Rouge Valley Health System and Durham Mental Health Services Integration Presentation CE LHIN Board Meeting: December 22, 2010
Background Mental Health Service Providers, Consumers and Family Members observed that people often visit Emergency Departments as a result of not being able to find the care they require in the Community. As a result, during FY 08/09 the CE LHIN supported the ED Avoidance Coalition with Pay For Results funds in order to strengthen the relationships between hospital and community Mental Health Providers. Six Community Crisis Support Beds were added in Ajax as part of this initiative.
Background Rouge Valley Health System worked with Durham Mental Health Services to use these Crisis Beds to support people with Mental Health issues by providing an alternative to hospitalization. Although the results of the Community Crisis Bed Program were difficult to connect to the Pay For Results ED Outcomes, both RVHS and DMHS believe that there is a real benefit to the system in continuing the service..
Background Elliot House provides a least restrictive treatment alternative for clients appropriate to remain in a community setting. The impact to RVHS stems from the potential reduction in voluntary inpatient mental health days thus allowing RVHS to focus on high risk patients that require involuntary hospitalization. Year to date estimated efficiency savings related to Elliot house admissions and mobile crisis is $112,848.00. The program also saves RVHS on ambulance transportation cost between the two sites for admissions. (C. Williams, RVHS Board BN: 19/04/10)
Integration Opportunity 125 clients have been admitted to Elliot House. 117 of these people were able to access the community beds directly through the mobile crisis team, rather than using the ED (ED Avoidance). Eight of those admitted to Elliot House were transferred directly from RVAP (ED Diversion; Inpatient Avoidance). Without community crisis beds, these eight patients would have been admitted to RVHS. This saved 80 inpatient mental health bed days (avg length of stay is 10 days)..
Integration Opportunity The cost for 80 inpatient days at RVHS is $81,040.00 for RVHS ($1,013/hospital day). The cost of providing 80 Elliot house bed days is $20,800 ($260.00/crisis bed day). Of the 117 clients admitted from the community, it is anticipated that some of these clients would have been seen at RVAP and required hospitalization. However, it is impossible to determine with certainty how many other hospital admissions were avoided.
Integration Opportunity: RVHS and DMHS Based on : The current and potential savings to RVHS Psychiatric In- Patient Unit, and Time Spent in the Emergency Department Potential for reducing Return Unscheduled Visits to the ED within 30 Days for Mental Health issues. Evidence of Improved Patient Experience, (based on Service User Surveys).
Integration Opportunity RVHS therefore offered to transfer funding to DMHs to support the Community Crisis Beds. This funding will be provided in FY 10/11 and 11/12, and is based on a Memorandum of Understanding, (MOU) between the two organizations. The MOU sets out specific Performance Metrics that have been developed by RVHS and DMHS with the support of CE LHIN Staff.
Performance Metrics Some examples of these Performance Metrics are: An increase in the numbers of admissions to the Ajax Community Crisis Beds based on several key areas. A decrease in the numbers of unscheduled return visits related to Mental Health Issues at RVHS Ajax ( decrease of 2 visits per month). Numbers of patients admitted to the Community Crisis Beds from RVHS Ajax to be 8 per month.
Motion Be it resolved that the CE LHIN Board of Directors not stop the proposed voluntary integration between RVHS and DMHS and congratulates both organizations for their focus on improving mental health care and supports in the Durham area.