North Zone Addiction and Mental Health. Strategic Plan A Strategic Plan for the Mental Health and Well- Being of Northern Albertans

Transcription

1 Nrth Zne Addictin and Mental Health Strategic Plan A Strategic Plan fr the Mental Health and Well- Being f Nrthern Albertans Published Octber 8,

2 AHS Nrth Zne Addictin and Mental Heath Strategy Nrth Zne Addictin and Mental Health Strategic Plan Statement f Accuntability The Nrth Zne Addictin & Mental Strategic Plan was develped t align with Alberta Health Services strategic directin and pririties. Perfrmance measures and ther metrics are detailed in the Operatinal Plan t prvide baselines fr assessing achievements. On behalf f the Nrth Zne Executive Leadership Team, I declare that we are cmmitted t achieving the results described in this three-year health plan. Shelly Pusch, Senir Vice President Nrth Zne March 3, 2014 Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 2 f 46

3 AHS Nrth Zne Addictin and Mental Heath Strategy Acknwledgements The prject team gratefully acknwledges significant cntributins, including cnsiderable input and feedback t the cmpletin f this strategic plan, frm the fllwing individuals: Heather Tprwski Dnna Kch Stacy Greening Dug Nrtn Debra Samek Ghislaine Bucher Nellie Klassen Dr. Sandra Crbett Celeste Williams Jan Libsekal Laurie Beverley Judy Bgdan Tzeggai Berhe Dn Hunt Bev Mylan Kathryn Wiebe Mnique Maisnneuve Tara Harpe Kate Campbell Margaret Agnew Fran Barnes April Nelsn Sui Sandy Pattersn Vice President, Nrth Zne Prgram and Perfrmance Executive Directr, Public Health, Addictin and Mental Health, Nrth Zne. Directr f Integrated Service Planning and Perfrmance - Nrth Zne Directr, Addictin and Mental Health, NW Nrth Zne Directr, Addictin and Mental Health, NE Nrth Zne Special Prjects, Public Health, Addictins & Mental Health, Nrth Zne Admin Assistant t Executive Directr, Public Health, A&MH, Nrth Zne Nrth Zne Clinical Department Head, Psychiatry Manager, Addictin and Mental Health Athabasca VP, QEII Hspital Executive Directr, Primary and Cmmunity Care, Addictin and Mental health Prvincial Advisry Cuncil n Addictin and Mental Health Psychiatrist Patient Care Directr, QEII Hspital Ppulatin Health Manager, Nrth Zne Representative, Prvincial Advisry Cuncil n Addictin and Mental Health Representative, Prvincial Advisry Cuncil n Addictin and Mental Health Executive Admin Crdinatr, Ppulatin and Public Health, Addictin and Mental Health Senir Planner, Integrated Service Planning Pririties and Perfrmance Directr, Zne Integratin and Clinical Standards, Primary and Cmmunity Care, Addictin and Mental health Manager, Zne Integratin and Clinical Standards, Primary and Cmmunity Care, Addictin and Mental Health Clinical Cnsultant, Zne Integratin and Clinical Standards, Primary and Cmmunity Care, Addictin and Mental Health Primary and Cmmunity Care, Addictin and Mental Health System Perfrmance and Reprting Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 3 f 46

4 AHS Nrth Zne Addictin and Mental Heath Strategy Table f Cntents Executive Summary... 5 Intrductin... 7 Purpse... 7 Hw the Strategy was Develped... 8 Stakehlder Engagement and Cnsultatin... 8 Alignment with AHS Prvincial Strategy... 9 Wh We Are and What We D The Ppulatin We Serve Our Call t Actin Strategic Alignment Strategic Pririties, Gals and Key Strategies Strategic Pririty #1: Reduce Deaths by Suicide and Intentinal Self Harm Strategic Pririty #2: Ensure the apprpriate use f Emergency Department in addressing A&MH cncerns Strategic Pririty #3: Imprve the Transitin f Patients frm Acute Care back t their Cmmunity Strategic Pririty #4: Reduce the Wait Lists fr Cmmunity A&MH Services Strategic Pririty #5: Address the Capacity Needs fr Inpatient Psychiatry Beds acrss the Nrth Zne Strategic Pririty #6: Supprt Families and Caregivers caring fr individuals with Cmplex A&MH Issues Enabler #1: Funding and Cmpensatin Framewrks Enabler #2: Leverage Technlgy and Infrmatin Sharing Enabler #3: Wrkfrce Develpment Enabler #4: Research, Educatin and Knwledge Translatin and Use Mnitring Prgress: Accuntability, Cntinuus Imprvement and Reprting Appendix A: Strategic Planning Timeline Appendix B: SWOT Analysis Summary Appendix C: Literature Review Appendix D: Addictin & Mental Health: Beds staffed and in peratin as f March 31/ Appendix E: References Appendix F: Glssary and Acrnyms Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 4 f 46

5 AHS Nrth Zne Addictin and Mental Heath Strategy Executive Summary The prevalence, impact and cnsequences f addictin and mental illness are well knwn and can strike at any age and in any ppulatin. There is a need t evaluate and transfrm the Nrth Zne addictin and mental health care given the increasing number f peple experiencing addictin and mental health cncerns acrss the Nrth Zne. The time t act is nw! The Nrth Zne Addictin and Mental Health team is cmmitted t imprving mental health and addictin care fr Albertans living in the Nrth Zne. This high level strategic plan demnstrates that cmmitment and is the result f an extensive stakehlder cnsultatin and review f data. It describes the current system, identifies service gaps, and prvides an verview f the six pririties and fur enablers t the pririties that will infrm the team s wrk ver the next three years. The strategy was develped t align with Creating Cnnectins, the Gvernment f Alberta s Addictin and Mental Health Strategy and the Alberta Health Services Health and Business Plan Thrugh this three-year plan, Nrth Zne Addictin and Mental Health team is wrking t ensure that: Thrugh an extensive and cllabrative planning prcess, six pririties were selected as fcus areas t make a real difference in the lives f peple with mental illness and addictin cncerns. In additin, fur (4) enablers t the pririties were identified as critical t building the rganizatinal capacity and infrastructure required t successfully address the service delivery pririties and achieve the desired results. Strategic Pririties: T prvide cmmn directin t Nrth Zne Addictin and Mental Health prgrams and services, these are the 6 pririties selected: 1. Reduce death by suicide and intentinal self harm in the Nrth Zne. Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 5 f 46

