Sharing info helps patients: N.S. doctor

An article posted on July 4th by CBC News:

New guidelines about sharing patient information will make it easier for some families that support adults with mental illness, a senior health official in Halifax says.

Capital Health is adopting a sliding scale of information sharing, where patients can decide how much to share and with whom. It's a move away from the all-or-nothing approach.

"This is different from before. Now we're looking to share some information with some people and be specific about it," said Dr. Ian Slayter [pictured], clinical director for general psychiatric services.

Slayter said patients may refuse to divulge any health information, but health-care providers will encourage them to share some details with those who support them.

He said studies have shown that communicating with family members results in a better outcome for the patient.

"We're saying that providers need to sit down with the patient and say, 'You're receiving some support from this person and they could be more effective if they understood a little something about your illness, what it's all about, what your treatment is and how they can help.'"

For example, Slayter said, if a relative or friend knows that a patient is having suicidal thoughts, then maybe they can provide more support to help them.

He said it's also useful for families to know about a certain medication so they can help the patient get it or administer it.

Joanne Zinck's youngest daughter was diagnosed with schizophrenia at age 20. She says one of her biggest hurdles with mental-health care providers has been around privacy.

"We were depended on to help her to get well, but yet we weren't able to get the information that we needed to be able to support her," said Zinck.

Slayter said the guidelines were drafted by a group of patients, their families and the specialists who treat them. He said they also consulted with the Meriden program, a family-oriented mental-health service in England.

The district health authority approved the guidelines last week. Some staff are working with the new rules already, but more will be trained this fall.

Also see:

CDHA Mental Health Program - Information Sharing Guidelines (PDF)

Collaboration in the Triangle of Care (PDF)

Dr. A.J.: Mental health-care needs fix

An article published in today's edition of The Chronicle Herald:

Physician urges collaboration over fee-for-service model

By John McPhee, Health Reporter

Big changes are needed to fix our ailing mental health-care system, a Halifax family doctor says.

For example, the way doctors are paid doesn’t allow them to take time with people, said Ajantha Jayabarathan [pictured], better known as Dr. A.J.

She and other general practitioners are paid for every patient they see, a system called fee-for-service. That may work for simple problems, but the complexity of treating mental illness is another matter.

The collaboration of many practitioners, from social workers to psychiatrists, is needed, Jayabarathan said in an interview Wednesday.

"Already they (the province and Doctors Nova Scotia) are looking at a different way to pay people," she said.

"For instance . . . I meet with a social worker, psychologist or a psychiatrist for an hour to discuss patients, or let’s say they came to my clinic once a month and we all work together. The whole system has been turned around."

Collaborative care is at the heart of a national conference that starts today in Halifax.

Jayabarathan, who will co-chair the 12th Canadian Collaborative Mental Health Care Conference, is passionate about the concept.

"I think what it will take is willingness, interest and people stepping forward to say, ‘I think we’re ready to do something like this.’ "

A lack of health-care providers or resources isn’t the problem. It’s a matter of using those resources more effectively.

"We’re drowning in a sea of plenty," said Jayabarathan, who has practised in Halifax for 25 years.

"Family doctors don’t work enough with psychologists and vice versa to really understand each other’s expertise. You are unlikely to use a resource that you don’t know much or anything about, even if they work down the hall from you."

The collaborative effort must go beyond the people providing the care, said Dr. Ian Slayter, director of psychiatric services for the Capital district health authority.

For the patient’s privacy and other reasons, the family or other people close to the patient are often shut out, Slayter said Wednesday. Patient confidentiality is important, but addressing that issue can be as simple as asking for consent.

"The patient benefits because they will get better support from their family or whoever supports them," said Slayter, who will co-chair the conference with Jayabarathan.

"Their practitioners and clinicians will be better informed about what’s actually going on with the patient. Because what I see in the office and what the family sees at home can be different."

And family members benefit because they’re included in the process.

"They not only feel more effective but they get help in dealing with their own anxieties and the difficulties they have dealing with a person with a serious illness," Slayter said.

Next week, Capital Health is expected to approve treatment guidelines that include a duty of care to the family, Slayter said. These guidelines will be distributed to practitioners and health centres.

A group from the Meriden Family Programme in Birmingham, England, has been training a Capital Health team in its collaborative family approach, Slayter said.

The Collaborative Mental Health Care Conference runs from today to Saturday at the World Trade and Convention Centre in Halifax. Speakers and workshops will include officials from the Mental Health Commission of Canada, local practitioners and people who have used the mental health system.

The conference is open to the public, but registration and fees apply, although efforts will be made to make the event as accessible as possible. About 350 people were registered by Wednesday, Jayabarathan said. For more information, go to www.shared-care.ca.

