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Community adopts co-ordinated approach towards mental health

Integrated response team decreases emergency visits

Monday June 9, 2008 -- Camille Jensen

North York General Hospital and community health service providers are creating an integrated approach towards mental health services in the Central Local Health Integration Network (LHIN).

After a mental health patient is admitted to emergency at North York General Hospital and is seen by an emergency doctor, a crisis nurse and psychiatrist will do an assessment to determine if the patient’s needs would be better served in the community.

If so, the crisis nurse contacts St. Elizabeth Mobile Crisis Team, who picks up the patient within an hour of the call. St. Elizabeth’s staff will then work with the patient over the next two weeks, helping them create a crisis plan to assist them in a future emergency.

If after two weeks, the patient needs continued support, St. Elizabeth’s will refer them to one of three short-term case management service providers in North York, the Toronto North Support Services, COTA Health or Bayview Community Services.

After six months, if the patient still requires more care, a long-term case-management service is provided.

Called the Emergency Department Diversion Program (EDPP), the new initiative creates a coordinated approach between the hospital and community providers who work together to make sure patients receive the proper care at an appropriate location.

Saul Goodman, program director of mental health at North York General Hospital, says there is a cohort of patients who come to the emergency department for help because they don’t know where to access community services. 

“They are using beds that are not really appropriate if good community supports were available to them,” explains Goodman.

Julie Paradis, crisis nurse in the emergency department at North York, says the new program provides patients with a better service.

“Sometimes it’s just making that connection. They are going home knowing the support is in place,” says Paradis. “This has made it so that people would not necessarily come back for their next crisis, they would know who to contact in the community.”

The program, initially funded for one-year, has shown that close to 50 per cent of the patients referred to St. Elizabeth’s Mobile Crisis Team would have been admitted to a short-term hospital bed prior to the program

“What we’ve been able to do is look at freeing up some of the mental health beds for patients that are more acutely ill,” says Susan Woollard, program director of the emergency services program at North York.

She says the program has been successful for North York General Hospital, which is currently over-capacity for its mental health beds.

Originally scheduled to run for one year on a trial basis, the Emergency Department Diversion Program has been extended by the health service providers who say it has multiple benefits for the region.

Mary Compton, manager of crisis services for St. Elizabeth Mobile Crisis, says the program helps patients and strengthens partnerships in the community.

"The day-to-day contact really keeps a consistency and fluidity to our work with our clients," says Compton. "It's a smoother operation when we are working together for the client and not each of us (working) separately."