6 AHS Nrth Zne Addictin and Mental Heath Strategy Ensure the apprpriate use f Emergency Department in addressing A&MH cncerns 3. Imprve the transitin f patients frm acute care back t the cmmunity. 4. Reduce the wait lists fr cmmunity addictin and mental health services. 5. Address the capacity needs fr inpatient psychiatry beds acrss the Nrth Zne. 6. Supprt families and caregivers caring fr individuals with cmplex addictin and mental health issues. Enablers t Pririties: Fur enablers were identified t supprt successful implementatin f the six strategic pririties. 1. Funding and Cmpensatin Framewrks 2. Leverage Technlgy and Infrmatin Sharing 3. Wrkfrce Develpment 4. Research, Educatin and Knwledge Translatin and Use The success in meeting this strategic agenda ver the next three years will be in large part due t the cmmitment and passin f nrthern Addictin and Mental Health leadership, staff, physicians, clleagues and partners. Funding requirements will need t be determined and may require the redeplyment f current funds/allcatin r new funds (grants, peratinal dllars, etc.) t ensure maximal impact fr ur clients and their families. This plan lays the fundatin t enhance addictin and mental health service delivery acrss the care cntinuum and imprve system access and capacity fr Nrth Zne clients, patients, and families. Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 6 f 46

7 AHS Nrth Zne Addictin and Mental Heath Strategy Intrductin Mental illness and addictin is experienced by millins f peple acrss Canada every day, either directly r indirectly. It is estimated that ne in five Albertans will experience a mental illness at sme pint in their lifetime and the remaining fur in five Albertans will have a friend, family member, r clleague wh has been r will be affected. Furthermre, as many as 10 percent f peple ver the age f 15 may be dependent n alchl r drugs and sme are experiencing bth mental disrders and substance abuse prblems. Addictin and Mental Health (A&MH) services in the Nrth Zne are feeling the strain f the grwing ppulatin and demands fr care (including specialty care). In respnse t these grwing service pressures, the Nrth Zne embarked in a strategic planning prcess in 2012 by examining the unique A&MH challenges f the Nrth Zne and wrking cllabratively t develp a strategic plan with a clear line f sight t the prvincial pririties. Purpse The Nrth Zne Addictin and Mental Health Strategic Plan prvides an verview f the strategic pririties the Nrth Zne intends t fcus n ver the next 3 years t respnd t the challenges and pressures in addictin and mental health service delivery. This strategic plan is in alignment with Creating Cnnectins: Alberta s Addictin and Mental Health Strategy and supprts the visin, missin, values and strategic directins f Alberta Health Services (AHS) as a whle. Alberta Health Services Visin, Missin, Values and Strategic Directins AHS Visin: T becme the best perfrming, publically funded health system in Canada. AHS Missin: T prvide a patient-fcused, quality health system that is accessible and sustainable fr all Albertans. The main gals f the system are a fcus n Access, Quality, and Sustainability fr health services. These gals drive wrk thrughut the rganizatin and remain a fcus f the develpment f the verall Addictin and Mental Health Strategic Plan fr the Nrth Zne. AHS Values: Alberta Health Services' cre values have ne thing in cmmn: the quality f patient care. Our seven values - respect, accuntability, transparency, engagement, safety, learning and perfrmance - drive us, and unite us. AHS Strategic Directins : 1. Bringing apprpriate care t the cmmunity 2. Achieving health system sustainability 3. Partnering fr better health utcmes Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 7 f 46

8 AHS Nrth Zne Addictin and Mental Heath Strategy Hw the Strategy was Develped Strategic plans cannt be created in islatin. As such, the Nrth Zne Addictin and Mental Health Strategic Plan was develped using a number f infrmatin gathering methds and surces t decide n future pririties and actins. These included: Stakehlder engagement and cnsultatin, including physician engagement SWOT Analysis (See Appendix B) Data cllectin and analysis Literature Review (See Appendix C) Prvincial Addictin and Mental Health Strategic Plan (Creating Cnnectins) AHS Health Plan and Business Plan Nte: The Strategic Planning timeline is available in Appendix A. Stakehlder Engagement and Cnsultatin Thrughut the strategic planning prcess, Alberta Health Services cnsulted with staff, physicians and ther stakehlders abut the implementatin and delivery f addictin and mental health services in Nrthern Alberta. The verall gal f the cnsultatin was t review data, share strategies, and identify what is wrking well and areas f imprvement, all f which have been cnsidered in the develpment f the Nrth Zne Addictin and Mental Health Strategic Plan Stakehlder engagement ccurred at three stages within the planning prcess: Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 8 f 46

9 AHS Nrth Zne Addictin and Mental Heath Strategy Alignment with AHS Prvincial Strategy The Nrth Zne Addictin and Mental Health Strategic Plan was develped and influenced by many ther strategic initiatives f Alberta Health Services. The fllwing dcuments cntributed substantially t the develpment f the Strategic Plan: Creating Cnnectins: Alberta s Addictin and Mental Health Strategy Tp 10 AHS Prvincial Addictin and Mental Health pririties Alberta Health Services Health Plan and Business Plan Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 9 f 46