(jmcphee@herald.ca)

Photo credit

Disclosure guidelines protect privacy, improve care

An opinion piece published in today's edition of The Chronicle Herald.

By Ian Slayter (pictured)

Capital Health’s Mental Health Program recognizes the need to listen better to our patients. Only the people living with mental illness can help us understand their goals and needs as they see them. For this reason, we must provide them with the information, treatment and support they need to follow their own path to recovery.

Often, care is shouldered by families — people, whether relatives or friends, who provide the emotional and practical support that is so critical to someone living with mental illness. They are one of our greatest resources because they provide timely, insightful information about a person who is becoming more ill or not responding well to treatments.

Providing families with general information about treatment and care improves their understanding of what their loved one may be experiencing. If we encourage patients to consent to share basic clinical information about their illness, treatment and needs, families are better able to help them. We know from research that working with families improves patient outcomes.

We have a duty of care not only to the patient but also secondarily to the family, as defined above, both to help them support the patient, and to help them cope with the challenges of living with, and caring for, someone with mental illness.

We have drafted disclosure guidelines, with insight from individuals living with mental illness, families and care providers to guide how and what information can be shared when the patient consents, and what is withheld when the patient is not prepared to do so.

This is all in accordance with the Personal Health Information Act and other applicable laws of Nova Scotia. We are now finalizing the guidelines in response to the extensive feedback received from stakeholders.

In an April 28 opinion piece titled "Mental health care: Are our rights to privacy being eroded?" Aileen McGinty stated that our policies, meaning the draft disclosure guidelines, "may not be in compliance with legislation." However, we have taken steps to ensure that the guidelines do follow legislation and the UN Convention on the Rights of Persons with Disabilities.

She suggested the guidelines prioritize the rights of family members over the rights of patients. We respect the rights of the individuals living with mental illness and work with them to arrive at the level of consent they are comfortable with, first and foremost. There are certain situations, allowed by law, where limited disclosure may be necessary to prevent danger.

Patients’ personal health information is private and confidential. The central message of our guidelines is that care providers should explain to patients that sharing of some of their clinical information about their illness, treatment and related needs can improve the level of their support. The care providers are advised to ask if the patient wishes to consent to share particular information with designated persons.

Ms. McGinty’s feedback is helpful; we need to make certain elements clearer. We have received a lot of helpful feedback from many people. The disclosure guidelines will be available on our website, OurHealthyMinds.com, along with other supporting material.

Collaboration is a major step in improving our services. The insight we gain from individuals and families based on their experiences in our system is invaluable. The disclosure guidelines provide a process to open communication among individuals, families and care providers, while protecting and respecting the rights of individuals living with mental illness.

Dr. Ian Slayter is clinical director, Adult General Psychiatry Services, Capital Health Mental Health Program; and assistant professor, Dalhousie University, department of psychiarty.

Also see:

CDHA Mental Health Program Disclosure Guidelines - DRAFT - 30 March 2011

Mental health beds full up

An article published in the January 5th edition of The Chronicle Herald:

Capital Health faced with ‘unrelenting demand’ for admissions since September

By John McPhee, Health Reporter

Capital Health’s psychiatric care system has been under "almost unrelenting" pressure this fall, the head of psychiatric services said Tuesday.

Every one of the district’s 69 mental health acute care beds has been filled since September.

Ian Slayter [pictured] doesn’t know why there has been such a continuous need for admission.

"Our length of stay has decreased a little bit but we still have a lot of people coming for care," he said. "Any particular week, it’s not more than usual, but we’ve had week after week of almost unrelenting demand for beds."

Those who are waiting for acute care beds are either kept in the emergency department where they were admitted or, more preferably, sent to a psychiatric bed in a nearby health district, Slayter said.

Compounding the problem, patients often stay in psychiatric beds after they’re ready to be discharged. That’s because there’s often nowhere in the community — such as supported apartments or nursing home beds — for them to go, Slayter said.

"It’s like filling up a bathtub. Sooner or later you’re gong to overflow."

A woman who contacted The Chronicle Herald said she was turned away from the Cobequid Community Health Centre’s emergency department this week, even though she was told she needed treatment.

The elderly Beaver Bank woman, who didn’t want to be identified, said she was previously treated and hospitalized for acute anxiety.

"One doctor tried to get me in the hospital (but) another doctor told me that the beds were filled," she said. "We have a desperate problem here."

Slayter couldn’t comment on the woman’s specific case, but said hospitals don’t send anyone home who needs to be admitted.

"If the people assessing the patient feel they need to be in hospital . . . then we will keep them in emergency until we have a bed to send them to," he said.

Psychiatric services has been trying to deal with the shortage of psychiatric beds with several programs, Slayter said.

