Action plan for patients with complex needs
VANCOUVER- Health Minister Terry Lake today released an action plan to respond to the immediate and long-term health needs of patients with severe addiction and mental illness in all health regions.
“These patients have unique and complex needs. The actions we are announcing today build upon our commitment to improve health services for all British Columbians,” said Lake. “This action plan is designed to reduce barriers and service gaps to better support patients’ care needs across the province.”
The action plan is designed to better meet the needs of a specific subset of patients with the most complex form of Severe Addiction and/or Mental Illness (SAMI) who present a greater risk to themselves and others. Lake directed the Ministry of Health to develop the plan in response to community concerns in Vancouver and ensure evidence-based approaches are in place to better support patients throughout the province.
“I am pleased to see the Government of British Columbia respond with a set of immediate actions that will help our citizens who suffer from severe addiction and mental illness,” said Vancouver Mayor Gregor Robertson. “This is a difficult problem and one that is going to require an ongoing commitment from a variety of partners. These first steps from the Ministry of Health will make a positive difference and put us on path to making long-term changes.”
Immediate actions that will be taken by Vancouver Coastal Health (VCH) over the next 120 days include:
- Development of a nine- to 12-bed psychiatric assessment and stabilization unit adjacent to the emergency department at St. Paul’s Hospital;
- Creation of a new Assertive Outreach Team to serve individuals in Vancouver’s Downtown Eastside (DTES);
- Two new Assertive Community Treatment Teams;
- Improved information-sharing protocols between key agency partners.
- An Implementation Committee comprised of senior officials from the Ministry of Health, Vancouver Coastal Health, BC Housing, Vancouver Police Department, and the City of Vancouver, will also work towards longer-term solutions for high-risk SAMI patients in Vancouver.
Lake said the provincial government and partners will continue to work in collaboration with the City of Vancouver, through the Implementation Committee, the Mayor’s Task Force on Mental Health and Addictions, and Project Link, which seeks to build stronger connections between health providers, police and the courts.
“This report is an excellent example of how partnerships can benefit patient care,” said Dr. David Ostrow, president and CEO of Vancouver Coastal Health. “Working with the Ministry of Health, Vancouver Coastal Health brought together clinicians, academics, researchers, government planners and operational leaders to develop and present targeted solutions. Moving forward, VCH will continue to build linkages across all sectors, including other health providers, the community sector, as well as police and the justice system.”
The Ministry of Health will also provide $750,000 annually to Providence Health Care’s Inner City Youth Mental Health Program to support a new Intensive Case Management Team to further enhance services available to homeless and inadequately housed youth aged 16-24.
The Provincial Health Services Authority (PHSA) will assume a leadership role in developing and implementing a fully-articulated service delivery model to address the needs of SAMI patients across the province requiring high-intensity and longer-term care, including:
- Establish a Clinical Expert Panel to support an evidence-based service-delivery model for SAMI patients who require high-intensity services;
- PHSA will work with VCH to better position the 100-bed Burnaby Centre for Mental Health and Addiction to accommodate complex-need patients who require longer-term, high-intensity care.
- A new secure six-bed inpatient facility will be developed to provide stabilization, assessment and case planning – with additional overflow capacity of eight beds;
- Five new high-intensity group homes will be developed to serve a total of 20 clients – (at least one home will be a facility for young adults aged 16-24 linked to Providence Health Care’s Inner City Youth Mental Health Program).
“We provide provincial leadership in B.C. for a diverse range of specialized mental health and substance use services across the province,” said Carl Roy, PHSA interim CEO. “This new initiative will provide support and hope for people with mental health challenges who also have substance-use concerns.”
The Ministry of Health is providing $5 million to support VCH and PHSA swiftly act on the recommendations this fiscal year.
Next fiscal year, the ministry will provide additional funding to all health authorities as part of an overall provincial approach totalling an estimated $20 million investment. Funding next fiscal year will include up to $12 million in matching funds to help regional health authorities further strengthen local services.
The additional provincial capacity for complex-needs patients, builds upon B.C.’s commitment to deliver community-based mental health and addiction services. The Province committed a total of $138 million in capital funding to build or expand 826 mental-health beds in communities around B.C. as part of the Riverview Redevelopment Project.
