North Shore Mental Health and Addictions: THE JOURNEY: From Services to Centre of Excellence November 2010

Agenda Introduction The Beginning The Present The Future Accessing Services

Mental Disorders

The Tentacles of Mental Illness, What Are They? High Prevalence/Low Prevalence Illness Psychotic Affective Behavioural –Addictive –Lifestyle Social Organic

Vision High quality Sustainable Comprehensive for the residents of the North Shore

The Beginning

Historic Service overview Acute –Emergency –Inpatient A2 Chronic –Magnolia –CPS –ATS Populations –Adult –Child & Youth –Geriatric Contractors –Substance use –Housing

Recent History Services historically evolved Developed process of Operational and Strategic review Social Advocacy and Engagement Implementation Innovations –RAPS –Central intake

Early Progress New, energized leadership Medical Director Administrative Director New psychiatrists hired Financial compensation augmented to ensure inpatient physician coverage Planning/funding initiated for short term improvements to Inpatient Unit Multidisciplinary Quality Committee formed Community Advisory Committee Multidisciplinary, closed inpatient unit for better and more efficient care

Later Progress Established Transitional Program Additional community acute bed at Magnolia New Rapid Access Clinic (E. 13 th Street entry) – crisis response Contract review for improved patient care Central intake process Community services redesign

The Present

Agenda for the Present Establishing priorities: our responsibilities Redesign: community mental health services Redesign: community addiction/concurrent disorders services

Priorities Priority populations need the right services at the right time in the right setting More services delivered in community – when it’s the right setting Services delivered in hospital – when it’s the right setting

From This: ATS: High Prevalence Illness: Depression Anxiety GP referred CPS: Low Prevalence Illness: Serious and Persistent 1.Inefficiency: multiple intake processes; lack of discharge criteria; over extended client enrollments; duplication of services also available in community 2.Services (ATS) beyond usual publicly funded system; not sustainable in our economy 3.Most severely ill slotted in ATS or CPS silo 4.No central intake and triage process 5.Need to increase crisis response capacity

15 To This: Serving the Most In Need Clients With Existing Resources Community Mental Health Services Former CPS and ATS Priority Clients Combined Programming: Group, Outreach, Rehabilitation, etc. Reduced administration Reduced duplication Clarity regarding mandate Using available resources for those most in-need

Our Opportunity! Integration of ATS and CPS for new Community Mental Health Services Shifting priority focus to most vulnerable population either with serious, persistent illness, or other debilitating illness Reduce administrative costs; co-locate teams; clinical cross training and skill development; opportunity to develop ACT teams

Substance Misuse/Concurrent Disorders Services The number of people with co-occurring disorders tends to be highly underestimated. These individuals: –Are highest in risk for harm –Incur the highest service costs –Experience the poorest outcomes K. Minkoff, MD

When compared with people who have a mental health problem alone, people with dual diagnosis are more likely to have: –Increased likelihood of suicide –More severe mental health problems –Homelessness and unstable housing –Increased risk of victimization –Increased risk for HIV infection –More contact with the criminal justice system –Increased risk of being violent Examples of Risk for Harms

The Future

Older than A2

Agenda for the Future A new Centre of Excellence Older Adult Mental Health and Addictions Child and Youth Services Academic –Research –Teaching

22 The new Centre 54,200-square-feet 4 floors: –Floor 1-3 Outpatient mental health services; ¾ of 2 nd floor expansion of UBC Medical School –Floor 4 Inpatient psychiatry; roof top garden; private and semi-private rooms; gathering area –Underground parking and Ambulance Station

Why a New Centre? Key recommendation from Operational Review This has been planned for replacement for 10+ years Inpatient: 26 beds – pods for populations Standard Observation Rooms Community Mental Services delivered at common site Family and Community Resources Teaching, Research

Benefits of New Centre Improved patient and staff safety, and security. Redesigned models of care including community mental health services Redesigned patient areas to provide modern patient care Provision of seclusion rooms built to code; safe for staff and patients

Older Adult Mental Health and Addictions Coastal’s older adult services redesign underway New model of care – streamline staff processes for improved client care

