Integrating hospital with community to address the opioid crisis

By Mike Lapaine

Ontario is in the midst of an opioid crisis and with every report and media article released, the severity of the problem becomes more apparent. In hospitals, the crisis can be seen on the faces of the people who come to us for care and support for themselves or their loved ones. The physical and social damage that individuals struggling with addictions and their families face is, quite simply, devastating and is most certainly the weak link in our health care system.

Adding more complexity, once you peel back the layers of addiction you can find any number of mental health issues which have been both dulled and exacerbated through the use of opioids and other harmful substances. Addictions and Mental Health are inextricably linked. Often, people with addictions present in the Emergency Departments across Canada or are admitted to hospital for acute care treatment for issues related to poor nutrition, falls, cardiac or stroke.

It would be a gross understatement to say that there are no simple solutions. What we can be sure of is that the opioid crisis cannot effectively be addressed by one sector of the healthcare system or even the healthcare sector on its own. As leaders in healthcare, we need to step outside of our hospital walls and indeed outside our sector to look for new ways to work with partners to ensure that our communities have the best care possible, well before, most certainly during and long after their acute care need.

Eighteen months ago, in recognition that mental health and addictions experiences are not limited to acute care, Bluewater Health fundamentally changed our mental health and addictions model. Together with the Canadian Mental Health Association Lambton Kent Branch we created a joint leadership position, accountable to both organizations. Effectively, the Integrated Vice President represents the connectivity between community and hospital. The Integrated Vice-President, Mental Health & Addictions Services is a member of the Executive Council for both organizations; she has a unique opportunity to educate and inform senior leaders about mental health and addictions and participate in policy development and strategic decisions. For Bluewater Health, this has served as a starting point to embed the mental health and addictions lens into every patient population cared for in the hospital setting.

Through this experience, we have learned that we need to re-examine the way “we have always done things.” Specific to the opioid crisis, we recently implemented Emergency Department (ED) Opioid Prescribing Guidelines. This included significant consultation with primary care partners, as well as stakeholders inside and outside of our walls. Key to this program is the compassionate approach to people who are presenting in the ED for opioid prescriptions, communication with primary care and in the event a patient does not have a primary care provider, referral to a primary care physician who has agreed to see the patient within three days.

Leaders in mental health and addictions – both locally and further afield – are able to implement advancements in mental health and addiction care at every stage of the patient journey with the strength of our collected wisdom and commitment. From prevention to early intervention to harm reduction to abstinence, with our partners we are part of a collective effort to become greater than the sum of our parts.

With this model in place, we are beginning to realize improvements for patients, for instance typical withdrawal management wait times have fallen from 19 days in April of 2014 to less than one day currently. Work is well underway for a residential treatment facility and true to our integrated model, our partners have been involved every step of the way during the initial phases of this project. Proposed services for our  Withdrawal Management Program  will include residential program beds, stabilization beds, continuing with existing community withdrawal management services, day treatment and referral services and with addictions counseling services. The goal is for this hub to be easily-accessible and community-based.

In order for a successful recovery from addictions to occur, community partners providing fundamental services such as primary care, housing, income and employment opportunities, will continue to be critical contributors to this collaborative model of service delivery to address the multiple needs of those with addictions, through an integrated model of care. Their insight will assist us in guiding the plan through a public health approach to address not only healthcare, but social welfare and education.

Moving forward, we know that there will be more opportunities to make improvements, push ourselves further and take risks, but we have the model in place and solid working relationships with our community partners. At Bluewater Health, we are a conduit to getting people the care they need, inside the hospital and out. As one organization, we cannot solve the addictions crisis in our community but with our partners, we are able to create of system of shared care that optimize existing resources and collectively plan and execute new services that may still be missing to complete this model, and increase the success rates for our clients and families who experience the devastating effects of addictions.

Mike Lapaine is President and CEO, Bluewater Health.