Pilot: Mental Health Emergency Teletriage Service. A Vancouver-based innovation in mental health service delivery

Transcription

1 Pilot: Mental Health Emergency Teletriage Service A Vancouver-based innovation in mental health service delivery

2 Presentation Outline Vancouver Context Mental Health Teletriage Service Developmental Evaluation: Activities & Preliminary Findings

3 Downtown Eastside Extreme income inequality Office of the Chief Coroner reported that accidental illicit drug overdose deaths in BC in 2016 were almost 80% higher than in 2015 Downtown Eastside is a neighbourhood with ~18,000; Open-air drug trade, sex work, poverty, mental illness, homelessness, and infectious disease

4 St. Paul s Hospital Inner-city hospital ; one of the busiest emergency departments in the province ~88% increase in psychiatric emergencies between 2009 and 2014 Developed ABSU in 2014 to support more effective and efficient triage

5 Vancouver Police Department VPD has 389 civilian employees, 1,327 sworn officers, and an annual budget of approximately $220 million Released a series of reports urging government to take action 16% increase in Section 28 apprehensions between 2010 and 2012 Mental health team, Car-87, Project Link, ACT

6 Mental Health Emergency Teletriage Service Retrospective chart reviews reveal that 50+% of patients brought to hospital under Section 28 are discharged after seeing emergency physician Clinical specialists interview patients remotely and assess their environment to gather important collateral information PDSA Cycle 1: October 17 November 27, Psych Assessment Nurse and 12 VPD Volunteers

7 Goals of the Program Improve the collaboration between health care professionals and the police Enhance triage decisions by providing vital collateral information via video-link Increase the capability of the police to deal with mental health emergencies Increase patient satisfaction with the system of care

8 Teletriage Team Members

9 Developmental Evaluation Activities Pre- and post- interviews/focus groups with PAN, VPD officers and technology support staff Surveys which were filled out by VPD and PAN after each call VPD voluntary post-cycle survey Ad hoc correspondence with Teletriage Team Evaluation Working Group set up to help inform the evaluation design and data collection

10 Pre-Cycle Interview Findings 1. Organizational Liability 2. Workload 3. Engaging Key Partners

11 Workload You might wait a couple hours for the ambulance, and then you get to the hospital and you re waiting more hours. A call can turn into 6 hours. It s not uncommon for a call to take a whole shift. The average is not reflective because it counts those people who get lucky and the patient is seen within 30 minutes. Also, the mental health templates that we fill out do not even capture the roadside waiting. We should be recording wait times starting from the time we call EHS. -Constable, VPD

12 Teletriage Calls The surveys identified the following issues with the calls: Hostility and aggressiveness of client Inappropriate levels of acuity (not stable enough for telehealth) Audio Technological issues; trouble establishing connection

13 Post-Cycle Findings 1. Training & Organization 2. Technological issues 3. Acuity of St. Paul s clients (and appropriateness for Telehealth assessment)

14 Acuity of St. Paul s Clients 1 & 2 - those are the districts that when ambulance picks them up, they come to SPH. I do not think you will have enough settled people, that are in that grey area, that need be assessed on a computer, and that will cooperate. The people here are drugged, angry, aggressive, psychotic just too sick for me to look at on a computer. A project like this might be better and more successful in a place like AAC. They already do phone calls, community liaison, through the calls on the phone. They get a lot of people that would benefit from video conference. I believe this whole way of going [telehealth] would be beneficial there. - Psych Assessment Nurse

15 District 1 and 2 in my experience are your most sick people. But there is District 3 & 4, SE and SW Vancouver people which would include south slope as well as Kitsilano/ Kerrisdale. I have gone to a lot of those calls where people are upset, and in despair, but not necessarily someone with a serious mental illness. As a police officer we can t walk away from them and go well you need to go to your doctor and follow-up. We are forced to take people to hospital; when they don t want to go we take them by force. So, the biggest numbers were from district 3 and 4 for one s that could be appropriate. ~Constable, VPD

16 VPD Districts and Section 28 breakdown Breakdown of Section 28 transports during PDSA Cycle 1: St. Paul s Hospital: 132 Vancouver General Hospital: 102 Access and Assessment Centre: 28 District 1 & District 3 & 4 130

17 Survey of Police Respondents Technology Issues Appropriateness of Clients Workload Communications between VPD and SPH Endorsement from VPD Liability

18 AAC An alternative venue for the Teletriage service AAC was opened in 2016 at VGH for the purpose of providing a single point of access for non-life threatening mental health and substance use issues Streamlined referral process; 24hr/7day service including psych nurses and psychiatrists; already providing telephonic services

19 Thanks for listening! Amanda Butler, MA (Criminology), PhD Student Faculty of Health Sciences Simon Fraser University Vancouver, British Columbia, Canada