Incorporating Mental Health and Addiction Services into PHC using Existing Resources Mary Rowland and Annette Viljoen

This Session is sponsored by:

Incorporating Mental Health and

Addictions Services into PHC using

Existing Resources

2013 Health Care Quality Summit

Regina, Saskatchewan

Presentation Overview

• To explain how Mental Health and Addiction Services has been incorporated into the Primary Health Care team using existing resources.

• To highlight the process the Meadow Lake PHC team is undertaking to develop the role of the MH/ADD counselor, strategies utilized and the outcomes achieved to date from the patient and provider perspective.

Session objectives

• Describe how the role of the MH/ADD counselor has impacted the patient and provider experience

• Learn about the change strategies used to successfully incorporate the MH/Add worker into the PHC core team

• To share our learning through our experiences over the past year

5

Where is

Meadow

Lake

anyway?

6

Who do we serve?

Includes RM 622, 561, 588,

City of Meadow Lake

First Nations Communities

of Canoe Lake, Flying Dust,

Waterhen, Island Lake, Big

Island Lake, Makwa

Sahgaiehcan

18,000 covered population

12,000 discrete patients at

Meadow Lake Associate

Clinic

Why is this important to our

patients ?

• “My sister was discharged as soon as she had met the program goals, but without any ongoing support or resources to help her continue healing at home, or any resources for us as family members to help her. Within a week, almost all of the work done while she was in the program was undone.”

• “I have accessed the mental health system for treatment of my son. The response was poor. I have accessed the ER on two occasions. Once because he was suicidal. We were sent home. Within two weeks we had to commit him to access treatment. Again, a year later the treatment was no better. He was considered an emergency with an appointment three weeks down the road.”

SK Ministry of Health

Why is this important to our health

care providers?

• “Family physicians are treating over 75% of mental health disorders---and almost every family has been touched by that. Providers need education about seeing this as a ‘normal’ health problem that can and should be dealt with in a normal way.”

• “Children with mild to moderate needs can often improve the most from rehab services. However, these kids are receiving few resources as more kids with high needs are presenting.”

• “The waiting list for specialists is too long. One and a half years for a child psychiatrist…...the window of opportunity to help these children and families is very small, and too often spent on a waiting list.”

SK Ministry of Health

What are we trying to achieve?

Better Care!

q Patients can access their PHC team consistently to meet

their needs, resulting in improved patient experiences

q Improved patient outcomes related to better management

of life stressors, right service at the right time

Better Teams!

q Improved provider work experience

Team Overview

March2012 David Brown

Building the Team

• Current Mental Health and Addictions Team

1.0 FTE Coordinator/Team Lead

2.0 FTE Mental Health Counsellor (adult)

1.0 FTE Mental health Counsellor (youth)

2.0 FTE Addictions Counsellor (adult)

1.0 FTE Addiction outreach Counsellor

1.0 Addiction Youth Counsellor

1.5 FTE Psychiatric Nurse

1.5 FTE Reception / Office assistant

4.5 FTE Detox Worker (4 casual positions)

Shared psychiatrist visits from North Battleford

PHC team Include:

Physician/NP

Registered nurse

MOA – Medical Office Assistant

*Mental Health and Addictions Counsellor

Diabetic Nurse educator

Dietitian

Pharmacist

Chronic Disease Nurse Educator

Sexual Health Nurse

*MH/ADDS Intake/PHC team

Coordinator/Team Lead 40%

Mental Health 25%

Psych Nurse 25%

Addictions 10%

Benefits

• Improved access to MH services

• Better prevention, detection and earlier

intervention

• Reduced stigma due to location of service

• Better treatment rates, comprehensive care and

follow-up

Benefits

• Better treatment rates, comprehensive care and follow-up

• Reduced economic burden

• Better mental health and general health outcomes *

• Reduced crises, hospital admissions, shorter LOS, decreased ER usage*

How are we doing?

Patient perspective

Physician perspective

Mental Health and Addictions perspective

Faye’s Story

Patient perspective • Faye

• Physician

• RN

• MOA

• Diabetic Educator

• Chronic disease educator – *Case Manager*

• Mental Health and Addictions Counsellor

• Occupational therapist

• CDM Clinical exercise therapist

• Physiotherapist

Physician’s Perspective

Mental Health and Addictions

Perspective • Our goals were to develop our relationship with primary

care providers, raise awareness of our services and improve access to our services for primary care patients.

• Over our one year pilot project we have been largely successful in meeting the above goals.

• There have been some downsides to our experiment with this model. Mental Health and Addictions Services has seen a significant increase in new referrals and wait times for service is increasing.

Where are we going? Goals

•assist in the identification of tools and resources for the use of

primary care providers in providing services to low risk patients and

•to serve moderate risk clients and coordinate referrals to the

specialized mental health and addictions service.

•to look at a one year term PHC counsellor position to set up

MH/ADD directives with in the PHC setting education and supporting

team members to provide level one screenings on all patients once a

year.

•to work with all team members to identify moderate and high risk

patients for earlier intervention.

•to provide education, brief intervention, rescreens and when

identified refer and coordinate specialized services.

PHC MH/SU Pathways

Screening 1

Screening 2

Low

Risk

Mod

Risk

High

Risk

- Reinforce

- Educate- Rescreen

- Brief

Intervention- Rescreen

- Assess

- Refer- Coordinate

- Assess

- Care Plan- Treat

PCT

PCT

PCT

PCT

PCTSpecialist

Practitioners

Shared

Care

Knowledge

Exchange

Dr David Brown

Conclusion

• The last year has been a valuable learning

opportunity

• Improvements to service delivery and

patient flow have been identified.

• We have a clear picture of our goals for

this year.

• We continue to change and improve at a

fast pace.

Thank you to…

• Faye

• PHC teams

• Meadow Lake Associate Clinic

• Mental Health and Addictions Services

Team

• Management team

Questions

Comments