Bed Registries Implications for Mental Health Care

The “Flow Map” – current state *For example: social service agency; community mental health agency; addiction treatment organization; long-term care home; school/college/university; community service organization; other organizations **Excludes The Hospital for Sick Children Source: Team analysis How people enter EDs…Once in a TC LHIN ED**…How people leave EDs… UHNSMHSHSC SJHC TEGH Voluntary Bribed/coerced Involuntary First-time visit Repeat visit Multiple visits to multiple sites Chose site Did not choose site Connected to supports Unconnected TC LHIN resident City of Toronto GTA and beyond Leave under own volition Without being seen by a physician Against medical advice Discharged Without referral or follow-up appointment Admitted No bed; wait in ED until bed available or admission no longer needed Admitted Transferred to bed in same organization Psychiatric Medical Transferred to bed at different organization Discharged With follow-up appointment within same organization With referral to hospital service provider With referral to community service provider Registration (worker/nurse) Triage (nurse) ED team; can include: Nurse Social worker Students Resident(s) (if on) MD Other staff (e.g., security) Psychiatric Emergency Services team (n/a for MSH; if needed, refer to CAMH); can include: Nurse Social worker Psychiatric assistant Resident(s) (if on) MD Other staff (e.g., security) Issue/challenge Success/leading/ evidence-based practice Ill physical health Physically healthy Safety concerns (for self and/or others) No safety concerns Walks-in alone Comes with/brought by family, friend or neighbour Sent by primary care provider or community psychiatrist Sent by community worker/organization* Accompanied by community worker/ organization* Transferred by acute care/psychiatric hospital Brought by crisis team (community; MCITs) Brought in by police Brought in by EMS Sent/transferred by criminal justice system (corrections facilities/courts) MCITs Short-stay/ assessment beds Addictions specialist in the ED Management of inpatient flows Partnerships with selected community services Variety of “fast forward” processes Psychogeriatric specialist in the ED Day/outpatient services for follow-up MH&A EDA Environment not typically conducive for people with mental health and addiction needs Lengthy waits often experienced through all parts of the process Inpatient beds not available when needed Varying models of service delivery Little/no consistent information collected and reviewed across the system Large number of people involved in care Variation in practice at the individual level Insufficient ability to identify sub- acute addiction needs Hard to transfer people across organizations Few complex care community services Little infrastructure for research Limited capacity of/ insufficient communication about the existing available alternatives to the ED People brought to ED with shortest wait vs. one with most appropriate services Ad hoc vs. systemic collaboration/ coordination across organizations Disposition often determined by resource availability, not the person’s needs No partnerships with community providers at the system level Transition between hospital and community services not always well managed Insufficient capacity and flow through some community- based services Insufficient ability to respond competently to the needs of Toronto’s diverse populations (e.g., ethnocultural groups, transitional- aged youth, etc.) MSHCAMH 2 3. The current state and where we want to go

15 *CAMH = Centre for Addiction and Mental Health; MSH = Mount Sinai Hospital; SHSC = Sunnybrook Health Sciences Centre; SJHC = St. Joseph’s Health Centre; SMH = St. Michael’s Hospital; TEGH = Toronto East General Hospital; UHN = University Health Network Consultation with consumers, family members and community-based service providers Partners, purpose and projects 2. Membership, purpose and structure of the MH&A ED Alliance Purpose… Partner organizations… SHSC MSH SJHC SMH TEGH CAMH UHN Indicators of Alliance impact Seniors MH&A project Standardized assessment form Frequent user project Inter-hospital bed access model MH&A ED Alliance Project Team Projects… Provide the right care, in the right place, at the right time in a respectful, client-centered manner through a collaborative process of reforming existing emergency MH&A services Reduce ED wait times Ensure delivery of consistently high quality care Improve consumer and family satisfaction Increase capacity to serve specific populations

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Data is not necessarily Information. Information is not necessarily Knowledge, Knowledge is not necessarily Wisdom …And none of the above justifies Action by itself!