A copy of the action plan is available online at: www.health.gov.bc.ca/library/publications/year/2013/improving-severe-addiction-and-mental-illness-services.pdf
Media Relations Manager
Ministry of Health
250 952-1887 (media line)
Two backgrounders follow
Action Plan Highlights
Improved emergency services/capacity at St. Paul’s Hospital – Within 120 days Providence Health Care will establish a nine- to 12-bed psychiatric assessment and stabilization unit adjacent to the emergency department at St. Paul’s Hospital. The new unit will provide additional in-hospital capacity for assessment and stabilization, while also facilitating timely patient drop-offs by police. New protocols will also be developed with the Vancouver Police Department to support timely access to psychiatric emergency care.
Assertive Outreach Team (AOT) – Within 120 days Vancouver Coastal Health will develop a new Assertive Outreach Team to provide integrated community-outreach services to support those without adequate housing supports. The team will assertively provide services to clients who still require intensive supports after being discharged from emergency, or those identified in need of community outreach by other service providers.
Two new Assertive Community Treatment Teams (ACT) – Within 120 days Vancouver Coastal Health will develop two new ACT teams to deliver medical, psychosocial, and rehabilitation services to clients in a community setting. ACT teams include registered nurses, social workers, occupational therapists, substance use specialists, vocational specialists, psychiatrists and team co-ordinators who work together to treat patients. The two new ACT teams will bring the total number of ACT teams in operation by VCH to five.
New Intensive Case Management Team for youth – The Ministry of Health will provide $750,000 annually to Providence Health Care’s Inner City Youth Mental Health Program to support the development of a new intensive case management team to work with youth aged 16-24 who are currently homeless or inadequately housed.
New role for the Provincial Health Services Authority – PHSA will assume a leadership role in developing and co-ordinating implementing a new service-delivery model to address the long-term care and treatment needs of complex SAMI patients who require high-intensity services. PHSA will also work with VCH to better position the 100-bed Burnaby Centre for Mental Health and Addiction to accommodate complex-need patients who require longer-term, high-intensity care.
New six-bed interim inpatient stabilization unit – This fiscal year, a new six-bed facility will be established within the campus of the Burnaby Youth Custody Centre to provide stabilization, assessment and individual case planning for complex SAMI clients who pose a risk to themselves or others. This new unit will be supported by addictions, mental health, and behavioural interventionists, and staffed 24/7. It will take referrals from Lower Mainland emergency departments, with admissions facilitated through the Mental Health Act, with supporting clinical care guidelines. The facility would include a shared kitchen space, and be designed to be more residential than institutional in nature. The estimated operating cost for this new unit is $2.5 million.
Five new high-intensity group homes – The Provincial Health Services Authority and Vancouver Coastal Health will design and contract for five new high-intensity group homes to serve a total of 20 individuals with care plans supported by clinical professionals at the Burnaby Centre for Mental Health and Addictions. Each group home will be supported by addictions, mental health, behavioural interventionists and 24/7 trained support staff. At least one of these new homes must be focused to serving young adults aged 16-24, and linked to the Inner City Youth Mental Health Program. It is anticipated the net new operating cost for this program would be $4 million to $5 million annually.
New service plans for all health regions – All five regional health authorities will review the service needs of SAMI population as part of their future service plans being developed. Through the Provincial Health Services Authority (PHSA), the Ministry of Health will make available up to $12 million in 2014-15 in matching funds to assist health regions in strengthening services for this population, as part of an overall provincial approach.
Serving People with Severe Addictions and/or Mental Illness (SAMI)
What is SAMI? - SAMI refers to Severe Addiction and/or Mental Illness. Individuals described as belonging to this population have one or more psychiatric diagnoses that significantly affect their ability to actively engage in personal, social and/or occupational areas of daily life.
A specific sub-set of these patients have highly complex needs and present a risk to themselves, or others. These individuals suffer from chronic, disabling substance use, often severe mental illnesses, neurodevelopmental disorders, severe trauma and/or brain injury, cognitive impairment, as well as significant physical health problems. These individuals are often homeless or inadequately housed, and are over-represented in interactions with police and emergency services. Vancouver’s Downtown East Side (DTES) has an especially high concentration of this population.
