Improvement Story session at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter. Mental Health and Addictions Services relocated one staff position to the primary health site in Meadow Lake to be able to provide just in time service to patients who may need information, support, brief intervention or a referral for more in depth services. Better Health Mary Rowland; Annette Viljoen

1. Incorporating Mental Health and Addiction
Services into PHC using Existing Resources
Mary Rowland and Annette Viljoen
This Session is sponsored by:

2. Incorporating Mental Health and
Addictions Services into PHC using
Existing Resources
2013 Health Care Quality Summit
Regina, Saskatchewan

3. Presentation Overview
• To explain how Mental Health and Addiction
Services has been incorporated into the
Primary Health Care team using existing
resources.
• To highlight the process the Meadow Lake
PHC team is undertaking to develop the role
of the MH/ADD counselor, strategies utilized
and the outcomes achieved to date from the
patient and provider perspective.

4. Session objectives
• Describe how the role of the MH/ADD
counselor has impacted the patient and
provider experience
• Learn about the change strategies used to
successfully incorporate the MH/Add worker
into the PHC core team
• To share our learning through our experiences
over the past year

5. 5
Where is
Meadow
Lake
anyway?

6. 6
Who do we serve?
 Includes RM 622, 561, 588,
City of Meadow Lake
 First Nations Communities
of Canoe Lake, Flying Dust,
Waterhen, Island Lake, Big
Island Lake, Makwa
Sahgaiehcan
 18,000 covered population
12,000 discrete patients at
Meadow Lake Associate
Clinic

7. Why is this important to our
patients ?
• “My sister was discharged as soon as she had met the program
goals, but without any ongoing support or resources to help her
continue healing at home, or any resources for us as family
members to help her. Within a week, almost all of the work done
while she was in the program was undone.”
• “I have accessed the mental health system for treatment of my son.
The response was poor. I have accessed the ER on two occasions.
Once because he was suicidal. We were sent home. Within two
weeks we had to commit him to access treatment. Again, a year
later the treatment was no better. He was considered an emergency
with an appointment three weeks down the road.”
SK Ministry of Health

8. Why is this important to our health
care providers?
• “Family physicians are treating over 75% of mental health disorders-
--and almost every family has been touched by that. Providers need
education about seeing this as a ‘normal’ health problem that can
and should be dealt with in a normal way.”
• “Children with mild to moderate needs can often improve the most
from rehab services. However, these kids are receiving few
resources as more kids with high needs are presenting.”
• “The waiting list for specialists is too long. One and a half years for a
child psychiatrist…...the window of opportunity to help these children
and families is very small, and too often spent on a waiting list.”
SK Ministry of Health

9. What are we trying to achieve?
 Better Care!
q Patients can access their PHC team consistently to meet
their needs, resulting in improved patient experiences
q Improved patient outcomes related to better management
of life stressors, right service at the right time
 Better Teams!
q Improved provider work experience

10. Team Overview
March2012 David Brown

11. Building the Team
• Current Mental Health and Addictions Team
1.0 FTE Coordinator/Team Lead
2.0 FTE Mental Health Counsellor (adult)
1.0 FTE Mental health Counsellor (youth)
2.0 FTE Addictions Counsellor (adult)
1.0 FTE Addiction outreach Counsellor
1.0 Addiction Youth Counsellor
1.5 FTE Psychiatric Nurse
1.5 FTE Reception / Office assistant
4.5 FTE Detox Worker (4 casual positions)
Shared psychiatrist visits from North Battleford

12. PHC team Include:
Physician/NP
Registered nurse
MOA – Medical Office Assistant
*Mental Health and Addictions Counsellor
Diabetic Nurse educator
Dietitian
Pharmacist
Chronic Disease Nurse Educator
Sexual Health Nurse
*MH/ADDS Intake/PHC team
Coordinator/Team Lead 40%
Mental Health 25%
Psych Nurse 25%
Addictions 10%

13. Benefits
• Improved access to MH services
• Better prevention, detection and earlier
intervention
• Reduced stigma due to location of service
• Better treatment rates, comprehensive care and
follow-up

14. Benefits
• Better treatment rates, comprehensive care and
follow-up
• Reduced economic burden
• Better mental health and general health
outcomes *
• Reduced crises, hospital admissions, shorter
LOS, decreased ER usage*

15. How are we doing?
Patient perspective
Physician perspective
Mental Health and Addictions perspective

16. Faye’s Story

17. Patient perspective
• Faye
• Physician
• RN
• MOA
• Diabetic Educator
• Chronic disease educator – *Case Manager*
• Mental Health and Addictions Counsellor
• Occupational therapist
• CDM Clinical exercise therapist
• Physiotherapist

18. Physician’s Perspective

19. Mental Health and Addictions
Perspective
• Our goals were to develop our relationship with primary
care providers, raise awareness of our services and
improve access to our services for primary care
patients.
• Over our one year pilot project we have been largely
successful in meeting the above goals.
• There have been some downsides to our experiment
with this model. Mental Health and Addictions Services
has seen a significant increase in new referrals and wait
times for service is increasing.

20. Where are we going?
Goals
•assist in the identification of tools and resources for the use of
primary care providers in providing services to low risk patients and
•to serve moderate risk clients and coordinate referrals to the
specialized mental health and addictions service.
•to look at a one year term PHC counsellor position to set up
MH/ADD directives with in the PHC setting education and supporting
team members to provide level one screenings on all patients once a
year.
•to work with all team members to identify moderate and high risk
patients for earlier intervention.
•to provide education, brief intervention, rescreens and when
identified refer and coordinate specialized services.

21. PHC MH/SU Pathways
Screening 1
Screening 2
Low
Risk
Mod
Risk
High
Risk
- Reinforce
- Educate
- Rescreen
- Brief
Intervention
- Rescreen
- Assess
- Refer
- Coordinate
- Assess
- Care Plan
- Treat
PCT
PCT
PCT
PCT
PCT
Specialist
Practitioners
Shared
Care
Knowledge
Exchange
Dr David Brown

22. Conclusion
• The last year has been a valuable learning
opportunity
• Improvements to service delivery and
patient flow have been identified.
• We have a clear picture of our goals for
this year.
• We continue to change and improve at a
fast pace.

23. Thank you to…
• Faye
• PHC teams
• Meadow Lake Associate Clinic
• Mental Health and Addictions Services
Team
• Management team

24. Questions
Comments