South West Local Health Integration Network
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Mental Health

Crisis Mental Health Response Enhanced - Click here for more information 

The Time is Now: A Plan for Enhancing Community Based Mental Health and Addiction Services in the South West LHIN

Briefing Note to LHIN Board

Executive Summary

Full Report on Community Capacity

Full Report Appendices

Tier 2 Mental Health Integration

Draft Report Presentation Video

Above: Consultant Jim Whaley presents draft report on Mental Health and Addictions Community Capacity to the South West LHIN Board on October 26, 2011 in Mitchell. 

 

The South West LHIN Board of Directors supported a proposed integration of mental health beds and services between St. Joseph’s Health Care (SJHC) London and Windsor Regional Hospital, St. Joseph’s Healthcare Hamilton and St. Thomas Elgin General Hospital (STEGH). The proposed integration is part of the recommendations made by the Health Services Restructuring Commission in 1997 and allows people to receive mental health care closer to home.

At its meeting April 27, 2011, the South West LHIN Board supported the integration initiative, provided specific requirements are being met by all parties, including: 

Amendment of the current Hospital Service Accountability Agreement (H-SAA) between the South West LHIN and SJHC London to include the following obligations:

  •  to submit a separate transfer agreement for the divestment to each receiving hospital that is acceptable to both the South West LHIN and the LHIN in which the receiving hospital is located;
  • to work with STEGH to ensure the completion of a contingency plan for the divestment of beds and services to STEGH to mitigate risks associated with capital building and service readiness;
  • to report quarterly or more frequently as required to the South West LHIN the progress of each phase of the integration; and

The South West LHIN Board of Directors also approved the phased reduction of 70 in-patient beds from SJHC Regional Mental Health Care (RMHC) London and has requested additional amendments to the H-SAA directing the SJHC to do the following:

  • Work in partnership with community partners to create individualized, appropriate and sustainable transition and discharge plans providing safe and secure placement of all patients impacted by the phased reduction of 70 in-patient beds over the next three years. In order to facilitate this reduction, $2.9 million in base funding in fiscal 2010/11 will be placed in a reserve account to support the 70 beds through the reduction period. Any funds not used while the reduction plan is implemented will be held in reserve for reallocation by the South West LHIN in support of community services and programs.
  • Establish transfer protocols with community organizations identified as receiving organizations outlining roles and responsibilities related to the support of patients through transition.

 The South West LHIN Board has also requested that the South West LHIN staff provide regular reports to the Board regarding the status of mental health realignment implementation in the South West LHIN.

Background

The South West LHIN received the Notice of Integration and Project Charter related to the final phases of Tier 2 Divestment from St. Joseph’s Health Care, London (SJHC).  LHIN staff conducted an internal review and evaluation process and brought a recommendation forward to the April 27, 2011 Board of Directors meeting. Additional information regarding the integration was provided at the March 9, 2011 South West LHIN Board Committee meeting and at the March 23, 2011 South West LHIN Board of Directors meeting to ensure that the LHIN Board has adequate opportunity to reflect on this complex integration prior to making a decision at its April meeting. 

In accordance with the 1998 Health Services Restructuring Commission (HSRC) directives,  SJHC has led the planning for the HSRC recommendations for the divestment of beds, services, clients and associated resources from St. Joseph’s Health Care - Regional Mental Health Care (SJHC - RMHC) to Grand River Hospital, Windsor Regional Hospital, St. Joseph’s Healthcare Hamilton and St. Thomas Elgin General Hospital.   Combined with recommendations from the Southwest Mental Health Implementation Task Force (2003), SJHC and their partners have developed a phased implementation approach to accommodate the completion dates of the construction projects of the receiving hospitals.  The phased transfer of beds and services are as follows: 

  • Phase 1:  Transfer of 50 beds, 1 Assertive Community Treatment (ACT) Team and 1 Transition Team to Grand River Hospital.  This was completed in December 2010; however, SJHC continues to provide Schedule 1 services to Cambridge area patients until new Schedule 1 beds are operating at Cambridge Memorial Hospital.  It was anticipated that Schedule 1 beds would be operational for Cambridge Memorial Hospital by April/May 2011; however, the approvals are still outstanding.
  • Phase 2:  Transfer of 59 bed and 3 ACT Teams to Windsor Regional Hospital in the fall of 2011
  • Phase 3:  Transfer of 14 beds and Simcoe Clinic Resources to St. Joseph’s Healthcare Hamilton in 2013/2014
  • Phase 4:  Transfer of 15 beds and the Crisis and Relapse Prevention Services to St. Thomas Elgin General Hospital.  Timeframe for completion is to be determined.
  • Phase 5:  156 longer-term mental health beds and 89 forensic mental health beds relocated to new facilities within SJHC-RMHC in 2013/14.  The 156 London-based longer-term mental health beds are to serve Elgin, Oxford, Middlesex, Lambton, Huron Perth and Grey Bruce for long term (up to 60 days) for psychosis, mood and anxiety, dual diagnosis, adolescent, geriatrics, along with various ambulatory services.  The 89 forensic mental health beds will be located in St. Thomas and are a provincial resource with wait lists managed by Connex Ontario. These bed numbers were increased from the original HSRC directions based on projections completed as part of the capital planning process for the new mental health facilities in London and St. Thomas respectively.

In addition to the divestment of beds, an overall reduction of 70 specialized mental health beds is planned resulting in a new per capita level (see pages 53-55 here) reflective of the changing direction of mental health care from institutionalized care to care and service in the community.  In parallel to the reduction of beds, there will need to be investment in the community to support the new work that will result from the change to care and service in the community. 

For further background information see “Tier 2 Divestment Backgrounder” (agenda item 5.5 b, Part 4)

For further information on HSRC Directives see HSRC Directives document (word doc)

Definitions:

Acute mental health beds, also known as Schedule 1 beds, are generally expected to provide up to 14 days of inpatient care.

Ambulatory Services:  these include outpatient clinics, day treatment programs and other community-based care, support and vocational services.

Assertive Community Treatment (ACT): Teams are interprofessional teams with professional, clinical experience in occupational therapy, psychiatric nursing, psychiatry, social work, therapeutic recreation, and vocational support.  ACT teams work in the community assisting clients with severe and persistent mental illness to live independently in the place of their choice and to achieve their personal, educational, and/or vocational goals. 
(http://www.sjhc.london.on.ca/mental-health-care/mood-and-anxiety-disorders-program/supporting-programs-and-services)

Dual Diagnosis: The Dual Diagnosis Program at St. Joseph’s Regional Mental Health Care London provides specialized assessment, treatment, rehabilitation, and support services to adults between the ages of 18-64 years of age with a developmental disability and mental illness or severe behaviour disorder. 
http://www.sjhc.london.on.ca/mental-health-care/dual-diagnosis-program 

Forensic Mental Health Beds are in-patient beds within the Forensic Program.  The Forensic Program provides specialized mental health services, with an emphasis on the high risk and high need client, to adults with a mental disorder who have committed a criminal offense.  The Forensic Program includes assessment, treatment, and rehabilitation programs, as well as an outpatient Forensic outreach team. 
Link to SJHC info if you want to include (http://www.sjhc.london.on.ca/mental-health-care/forensic-program)

Longer-term mental health beds are generally expected to provide 60-90 days of inpatient care.