Increasing Access to Mental Health & Addictions (MH&A)

Services in Rural Areas BC Patient Safety & Quality CouncilQuality Forum, Vancouver, Feb 2015

Presenters: Kathleen Collins, Selina Tsang

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Rural Setting: Pemberton

Pemberton is located• 25 min north of Whistler • 2 hours from Vancouver

Health Services• Served by 4 to 5 GP’s• No local hospital• Only emergency in

local health centre

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Stakeholders

• Family doctors• MCFD / CYMH – community mental health

services• Emergency (community and acute)• BC Ambulance Transport• Secondary level of acute care • Tertiary level of acute care

A fractured youth mental health system in B.C. that is confusing

and frustrating for youth and their families to navigate

Communication lapses between service providers

Long waits to see mental health

professionals or to receive treatment

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Mental Health Services in Pemberton• CYMH services not well understood -- often

confused with Child Protection Services and Adult MH Services

• Variation in who delivers community MH services.

Note: Vancouver Coastal Health (VCH) Child Youth Mental Health (CYMH)

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Barriers to Access• CYMH services available only during

weekday office hours

• Inadequate child psychiatrist coverage – only available in Squamish– up to 2 months wait

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Lack of coordination between systems Unsupported vulnerable youth

• GP not following protocol to certify kids under the MH Act

• Nearest hospital (LGH) not staffed with child psychiatrist

• GP confused why they can’t refer directly to BCCH (CAPE unit) Child & Adolescent Psychiatric Emergency

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Project GoalsEstablish standardized process for Pemberton children, youth and families to access psychiatric assessment

• Emergent need• Urgent need

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Lean Approach• Assembled design team

GP, psychiatrists, nurses, leadership from Regional Mental Health, Lion’s Gate Hospital, CYMH

• Established clarity and shared understanding

• Clarified roles and responsibilities

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Current State Map

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An emergent patient may be…Refused transport to secondary hospital if ER Doc refuses to accept patient

Typically only accepted for medical issues

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Even if an emergent patient is brought to hospital, he/she may be de-certified and not admitted.

Now patient needs to find transport home.

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An urgent patient• Ideally accesses local help• But when local resources are unavailable /

inadequate• Cannot escalate to Emergency (do not fit

Emergent criteria)

Take their chances to get seen by BCCH Urgent Assessment Clinic

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Future State Map

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Emergent CasesLLTO Policy Revisions

• Policy specifically references MH&A patients

• Receiving sites must accept the transfer of a patient in a LLTO situation when the services needed for the patient do not exist at the sending site

Resulting Changes

Certified children and youth receive psychiatric assessment at LGH (by adult psychiatrist in the interim)

Addition of child psychiatrist at LGH

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What does it take to …• Create a New Urgent Assessment Clinic?• In a rural setting (aka lack of resources)?

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Unleash the Power & Passion of a Committed Team

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PEOPLE

Combination of adult &

child psychiatrists

CYMH + VCH staff

Psychiatrist bills MSP for seeing

patient

COST

CYMH covers

transcription costs

VCH covers cost of

psychiatrist time for no-

shows

Same space

used by adult MH

- VCHPLACE

CYMH office space (child psych)Private

office space in Whistler

(child psych)

CONSULT NOTES

Charts held by CYMH

TIME

Clinic available every 1–2 weeks

Hold time or book lunch time slots

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Referral Process• Accept referrals from

Self / FamilySchoolsGeneral PractitionerEmergency Clinic

• CYMH Intake coverage 7 days a week• Referral triaged by CYMH leader

Standard process documented in Pemberton Child and Youth Urgent Assessment memorandum of understanding

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LGH liaison notifies Community of impending discharge

Community Mental Health

Pemberton emergency

medical centre

Urgent Ax ClinicLGH

GP / Referring

MD

Partners …for the Benefit of the Kids

* If patient gets transferred to BCCH, CAPE doctors invite CYMH in discharge planning

Psychiatrist consult notes sent to GP / referring physician

CYMH shares specific strategies for high risk youth in anticipation of future patient visits.

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Measures of SuccessUrgent Psychiatric Assessment Clinic Established urgent assessment clinic in

Dec 2013 Guaranteed appointment within 2 weeks,

often seen as soon as next day 8 urgent cases seen to date 8 urgent cases receiving psychiatric

assessment within target of 1 week

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Voice of ProvidersWe know we

can call CYMH when

we need help with a patient

Knowing there are local psychiatric services we can

access makes it much easier to make decisions about urgent patients. We now have much

more confidence that patients will receive the urgent care they

need in their own community within a quick time frame.

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Voice of PatientThey were going to send me to the city...to Lion's Gate...They phoned someone from the Ministry and found out I could see a psychiatrist in Pemberton. Then someone came to the clinic to help my parents understand how to help me. My parents let me come home with them... I am doing much better now. I am glad I didn't have to go to the city."

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Design Team• Project Sponsors:

– Yasmin Jetha, Regional Director, MH&A Program– Dr. Steve Mathias, Regional Youth Medical Lead– Olga O’Toole, Regional Manager, CYMH Vancouver Coastal

Region– Rena van der Wal, Executive Director, Lean Transformation

Services• Process Champion: Elizabeth Stanger, Director MH&A Coastal• Project Owner: Kathleen Collins, CYMH Team Leader• Physicians: Dr. Lance Patrick, Dr. Apu Chakraborty,

Dr. Rebecca Lindley, Dr. Helen Rosenauer, Dr. Bobbie Rathbun• Health Centre: Tracey Kavanagh, Janet Hamer• Lean Advisor: Selina Tsang