Hospital steps up mental health care
“What’s wrong with you?” asks the voice, menacingly. “You are such a mess. You should be ashamed.”
The voice continues its harangue as staff members at Queensway Carleton Hospital — who are hearing it through earphones — attempt to calmly play a game of cards or concentrate on a word puzzle. Focusing is not easy.
This exercise — called hearing voices — is a lesson in empathy for staff at the hospital, which has been revamping its mental health program in response to rapidly growing demand in recent years.
“We have all experienced pain and can relate, but when you have a nurse who hasn’t experienced hearing voices, it is difficult to be empathetic,” said Dom Ielo, clinical director of mental health at the hospital.
Helping staff to better understand what life is like for people who routinely hear voices is just one way the hospital is changing its approach to the growing numbers of mental health patients it sees in its emergency department every year.
Queensway Carleton has seen a 32 per cent increase in mental health patients in emergency in five years, the single largest increase at the hospital. The hospital sees more than 24,000 people every year who suffer from anxiety, depression, dementia and other mental health disorders.
What is behind the jump? A number of issues, say hospital officials, including increased awareness, limited access to community help, the opioid crisis, and increasing rates of mental illness among the young. In the past year, the rate of youth and young adults accessing emergency mental health services at Queensway Carleton has grown at twice the rate of the rest of the hospital’s mental health services.
“From my perspective, there is a real problem and it is region wide,” said the hospital’s chief of psychiatry, Dr. Kathi Kovacs. “Emergency is increasingly flooded with mental health patients.”
General hospitals, including Queensway Carleton, The Ottawa Hospital and Montfort, are at the front line of the increase in acute mental illness demand. The Royal, the regional mental health centre, does not have an emergency department.
With a large and growing catchment area of about 450,000 and multiple factors leading to increasing demands on mental health services, Queensway Carleton has made changes to better cope with the new reality.
“Our doors can never be closed,” said hospital chief executive and president Tom Schonberg. “We have to accept that intake, that is a reality of life. We have to be able to cope.”
Among changes are the introduction of mental health crisis nurses in emergency, 24/7. The nurses often spend hours with a single patient, doing a full assessment, offering some therapeutic treatment and making contact with community resources.
Other recently introduced services include a peer support program to connect patients with others who have had successful experiences with the mental health department, and the introduction of dedicated appointment times to reduce wait times for urgent referrals, among other changes.
The hospital says its efforts have paid off. Admission rates of people showing up at emergency with acute mental health needs have fallen from 50 per cent to 25 per cent and lower. In addition, 99 per cent of people who are not admitted are given an alternate care plan and connected with community resources.
The hospital says it has also seen improved patient outcomes and a 30 per cent improvement of readmission rates for — from 10.8 per cent to 7.5 per cent, which is among the best in Ontario.
The hospital is beginning plans to renovate and expand its 24-bed mental health unit.
Hospital officials acknowledge they have more work to do, but they are already seeing results serving a need that is unlikely to decrease any time soon.
From my perspective, there is a real problem and it is region wide.