Psychiatry restructuring, improving mental illness and addictions care

November 24, 2016

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Psychiatry restructuring, improving mental illness and addictions care

A responsive system that treats patients in a streamlined fashion is the goal of the region’s Balanced Care Model for mental health and addictions services.

Long waits and care disruptions were common for patients needing mental health and addictions services. This led to some of the region’s most vulnerable patients falling through the cracks.  “We knew we needed to do something. As an organization, we are committed to delivering safe, high quality care from the patients’ perspective. When deep diving into some of the issues in our Mental Health and Addictions service line, we knew we could improve it,” said Lorri Carlson, executive director for mental health and addictions services in the region. “We knew we had to bring those providing service in the community together with those working in the hospital to better serve our clients.”

That’s the foundation of the Balanced Care Model.

“We’re improving the whole system. The model is forcing us to focus on how we can integrate our services, so nobody gets missed,” Carlson explained.

To do this, the region is focusing on four key areas.

Common referral pathway

This means a single point of contact for patients needing any mental health or addictions services. The system is now set up to triage and assign services to patients according to their needs.

“There is one point of contact that sets patients up with the care they need, when they need it,” said Dr. Senthil Damodharan, dyad lead for the work. “We are not fully there yet, but we are in a much better place than we were four or five years ago.”

This approach has many benefits. “This model increases efficiency,” said Dr. Damodharan. “We have staff dedicated to organizing referrals based on need.  Clinical staff assesses if the patients’ need is urgent, or if they can wait for an office appointment a month from now.”

The common referral pathway means patients experiencing crisis connect with a crisis team immediately. With experienced clinicians at the helm, fewer patients are falling through the cracks.

Hospital based work

In the past, psychiatrists worked both in the community and in the hospital. If someone experiencing a crisis came to the emergency department, they would have to wait until the psychiatrist came to the hospital after their clinic work.   Conversely, psychiatrists seeing patients in the hospital would be away from those in the community, limiting how many patients they could see overall.  

“We worked together for the solution,” Dr. Damodharan said. “We divided all the psychiatric work in the region.”

Now, there are psychiatrists dedicated to in hospital work, others are staying to work solely in the community and a few will continue to do both. The result is enough psychiatry resources in each stream to manage all patient needs efficiently and effectively.  

“An issue we had was patient care on discharge from hospital. They often struggled to access timely community psychiatric care. Now that there is a dedicated community team, patients are referred automatically upon release,” Dr. Damodharan explains.

Community based work

With psychiatrists now focused in hospital, those providing care in the community are able to see more patients.

“In the past, the two streams were functioning separately. The Balanced Care Model has forced us to break a barrier and make all psychiatry work part of the same system,” Dr. Damodharan said. “We have made the conscious decision to bridge the gap.”

Electronic health record

The fourth and last component to the Balanced Care Model involves implementing an electronic system that stores all hospital and diagnostic information for each patient. In the past, patients may visit multiple sites for service and have multiple paper charts.  Staff often had no way of knowing this. Now the mental health information is part of the patients’ electronic health record.  Clinicians document in real time so information from each visit is available the same day to clinicians with access, on a need to know basis. 

“This improves the safety for high risk patients who may have suicidal ideas and visit the detox, the emergency department or who are visited by the Community Outreach and Stabilization Team,” said Carlson.

“Any clinician needing to access a patient record now can. This means care plans can be updated more efficiently and patients can move through the system with fewer delays,” Dr. Damodharan said.

For more information on mental health services in the region, visit rqhealth.ca.

 
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