HUB at St. Paul’s Hospital to transform emergency access, treatment and follow up for people with mental-health and/or substance-use challenges

HUB marries public and private sector, philanthropy and innovation to better serve vulnerable patients

Vancouver, March 15, 2017 – A groundbreaking service for people with mental-health and substance-use challenges opens this spring at St. Paul’s Hospital that will unite emergency care, rapid access to treatment and a transition centre to provide better and faster care for this vulnerable client population.

The HUB, the first emergency care model of its kind in BC, will include two fully equipped units next to the hospital’s Emergency Department (ED) to care for patients, from their arrival at the ED to their transition back to their communities. 

Specialists will provide these patients with culturally appropriate, trauma-informed care in a dignified, private setting separate from the ED.

The HUB also includes a clinic one floor above the ED where specialized addictions nurses and physicians treat those dependent on a variety of substances, including opioids. The team can provide opioid-dependent patients on replacement therapy such as Suboxone or methadone as quickly as possible.

The HUB, opening amid a public-health emergency in BC, with over 900 people dying from drug overdoses last year, will help St. Paul’s busy ED deal effectively with growing needs. It sees over 10,500 patients with mental-health and substance-use issues each year, the highest number of any ED in the province. The HUB will triage an estimated 6,000 patients with mental-health and/or substance-use challenges each year, or more than half the patients who visit the ED annually, ensuring they’re directed to the appropriate care they require.

It will decrease the amount of time police wait with patients with mental-health and/or substance-use challenges who require an escort to the ED until a doctor sees them and responsibilities are transferred. Police currently spend about 75 minutes per patient in the ED. The HUB is expected to reduce this time by two-thirds, to 20 minutes per person.

The catalyst for the HUB was an anonymous donation of $750,000 made to the Vancouver Police Foundation in 2015. The donor requested it be specifically used to alleviate the city’s mental-health and substance-use challenges. The VPD then approached St. Paul’s to establish a “transitional centre” based on St. Michael’s Rotary Centre in Toronto, which helps patients move back to their communities, equipped with the resources they need.

There are three components to the HUB:

Site A: The Clinical Unit

This is a clinical treatment area for patients requiring acute care, housed in a fully equipped redeployable medical unit provided by Coquitlam, BC-based Weatherhaven Global Resources Ltd. The private firm custom builds these units for medical, humanitarian, military and commercial applications worldwide. It will feature plenty of natural lighting and space plus first-class clinical facilities.

Site A provides:

  • Eight to 10 patient beds.
  • A nursing station area with three nurses on duty 24 hours a day.
  • A social worker.
  • A fully equipped medical supply room.

Site B: The Vancouver Police Foundation Transitional Care Centre (VPFTCC)

Only the second of its kind in Canada (after St. Michael’s Hospital Rotary Centre), the transitional care centre is a unit with eight to 12 spaces for those who don’t require hospital admission or patients who have been discharged. The centre, also custom-made by Weatherhaven, will provide discharged patients with a safe, supportive area to rest and recover. They will get help in navigating the system of services they need, such as supported or transitional housing, income support, counselling and connections to Aboriginal healing programs. This support is intended to slow the ‘revolving door’ of crisis response and help facilitate smoother transitions from acute to community care services.

The transitional care centre’s services will include:

  • Help connecting with primary health care, specialist care and community agencies.
  • Common lounge/kitchen area.
  • Overnight accommodation with bathroom and shower facilities.

Rapid Access Addiction Clinic (RAAC)

The RAAC at St. Paul’s provides treatment and support for all substance-use issues. Patients can receive treatment in as few as 24 hours after their ED discharge or clinic referral. It is staffed by physicians and nurses specializing in addiction medicine along with social workers and “peer navigators” who have recovered from substance use. The RAAC includes a comfortable quiet room for those who are ready to be treated with Suboxone or other oral opioid replacement therapy.

The HUB came together due to the efforts of these partner organizations:

  • Ministry of Health.
  • Providence Health Care.
  • PHC Office of Innovation and Strategic Partnerships.
  • St. Paul’s Foundation.
  • Vancouver Coastal Health
  • Vancouver Police Department and Vancouver Police Foundation.
  • City of Vancouver.
  • Weatherhaven Global Resources Ltd.

The HUB’s $3.5 million in capital costs come from:

Vancouver Police Foundation ($750,000 via private donor);
City of Vancouver ($1 million grant);
St. Paul’s Foundation ($1.75 million to match the VPD and City’s financial support);

Weatherhaven has entered into a research-and-design partnership with PHC to provide customized, redeployable units for Sites A and B.

 

Vancouver Coastal Health is providing $3 million in annual operating funds via the Ministry of Health. The HUB model was chosen for a number of reasons, including its redeployable features. Because of the current plan to redevelop St. Paul’s at a new site in the city, it did not make economic sense to build permanent new ED capacity at the current St. Paul’s. The HUB keeps the healthcare system cost-effective, while also maintaining top service levels for the clients it will serve.  As well, the innovative model of care that the HUB provides will be incorporated into the new hospital, offering a seamless transition from acute to community care.