10 Wh We Are and What We D The AHS Addictin and Mental Health prtfli in the Nrth Zne prvides addictin and mental health services acrss the cntinuum f care t a ppulatin f ver 447,000 peple acrss a widely varied gegraphic area f apprximately 448,500 km2 (73% f Alberta s land mass). The Nrth Zne Addictin and Mental Health team includes: AHS Staff: A skilled and dedicated wrkfrce f ver 325 full time equivalents including therapists, cunselrs, nurse practitiners, registered nurses, licensed practical nurses, curt liaisn wrkers, utreach wrkers, crdinatrs, aides, and ther staff in cmmunities acrss the Nrth Zne. (Nte: des nt include cntracted agency staff.) Adult Psychiatrists: 10 adult psychiatrists are permanently lcated in Peace River, Frt McMurray, St. Paul, and Grande Prairie. Travelling psychiatrists regularly visit cmmunities f High Prairie, Athabasca, Hintn, Slave Lake, Onway, Mayerthrpe, Westlck, and Edsn Child Psychiatrists: A full time child psychiatrist lcated in Grande Prairie and travelling psychiatrists wh prvide supprt in Edsn, Frt McMurray, St. Paul, Peace River, High Prairie, Barrhead and High Level Family Physicians: Apprx. 218 The Ppulatin We Serve The ttal dcumented ppulatin in this Zne is 466,135 (2012). There is significant diversity in the distributin f the ppulatin acrss the Nrth, spanning frm mre highly ppulated areas t very remte ppulatins. There are 367 cmmunities lcated ver 16 Cunties as well as 8 Métis Settlements, 31 First Natins and 96 Reserves in the Nrth Zne. Majr industries in the Nrth include frestry, il and gas and agriculture. The Nrth has a large transient wrker ppulatin that is significantly impacted by the bust and bm ecnmy related t its majr industries. The Nrth has a relatively yung ppulatin with nly 8.8% f the ppulatin aged 65 r lder cmpared t 10.9% fr the prvince. The average age varies frm yunger ppulatins in Frt McMurray t lder ppulatins in sutheast rural cmmunities in the zne. The average census family incme per year is $91,832 (Alberta average: $98,240), althugh it ranges frm $77,507 in the Nrth West t $140,751 in the Frt McMurray area. Encmpasses tw reginal hspitals: Queen Elizabeth II Hspital (Grande Prairie) and the Nrthern Lights Reginal Health Care Centre (Frt McMurray). Smaller hspitals and health centers, Primary Care Netwrks, a Family Care Clinic, and independent primary care prviders prvide lcal care t residents thrughut the Nrth Zne. 10

11 AHS Nrth Zne Addictin and Mental Heath Strategy Our Call t Actin Thrugh detailed analysis and cmprehensive discussins abut the future f Addictin and Mental Health services in the Nrth Zne, six (6) strategic pririties and fur (4) enablers t the pririties have been identified. The strategic pririties identified fr Nrth Zne Addictin and Mental Health ver the next three years are the rganizatin s respnse t the imprtant issues identified in the stakehlder engagement sessins, data analysis, envirnmental scan and literature review that was cmpleted as part f the strategic planning prcess. These pririties address critical issues while cnsidering the strategic directins utlined in the Creating Cnnectins: Alberta s Addictin and Mental Health Strategy Strategic Pririties Six pririties will prvide cmmn directin t Nrth Zne Addictin and Mental Health prgrams and services. 1. Reduce death by suicide and intentinal self harm rates in the Nrth Zne 2. Ensure apprpriate use f the Emergency Department in addressing A&MH cncerns 3. Imprve the transitin f patients frm acute care back t the cmmunity 4. Reduce the wait lists fr cmmunity addictin and mental health services 5. Respnd t the capacity needs fr inpatient psychiatry beds acrss the Nrth Zne 6. Supprt families and caregivers caring fr individuals with cmplex A&MH issues Enablers Fur enablers will supprt successful implementatin f the strategic pririties 1. Funding and cmpensatin framewrks 2. Technlgy and Infrmatin Sharing 3. Wrkfrce Develpment 4. Research, Educatin, and Knwledge Transfer and Use Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 11 f 46

12 Strategic Alignment AHS Missin AHS Visin AHS Values AHS Strategic Directins AHS Health and Business Plan Creating Cnnectins: Alberta s Addictin and Mental Health Strategy Tp 12 AHS Prvincial Addictin and Mental Health pririties Nrth Zne Addictin and Mental Health Strategic Plan T prvide a patient-fcused, quality health system that is accessible and sustainable fr all Albertans. T becme the best perfrming, publicly funded health system in Canada. Respect, Accuntability, Transparency, Engagement, Safety, Learning and Perfrmance Bringing Apprpriate Care t Cmmunity Partnering fr Better Health Outcmes Achieving Health System Sustainability Strategic Directins: Build healthy and resilient cmmunities Fster the develpment f healthy children, yuth and families Enhance cmmunity-based services, capacity and supprts. Address cmplex needs Enhance Assurance 1) Pstpartum Depressin Screening 2) Primary Health Care Tls and Supprt 3) Crdinated and Cnsistent Access t Child and Adlescent A&MH Services 4) Bed Plan fr Children s Mental Health 5) Basket f Fundamental Services fr A&MH 6) Tertiary Care Framewrk Strategic Pririties Reduce Death by Suicide and Intentinal Self Harm Apprpriate use f the Emergency Department in addressing A&MH cncerns Transitin f patients frm acute care back t the cmmunity Reduce wait lists fr cmmunity A&MH services Respnd t the capacity needs fr inpatient psychiatry beds Supprt t Families and Caregivers caring fr individuals with cmplex A&MH issues Enablers: Plicy Directin and Alignment Individuals with Lived Experience and Family Engagement Funding and Cmpensatin Framewrks Wrkfrce Develpment Research, Evaluatin and Knwledge translatin and Use Leverage Technlgy and Infrmatin Sharing Cultural Safety, Awareness and Cmpetency 7) Expand Telemental Health 8) Cnceptual Framewrk fr Husing 9) Cmplex PDD 10) Wrkfrce Develpment 11) System Perfrmance Outcme Measurement 12) Research, Evaluatin and Knwledge Translatin Enablers Funding and Cmpensatin Framewrks Technlgy and Infrmatin Sharing Wrkfrce Develpment Research, Educatin and Knwledge Translatin and Use 12