"We’ve been taking some of the more complex cases and building residential placements for people," he said. "It costs quite a bit of money — it’s a 24-hour support service — but when no one else has been willing to take them, we’ve done that in several cases over the past couple of years."

In another program, 35 to 40 people have been placed in supported apartments, where people live alone but they can call for help any time of the day, he said.

And plans are in the works for a psychiatric intensive care unit at the East Coast Forensics Hospital in Dartmouth. Five to 10 beds will be established in early spring for people at a high risk of harming themselves or others.

(jmcphee@herald.ca)

Facts don’t concur

A letter to the editor published in today's edition of The Chronicle Herald:

In his March 24 opinion piece, "Mental health clinics work," Dr. Ian Slayter states, "priority is given to people with more serious mental illness."

Dr. Slayter’s statement is inconsistent with the facts for the Dartmouth Community Mental Health Clinic. Of the 137 new referrals to the Dartmouth Community Mental Health Clinic in January 2010, the most recent month where data is publicly available, none were seen as "urgent/rapid follow-up."

In November 2009, the next most recent month, 94 people were referred to the same clinic and none were seen as "urgent/rapid follow-up." In October 2009, none of the 92 new referrals were seen as "urgent/rapid follow-up."

In total, of the 323 new referrals to the Dartmouth Community Mental Health Clinic over a four-month period, excluding December 2009 because the data are not publicly available, none were seen as "urgent/rapid follow-up."

Wait-time data for the five community mental health clinics in the Capital Health district can be accessed by visiting its website (www.cdha.nshealth.ca), clicking on "Accountability" and selecting "Mental Health Community Team Wait Times." A dash means there were zero people in a category.

Stephen W. Ayer, executive director, Schizophrenia Society of N.S.

Mental health clinics work

A letter to the editor published in today's edition of The Chronicle Herald:

By Dr. Ian Slayter

While we agree mental health services are under-resourced in Nova Scotia, we disagree with this paper’s criticism of the direction taken by our community mental health clinics. Through these clinics we try to provide the best fit between the mental health needs of individuals living in the Capital Health district and the skills and training of teams of health professionals. One article focused on the model of care at the Bayers Road Community Mental Health Clinic. The same model is followed at each of our other community mental health clinics in Dartmouth, Lower Sackville, Cole Harbour, and Windsor.

We are pleased with the direction followed by all five clinics. The clinics have difficulty meeting the high demand for service, nevertheless they do a very good job in the circumstances.

Each clinic works as a team. Priority is given to people with more serious mental illness. Individuals see one or two clinicians — a nurse, social worker, occupational therapist, intensive case manager, or psychologist — and a consultant psychiatrist. Patients with milder mental illness, for example, an adjustment reaction to a stressful situation, usually do not need a team approach. Not everyone needs to see a psychiatrist.

The different professionals offer a wide variety of knowledge and skills. Some skills overlap, some are unique to a particular discipline. For example, only an occupational therapist can do an assessment of someone’s functional level, only a psychiatrist can prescribe psychiatric medication. It might be noted at this point that the community mental health teams work closely with family physicians and that they too can assess, follow, treat, and prescribe medications for persons with psychiatric problems.

Patients are usually referred by family physicians. These referrals are reviewed by a member of the team and the patient may receive a call to ask for further details. Patients are not assessed by phone. The initial assessment is done face-to-face to determine what services the patient needs. Sometimes the person doing the assessment will refer the individual to another clinician as we try to match the needs of the patient with a clinician who has the skills needed.

Our clinicians work within their scope of practice. This means that they assess and treat within the boundaries of their knowledge and skill, as determined by their training, experience, and the guidelines of their profession.

We consider it our responsibility to see the patients as soon as reasonably possible. To provide timely care to those in greatest need, we discharge patients from our service who are ready in order to see those who are waiting and whose needs are more urgent. For the best care of our patients, and not because of management dictates, we do work to see new referrals within the target times set by the Department of Health: urgent patients within one to seven days, semi-urgent patients within 28 days, and non-urgent patients within 90 days.

This team model of care, where the psychiatrist acts primarily as a consultant to the other clinicians, is the standard model followed by public clinics in Canada, the United States, Australia, and elsewhere.

We are looking at newer ways to make our care more effective and efficient to better serve our patients.

As with other conditions, many people’s mental illnesses can be managed successfully in the community with the assistance of a variety of health professionals. However, this model is not for everyone. Depending on the nature and severity of their illnesses, some people require acute inpatient or specialized care, periodically or over the long term.

Could we do better with more resources? Certainly. And every part of the health care system would say so. Through Community Mental Health Clinics such as the one at Bayers Road, we succeed in providing effective, evidence-based care throughout our district in a responsible and efficient manner.

Ian Slayter, MD (Psychiatrist), is clinical director of General Psychiatric Services for Capital Health.