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Mobile Crisis Intervention. The Next Decade of Service. St. Joseph’s Health Centre. Relationship to Canada’s health system Relationship to Ontario’s health system Relationship to health system of the GTA Relationship with Toronto Police Service Where we work How we work

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Mobile Crisis Intervention


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    Presentation Transcript
    1. Mobile Crisis Intervention The Next Decade of Service

    2. St. Joseph’s Health Centre Relationship to Canada’s health system Relationship to Ontario’s health system Relationship to health system of the GTA Relationship with Toronto Police Service Where we work How we work How we’re doing Where we’re going

    3. St. Joseph’s Health Centre

    4. Canada

    5. Ontario

    6. Greater Toronto Area

    7. Greater Toronto Area SJHC

    8. In Comparison… New York, N.Y. 8,175,133 Los Angeles, Calif. 3,792,621 Chicago, Ill. 2,695,598 Toronto, ON. 2,615,060 Houston, Tex. 2,099,451 Philadelphia, Pa. 1,526,006 Phoenix, Ariz. 1,445,632 San Antonio, Tex. 1,327,407 San Diego, Calif. 1,307,402 Dallas, Tex. 1,197,816 San Jose, Calif. 945,942

    9. SJHC Statistics for 2010-2011 Beds: 376 Admissions: 21,657Births: 3,080Ambulatory care visits: 272,689 Surgical Cases: 31,568Diagnostic Imaging Procedures: 165,125Emergency Department Visits: 93,741 Mental Health ED Visits: 7,248

    10. Mental Health and Addictions • 26 bed Withdrawal Management Service offering residential, day and community services • Addiction Medicine service with 13 family physicians • 6 bed Child and Adolescent MH beds • 6 bed Short Stay Unit • 6 bed Psychiatric Intensive Care Unit • 29 general adult psychiatric unit

    11. Mental Health and Addictions • Mobile Crisis Intervention Team • Geriatric Mental Health Outreach Team • Assertive Community Treatment Team • Case Management Team • Day Hospital • Depot Clinic • Shared Care Service • Psychiatric Outpatient clinic (16 docs, RN, dietician) • Recovery Support Program

    12. Hospitals in Toronto SJHC

    13. SJHC MHA ED visits compared to PEERS

    14. socialized health care (works for us)

    15. OHIP • The Ontario Health Insurance Plan is funded by taxes paid by the residents and businesses of Ontario and by transfer payments from the federal government. • Every Ontario resident with his or her primary and permanent home in Ontario is entitled to access emergency and preventive medical care under OHIP free of charge. Ontario residents may go to any doctor practicing in the province any time they wish. It does not cover such areas as prescription drugs or dental care.

    16. LHIN The 14 Local Health Integration Networks of Ontario plan, fund and coordinate services delivered in their region by: • Hospitals • Long-Term Care Homes • Community Care Access Centre's (CCAC) • Community Support Service Agencies • Mental Health and Addiction Agencies • Community Health Centre's (CHCs)

    17. LHIN Priorities • INTEGRATION INITIATIVES include a continuum of relationships that can exist between and among individual service providers, programs, organizations and systems of services • Creating HEALTH EQUITY

    18. MCITs in Toronto

    19. TPS Divisions Humber River Regional Hospital MCIT Catchment Area Scarborough Hospital MCIT Catchment Area SJHC MCIT Catchment Area SMH MCIT Catchment Area

    20. Parkdale The team works in an area which is heavily populated by individuals suffering from a major mental illness: Proximity to a former provincial psychiatric hospital City by-laws that allow boarding homes A neighborhood with a large proportion of former mansion-like homes with the potential to be subdivided Becoming gentrified (which brings in even more drug traffic)

    21. Parkdale

    22. Parkdale

    23. Parkdale

    24. MCIT STATS 2011-12 Visits/calls: 903 Number of individuals served: 594 Telephone Consultations: 324

    25. Managing a team TPS Chief + Board MCIT city-wide Inspector 11 Div. S. Sergeant 14 Div. S. Sergeant 11Div. PC MCIT MCIT 14 Div. PC SJHC RN SJHC Manager SJHC corporate objectives, policies + procedures LHIN Priorities

