CMHA Ontario 2019 pre-budget submission addresses hallway medicine

A core set of provincewide mental health and addictions services should focus on providing seamless programs and support across the lifespan, from children and youth to adults and seniors. Another focus should also be placed on enhancing substance use and addictions treatment programs for Ontarians.

Core services will ensure consistent treatment delivery across Ontario, reduce emergency room visits, help patients navigate the system and lead to better health outcomes.

One cost-effective option for addressing the current opioid crisis, for example, is rapid access to addiction medicine (RAAM) clinics. There are over 30 RAAM clinics in communities across Ontario where individuals presenting with alcohol or opioid-related conditions are offered evidence-based treatments by an addiction physician or health care practitioner within days. Data from one site which tracked 14 patients suggests that three months after the RAAM clinic opened:

• Visits to local hospital emergency departments decreased by 63 per cent
• Hospital inpatient treatment decreased by 80 per cent
• Withdrawal management services decreased by 97 per cent

A net-cost analysis of the above example estimated total health care savings to the health system of approximately $71,000, factoring in expenses to run the clinic.[1] Several CMHAs, including CMHA Brant Haldimand Norfolk, CMHA Middlesex, CMHA Peel Dufferin and CMHA Simcoe County provide services through RAAM clinics.

Furthermore, CMHAs support the implementation of Consumption and Treatment Services as cost-effective means to reduce fatal overdoses and prevent illnesses.

There are many challenges facing community-based agencies in this area as many agencies lack capacity as well as financial and technical resources for data collection. Further investments are needed to build the data infrastructure of the community mental health and addictions sector. Without valid, comparable, consistent data, we cannot adequately measure our performance. And without effective performance measurement indicators, we cannot improve the quality of our performance. Quality improvement initiatives cannot succeed without this necessary data infrastructure. The first step is to invest in a data strategy for the entire community-based mental health and addictions sector.

Many CMHA branches across Ontario are leading the path to continuous health quality improvement. Often, they are doing this in conjunction with CMHA Ontario, which co-leads the Excellence through Quality Improvement Project (E-QIP). E-QIP provides quality improvement education, training and resources, and builds capacity within the mental health and addictions sector. The project ensures dedicated and skilled service providers have the support they need to improve the quality of care they offer to clients. E-QIP provides coaching to health service providers to help streamline health service delivery and implement cost-effective and efficient methods to enhance service provision.

Supportive housing is consistently identified as one of the top priorities by our local CMHA branches. Provincewide, CMHAs provide about 30 per cent of all the mental health supportive housing units and nearly 20 per cent of the total residential addiction support. CMHA’s supports the goal of an additional 30,000 supportive housing units across the province over the next 10 years.

Supportive housing provides an anchor for life. Research indicates that having a place to call home means a better quality of life and success in education and work. It improves outcomes from even severe mental health and addictions problems. Supportive housing can also decrease problematic drug and alcohol use and it has the potential to improve physical health and social inclusion.
Evidence from the nationwide housing-first demonstration project, At Home/Chez Soi, found that overall supportive housing resulted in substantial reductions in overnight stays in shelters and fewer stays in institutions such as hospitals, correctional facilities and addiction treatment facilities. Every $10 invested in housing-first services resulted in an average reduction in costs of other services of $9.60 for high-needs participants and $3.42 for moderate-needs participants.[2] Over a two-year period, every $10 invested in housing-first services resulted in an average savings of $21.72.[3]

Increased support is needed for joint primary and mental health and addictions integrated care models that work to address the physical and mental health and addictions needs of Ontarians. Such cost-effective, community-based primary health care and mental health and addictions services reduces pressures on hospital emergency departments.

One example that combines primary care with mental health care is CMHA Ontario’s BounceBack program. BounceBack is a unique, telephone-based psychotherapy program available across Ontario designed to help adults and youth 15 and older to manage symptoms of depression and anxiety. Access to the program is by referral from a family doctor, nurse practitioner or client self-referral. If clients submit a referral themselves, their primary care provider is notified and kept informed of their progress in the program. There’s no waiting period for BounceBack and the program is free to people living in Ontario who have a valid health card. Once a referral is submitted, clients who are accepted into the program are contacted by a BounceBack coach within five business days to start the program.

BounceBack is shown to reduce a person’s symptoms of depression and anxiety while improving their emotional wellbeing and quality of life. The program has also shown to reduce avoidable use of hospital and emergency department resources, thus helping to end hallway medicine.

Evidence shows that mobile crisis intervention teams are effective in supporting people who are experiencing a mental health or addictions-related crisis.[4] MCITs are staffed by a uniformed police officer and mental health and addictions worker. These teams co-respond to a person in crisis to:

• Ensure timely and direct links with community services and resources
• Prevent and reduce harms to clients
• Decrease encounters with and entry into the justice system
• Prevent unnecessary admissions to hospital emergency departments

MCITs are one component of mental health and addictions-related crisis support that several CMHA branches currently provide across Ontario.