Mental health key component of St. Mike’s inner city health program

Since its founding in 1892, St. Michael’s Hospital’s mission has been to provide the best possible care to the inner city community that surrounds it.

St. Michael’s has a unique patient population given its diverse catchment area. The area includes some of the highest and lowest income households in Canada. At one end are neighbourhoods such as St. James Town and Regent Park, which are more diverse and impoverished and have lower education levels and higher burdens of illness compared to the City of Toronto as a whole. On the other hand, areas such as Rosedale are among the wealthiest in the county.

In a recent study, researchers with the hospital’s Centre for Research on Inner City Health and the Institute for Clinical Evaluative Sciences found that more low-income patients in the Toronto Central Local Health Integration Network were hospitalized for mental health issues, visited emergency departments for non-urgent issues and remained in acute care hospital beds while waiting to be transferred to more appropriate levels of care in the community such as nursing homes, than patients in the higher-income bracket.

In addition, the researchers found that mental health inpatients were nearly twice as likely to live inside rather than outside of the Toronto Central LHIN.

St. Michael’s treats approximately 550 people in the psychiatric inpatient unit each year and places great emphasis on its mental health program. Mental health is one of the hospital’s six core services and is part of its inner city health program.

St. Michael’s focus on mental health services does not revolve solely around inpatient care. It also offers a continuum of innovative, high-quality, integrated, comprehensive mental health services to the surrounding community of southeast Toronto and beyond.

In partnership with the community, the mental health service provides assessment, treatment, rehabilitation, linkages to community agencies and support to individuals who have severe and persistent mental illness. These individuals may be marginally housed, homeless and suffer from addictions and HIV-related disorders.

Intensive services such as assertive community treatment and intensive case management are provided for people with serious mental illness by interdisciplinary teams of addictions counsellors, occupational therapists, pharmacists, psychiatrists, registered nurses, peer support workers, vocational rehabilitation therapists, rehabilitation therapists and social workers.

A St. Michael’s psychiatrist recently launched an inner city mental health curriculum. This pilot project elective course consists of 10 monthly seminars and is open to all psychiatry University of Toronto psychiatry residents, years two through five, doing rotations or call at St. Michael’s. It is also open to nurses, social workers, occupational therapists and other clinicians from the mental health service.

The purpose of this course is to help residents, clinicians and allied health professionals from the mental health service develop knowledge and skills that will help them enhance their ability to provide excellent care for the unique patient populations they serve within the inner city. Participants will also learn more about the importance of working within an interprofessional care environment.

“We are very excited about this new course,” says Dr. Mark Halman, a staff psychiatrist and course director. “The 90-minute seminars, which will cover a variety of topics including addictions, advocacy, homeless populations, first episode psychosis in an inner city setting and mental health systems, provide a natural link to what we do here at the hospital on a daily basis. We are in essence putting down on paper a model we live and breathe by when we treat our patients.”

Dr. Halman also noted that the course will empower people on the front line to focus on how care can best be provided in the community versus in an acute care setting.

The course will use a variety of teaching methods including case-based seminars, presentations from people with lived-experience (peer supports), and lectures from content experts.

In addition to this unique course the hospital has established an urgent care clinic for mental health and addictions. This clinic was created to provide vital short-term follow up care for patients discharged from the emergency department or the psychiatric inpatient unit, who no longer require acute care but are not able to wait for community-based care.

The clinic, which was launched in April and expanded in September, operates three days a week. Patients are usually seen for a maximum of three months before being transitioned to community-based services.

“The urgent care clinic is a great addition to our mental health service,” says Dr. Vicky Stergiopoulos, psychiatrist-in-chief. “Having this type of clinic available enables us to provide better continuity of care and prevents our patients from experiencing setbacks in their treatment and recovery following their discharge, a time of vulnerability for them.”

The mental health service has also recently hired a registered nurse who has advanced training in addictions. Lauren Alexander, a former psychiatric emergency service nurse at the hospital, provides addictions consultations to patients from all units at St. Michael’s. Her role will enhance the patient experience, Dr. Stergiopoulos said. Patients with addictions who end up in other hospital programs and services at St. Michael’s can still receive treatment for their addiction while receiving other necessary acute care.

In addition to these new programs and services, the hospital also offers psychiatric emergency services, including the emergency crisis service, crisis stabilization unit, mobile crisis intervention team, community mental health liaison team, geriatric mental health outreach program and the medical psychiatry consultation liaison service.

Through its inner city health program, the mental health services community advisory panel was also created. This group of community partners and people with lived experience meets monthly and is responsible for making recommendations to the hospital around mental health issues and the types of services and supports most needed by our patients and our community.