Constables /$373,519 ( st Class Constable wages x 3.3)

LESSONS LEARNED Value of Partnerships Learning in the Moment Front Line Input/Right Staff Engagement Strategy Modelling Sessions

Utilize “land mines” to support success  Funding  Timelines  Safety  Numbers and increased wait times

Next Steps  Renovations – 10 crisis beds on site  Keeping space warm and welcoming  Connecting with community resources  Peer support  EMS diversion protocol  Ongoing communication with referral partners  Family volunteer program,

Thanks ! Questions? Primary Contacts: Lori Hassall Pam Hill