New outreach plan aims to keep clients out of emergency care
Plans are under way for a new mental-health delivery system for the most marginalized people in the Downtown Eastside and other parts of B.C.
Lorna Howes, Vancouver Coastal Health’s director of mental-health services, said an assertive community treatment team (ACT team) will be operational this month targeting sex-trade workers and clients discharged from the Burnaby Centre for Mental Health and Addiction.
Howes said the authority is “on board to see if we can get the ACT teams targeted onto specific populations.”
Another ACT team is being struck through RainCity Housing and Support Society. It was developed as part of a research demonstration project by the Mental Health Commission of Canada.
Michelle Patterson, a research scientist with Simon Fraser University’s Centre for Applied Research in Mental Health and Addiction, said ACT teams are already up and running in some U.S. and Ontario cities.
Already some successes are being documented, she said.
The teams involve “multidisciplinary integrated treatment teams that combine a number of professionals,” Patterson said.
“People can have their housing needs, their income-assistance needs, their mental-health and addiction needs [and] their health needs all met by the same group of people, who are all in communication with each other,” said Patterson.
A key component would be outreach, so treatment could be taken to the people who need it most.
ACT teams would go far to bridge the “huge chasms between different systems of care,” she said.
“I study the system and it is so complex and so complicated I can’t imagine how somebody with a mental illness navigates it,” Patterson said.
“If I had a loved one who needed care, I would struggle to find the care they need, and that just boggles my mind.”
Howes said if ACT teams are to be successful, there needs to be a supply of safe housing available.
“ACT teams really need access to housing in order to be able to do their work in a focused way,” she said.
“We have good literature on it. It is a very intense case-management model. We have some pieces of it already, but we don’t have it in its major formalized way,” she said.
“We would look forward to a very formalized ACT team process where it’s well resourced and has all the right players.”
The Vancouver Intensive Supervision Unit is based on an ACT model. A team of people, including health workers, probation officers, addiction counsellors and other support workers, monitors 58 mentally ill offenders who are under court orders.
Psychiatrist Dr. Bill MacEwan, currently the only psychiatrist to provide outreach treatment in the Downtown Eastside, said ACT teams are pricey — $2 million annually for 100 clients — but the health economics make sense because they go far to prevent hospital admissions.
A bed at St. Paul’s Hospital, where MacEwan runs a psychiatric ward, costs between $1,500 and $1,800 a day, he said.
“If you have a person in an ACT team and you save 10 days [in the hospital], you are saving $18,000 on that one person, conservatively,” MacEwan said.
“I don’t think anyone feels like these are a bad idea. You do get down to the politics of who runs them and how they are run. There’s a lot of issues around that.”
Like Patterson, MacEwan is also critical of what he calls “a real disconnect” between systems of care.
For example, after a pricey stay in the psychiatric ward, people are often discharged to the street because they are homeless or housing can’t be found. Once on the street or in subpar housing, they eat up police time and resources, their health deteriorates and they return to hospital.
He said three-quarters of people admitted to the St. Paul’s psychiatric ward are discharged within 48 hours, and 25 per cent come back within a month.
“You would think that somebody would have their finger on that pulse when you are spending this amount of money,” he said.
“You’ve got a relatively small group who are eating up huge amounts of resources, time and energy and really make everyone feel like it’s just not working.”
Patterson said: “Right now a lot of people are relying on very emergency forms of care. Ambulances, police, emergency rooms, the prison system — those are all very expensive.”