    26. What’s Working 40%

    27. What’s working 2000 Pre-MCIT2007 Post-MCIT Source: St. Michael’s Hospital, 2007

    28. How do we do it? • Communication – RN and PC, manager and staff sergeants • cc on everything • MOU • Quarterly meetings • Involved in each other’s hiring decisions • Keep in the forefront the other organization's mandate • Education

    29. Future goals • Training • City-wide coverage /standardization • EMS

    30. Training for RN’s • Driving police vehicles • Firearms safety • Use of force

    31. City-wide coverage

    32. EMS • Communication between EMS & MCIT. • Avoid unnecessary transports to hospital. • Stop transport of people threatening suicide by EMS prior to MCIT arrival.

    33. One our success stories: • 52 year old female • Borderline Personality • Dissociative Identity Disorder • Numerous overdoses • Depression and anxiety • Frequent user of the emergency services • Hospital visits varied but could be as many as 3 per week

    34. END OF ACT 1

    35. Mobile Crisis Intervention The Frontline Nurse Perspective

    36. “Bringing the Emergency Room to the person in Crisis” Mobile Crisis Intervention Team

    37. MCIT: • Is the partnership between St Joseph’s Health Centre and Toronto Police Divisions 11/14 • Utilizes the resources of 1 base hospitals and 2 local hospitals • Care provided is flexible re: hospitals & jurisdictions • Consists of a police officer in a modified uniform and a mental health nurse, combining the expertise of both professions to determine the best care/response to each situation • Responds to 911 calls involving individuals who are in crisis, non-emergency calls • Respond to location of individuals in crisis within our divisional boundaries • Operates 7 days a week, 365 days a year, 10 hours per day based on statistical analysis (1300-2300 hrs)

    38. Purpose of MCIT: • To de-escalate crisis and avoid unnecessary arrest and/or emergency room visits • Provides short term support and stabilization in order to manage the crisis • Provide referrals to services and resources available in the community • Ensure continuity of care between the initial intervention and the involvement of follow up agencies • Or simply EDP (Emotional Disturbed Person)

    39. Mental Illness • There is NO cookie cutter fix for those suffering from Mental Illness • Symptoms of mental illness vary from mild to severe depending on the type of illness , the family and the socio-economic environment • Severe impairments of thoughts & judgment - constituting a medical emergency • Characterized by alternations in thinking ,mood or behavior

    40. MCIT : Who do we serve ? • We provide immediate on site response to people of all ages in our catchment area with urgent or emergent mental health • This often includes addictions and/or homelessness issues

    41. How do we get dispatched: • Dispatched (radio calls) • Divisions / Supervisors • MCIT Cell • Hospitals / Doctors • Community agencies • Families • In car Computer / volunteer

    42. MCIT: calls we attend • Responds to calls involving bizarre behavior, substance abuse and caring for people in crisis • Mental crisis could include thoughts of suicide , distorted or psychotic thinking , anxiety , overwhelming depression , feeling unable to cope and out of control • Cases of suicidal attempts/ideation and self harm • Executes Forms 1, 2, 47 & 49 in conjunction with other teams in the Mental Health and Addiction programs

    43. Calls we do not attend: • Persons intoxicated on drugs or alcohol • Elopee • Violent individuals or people with weapons • Overdoses • Barricaded EDP’s • Individuals wanted on “Forms” who’s location is not known.

    44. MCIT: What do we do ? • Perform a mental health assessment on site • Conduct appropriate referrals to community agencies • Provide telephone support and follow up visits • Find appropriate shelter for the homeless • Take client to hospital if deemed necessary • Offer confidential , non-judgmental crisis support

    45. CIT01

    46. CIT01

    47. CIT01

    48. CIT01

    49. CIT01