Child and Youth Services Extensive work with Ministry of Child and Family Development, municipalities, School Districts Reduced duplication in community Additional psychiatry available for consultation

Inpatient Innovations Implementation of modified iCARE to improve client discharge from hospital Checking client mental health goals daily

Opportunities with primary care Improved Access Rapid elective consult General medicine in Community Mental Health

Academic Opportunities Collaborative applied research proposal –SPECT Imaging –Bipolar psychosocial correlates UBC Teaching space

30 Welcoming Practice Wherever the client appears in the system of care, it is the right place for them to access the services of the system NO WRONG DOOR

Access

Urgent Referrals 1)Emergency Department 2)Rapid Access Psychiatric Services Psychiatric crisis intervention and stabilization with provision for psychiatrist consult. Client will be referred to Community MH& A once stabilized, and if clinically indicated. Need for service within 72 hours due to acute symptoms of a mental health disorder.

Community Mental Health Age-based Services Adult Mental Health & Addiction Services Intake → Fax: Older Adult Mental Health Intake → Fax: Child & Youth Mental Health Intake → Fax:

Adult Community Mental Health Services Mandate Provides multi-disciplinary assessment, treatment, rehab, and support services to individuals 19 and over living on the North Shore and experiencing an acute, chronic, or serious and persistent mental illness that impacts daily functioning

Adult Community Mental Health Services Mandate – cont’d Intended for individuals who require a team-based approach to specialized services that can not be provided by the individual’s primary care provider / GP, private psychiatrist, or other community resource alone, are willing to engage in the services, and would benefit from the range and/or type of services provided

Adult Community Mental Health Services Mandate – cont’d Individuals must have a physician referral and be willing to have the service provider work collaboratively with their primary GP.

Adult Community Mental Health & Addiction Services Services are provided at several sites on the North Shore, and on an outreach basis as necessary: – West 17 th St, NV – St. Andrews, NV – Marine & W 22 nd St, WV – Residential Facilities in NV & WV

Adult Community MH Services Assessment Psychiatric Consultation Group Programs 1:1 Therapy (9 to 12 sessions) Case Management Psychosocial Rehabilitation Family Support Program Health & Wellness Clinic Peer Support

Urgency? No Yes Adult Community Mental Health & Addiction Services Central Intake Rapid Access Psychiatric Services / ER GP Referral

GP Referrals Stepping Stones Substance Misuse Program Long Term Program Short Term Program Community Residential Program Central Intake Adult Community Mental Health & Addiction Services

Patient – What to Expect: Telephone screening phone call within one business day AND Immediate access to support and orientation groups and appointment for in-person assessment OR In-person meeting scheduled with intake worker at Shakespeare House for tour and orientation OR Referral to other resources in the community (if patient does not require addiction or comprehensive mental health services)

GP Communication – What to Expect √ 1. Confirmation of referral and disposition √ 2. Copy of Initial Assessment 3. Progress Summary q 6 months (STP) or Copy of Annual Case Review (LTP-TBD) √ 4. Letter advising of discharge and follow-up recommendations

Date ____________________________ RE: ____________________________ Dear Dr./Other: ____________________ DOB: ___________________________  Your referral on your patient has been received.  Client seen at _____________________________________________. See attached report.  Client screened and assessment appointment scheduled at __________________________  Client screened and referred to _________________________________________________.  Client screened and declined service. Referral is inactivated.  Unable to contact client after 3 phone calls. Referral is inactivated.  Client does not meet the mandated services for North Shore Mental Health & Addiction Services. Referral is inactivated. Recommend: ____________________________________________________.  Client does not live within the catchment area of North Shore Mental Health & Addiction Services. Referral is inactivated. Recommend: _____________________________________________________.  Client withdrew without notification. No further contact. Referral is inactivated.  Other ____________________________________________________________ Should you have any questions, please contact:  Central Intake Office at or ________________________________  RAPS Clinic at , Local 4513 or _____________________________  RAPS Emergency at , Local 4289

Impacts for the community Appropriate care setting for patients and families Fulfilling community ethic of humanitarian care Opportunity to improve system flow and improve wait times in overall mental health & addictions system

Questions? Thank You!