This post is part of a series about how quality standards can be used to support quality improvement together with others who are working on adopting the quality standards. The introductory post can be found here.
Mental illness is a prevailing health care issue that affects people of all ages and walks of life. There are significant gaps in the quality of care that people with mental illness receive. To address this, Health Quality Ontario has a series of quality standards that aim to reduce variation in mental health care across the province.
Brockville General Hospital (BGH) is implementing quality standards for mental health care by increasing awareness of these standards among staff and community partners, and identifying gaps in care by comparing care currently being delivered against the care outlined in these standards.
Health Quality Ontario had a chance to catch up with Meredith Armstrong, a social worker in Outpatient Mental Health Services to talk about how BGH is engaging in quality standards work.
Which quality standard was your team interested in addressing?
We have actually worked with a number of quality standards - major depression, schizophrenia (care in hospital), behavioral symptoms of dementia, and those related to opioids.
How did you work with the quality standards?
For a period of about a year (from January 2017 to January 2018), we hosted a series of presentations for internal mental health staff members and community partners about the quality standards.
The community partners we invited included local mental health organizations, family health teams and health units, long-term care facilities, South East LHIN and Health Links personnel, and other local service providers, such as partners from the Alzheimer Society, the Assault Response and Care Centre, and the local police force.
Dr. Rob Malone, Chief of Psychiatry at BGH, is a champion of Health Quality Ontario's Quality Standards Program and was a key speaker during these presentations. He provided an overview of the quality standards and facilitated discussion among participants.
What were the outcomes of these presentations?
As a first step, the presentations provided us with an opportunity to raise awareness about the mental health quality standards for both internal staff and community partners.
Specifically, we used the presentations as an opportunity to identify gaps in health care services, particularly as compared with the care outlined in the major depression quality standard. When we completed a comprehensive analysis of our services, two gaps became clear:
1.Wait times for recommended clinical counselling was usually longer than what was recommended.
Our wait list for one-on-one counselling is 18 months. We have since developed two services that patients can access while they wait for longer term counselling:
- In-hospital group education: Patients can now be referred to in-hospital group education sessions by their physicians. These sessions focus specifically on depression and mood regulation.
- Community-based walk-in counselling: We are working with our main mental health and addictions service agency to provide patients with access to walk-in counselling services in the community. The walk-in clinic is run by hospital staff twice a week and community agency staff three times a week. We established a joint venture/partnership and committed to sharing staffing resources for this project. No referral is required.
We are hoping that some patients who access these new services may find they no longer need longer term counselling, which may help reduce overall wait times.
2.Our mental health clinicians could benefit from more continuing education in evidence-based treatments like cognitive behavioral therapy (CBT) and interpersonal therapy.
- The hospital’s management has provided time and reimbursement to staff for education (such as courses and conferences) on evidenced-based treatments recommended in the major depression quality standard.
- One of our staff psychiatrists has volunteered to supervise and train a group of five social workers here at BGH in interpersonal therapy techniques. The training will take place over 12–16 sessions, and will include meeting with the psychiatrist once a week; learning the interpersonal therapy model; and taking a video recording of patient sessions (with consent), reviewing the recordings and discussing our progress with the psychiatrist and our peers. Through this process, we aim to set a higher standard of care among our social work clinicians. We also hope to replicate this training model to have the nurses on the team train in Cognitive Behavioural Therapy.
How else are you working with your community partners?
We are now better at using technology to ensure that discharge summaries and assessments by our psychiatrists can be automatically forwarded electronically to primary care physicians. Primary care physicians can follow through with treatment recommendations much sooner, which provides a better continuum of care for patients.
What are your next steps?
We will continue implementing our strategies to fill gaps in care. In addition, we are hoping to do a short evaluation with patients who attend the community-based walk-in clinic to determine if it’s a helpful interim step while waiting for longer-term counselling.
Are you working on implementing quality standards related to mental health? Leave a question or comment below, or reach out to Meredith Armstrong on Quorum.