Partner Quotes:

  • Ministry of Health 
    “BC is a leader in substance use treatment and harm reduction, which includes creativity needed to improve treatment and support. The HUB is an example of that and we are proud to provide funding to this innovative way to streamline care for mental-health and substance-use patients.” - Terry Lake, Health Minister.

  • Providence Health Care 
    “The HUB will provide culturally appropriate, trauma-informed care to patients and offer them dignity and privacy in a space better suited to their needs. By bringing emergency care, rapid access addiction treatment, and a transitional care centre together under the HUB, Providence aims to ease the current ED congestion, turbulent transitions to community care, and increased police wait times with patients to an innovative approach that can also be used at the new St. Paul’s.” — Dr. Bill MacEwan, psychiatrist, St. Paul’s Hospital. 

  • PHC Office of Innovation and Strategic Partnerships
    “Through solutions like the HUB, the Innovation Office is working to accelerate ways to improve both the quality of care and health outcomes for our patients. The HUB is the first of many future care-model innovations our Office will evaluate for their suitability at the future St. Paul’s.” — Shauna Turner, Chief Innovation Officer, Providence Health Care. 

  • Vancouver Police Department (VPD) and Foundation (VPF) 
    “The HUB will not only provide better patient care but it will also greatly reduce the amount of time our officers wait with patients in the Emergency Department. The HUB will free up their time so they can get back on the road quicker to help keep Vancouver safe. I would like to thank the Vancouver Police Foundation for their generous support for the Transitional Care Centre – an integral part of the HUB.” —Adam Palmer, Chief Constable, Vancouver Police Department.

  • City of Vancouver (COV) 
    “The HUB is an important next step to tackle a province-wide crisis with mental health and addictions that needs urgent, dramatic action. There's a desperate need for more treatment-on-demand and personalized care for our most vulnerable residents suffering from mental illness and substance-use. Addiction is a health issue, not a criminal one; the HUB at St. Paul’s will help stop the revolving door with mental health and addictions services, filling a critical gap in patient care.”– City of Vancouver Mayor Gregor Robertson.

  • St. Paul’s Foundation 
    “We have been a strong supporter of the HUB concept from the start. Our donors are playing a key role in bringing this transformative health-care model to life.” — Dick Vollet, Foundation President and CEO.

  • Vancouver Coastal Health  
    “The HUB is being established at a time when such community resources are vitally needed and is a key part of our strategy for helping Vancouver’s Downtown Eastside in the face of this public-health crisis.”  — Dr. Patricia Daly, Chief Medical Health Officer, Vancouver Coastal Health.

  • Weatherhaven Global Resources Ltd. 
    “While we have used our redeployable units overseas in disaster-relief and other situations, we are proud to bring these custom-made units to St. Paul’s HUB to transform care to a vulnerable patient population. This is the first time the specific units to be used at St. Paul’s have been used in Canada as a medical clinic.” — Ray Castelli, Weatherhaven CEO  

Available visuals:

High-resolution stills and computer-generated video of the HUB sites (interior and exterior shots) can be viewed here.

Interviews:

With the Ministry of Health:
Ministry of Health Communications
250-952-1887 (media line)

With Providence health Care/Providence Health Care’s Office of Innovation/St. Paul’s Foundation/Vancouver Coastal Health:
Ann Gibbon
agibbon@providencehealth.bc.ca
Tel:  604-682-2344 X 66987
Cell: 604-837-6003  

With the City of Vancouver:
Corporate Communications
604-871-6336
media@vancouver.ca

With Weatherhaven:
Sweena Chatha
schatha@weatherhaven.com
604.636.1301 | C: 604.308.0456

With the Vancouver Police Department/VP Foundation: 
VPD media relations
media@vpd.ca

Backgrounder

About the HUB at St. Paul’s

The Background:

St. Paul’s Hospital treats the largest number of mental-health and substance-use patients in Vancouver each year. Its Emergency Department (ED) has dealt with a 112-per-cent increase in visits from these vulnerable patients since 2010, caring for almost 11,000 a year.

Mental-health and substance-use patients’ complex and specialized care needs require more ED time than those of other patients. This causes longer wait times for all patients. To ease the ED’s growing volumes and provide fast, quality emergency care to this group of patients and ultimately, cut wait times for all ED visitors, St. Paul’s and its partners have launched the HUB.

The $3.5-million HUB, the first care model of its kind in British Columbia, unites public and private partners, philanthropy and innovation with the common goal of improving care for mental-health and substance-use patients. The HUB will result in faster triaging and more streamlined care, while smoothing patients’ transition from acute care to community support. It strives to slow the revolving door of crisis response for these patients.  The opening of the HUB comes amid BC’s overdose crisis, which further underscores the need for rapid access to substance-use treatment.