13 Strategic Pririties, Gals and Key Strategies Strategic Pririty #1: Reduce Deaths by Suicide and Intentinal Self Harm Nrth Zne Strategic Gals (What d we want t achieve?): S1.1 Save lives and reduce the number f deaths by suicide f males aged by 10% in the Nrth Zne by S1.2 Prevent injury and reduce the rate f intentinal self harm in females aged years by 10% in the Nrth Zne by Ratinale Suicide and intentinal self harm are significant public health prblems that are largely predictable and preventable and tuch the lives f many peple living in the Nrth Zne f Alberta. The large majrity (90%) f peple wh died by suicide had a health service in the year befre their death (Alberta Centre fr Injury Cntrl & Research, 2012). Deaths by suicide are 2.5 times higher in Abriginal ppulatin and Abriginals experience majr depressin at a rate that is twice the natinal average. Albertans wh died by suicide averaged mre than twice the number f per-persn health care visits in the year prir t their death (Mrrisn & Laing, 2011). Death by suicide (and intentinal self harm) is traumatizing fr surviving family and friends. Nrth Zne The suicide rate in the Nrth Zne f Alberta is abve the Alberta prvincial average (16.1/100,000 vs. 12.8/100,000). Nrth Zne ptential years f life lst t suicide (per 100,000) was (2009), a value that was significantly higher than the Alberta average (418.6 years). In Alberta in 2011, there were 484 deaths by suicide (DIMR, 2012); 72 f these deaths by suicide ccurred in the Nrth zne (15% f all deaths by suicide in the prvince). 57 (79%) f the deaths by suicide were males, 33 (58%) f these were f males aged years. 44% f the deaths by suicide ccurred in the frmer Aspen health regin, 33% in frmer Peace Cuntry, and, 22% in frmer Nrthern Lights. What We Knw... Suicide rates have increased by 60 percent acrss the glbe in the last 45 years (Wrld Health Organizatin, 2013) Intentinal self harm rates in the Nrth Zne are the highest in the prvince at 271/100,000 in 2011/2012. Alberta has the secnd highest rate f suicide in Canada, (CMHA 2012) One death by suicide is estimated t cst between $433,000 and $4,131,000 (CMHA, 2012) 13

14 AHS Nrth Zne Addictin and Mental Heath Strategy In Alberta in 2011, there were 1193 admissins t Emergency department and inpatient beds due t acts f intentinal self harm. 761 (64%) intentinal self harm admissins were females and 683 (90%) were females aged years. Twenty-fur percent f individuals wh visited emergency fr mental health/substance related were First Natins, the highest prprtin between ages Intentinal self harm is ne f the tp three diagnses. A fcused and crdinated plan f actin is required in the Nrth Zne t reduce the rates f suicide and intentinal self harm. What fllws are the gals, strategies and actins the Nrth Zne plans t take t address the high suicide and intentinal self harm rates ver the next three years. Strategies (Hw are we ging t achieve the gals?): Priritize suicide preventin activities in the Nrth Zne acrss the lifespan. Enhance the capacity f physicians and health prfessinals fr early identificatin and interventin f thse at risk f suicide and/r affected by suicide in the Nrth Zne. Prvide supprt services fr thse impacted by suicide. Increase the quality, timeliness and usefulness f surveillance data regarding suicide and intentinal self harm. Establish cllabrative partnerships with ther stakehlder grups wrking t address suicide acrss the Nrth Zne. Ensure that staff and physicians are aware f and cmpliant with the AHS Suicide Risk Management Plicy Suite. Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 14 f 46

15 AHS Nrth Zne Addictin and Mental Heath Strategy Strategic Pririty #2: Ensure the apprpriate use f Emergency Department in addressing A&MH cncerns Nrth Zne Strategic Gals (What d we want t achieve?): S2.1 Decrease the Emergency Department (ED) visit rate fr addictin and mental health cncerns by reviewing the apprpriate use f ED and prviding alternate levels f service and interventin in the cmmunity. S2.2 Imprve the Addictin and Mental Health supprts in the Emergency Departments (ED) acrss the Nrth Zne. This wuld encmpass ptentially increased resurces and ensures using existing ptimal. S2.3 Imprve access t apprpriate cmmunity based addictin and mental health services. S2.4 Reduce the number f repeat visits t the Emergency Department within 7 days and 30 days f inpatient discharge fr individuals seeking care fr mental illness r substance abuse. Ratinale (Nte: Infrmatin in this sectin reflects stakehlder feedback during the SWOT analysis) Emergency departments (ED) are an apprpriate pint f access fr sme individuals experiencing a psychiatric emergency. Hwever, many peple in crisis turn t ED due t a lack f ther available ptins. A lack f access t cmmunity addictin and mental health services and supprts, primary health care and cmmunity-based psychiatric care are key reasns fr ED visits. With lng wait lists fr service in the cmmunity, patients can deterirate further while waiting t access service and present t the ED in crisis. Oftentimes, repeat ED visits are the result f limited husing supprts and hspitals having insufficient infrmatin t refer individuals t mre apprpriate and lng-term services and supprts in the cmmunity. In additin, when patients arrive t ED, apprpriate interventin and supprt is nt always available. There is a lack f expertise in ED staff and physicians t address A&MH needs with n cnsistent prcess in place acrss the Nrth Zne fr ED staff and physicians t access timely psychiatric expertise (psychiatrist, addictin and What We Knw... Nrth Zne has the highest ED visit rate f 3,261/100,000 fr A&MH related cncerns in the prvince (2112/100,000) (AHS, 2013). 14,599 emergency rm visits tk place in the NZ fr mental health and/ r substance related prblems during fiscal year 2011/12. (A&MH Services: Nrth Zne, 2013) Females are mre likely t be treated in the Emergency Department fr mental health and/r substance related prblems in almst all age grups in the Nrth Zne (A&MH Services: Nrth Zne, 2013) Males in the Nrth Zne had the highest rate f ED visits related t vilence and purpsely inflicted injuries (injury resulting frm firearms, fights/brawls, sexual assault, cutting/piercing, maltreatment, drug/liquids, neglect/abandnment) cmpared t ther znes acrss the prvince. (Alberta Health, 2013) Apprximately 24% f the individuals visiting the ED fr mental health and/ r substance related prblems were identified as First Natins peple with Treaty Status. Highest prprtin between ages Highest number at St. Paul and High Level ED s Greatest number f visits related t: Substance related disrder Anxiety Disrders Intentinal Self harm In 2011/2012, percentage f individuals wh visited an ED within 7 days fr substance use and/r mental health prblems fllwing discharge frm acute care hspital = 4% in NZ, slightly higher than the Alberta average f 3%. (AHS, 2013). In 2011/2012, the percentage f individuals wh visited an ED within 30 days fr substance use and/r mental health prblems fllwing discharge frm acute care hspital = 7% in NZ, n par with the Alberta average. (AHS, 2013) Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 15 f 46

