Many people experiencing a mental health crisis turn to emergency departments (EDs), such as North York General Hospital's Charlotte & Lewis Steinberg Emergency, for help. Treating mental health issues, however, often requires more than a hospital ED visit. Once stabilized in the acute care setting of a hospital, it can be vital to receive follow-up care in the community for non-life threatening issues.
“It's not unusual for us to see people with mental health issues who have been suffering for a while and had no idea where to seek support, or were discouraged by long waits to access both community or hospital-based services,” says Sandy Marangos, Director of Emergency Services and Mental Health at North York General.
Follow-up supports minimize repeat ED visits
EDs are often the first stop for many people seeking mental health crisis supports, but EDs are not always optimal for patients who do not need a hospital admission. The busy, confusing and noisy environment in the ED is not conducive to doing more than just managing the immediate crisis. In addition, there is a real need to inform people about available community-based follow-up supports to ensure that unnecessary repeat ED visits are minimized.
Better integration between community and hospital-based services is one way to ensure patients receive the best care. To achieve this end, North York General is part of the Access to Resources and Community Services (ARCS) program. Through ARCS, patients who may initially seek mental health treatment in the EDs of North York General and Humber River Hospital, but who do not need a hospital admission, are referred to Cota for community-based follow-up care, which it provides in collaboration with Toronto North Support Services and Bayview Community Services.
Patients contacted within 48 hours
One of the key features of the ARCS program is its responsiveness. Within 48 hours of an ED visit for a mental health issue, a patient is contacted by a community-based worker who will offer immediate supports, coordinate community services and provide short-term case management, as may be required. “Our focus in the ED is to treat the immediate crisis at hand,” Sandy explains. “This partnership really helps us ensure that patients receive prompt high quality care, and follow-up in their community through a multidisciplinary approach. It also decreases their need to return to the ED.”
Officially launched in November 2016, ARCS is the revamped version of the Emergency Department Diversion Project, piloted by North York General in 2007. The key difference is the addition of Cota as the lead community-based organization coordinating the ARCS program. Cota is an accredited community-based organization that has been supporting adults with mental health and cognitive challenges for over 40 years.
“Cota is committed to service-level integrations between community and hospital-based services. We believe that, done right, they lead to better coordination and transitions of care and result in improved patient experiences and outcomes” says Paul Bruce, Cota's Executive Director. “We are very pleased to be involved in the ARCS initiative and feel confident that it will continue to have a positive impact in the lives of many patients.”
Linking patients to the right care, at the right time
These patients include Li*, who required further treatment after her visit to the Charlotte & Lewis Steinberg Emergency. Li initially received short-term case management through the ARCS program but then mental health issues returned so she reached out again to David, her Cota case manager. Through a combination of the right medication and community resources, Li was better able to find balance in her life. “It marked a turning point in the depression I went through,” Li says of her ARCS program experience.
According to Sandy, stories such as Li's are common. “The ARCS program is all about linking patients with the right care, at the right time, in the right place,” she says. “By partnering with community agencies such as Cota, we are able to tackle a major health care challenge — mental health — and transition patients seamlessly from the acute care setting to support within the community.”
* named changed