Current supports for those suffering from addictions and mental illness in Vancouver:
Car 87 - In Vancouver, police officers are supported by a mobile specialized mental-health response team which is made up of specially trained police offers and registered nurses. This service is available 20 hours a day, 7 days a week to provide initial assessment and arrange follow-up care for those experiencing a crisis.
Police Education – In 2002, Vancouver patrol officers began to receive additional training to enhance the knowledge and skills of police officers in identifying and responding to incidents involving those with mental illness. Since the training became mandatory in 2010, there has been a 109-per-cent increase in the number of individuals brought to St. Paul’s Emergency Department by police under the Mental Health Act.
Assertive Community Treatment Teams (ACT) – Since 2011, approximately $5 million have been invested to develop three ACT teams which successfully operate in collaboration with the Vancouver Police Department and BC Housing. ACT is an evidence-based form of multidisciplinary care designed to provide an extensive spectrum of medical, psychological and rehabilitation services to individuals with SAMI, within a community setting. Those receiving ACT follow-up had a 70-per-cent reduction in ER visits, a 61-per-cent reduction in criminal justice involvement and a 23-per-cent reduction in victimization.
Primary care outreach teams – In the Downtown East Side (DTES) and downtown core, primary care outreach teams care for over 1,570 individuals living in low-threshold supportive housing, across 19 sites, as well as clinical interventions to the chronically homeless in eight different shelters. These outreach services have been shown to reduce the impact on emergency services, including a 20-per-cent reduction in emergency-room visits, with the greatest benefit being reducing repeat visits among frequent ER users.
Housing – In partnership with the Province of B.C., the City of Vancouver Housing and Homeless Strategy has aimed to end street homelessness by 2015 through the provision of 14 new supportive housing projects (approximately 1,500 affordable rental housing units) for those who are homeless or at-risk of homeless.
Harm reduction and addiction treatment services – Harm reduction services include needle exchange programs; a supervised injection site (Insite); a safer smoking kit distribution program that provides health service referrals to individuals who smoke crack cocaine in the DTES; and a pilot of a managed-alcohol program. Addiction treatment services include the Onsite withdrawal management service, located directly above Insite, which offers personalized treatment and basic support services. Daytox facilities provide medically monitored withdrawal services to those who do not require or wish to receive inpatient care. In addition, the 100-bed $13 million Burnaby Centre for Mental Health and Addiction is a residential treatment facility that provides inpatient treatment services.
Youth Services – Providence Health Care operates the Inner City Youth Mental Health Program which provides intensive case management and assertive outreach targeted at homeless or inadequately housed youth with mental illness aged 16-24. There is also the Crossing at Keremeos, a long-term addiction treatment facility for youth and their families. In addition, the Early Psychosis program within VCH provides early identification and treatment for people aged 13 to 30 with definite or possible untreated psychosis. Youth services within VCH are provided in partnership with the Ministry of Children and Family Development (MCFD) and the Provincial Health Services Authority (PHSA).
The Drug Treatment Court of Vancouver (DTCV) – is a specialized court that has been in operation since 2001 and provides an alternative approach to mainstream court processes for individuals who commit criminal offences to support their addiction to cocaine, heroin or crystal methamphetamine. Participation is voluntary and requires participants to take part in a supervised 14 month intensive day treatment program through the Drug Court Treatment and Resource Centre. An evaluation found that drug-related recidivism among participants was significantly reduced over a two year tracking period.
Vancouver Downtown Community Court – has been in operation since 2008 and brings into one location a broad range of integrated services aimed at helping offenders break free from the cycle of crime, homelessness addictions and mental illness. Health, income assistance, and housing staff, as well as victim services and a native court worker are located together along with Crown counsel, defence counsel, a police officer and probation officers – 14 agencies in total.
Vancouver Intensive Supervision Unit – was created in response to a growing need in Vancouver’s Downtown Eastside for services that address the complex needs of individuals who have severe mental illness and frequently come in contact with the justice system. Staff members from the Corrections Branch, Vancouver Coastal Health, and the Watari Research Association deliver interdisciplinary support and supervision. Clients are provided assistance with daily living activities, medical and psychiatric care, as well as legal and leisure services. Staff members also develop and update case management plans.
Media Relations Manager
Ministry of Health
250 952-1887 (media line)
Connect with the Province of B.C. at www.gov.bc.ca/connect
Tiko Kerr, Vancouver Artist and patient of Dr. Julio Montaner