16 AHS Nrth Zne Addictin and Mental Heath Strategy mental health prfessinals, etc.) fr cnsultatin purpses. A&MH educatin t ED staff and physicians requires enhancement alng with a cnsistent A&MH prtcl fr the ED t ensure patients get the care they need when they need it. The impact f the lack f supprt in the ED t manage patients with A&MH cncerns is significant and can lead t: High use f ED Services: Patients are using cstly ED services when a prprtin f care that they seek can be prvided in the cmmunity. Under treatment r n treatment because f lack f expertise in ED. Peple experiencing mental illness and addictins are presenting t the ED and ften have cmplex health issues that require a multidisciplinary apprach (unable t be prvided in the ED). Over admissin t Inpatient Unit: Patients may be admitted unnecessarily due a lack f mental health/addictin knwledge in prviders in the ED. This becmes a prblem when the psychiatrist is nt available fr cnsultatin and children/yuth/adults may be admitted t the hspital unnecessarily. Discharge Prblems: Patients ften leave the ED withut referral due lack f knwledge f cmmunity resurces and relatinships with addictins and mental health prgrams. Strategies (Hw are we ging t achieve the gals?): Imprve the Addictin and Mental Health supprts in the Emergency Departments (ED) fr patients with addictins and mental health cncerns. This wuld encmpass ptentially fr bth increased resurces and ensures using ptimal. Enhance the flw f patients thrugh the ED and frm ED t an inpatient unit fr patients experiencing A&MH issues. Enhance the flw f patients frm the ED t cmmunity A&MH services. Imprve the service crdinatin, cmmunicatin, and cllabratin between specialist mental health services, emergency departments and cmmunity A&MH services. Increase the quality, timeliness and usefulness f surveillance data regarding ED utilizatin fr addictin and mental health related issues. Review and mnitr the reasns fr the ED visit t better understand why patients are accessing care in the ED and their existing linkages t cmmunity A&MH services. Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 16 f 46

17 AHS Nrth Zne Addictin and Mental Heath Strategy Strategic Pririty #3: Imprve the Transitin f Patients frm Acute Care back t their Cmmunity Nrth Zne Strategic Gals (What d we want t achieve?) S3.1 Establish cnsistent guidelines and prcesses (between znes and within the Nrth Zne) fr fllw up with patients t ensure they have the supprt they require in the cmmunity fllwing discharge frm an addictin and mental health hspital admissin. S3.2 Reduce readmissin t a hspital facility within 7 and 30 days (ED admissins and readmissins t inpatient) by ensuring peple are prperly cnnected t services in their cmmunity. Ratinale The smth and safe transitin f patients with A&MH cncerns frm acute care back t the cmmunity in the Nrth Zne is challenged with a lack f fllw up/cntinuity f care, medicatin management, and husing supprts. Withut apprpriate fllw up care and cntinuity, the patient can face significant risk f adverse events during the transitin frm acute care back t their cmmunity. Prly managed transitin can lead t diminished health, avidable cmplicatins, increased cst, and readmissin t hspital. The challenges with cntinuity f care during a transitin frm the acute care centre back t the cmmunity may be a result f, but nt limited t, the fllwing: Lack f cmmunicatin and knwledge sharing between patients, caregivers, and prviders befre, during and after the acute care encunter. Lack f cnsistency in develping a transitinal care plan; the care plan fr the patient is nt always clear frm admissin thrugh t discharge and transitin back t the cmmunity. Patients are being discharged frm hspital quicker and mre acute due t the capacity issues and service demands placed n acute care sites. Given the Nrth Zne s large gegraphic area, health care prviders in the acute care setting are ften segregated and gegraphically remved frm the patient's hme setting. Hme health care services may be underutilized r unavailable What We Knw... In 2011/2012, 12% f patients were fllwed up (30 days) pst discharge frm Acute Care hspitals t cmmunity mental health r utpatient hspital services fr individuals with substance use and/r mental healthrelated prblems (AHS, 2013). This is lwer than the Alberta average f 15% during the same time perid. Percentage f repeat hspital admissins fr mental illness in = 9% in NZ (Three r mre episdes f care in general hspitals fr select mental illness within ne year); slightly lwer than Prvincial average (10%). (AHS, 2013) The 30-day readmissin fr mental illness in 2010/2011 = 12% in NZ; higher than Alberta average f 10% during same time perid. (AHS, 2013). Percentage f repeat hspital admissins (tw r mre) fr substance use and/r mental health related prblems during 2011/2012 year = 19% in NZ; slightly higher than the prvincial average f 18%. (AHS, 2013). 9% f readmissins ccurred within 30 days. 4% f readmissins ccurred within 7 days. in the patient s hme cmmunity. Primary care physicians ften have little r n infrmatin abut their patients' hspitalizatins making it difficult fr cntinuity f care in the cmmunity. The situatin is even wrse fr thse patients wh have n primary care prvider in their lcal cmmunity. Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 17 f 46

18 AHS Nrth Zne Addictin and Mental Heath Strategy Primary care physicians are rarely visiting their patients when hspitalized. Care is being prvided by hspitalists r physicians wh nly treat patients in the hspital. The remval f patients' primary care physicians in the hspital has led t an increased need fr care crdinatin amng prviders that desn't always ccur. Fcused attentin is required tward imprving the transitin f patients frm acute care t cmmunity is fr the Nrth Zne residents t ensure ptimal patient utcmes. Strategies (Hw are we ging t achieve the gals?): Enhance the fllw up/after care and nging treatment capacity in the cmmunity Explre structured supprtive husing ptins fr patients. Develp clear pathways fr transitining patients frm ne care setting t anther within the Nrth Zne and between znes. Enhance the cmmunicatin and linkages between primary care prviders (family physicians), Abriginal cmmunities and A&MH prgrams/ psychiatrists. Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 18 f 46

