COLLABORATIVE MENTAL HEALTH CARE WHERE COULD WE GO?

Size: px

Start display at page:

Download "COLLABORATIVE MENTAL HEALTH CARE WHERE COULD WE GO?"

Bertha Potter
6 years ago
Views:

1 COLLABORATIVE MENTAL HEALTH CARE WHERE COULD WE GO? Nick Kates, MB.BS, FRCP (C) MCFP (hon) Chair, Dept. of Psychiatry McMaster University Quality Improvement Advisor, Hamilton Family Health Team

4 Thank you Peter Selby Arun Ravindran Marina Bourlak Rosa Dragonetti Myra Fahim Julia Lecce Terry Isomura Sari Ackerman

5 Plan Forces driving / enabling collaboration A new role for primary care Opportunities for improving the quality of what we do Things that can make this happen

6 Forces Driving Collaboration 1997

7 The World in 1997

11 Forces driving better collaboration in 1997 Problems in the relationship Need to improve access / wait times Desire to support primary care / increase skills and comfort Need to improve communication between the two sectors

12 And in 2014

13 Forces driving better collaboration Reducing preventable emergency visits Containing costs/ increasing efficiencies Reducing preventable ED visits Improving transitions Addressing co-morbid conditions / complexity (Health links) Improving the quality of care Reducing disparities Increasing evidence that it works Acceptance by funders and planners

14 Other factors

15 Other factors

16 Other factors

17 And. The economic impact of Integration Impact for Psychiatry AMA resolution to implement integration of Physical and Behavioural Health Focus on Integrating Physical & Behavioural health

19 Co

20 What works key principles Policy & plans Advocacy Training Doable and limited interventions Mental health service support Co-ordinators or care Access to medication Resources human and funding Collaboration with other sectors Process not an event

21 Crossing Boundaries (Kings College Mental Health Foundation) Multidisciplinary Teams Information-Sharing Shared care protocols Joint funding Liaisons Navigators Reducing stigma Research Co-location 9 key components for successful collaboration

What works key elements 011 Position paper Care Co-ordinator Access to Psychiatric consultant Enhanced consumer education Introduction of evidence-based

22 What works key elements 011 Position paper Care Co-ordinator Access to Psychiatric consultant Enhanced consumer education Introduction of evidence-based approaches Screening of people with chronic medical conditions for depression or anxiety Skill enhancement for primary care providers Access to brief psychological therapies

23 Importance of personal contacts Qualities of a good consultant Friendship Balance Respect Equality Affable Available Able

24 hat still prevents us from collaborating Physician remuneration models Funding models Attitudes Cultures of care Power and control Comfort / convenience Training Not taking full advantage of team How are our systems are designed

25 Thought for the Day Systems are perfectly designed to get the results they achieve. Paul Batalden

26 Failures to collaborate are often system failures

27 Improving collaboration Better collaboration and delivering better quality care require changes in the way our systems of care are conceptualised and organized, both within and between systems.

28 Where could we be heading and what can we achieve the vision thing

29 Beware of Great Predictions In 1943 Thomas Watson, Chairman of IBM, reportedly predicted: I think there is a world market for about five computers.

30 We need a new vision of the role of primary care in an integrated mental health system

The potential role of Primary Care Looks after a population Enduring relationships with the individual and their family Screening and early detection Initiation of treatment Monitoring and

31 The potential role of Primary Care Looks after a population Enduring relationships with the individual and their family Screening and early detection Initiation of treatment Monitoring and follow-up Co-ordination and continuity of care Referral and system navigation Family interventions Point of entry into an integrated MH&A system Could provide more (and effective) MH&A care

Mental Health and Addiction Services Provide rapid access to consultation and advice Respond quickly to help with urgent problems Priorize people who cannot be managed in PC (complexity /resources)

32 Mental Health and Addiction Services Provide rapid access to consultation and advice Respond quickly to help with urgent problems Priorize people who cannot be managed in PC (complexity /resources) and provide ongoing care Stabilize problems, and return to primary care providers for ongoing management and monitoring, Continue to be available to / support the PC Team (shared care) Provide information on and link with community resources

33 Support Mental Health Linkage Stabilise Urgent Care Consultation Build capacity Ongoing Care Communication Co-ordination Integration Consultation Co-Location System Links Early Detection Family support Initiate Treatment Person Family Care Coordination Monitoring Health promotion Primary Care

34 How do we take full advantage of the role that primary care can play?

35 Quality health care A high-performing health system that is: - Effective - Safe - Timely - Consumer and familycentered - Equitable - Efficient - Integrated - Focused on population health

More effective care - Increasing the capacity and skills of primary care Translate MH concepts and tools Teach / model relevant skills Motivational Interviewing PHQ-2 In-Office education Program /

36 More effective care - Increasing the capacity and skills of primary care Translate MH concepts and tools Teach / model relevant skills Motivational Interviewing PHQ-2 In-Office education Program / online resources (BCs Adult Mental Health Module) Primary Mental Health Care is not just Mental Health Care in a Primary Care Setting Child / geriatrics / addictions Increasing comfort Primary Mental Health Care is not just Mental Health Care in a Primary Care Setting

37 Safer care Every person has a plan and is given a copy of their plan, which is updated at every visit Medication reconciliation at every visit Transitions

Opportunities for earlier detection Addictions Medical

38 More efficient care Better integration of physical and mental health care Co-morbidities Complex conditions Opportunities for earlier detection Addictions Medical care of people with mental health problems (reverse shared care)

39 DETECT PROBLEMS EARLIER (AND INTERVENE!) Enhanced 18 month visit Not an end Follow-up Identify those at greatest risk (Red, yellow, green) Make sure those with needs reach services they require

40 In my beginning is my end TS Elliot

42 Population focus Proactive care Monitoring Relapse prevention

43 Better integrated care

44 Better integrated care

Community partnerships Need to improve care for individuals Comprehensive plans Address non-medical issues System navigation Working in agencies Need to

45 Community partnerships Need to improve care for individuals Comprehensive plans Address non-medical issues System navigation Working in agencies Need to address social and environmental determinants Need to work with community partners Build community resilience Integrate Community Programs within Primary Care Settings

46 The Second Stage of Medicare To alter our delivery system to reduce costs and put an emphasis on prevention

47 CONSUMER CENTRED CARE Re-designing services based on a person or family s experience Family engagement Promote recovery / support self management

48 Reducing inequities

49 More equitable care Address disparities in access as well as outcomes Identify and eliminate stigma in our own settings

50 Enablers to help us get there

51 IHI s Triple Aim Better health for populations (better health) Better experience of seeking / receiving (providing) care (better care) Sustainable and cost efficient (better value) And all at the same time

53 Making the case for Collaborative Mental Health Care Evidence Advocacy Networks (tipping point) Spread of ideas that work Cost-benefit analyses

54 Preparation of Future Practitioners Training Competencies Preparation

HOSPITAL AUTHORITY MENTAL HEALTH SERVICE PLAN FOR ADULTS

HOSPITAL AUTHORITY MENTAL HEALTH SERVICE PLAN FOR ADULTS 2010-2015 Introduction The Hospital Authority (HA) has developed the HA Mental Health Service Plan for Adults 2010-2015 (the Plan) as a framework