The HUB got underway when the Vancouver Police Department approached St. Paul’s about what could be done about the issue. A major catalyst for the HUB was an anonymous $750,000 donation to the Vancouver Police Foundation in 2015, earmarked for Vancouver’s mental-health and substance-use patient care. Then other partners joined, including the City of Vancouver, which committed $1 million, and the St. Paul’s Foundation, which committed $1.75 million, for a total of $3.5 million. 

The HUB’s three services:

  1. Site A, a fully equipped, redeployable new clinical unit with eight to 10 beds, adjacent to the ED, which provides acute care to patients.
  2. Site B, a transitional, non-medical eight-to-12-bed unit for discharged patients, also near the ED. It facilitates their return to their neighbourhoods and connects them to vital services such as housing and continuing medical care. The transitional care centre is modelled after the Rotary Centre at St. Michael’s Hospital in Toronto. The hospital has seen a substantial decrease in mental-health/substance-use patient readmissions since the Rotary Centre opened in 2000.

    Sites A and B are provided by Weatherhaven Global Resources Ltd., a privately owned Vancouver-area firm that custom manufactures redeployable modular  units for different uses around the globe. The company is providing its HERcon™ Max (Hardwall Expandable Redeployable Container) for each of the HUB’s two sites – its first Canadian medical application of these units. They have been custom-made to meet the HUB’s requirements, with extensive input from the VPC, City of Vancouver, clinicians and others. They provide excellent insulation and noise absorption for patients, along with windows for natural lighting.

    Each mobile unit is 54 feet long by 34 feet wide. The highest exterior point is 19 feet tall while the interior has 10-foot high ceilings. All internal services, such as electrical wiring, plumbing and sewage, will be custom installed at the HUB site.

  3. The Rapid Access Addiction Clinic. Launched in September, 2016, the RAAC is a low-barrier outpatient clinic for those with various substance-use disorders. It streamlines the wait times for opioid-use disorder patients ready to receive treatment and can welcome them in as few as 24 hours after their discharge from ED or referral. In December the RAAC launched its Treatment Initiation Zone (TIZ), a quiet room with five large, comfortable chairs where patients can come directly from ED to start opioid substitution therapy like Suboxone.

Police must often stay with patients until they’re seen by a doctor, and that can take, on average, 75 minutes per patient. The HUB is expected to reduce that wait time by about two thirds, to 20 minutes. The HUB is also expected to take care of 6,000 patients annually, a little over half the current volume of mental-health and substance-use patients receiving care at St. Paul’s ED.

HUB Partners and Funding:

  • Ministry of Health (MOH) 
    The HUB aligns with the MOH business plan, objectives and strategic priorities. In light of the Province’s declaration of an overdose crisis, providing additional solutions and access to treatment to help address this issue is a top priority.  The Ministry is providing $3 million to the HUB in annual operating funds through Vancouver Coastal Health.

  • Providence Health Care 
    With the HUB’s launch, Providence aims to transform and improve the current state of St. Paul’s Hospital’s ED congestion, smooth the transitions to community care and decrease police wait times with patients in the ED. 

  • Vancouver Police Department (VPD) and Foundation (VPF) 
    The Vancouver Police Foundation has committed $750,000 toward the capital costs of the HUB. Representatives from the VPD and its Foundation have been instrumental in the development of the HUB concept, particularly the Vancouver Police Foundation Transitional Care Centre, or Site B. 

  • City of Vancouver (COV) 
    The HUB aligns with the recommendations from the Mayor's Task Force on Mental Health and Addictions, the city’s first-ever mental health and addictions plan. In November 2016, Vancouver City Council approved a $1-million grant towards the capital costs of the HUB. 

  • St. Paul’s Foundation 
    St. Paul’s Foundation has been a strong supporter of the HUB concept from inception, and has committed to matching the capital contributions of the VPF and COV for a total contribution of $1.75 million.

  • PHC Office of Innovation and Strategic Partnerships
    Leveraging the innovation process developed by this Office, and by bringing non-traditional public/private partners to health care, it aims to transform how health care problems are identified, solutions tested and new models of care validated. Through innovative solutions like the HUB, it strives to accelerate the health care system’s adoption of solutions to improve both the quality of care and health outcomes for our patients. PHC’s Office of Innovation and Strategic Partnerships is funded by a generous donation from St. Paul's Foundation.

  • Vancouver Coastal Health (VCH) 
    VCH’s “A Second Generation – Health System Strategy for Vancouver’s Downtown Eastside” maps out a plan to address one of the most vulnerable populations – people living in Vancouver’s Downtown Eastside. A significant percentage of the people described in this report are the same patients that are presenting at the SPH ED, and will benefit from the enhanced service integration between acute and community services. 

  • Weatherhaven Global Resources Ltd. 
    Headquartered in Coquitlam, BC, Weatherhaven is an international supplier of shelter systems for medical, humanitarian, military and commercial applications worldwide. For over 30 years, it has engineered, produced and installed high-quality shelter units around the globe.  Weatherhaven has entered into a research-and-design partnership with PHC to provide custom-made units for the HUB’s Sites A and B.