Service integration is a key focus of the government’s healthcare transformation agenda. However, just mention “service integration” to service providers today, and you’re often met with a mixed response. Understandable, given the current system’s complex service delivery system. In the Mental Health sector alone there are acute-care hospital settings, tertiary care centres, and community mental health clinics and agencies, to name a few, all with differing mandates, and all attempting to provide responsive, effective, efficient service to growing numbers of people who are experiencing mental illness. How does one even begin to contemplate integrated service delivery with so many different service providers in the mix?
Dr. Bharat Chawla, staff psychiatrist at Peterborough Regional Health Centre (PRHC), and lead psychiatrist for the region’s new Early Psychosis Intervention (EPI) program is able to offer some suggestions. “Here at PRHC, and in our community and region, we are moving forward with mental health service integration initiatives, and we are seeing the benefits that integration can bring – not just to patients and their caregivers, but to physicians and staff as well.”
Dr. Chawla is a strong advocate of PRHC’s Mental Health Service. He comments on the Service’s five, well-developed, patient-centered programs – the Inpatient Program, the Adult Outpatient Program, the Schizophrenia Clinic, the Family and Youth Clinic, and the Psychogeriatric Assessment Service for the Elderly. Each has a very distinct role in service delivery, but all work closely together. He notes that program planning, previously conducted independently by each program, is now a more integrated process, as demonstrated by the Programs’ recent, collective review and modification of discharge planning practices. “Program staff came away with a better understanding of each others’ practices, how processes in one program can impact another, and they were able to identify areas to improve upon, such as charting, thus facilitating a smoother flow of clinical information that is often shared between program clinicians, in support of preparing a patient for discharge”.
Physicians and staff understand the importance of streamlined transition points (moving from one department to another, or from program to program), particularly for mental health patients, who, like other clients of the health-care system, can be easily overwhelmed. Dr. Chawla offers the example of a patient in crisis, who enters the system through the Emergency Department, and is connected and spends time with a member of the Urgent Care Services Team, whom at a later point in the patient’s care, may be the leader of a group therapy session in which that patient participates, post-discharge, through the service’s Adult Outpatient program.
Dr. Chawla is quick to note that improvements in service integration are not focused strictly within the hospital’s mental health service. “We are increasingly working with our community partners in support of greater service integration”. He is pleased with the new Peer Support Program, a collaborative initiative between the hospital’s mental health Inpatient Program and the Canadian Mental Health Association (CMHA) Peterborough Branch. This initiative pairs an inpatient with a community Peer Support Worker (a previous or current mental health consumer, now employed by CMHA), who, through experience, education and training, assists the inpatient in moving to recovery. It links the patient with community supports, earlier in their hospital stay, and, on a more personal level.
Earlier this year, Dr. Chawla was named Lead Psychiatrist for the new Haliburton Kawartha Pine Ridge Early Psychosis Intervention Program (HKPR-EPI), a program that functions as a network of collaborating services within existing organizations. The program identifies and provides intensive and comprehensive service to individuals (and their families) experiencing first-episode psychosis. Research demonstrates that long-term suffering and expense can be prevented through early intervention and Dr. Chawla observed there was certainly a hospital and community interest for such a program in the HKPR region. A Task Group was struck, a proposal was submitted to the Ministry, and “…we now have a program we are all excited about,” says Dr. Chawla.
Recently, a partnership was forged between PRHC Mental Health Services and the Peterborough Community Access Centre. “Transition from hospital back to community can be a difficult time for patients, many of whom have no family doctor to provide follow-up care,” notes Dr. Chawla. “Non-compliance with discharge plans often becomes a problem, resulting in greater risk of readmission to the hospital, sometimes in crisis. Mental Health Services and the Access Centre worked together, came up with a screening process and a referral protocol, and the Access Centre now coordinates short-term provision of professional and personal support services for discharged mental health patients in the their homes.”
Patients, caregivers, and organizations are not the only winners here. Dr. Chawla contends his diverse medical practice is more efficient because of service integration. He provides inpatient and outpatient assessment and treatment, consultation to the Psychogeriatric Assessment Service for the Elderly and Schizophrenia Clinic, and community outreach. He often follows patients and their caregivers, as they transition from one to the next of the hospital’s various mental health programs, and to and from community services. “I benefit from integrated service much the same as patients do. A streamlined intake process, that directs referrals to the relevant hospital mental health program, or back to the community for more appropriate care, may reduce the time a discharged patient waits to see me for a follow-up visit.”
Dr. Chawla suggests that when “service integration” is seen as a “task” that must be accomplished, it can be pretty daunting. “Because we are seeing successes through more collaborative and partnering approaches, both internally and externally, we now see service integration not so much as a task, but as a basis for all programming and planning discussions.”