19 AHS Nrth Zne Addictin and Mental Heath Strategy Strategic Pririty #4: Reduce the Wait Lists fr Cmmunity A&MH Services Nrth Zne Strategic Gals (What d we want t achieve?): S4.1 Ensure 90% f children/yuth receive mental health treatment within 30 days. S4.2 Reduce yuth wait time t access cmmunity addictin services. S4.3 Reduce the adult wait times fr cmmunity mental health and addictin services. Ratinale Timely access t addictin and mental health services is critical fr successful preventin and treatment f children, yuth and adults with addictin and mental illness. Cmmunity mental health and addictin services in the Nrth Zne are struggling t meet demand fr care which is leading t lengthy delays fr patients t btain services. Sme Nrth Zne residents face lng waits when trying t access care in cmmunity and may g t the ED when in r near crisis. Fr peple with mental illness and/r addictin issues, having t wait fr care puts them at greater risk f relapse, crisis hspitalizatin, r even suicide attempts. The fllwing were cited by key stakehlders as prblems that may be cntributing t the lng wait lists fr cmmunity addictin and mental health services: Staffing has nt increased at the same rate as the ppulatin grwth and increasing demand Increased prevalence f addictin and mental health cncerns and demand fr care. Limited ffice space t run grup prgramming Pr management f n shws. Lack f centralized referral system fr cmmunity addictin and mental health services (ne patient may be n mre than ne wait list thereby inflating the wait list) Alberta Health Services has priritized wait times fr access t A&MH services and it als a pririty fr the Nrth Zne. We need t make sure peple are able t get the apprpriate care and treatment they need in a timely manner. What We Knw... Percentage f children aged 0 t 17 years receiving scheduled mental health treatment within 30 days is nt meeting target in NZ Median wait time in cmmunity mental health services fr children and adlescents (0-17 years) =16 days in NZ in 2011/2012. (AHS, 2013); slightly higher than Alberta average f 14 days. During 2011/2012, an average f 68% f children (aged 0-17 years) were seen in cmmunity mental health services within 30 days f referral (AHS, 2013). Median wait time in cmmunity mental health services fr adults (18 years +) =12 days in NZ in 2011/2012; slightly higher than the Alberta average f 11 days. (AHS, 2013) Yuth wait time (days) fr cmmunity addictin services in the Nrth Zne in 2011/2012 (90 th percentile) was the highest in the prvince: 19 days (Alberta average: 10 days) (AHS, 2013). Adult wait time fr cmmunity addictin services in the Nrth Zne in 2011/2012 (90 th percentile) = 11 days (Alberta average = 8 days). (AHS, 2013) The rate per 100,000 ppulatin receiving mental health services in AHS Nrth Zne was 4,599 in 2011/2012 cmpared t 3686 acrss the prvince. (AHS, 2013) Rate per 100,000 ppulatin receiving AHS addictin services in NZ was the highest in the prvince at 1,413/100,000 in 2011/2012. AHS cntracted cmmunity addictin services admissin rate was 330/100,000 in 2011/2012; higher than the prvincial average (251/100,000). (AHS, 2013) Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 19 f 46

20 AHS Nrth Zne Addictin and Mental Heath Strategy Strategies (Hw are we ging t achieve the gals?): Develp a clear understanding f wh is n the wait lists and the factrs cntributing t the length f the wait lists. Establish clear referral criteria fr cmmunity addictin and mental health services t ensure patients are being referred t the mst apprpriate service. Enhance the cncurrent service delivery mdels between addictin and mental health. Enhance mental health prmtin and addictin and mental illness preventin activities acrss the Nrth Zne. Expand the capacity f cmmunity A&MH services by partnering and leveraging the wrk f the Basket f Services Prject, GAPMAP inventry and Cmplex Service Teams. Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 20 f 46

21 AHS Nrth Zne Addictin and Mental Heath Strategy Strategic Pririty #5: Address the Capacity Needs fr Inpatient Psychiatry Beds acrss the Nrth Zne. Nrth Zne Strategic Gals (What d we want t achieve?): S5.1 Mnitr and reduce the number f admissins t ff service beds fr addictin and mental health cncerns. S5.2 Increase access t adult and pediatric inpatient psychiatry beds fr Nrth Zne residents. S5.3 Reduce the LOS f patients in 1) a designated psychiatry inpatient beds and 2) ff-service A&MH patients acrss the Nrth Zne. S5.4 Reduce the number f days stayed in Alternate Level f Care fr Nrth Zne patients with addictin and mental health diagnses. Ratinale The Nrth Zne currently has a ttal f 34 adult inpatient psychiatric beds and 0 pediatric psychiatry inpatient beds t supprt a ppulatin f ver 447,000. This is nt sufficient t address the needs f the ppulatin. The Canadian Psychiatric Assciatin recmmends a rati f 50 psychiatric beds per 100,000 ppulatin r 0.5 per 1000 ppulatin. Given this rati, a ttal f beds wuld be needed in the Nrth Zne t cmply with the Canadian Psychiatric Assciatin s recmmended bed ratis. In additin, anecdtal stakehlder feedback indicates that sme patients are being admitted t an inpatient bed unnecessarily due a lack f mental health/addictin knwledge in prviders in the ED and limited access t psychiatry expertise after regular business hurs. Withut access t timely cnsults, ED physicians may hld a patient in ED r admit them until a cnsult can be cmpleted. Strategies (Hw are we ging t achieve the gals?): What We Knw... Nrth Zne has: 34 adult psychiatry inpatient beds, 0 child/yuth psychiatry inpatient beds, 4 yuth detx beds 126 adult addictin inpatient beds, 6 Adult Cmmunity Mental Health beds. See Appendix D fr A&MH Beds staff acrss the Prvince as f March 31/13. Cmpared t all znes, the Nrth Zne has the lwest beds per 100,000 ppulatin rati acrss the prvince (see Appendix D). In 2011/2012, the Mental Illness general hspitalizatins age standardized rate fr the Nrth Zne was 620/100,000; significantly higher than the Alberta average (423/100,000) (AHS, 2013). Participate in the prvincial A&MH Bed Review. Develp a clear understanding f the utilizatin f inpatient psychiatric beds and ff-service beds fr A&MH in the Nrth Zne and address capacity needs. Develp clear pathways fr access t A&MH services (acrss all levels f care) within the Nrth Zne and Edmntn Zne. Optimize the use f existing psychiatry inpatient beds by adpting innvative care mdels in acute care and streamlining the A&MH bed admissin and discharge prcesses. Adpt innvative care mdels t prvide A&MH care t patients in the cmmunity rather than admissin t an inpatient unit. Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 21 f 46

