Mental health outpatient programs at Joseph Brant Memorial Hospital: a hope-based approach

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Where does it hurt? It’s a simple question and for physical pain it’s simple enough to answer. But what happens when where it hurts is our hearts and our minds – when it is a mental illness? Statistics show one in five Canadians experience a mental health problem at some point in their lives and yet mental illness still carries a stigma that stops many from seeking help. This is unfortunate because effective treatment exists for almost all mental illnesses.

Getting treatment can present its own problems. Waiting times for individual counselling may be months. Concurrent disorders – where a person has both a mental illness and a substance abuse problem – present unique challenges.

Timely and effective treatment begins with the individual but help can be found in groups. At Joseph Brant Memorial Hospital in Burlington, group therapy is being used in two innovative programs to address long waiting lists and concurrent disorders.

Take Action for Change (TAC) Take Action for Change is the product of a ‘roll-up-your-shirt-sleeves’ determination on the part of Dr. Nimishchandra Purohit, Chief of Psychiatry, and his staff. When Dr. Purohit came to Joseph Brant as a staff psychiatrist in 1999, the waiting list was six to nine months long. He had an idea to use groups and a specialized evaluative tool, BASIS 32¨, to tackle the wait list.

“It’s a good way, at a glance, to get a broad look at people who need to be fast tracked for immediate individual attention,” says Dr. Purohit. Scoring the 32 items provides summary indicators of how patients feel before and after receiving care. The survey is based on an algorithm that gives an overall score with five subscales: Relation to Self and Others, Depression and Anxiety, Daily Living and Role Functioning, Impulsive and Addictive Behavior, and Psychosis.

Encouraged by Dr. Sydney Kennedy, Psychiatrist-in-Chief, University Health Network Toronto, he presented his idea to Dr. Carruthers, Chief of Staff at Joseph Brant and Don Scott, hospital President and CEO. “They said if I believed it would help people, I should go ahead. I really appreciated their support,” said Dr. Purohit.

Dr. Purohit then enlisted the help of three staff social workers, Fiona Wheelband and Virginia Scollay (Outpatient Psychiatry) and Lisa Anderson (Inpatient Psychiatry). “It couldn’t have happened without them,” says Dr. Purohit, praising their dedication to do the necessary research and ground work on many hours of personal time. Invitations were sent to those on the waiting list to participate in this new group.

TAC is a 10-week program that covers medication, depression, anxiety, stress management, relapse prevention and problem management. “It started as pilot in the summer of 2000 and just took off,” Fiona says. Within four to six months, wait lists were down to two to three weeks.

Participants receive education about their illness to help in their own recovery. Group work allows more people to receive the information they need quickly. “You also get the benefit of peer support which is as important as the information provided,” says Fiona.

Participants are admitted to the group by the family doctor, crisis or the inpatient psychiatry unit. Since the goal of an inpatient psychiatry unit is to stabilize acute cases and discharge as soon as possible, the TAC group can help provide a continuum of care. TAC has been running for four years now. Approximately 35 – 40 per cent of the participants find the help and information they need and do not require further individual counselling. BASIS 32¨ results support the effectiveness of the group from a client perspective.

Health and Hope Health and Hope is a 10-week group program that provides psycho educational counselling; it is unique in that it treats individuals with concurrent disorders. The BASIS 32¨ tool is used in this group as well. Participants can be referred by their family doctors but can also self-refer.

Historically, services for this population have been poorly linked. Many mental health programs exclude people with active substance abuse problems while many addiction programs exclude people with mental health problems. Integrated treatment combines elements of both mental health and addiction treatment in a unified program within a single setting.

Integrated treatment for concurrent disorders has been available to residents of Burlington and surrounding area since 1998 because of a client-centred collaboration between Joseph Brant and ADAPT (Alcohol, Drug and Gambling Assessment, Prevention and Treatment). Staff from both organizations had watched clients fall through the cracks and bounce back and forth between agencies in a parallel or sequential service delivery model. They embraced the idea of integrating services.

Health and Hope has been running now for seven years. Neil Tarswell, a program therapist and social worker at Joseph Brant who facilitates Health and Hope, notes that “this group (concurrent disorders) was identified as underserved by the Ministry of Health. Although funding was not provided, Joseph Brant showed the foresight and leadership to pick up on it.”

While Neil educates the group in mental health issues, his counterpart from ADAPT, Samantha Clark, provides expertise in addiction issues. “It is such a valuable group. Clients have given very positive feedback,” says Samantha.

Wayne Robertson, client, says, “If I’d had this experience when I was younger, I might not have had the breaks in sobriety that I did. Treating the two medical issues separately was a vicious circle. I was so frustrated, many times I just felt like giving up. I don’t really believe I would be here today without the education and support I received from this group.” Wayne is pleased to be able to give that support back in his current role as a volunteer. TAC and Health and Hope are examples of best practice and innovation. Natalie Snyder, Manager of Mental Health Ambulatory/Outpatient Services, says, “It’s a hope-based approach. People dealing with mental health issues need to know they can have stability and quality of life.” This is one more way Joseph Brant lives its vision of Best People. Best Care. Healthiest Community.

If you want to know more about these two groups, please contact Joseph Brant Memorial Hospital Mental Health Ambulatory/Outpatient Services at 905-631-1939.