Incorporating Mental Health and Addictions Services into a Primary Health …


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Improvement Story session at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit Follow @QualitySummit on Twitter.

Mental Health and Addictions Services relocated one staff position to the primary health site in Meadow Lake to be able to provide just in time service to patients who may need information, support, brief intervention or a referral for more in depth services.
Better Health

Mary Rowland; Annette Viljoen

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Incorporating Mental Health and Addictions Services into a Primary Health …

  1. 1. Incorporating Mental Health and AddictionServices into PHC using Existing ResourcesMary Rowland and Annette ViljoenThis Session is sponsored by:
  2. 2. Incorporating Mental Health andAddictions Services into PHC usingExisting Resources2013 Health Care Quality SummitRegina, Saskatchewan
  3. 3. Presentation Overview• To explain how Mental Health and AddictionServices has been incorporated into thePrimary Health Care team using existingresources.• To highlight the process the Meadow LakePHC team is undertaking to develop the roleof the MH/ADD counselor, strategies utilizedand the outcomes achieved to date from thepatient and provider perspective.
  4. 4. Session objectives• Describe how the role of the MH/ADDcounselor has impacted the patient andprovider experience• Learn about the change strategies used tosuccessfully incorporate the MH/Add workerinto the PHC core team• To share our learning through our experiencesover the past year
  5. 5. 5Where isMeadowLakeanyway?
  6. 6. 6Who do we serve? Includes RM 622, 561, 588,City of Meadow Lake First Nations Communitiesof Canoe Lake, Flying Dust,Waterhen, Island Lake, BigIsland Lake, MakwaSahgaiehcan 18,000 covered population12,000 discrete patients atMeadow Lake AssociateClinic
  7. 7. Why is this important to ourpatients ?• “My sister was discharged as soon as she had met the programgoals, but without any ongoing support or resources to help hercontinue healing at home, or any resources for us as familymembers to help her. Within a week, almost all of the work donewhile 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 twoweeks we had to commit him to access treatment. Again, a yearlater the treatment was no better. He was considered an emergencywith an appointment three weeks down the road.”SK Ministry of Health
  8. 8. Why is this important to our healthcare providers?• “Family physicians are treating over 75% of mental health disorders---and almost every family has been touched by that. Providers neededucation about seeing this as a ‘normal’ health problem that canand should be dealt with in a normal way.”• “Children with mild to moderate needs can often improve the mostfrom rehab services. However, these kids are receiving fewresources as more kids with high needs are presenting.”• “The waiting list for specialists is too long. One and a half years for achild psychiatrist…...the window of opportunity to help these childrenand families is very small, and too often spent on a waiting list.”SK Ministry of Health
  9. 9. What are we trying to achieve? Better Care!q Patients can access their PHC team consistently to meettheir needs, resulting in improved patient experiencesq Improved patient outcomes related to better managementof life stressors, right service at the right time Better Teams!q Improved provider work experience
  10. 10. Team OverviewMarch2012 David Brown
  11. 11. Building the Team• Current Mental Health and Addictions Team1.0 FTE Coordinator/Team Lead2.0 FTE Mental Health Counsellor (adult)1.0 FTE Mental health Counsellor (youth)2.0 FTE Addictions Counsellor (adult)1.0 FTE Addiction outreach Counsellor1.0 Addiction Youth Counsellor1.5 FTE Psychiatric Nurse1.5 FTE Reception / Office assistant4.5 FTE Detox Worker (4 casual positions)Shared psychiatrist visits from North Battleford
  12. 12. PHC team Include:Physician/NPRegistered nurseMOA – Medical Office Assistant*Mental Health and Addictions CounsellorDiabetic Nurse educatorDietitianPharmacistChronic Disease Nurse EducatorSexual Health Nurse*MH/ADDS Intake/PHC teamCoordinator/Team Lead 40%Mental Health 25%Psych Nurse 25%Addictions 10%
  13. 13. Benefits• Improved access to MH services• Better prevention, detection and earlierintervention• Reduced stigma due to location of service• Better treatment rates, comprehensive care andfollow-up
  14. 14. Benefits• Better treatment rates, comprehensive care andfollow-up• Reduced economic burden• Better mental health and general healthoutcomes *• Reduced crises, hospital admissions, shorterLOS, decreased ER usage*
  15. 15. How are we doing?Patient perspectivePhysician perspectiveMental Health and Addictions perspective
  16. 16. Faye’s Story
  17. 17. 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
  18. 18. Physician’s Perspective
  19. 19. Mental Health and AddictionsPerspective• Our goals were to develop our relationship with primarycare providers, raise awareness of our services andimprove access to our services for primary carepatients.• Over our one year pilot project we have been largelysuccessful in meeting the above goals.• There have been some downsides to our experimentwith this model. Mental Health and Addictions Serviceshas seen a significant increase in new referrals and waittimes for service is increasing.
  20. 20. Where are we going?Goals•assist in the identification of tools and resources for the use ofprimary care providers in providing services to low risk patients and•to serve moderate risk clients and coordinate referrals to thespecialized mental health and addictions service.•to look at a one year term PHC counsellor position to set upMH/ADD directives with in the PHC setting education and supportingteam members to provide level one screenings on all patients once ayear.•to work with all team members to identify moderate and high riskpatients for earlier intervention.•to provide education, brief intervention, rescreens and whenidentified refer and coordinate specialized services.
  21. 21. PHC MH/SU PathwaysScreening 1Screening 2LowRiskModRiskHighRisk- Reinforce- Educate- Rescreen- BriefIntervention- Rescreen- Assess- Refer- Coordinate- Assess- Care Plan- TreatPCTPCTPCTPCTPCTSpecialistPractitionersSharedCareKnowledgeExchangeDr David Brown
  22. 22. Conclusion• The last year has been a valuable learningopportunity• Improvements to service delivery andpatient flow have been identified.• We have a clear picture of our goals forthis year.• We continue to change and improve at afast pace.
  23. 23. Thank you to…• Faye• PHC teams• Meadow Lake Associate Clinic• Mental Health and Addictions ServicesTeam• Management team
  24. 24. QuestionsComments