22 AHS Nrth Zne Addictin and Mental Heath Strategy Enhance the invlvement f A&MH management and service planning n capital prjects acrss the zne t better frecast, plan and build apprpriate infrastructure t meet the needs f the ppulatin. Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 22 f 46

23 AHS Nrth Zne Addictin and Mental Heath Strategy Strategic Pririty #6: Supprt Families and Caregivers caring fr individuals with Cmplex A&MH Issues Nrth Zne Strategic Gals (What d we want t achieve?): S6.1 Increase access t caregiver supprts in the Nrth Zne by ensuring apprpriate and timely resurces and caregiver supprt prgramming are in place. Ratinale Caring fr a child r lved ne with addictin and mental illness can be very rewarding, but the husehld disruptin, financial pressure, and the added wrklad can als be verwhelming and result in significant stress fr the caregiver and family. Caregiver stress can be particularly damaging, since it is typically a chrnic, lng-term challenge. Withut adequate help and supprt, the stress f caregiving can lead t a wide range f physical and emtinal prblems, including heart disease and depressin; all f which affects the caregiver s ability t prvide care and keep the patient in the hme. Stakehlders cited that there is lack f awareness arund existing prgrams and verall limited supprt available fr families/caregivers caring fr lved nes with cmplex mental health and addictin issues thrughut the Nrth Zne. It is essential that caregivers are cared fr in a way that allws them t cntinue t care fr their lved nes in their hmes. Strategies (Hw are we ging t achieve the gals?): Understand what currently exists t supprt caregivers and families (A&MH) and identify gaps in caregiver supprts and prgramming. Develp caregiver burnut preventin, early identificatin and interventin supprts thrughut the Nrth Zne. Increase the awareness and netwrk f available caregiver supprts and services. Establish guidelines fr supprt t caregivers f individuals with addictin and mental illness t ensure they receive apprpriate and timely supprt. Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 23 f 46

24 AHS Nrth Zne Addictin and Mental Heath Strategy Enabler #1: Funding and Cmpensatin Framewrks Nrth Zne Strategic Gals (What d we want t achieve?): E1.1 Review the current A&MH Nrth Zne funding mdel t fully understand the allcatin f funds in the Nrth Zne A&MH department. E1.2 Identify gaps acrss the Nrth Zne and build the business case t senir leadership fr an equitable funding frmula that acknwledges the increased csts in prviding A&MH services in the Nrth Zne due t high needs, large gegraphical area and ppulatin distributin. E1.3 Identify and execute cst saving and reinvestment pprtunities. E1.4 Increase revenue generatin in the Nrth Zne A&MH department. Ratinale As with many departments f Alberta Health Services, financial pressure is an nging challenge fr Addictin and Mental Health in the Nrth Zne, especially in an envirnment f cut backs and reduced budgets. Over the years, the Nrth Zne Addictin and Mental Health budget has nt increased with the increase in ppulatin thereby preventing the ability t increase in staffing and expansin f prgrams t supprt the needs. The Nrth Zne is challenged t address the A&MH needs f the ppulatin given the resurces currently available. Althugh the Nrth Zne has access t grant funding, there are challenges with grant funding being limited, time-bund, temprary and slw t access when fllwing the applicatin prcess. Nw mre than ever, the Nrth Zne needs t find ways t maximize efficiencies and develp innvative business mdels and identify pprtunities fr cst savings, revenue generatin and reallcatin f funds in rder t deliver high quality addictin and mental health services acrss the zne. Strategies (Hw are we ging t achieve the gals?): Cllabrate with existing initiatives t understand where services are currently being prvided, gaps in service, pprtunities and the estimated cst f the pprtunities (i.e. Basket f Services and Gap Map) and build a business case fr an equitable funding frmula. Establish partnerships with crpratins in rder t build the capacity f crpratins t prvide A&MH services t emplyees. Identify and execute cst savings and reinvestment pprtunities. Increase the quality and timeliness f budget surveillance data including revenue generatin and cst savings activities. Identify and execute revenue generatin pprtunities fcusing n crprate partnerships and cst recvery frm ut f prvince and federal services. Review the Business and Industry Clinic (Residential Addictins Prgram) and identify pprtunities fr expansin and further crprate partnerships. Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 24 f 46

25 AHS Nrth Zne Addictin and Mental Heath Strategy Enabler #2: Leverage Technlgy and Infrmatin Sharing Nrth Zne Strategic Gals (What d we want t achieve?): E2.1 Increase access t Mental Health primary and specialty medical care fr patients by increasing the clinical use f telehealth. E2.2 Increase the use f telehealth t deliver patient/family and staff A&MH educatin events. E2.3 Increase care prvider access t patient infrmatin thrugh electrnic medical recrd expansin and integratin. Ratinale There are significant pprtunities t enable mre effective addictin and mental health services and t imprve efficiency f existing services by leveraging existing technlgy available thrughut the Nrth Zne. Telehealth technlgy is available in the Nrth Zne, and it is nt being utilized t its full capacity. Challenges t accessing telehealth due t increasing demand, lack f awareness f the technlgy, and a lack f administrative supprt required t address n shws, transcriptin and bking were cited as tw majr barriers t expanding telehealth use in the Nrth Zne. There is an pprtunity t wrk with the prvince t address these barriers and increase the capacity and use f telehealth and telepsychiatry technlgy t bring services clser t hme fr patients as well as t bring educatin and training pprtunities t staff and patients/families Cnference Type Prviding Zne Unique Events Prvided by Zne Patients Seen in Events Prvided by Zne Case Reviews Discussed Mental Health AHS - Calgary Zne AHS - Central Zne 1,523 1, AHS - Edmntn Zne 1,083 1, AHS - Nrth Zne AHS - Suth Zne CASA Ttal 3,299 3, Surce: Clinical Utilizatin Reprt Mental Health Telehealth, 2011 Surce: Clinical Utilizatin Reprt Mental Health Telehealth, 2011 Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 25 f 46

