With a new approach to care, St. Joseph’s Health Care London is offering renewed hope for people suffering from both addiction and mental illness.
Over the past fifteen years, awareness of the frequency and severity of concurrent disorders – a unique diagnosis of an addiction combined with a mental illness – has increased throughout both the mental health and addictions fields. Historically, these afflictions have been viewed as separate and distinct with quite different approaches to assessment and treatment. Because neither approach is fully suited to the treatment of people suffering from concurrent disorders, both the addictions and the mental health systems have tended to exclude people with concurrent disorders.
“The need to avoid enabling patients’ illnesses is a strong part of the addictions paradigm,” explains Dr. Adrian Hynes, physician leader for the concurrent disorders program at St. Joseph’s Health Care London (SJHC). “Supporting patients is a strong part of the severe mental illness paradigm. Learning to support patients without enabling them – that is without enabling their illness – is often a difficult balancing act that is especially necessary in concurrent disorders treatment.”
Over time, models of treatment for concurrent disorders have developed, largely because of the personal experiences of interested treating professionals from both fields. Models of treatment that are currently validated in literature and in practice are characterized by integration of treatment, staged interventions, comprehensiveness, dual training of treatment professionals, cultural sensitivity, long-term care, outreach and persistence of treatment. In practice, this implies intensive treatment with close follow-up and outreach and continuity of patient care. Greatly improved results, from the point of view of both illness/symptoms and quality of life, have been achieved with these models. However, because there remains a severe shortage of addiction psychiatrists throughout the country, these models have tended to remain confined to university centres and effective outreach to referral regions has not yet occurred.
“For the first time in Southwestern Ontario, we are currently using the opportunity provided by regionalization of tertiary care to attempt availability of excellent concurrent disorders treatment and care throughout the region,” says Dr. Hynes. “The system components for doing this comprise the ready availability of tertiary care, assessment and initial treatment – both inpatient and outpatient – with ready availability of the tertiary care team for discussion, advice, assessment, both in the main facility and on an outreach basis to various centers throughout the region.”
With the focus of moving towards this new model of treatment for the concurrent disordered population, the SJHC concurrent disorders team has made itself widely available for education-both on an ad hoc basis, based on individual case situations, as well as a more formal basis-for advanced concurrent disorders training for primary and secondary caregivers, in both the addictions and mental health fields.
In addition to this outreach educational component, the team is committed to on-site education for the wide variety of professionals involved in the care of the concurrent disordered and the different levels of those disciplines, including: medical students, residents and fellows; social work students and graduates; nursing students and graduates; and occupational therapy students and graduates. Placements with the SJHC program are available from one month up to several months.
Also of significance in this new approach to treatment is the collaboration of care providers across various mental health programs. When patients from other programs are admitted to the concurrent disorders inpatient unit, the professionals from that other program are welcomed to the patient’s case conferences, which always have an educational as well as a treatment planning component to them. This level of collaboration provides stronger continuity of care and benefits the patients and the care professionals alike.
After some minor initial hesitation, which is only natural whenever a new approach is adopted, the reception for this approach to treatment throughout the region has been very positive in its first year of operation. The concurrent disorders program has managed to keep waiting time for initial assessment down to one month and is confident that it will continue to do so. Outcomes evaluation instruments are now in place for all patients assessed, potentially allowing the program to follow up on these evaluations annually, thus monitoring outcomes throughout the region.
Says Dr. Hynes, “We believe that this model of spreading expertise through a region, with ready availability of tertiary care expertise, holds great promise for the future of concurrent disorders treatment, not just in this region but in others throughout Canada.”