Annual Report 2022-2023: Michael Garron Hospital/Toronto East Health Network

Submitted by Dr. Michael Rosenbluth, Chief Dept Psychiatry/Medical Director Mental Health Program

The goal of the Department of Psychiatry and the Mental Health program is to optimize patient outcomes while working to  increase the capacity of community-based clinicians and agencies, to treat psychiatric outpatients.

As part of a hospital wide initiative, we have been involved with the creation of an Ontario Health Team to achieve greater integration of hospital and community agency services to improve care for our community with regard to psychiatric and substance related services.

The hospital service and department have been involved in creating the East Toronto Health Partners Adult Mental Health Working Group. The purpose is to lead strategic planning, integration and coordinated service planning, organization and delivery across all sectors involved in adult mental health in East Toronto with the goal to improve care for adults accessing mental health services. This involves setting strategic priorities and develop operational objectives, policies, practices and activities to facilitate integration and coordination of ETHP adult mental health services, and to promote collaboration between organizations, staff, physicians (including primary care) and the greater community toward meeting strategic priorities of ETHP in adult mental health, and to collaborate with the ETHP Digital Committee to develop digital approaches to care navigation, delivery and information sharing to support integration across ETHP, and to harmonize client, caregiver and provider education and support programs, policies and practices across the ETHP adult mental health providers.

In the field of addictions, we are collaborating to provide coordinated and rapid access to care with community and hospital partners.

We have consolidated our transitional youth program, which is  three-month clinical navigation for 16 to 29 year olds experiencing barriers or struggling to engage in services within the mental health system, providing brief clinical support and system navigation to hospital community clinics, and support with transition to adult mental health services. In the first two years of the program we received 500 referrals, of which 80%  successfully engaged in the program with two or more visits; with almost 50% discharged as connected warmly to another service, 26% of discharged did not want or need a connection to another support, and 39% less likely to have problems associated with accessing services and supports. Also there was a substantial decrease in emergency room visits for those involved with the transitional youth program 

The Michael Garron Hospital Paediatric and Child and Adolescent Mental Health Services are exploring a collaboration with  the Extensive Needs Service, a partnership between Holland Bloorview, the Children's Hospital of Eastern Ontario  (CHEO) and McMaster Children’s Hospital. This service is aimed at addressing the particular needs of children up to age 18,  whose complex needs have not been met by existing services and who are experiencing frequent emergency visits or referrals   to urgent and crisis services.  Presentations include challenging or interfering behaviour of at least 12 months duration, safety concerns, impaired functioning, and complex caregiver needs, despite the involvement of three or more providers. These children and youth live with co-occurring neuro-developmental conditions or acquired brain injury, mental health  conditions, and chronic physical health conditions.  The collaboration will provide funding for local, intensive and individualized services for these children, youth and families, to include mental health assessment and treatment, psychopharmacology,  specialized and intensive behavioural intervention, parent support, allied health treatment such as occupational therapy and    speech and language pathology, respite, and transition support to school, community services and adult services. We are  excited to explore the potential for this important collaboration to support the children and families within our local communities.

With regard to quality improvements, we have been interested in certain metrics. For example, falls on the inpatient unit for the last 13 years were between 30 to 66 falls per year and in the last year since we implemented adjustments, including bed alarms, wireless nurse calls, and special falls risk prevention beds, the falls fell to seven. Similarly, we are pleased that the results when we  focussed on workplace violence prevention. Through different interventions, workplace violence has fallen from 56 incidents five years ago to three incidents last year. We have focussed on following up emergency visits within 30 days of discharge, and have seen a yearly decrease in the percentage of patients who went to emergency within 30 days of being discharged. Also we have been focussing on decreasing our length of stay, and we have been successful in this regard despite some outliers. 

Thus, by emphasizing education, innovation, collaboration and integration, and responsivity, we strive to optimize clinical care of those challenged with mental health issues both acute and chronic, and increase the capacity of community-based clinicians and agencies, to engage and treat patients more effectively.