26 AHS Nrth Zne Addictin and Mental Heath Strategy Strategies (Hw are we ging t achieve the gals?): Establish cllabrative partnerships with ther stakehlder grups wrking t expand the use f telehealth services acrss the Nrth Zne. Develp best practice guidelines, prcesses and financial supprt fr clinical and educatinal telehealth use acrss the Nrth Zne. Identify sites fr targeted telehealth expansin acrss the Nrth Zne. Increase awareness f telehealth technlgy and use amngst A&MH prviders and residents acrss the Nrth Zne. Establish cmmunity f practice thrugh telehealth t supprt staff. Participate in the current initiatives fr electrnic medical recrd integratin acrss the Nrth Zne. Increase access t ther technlgies including nline educatin and peer supprt netwrks fr staff and patients/families. Establish and mnitr reprts n telehealth and telemental health utilizatin acrss the zne. Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 26 f 46

27 AHS Nrth Zne Addictin and Mental Heath Strategy Enabler #3: Wrkfrce Develpment Nrth Zne Strategic Gals (What d we want t achieve?): E3.1 Increase the number f full time staff wrking in A&MH acrss the Nrth Zne. E3.2 Imprve staff retentin and reduce the turnver rate and vacancy rate fr A&MH prfessinals acrss the Nrth Zne. E3.3 Imprve A&MH staff engagement rates acrss the Nrth Zne. E3.4 Imprve staff rle clarity and cnsistency f respnsibilities and titles acrss the Nrth Zne A&MH staff. E3.5 Ensure access t the right staff in the right place t meet the needs f the ppulatin. Ratinale Healthy and qualified staff and physicians are vital fr the Nrth Zne t prvide timely and quality addictin and mental health services t patients. A cmbinatin f factrs such as staff retirement, high turnver, high wrklads, aging ppulatin, insufficient funding, high csts f travel, and an increased demand fr A&MH prfessinals are cntributing t the staff and psychiatrist recruitment and retentin challenges in the Nrth Zne. Understaffing and pr retentin can lead t heavy wrklads and lw mrale fr the remaining staff which can result in a vicius cycle f further staff lss and increased recruitment difficulties. Traditinal human resurce strategies have fcused n increasing the supply f prviders thrugh initiatives such as increasing the number f training seats and targeted recruitment. Hwever, given the current fiscal envirnment and increasing service demands, such strategies will nt be enugh t address the wrkfrce challenges. We must increase attentin tward nging mnitring f the HR envirnment and lk at ways t use ur wrkfrce differently. Strategies (Hw are we ging t achieve the gals?): Develp and implement an A&MH Recruitment and Retentin Plan that attracts, retains, trains and develps highly qualified staff and psychiatrists wh are enthusiastic abut A&MH in the Nrth Zne. Imprve the quality and timeliness f A&MH Human Resurce data acrss the Nrth Zne. Cnduct a cmprehensive staffing review fr A&MH acrss the zne t evaluate staff cmpsitin, jb descriptins, rtatins, vacancies, gaps in rles, etc. Create a staffing prfile fr the Nrth Zne in relatin t the level f service needed by the ppulatin, service users and access standards. Optimize the wrkfrce by explring alternative and innvative staff rles and staffing mdels fr A&MH service prviders that include crss-training, adpting a prgrammatic hire mdel, utilize staff t full scpe f practice and implementatin f the Wrkfrce Cncurrent Capabilities prvincial initiative. Establish cnsistent prcesses fr frms, standards, prtcls, staff cmmunicatin and staff meetings acrss the Nrth Zne. Enhance the wrkplace wellness activities fr A&MH staff and psychiatrists wrking in A&MH in the Nrth Zne. Increase access t timely psychiatry expertise acrss the Nrth Zne. Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 27 f 46

28 AHS Nrth Zne Addictin and Mental Heath Strategy Increase partnership with the HR department as it relates t recruitment in rder t enhance the presence f A&MH management in the Nrth Zne recruitment activities. Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 28 f 46

29 AHS Nrth Zne Addictin and Mental Heath Strategy Enabler #4: Research, Educatin and Knwledge Translatin and Use Nrth Zne Strategic Gals (What d we want t achieve?) E4.1 Enhance the knwledge and skills f primary care physicians and A&MH service prviders. E4.2 Enhance the prcess fr accessing specialized A&MH expertise and cnsultatin. E4.3 Cllabrate with A&MH Strategic Clinical Netwrk (SCN), researchers and research centres fcusing n addictin and mental health t cntinually imprve A&MH services and patient utcmes. E4.4 Imprve patient satisfactin utcmes. Ratinale In rder t effectively prevent addictin and mental illness and prvide quality care t patients and families experiencing addictin and mental illness, success will depend n all stakehlders having an adequate knwledge f current issues in addictin, mental health and mental illness. T d this, enhancement f educatin and knwledge exchange must be accmplished n fur frnts: Firstly, all individuals living in Nrthern Alberta must be aware f the available A&MH prgrams and services available t them where they live. Secndly, individuals living with addictin and/r mental illness, as well as their families and caregivers, must be well infrmed in rder t make educated chices in their care and treatment plans. Thirdly, all A&MH health care prfessinals must be up t date n new A&MH develpments, practices and existing prgrams/services. Finally, ther service prviders, such as primary care family physicians, private practice mental health prviders, teachers, first respnders (EMS, plice, fire) etc. must be familiar with addictin and mental health issues in rder t recgnize, refer (and treat in sme cases) apprpriately and in a timely manner. Strategies (Hw are we ging t achieve the gals?): Increase the awareness f Nrth Zne citizens (including health care prviders) n the A&MH services available in the cmmunities they live. Increase the addictin and mental health educatin and training pprtunities available t patients, families, caregivers, A&MH staff, physicians, and cmmunity agencies. Enhance the educatin fr patients, families and caregivers wh are living with (r caring fr smene) an addictin and/r mental illness. Strengthen A&MH physician and health care prvider culturally sensitive rientatin, prfessinal develpment and cmpetency-based training pprtunities. Strengthen A&MH knwledge f primary care prviders, teachers and cmmunity based agencies. Wrk cllabratively with A&MH SCN, universities and training institutins t enhance the research and training pprtunities fr A&MH prfessinals in the Nrth Zne. Establish and cmmunicate a care pathway fr physicians and health prviders t access timely A&MH expertise and cnsultatin in the cmmunity. Ppulatin & Public Health / Addictin & Mental Health Nrth Zne Page 29 f 46