Bed Registries Implications for Mental Health Care

1. Bed Registries Implications for Mental Health Care

2. 3. The current state and where we want to go Success/leading/ evidence-based practice The “Flow Map” – current state 2007-8 Issue/challenge Ad hoc vs. systemic collaboration/ coordination across organizations How people enter EDs… Once in a TC LHIN ED**… How people leave EDs… Hard to transfer people across organizations Disposition often determined by resource availability, not the person’s needs CAMH MSH UHN SMH SHSC SJHC TEGH MH&A EDA • Leave under own volition Environment not typically conducive for people with mental health and addiction needs • Triage (nurse) • Voluntary • Bribed/coerced • Involuntary • Without being seen by a physician • Against medical advice • 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) • Registration (worker/nurse) • First-time visit • Repeat visit • Multiple visits to multiple sites • Discharged Lengthy waits often experienced through all parts of the process • Without referral or follow-up appointment • ED team; can include: People brought to ED with shortest wait vs. one with most appropriate services • Nurse • Social worker • Students • Resident(s) (if on) • MD • Other staff (e.g., security) Day/outpatient services for follow-up Variation in practice at the individual level Varying models of service delivery • Chose site • Did not choose site Insufficient ability to identify sub-acute addiction needs • Discharged Insufficient capacity and flow through some community-based services • With follow-up appointment within same organization • With referral to hospital service provider • With referral to community service provider Variety of “fast forward” processes Addictions specialist in the ED Psychogeriatric specialist in the ED Large number of people involved in care • Ill physical health • Physically healthy Transition between hospital and community services not always well managed • Psychiatric Emergency Services team (n/a for MSH; if needed, refer to CAMH); can include: Partnerships with selected community services MCITs • Safety concerns (for self and/or others) • No safety concerns Insufficient ability to respond competently to the needs of Toronto’s diverse populations (e.g., ethnocultural groups, transitional-aged youth, etc.) • Admitted Short-stay/ assessment beds Inpatient beds not available when needed • Nurse • Social worker • Psychiatric assistant • Resident(s) (if on) • MD • Other staff (e.g., security) No partnerships with community providers at the system level • No bed; wait in ED until bed available or admission no longer needed Management of inpatient flows • Connected to supports • Unconnected • Admitted • Transferred to bed in same organization • Psychiatric • Medical • Transferred to bed at different organization Limited capacity of/ insufficient communication about the existing available alternatives to the ED • TC LHIN resident • City of Toronto • GTA and beyond Little/no consistent information collected and reviewed across the system Few complex care community services Little infrastructure for research * 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 2

15. 2. Membership, purpose and structure of the MH&A ED Alliance Partners, purpose and projects Purpose… Projects… Partner organizations… CAMH 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 Standardized assessment form MSH Inter-hospital bed access model SHSC MH&A ED Alliance Project Team SJHC Seniors MH&A project • Reduce ED wait times • Ensure delivery of consistently high quality care • Improve consumer and family satisfaction • Increase capacity to serve specific populations SMH Frequent user project TEGH Indicators of Alliance impact UHN Consultation with consumers, family members and community-based service providers * 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

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