Reports find gaps in crisis services
By Jenn Watt
Published Nov. 7, 2017
Crisis services in Haliburton County and surrounding areas are in need of improvements to address gaps in coverage, according to two reports recently released by the Central East Local Health Integration Network.
More staff, local safe beds and the elimination of voicemail on the 24-hour help line for those experiencing “the onset of an emotional disturbance or situational distress … involving a sudden breakdown of an individual’s ability to cope” are among the recommendations put forward.
Two phases of the Community Crisis Service Review Priority Project, completed in March 2015 and July 2016 respectively, describe in detail what’s missing and provide recommendations on how to improve the system. The reports were posted on the Central East LHIN website following a request by the Haliburton Echo.
The reports were generated with the goal of reducing the frequency of emergency department visits for mental health and addiction issues.
Crisis support services are available to step in to help a person through that situation and prevent it from getting worse. Although many crises result from those who have a diagnosed mental illness, many do not.
“Timely, 24-hour access to a variety of crisis service options is an important part of crisis response,” the review states. “Crisis intervention options should include crisis telephone lines, walk-in services, mobile crisis response, and residential services (i.e. crisis/safe beds), along with psychiatric emergency/medical crisis services.”
Currently, for the north east cluster of the Central East LHIN, which includes Haliburton County, there are six crisis/safe beds provided by Four Counties Crisis.
A one-month pilot review found that during 30 days in November of 2014, there were 22 admissions to the beds in total, with the average length of stay at nearly six days.
During that same period, there were 16 people who needed a bed, but one wasn’t available.
The same review also found that 1,223 calls came in to the crisis telephone line. Of those, 155 left voicemail messages and of those 87 per cent were retrieved within the ministry standard of 90 minutes. For the 20 calls that were labelled “failed retrieval,” the reasons included high call volumes, unclear voicemail messages, no information left on voicemail and no call-back requested.
“Each of the three providers [of crisis services] operates a 24-7 crisis telephone line with the capacity to service up to three clients at a time, or as few as one client at a time depending on the time of day and whether crisis response staff are out on mobile visits,” the review document says. “When an immediate telephone response is not possible, callers are routed to voicemail as no provider offers the option for callers to hold in queue and wait for an available operator.”
Dave Jarvis, director of Haliburton Highlands Mental Health Services, said many of the recommendations found in the review ring true for the county. Jarvis is listed as one of the contributors to the first review document.
“One of the biggest issues in Haliburton County: the crisis services are underfunded,” Jarvis said.
Four Counties Crisis has one full-time worker for Haliburton County who works in the same office as HHHS Mental Health Services.
“When any crisis calls come through they come through our phone service and we back that crisis worker up. If that person is occupied with another issue or incident, we would send one of our staff,” he said.
Although in cities crisis services often includes a mental health worker who travels with police, in Haliburton the resources are not there for that service.
Jarvis said crisis services is particularly important because it is holistic. People who call self-define what a crisis is and they are given help to find a way forward.
“The crisis may be related to food. It may be a legal issue. It may be housing. It may be heat related. It may be that somebody’s in a mental health crisis,” he said.
“I believe that crisis services are really the gateway to longer-term help,” he said.
Some of the gaps in service come from the geography of the Haliburton Highlands. The Central East LHIN covers a region that starts with Scarborough in the south and runs all the way to Haliburton County. Within that area is a diverse population and a range of challenges.
“While TSH [The Scarborough Hospital] and DMHS [Durham Mental Health Services] provide mobile crisis response to an area of 164.2 and 2,523.6 km² respectively, 4CC [Four Counties Crisis] has one team that covers an area of 12,908 km² … The single team model of 4CC is therefore challenged to meet the MOHLTC [Ministry of Health and Long-Term Care] standard of a mobile response visit within 24 hours,” the report states.
Because that team is located in Peterborough, Jarvis said it struggles to respond to all the calls that come in.
“Does Haliburton get its fair share?” he asked. “No, not when the person’s centralized in Peterborough and has to travel three hours to provide service.”
The north east cluster also has no mobile response team, as these are normally dispatched in conjunction with police services and 4CC has partnerships only with Peterborough Police.
In addition to compiling information and conducting a pilot review of services, the LHIN also conducted focus groups and asked for stakeholders, clients and staff to complete surveys.
The results of those feedback mechanisms returned similar complaints.
A focus group of stakeholders identified crisis as 24-7, lack of staffing for the phones and response teams 24-7 as issues. Lack of transportation for clients in the north east cluster as well as not enough crisis beds were also identified. Clients in these groups were complimentary of staff and said they were familiar with services. They praised the empathy of the crisis workers, however, they said that they would like to have more staff on the phones.
“Clients frequently have to leave voicemail and it takes time for crisis intervention workers to call back or visit with a mobile crisis response,” the review says.
In the second phase of the review, authors lay out recommendations on how to improve the system.
Among them, adding crisis/safe beds in Haliburton, City of Kawartha Lakes and Northumberland. The authors estimate it would cost $160,000 in one-time costs to set up the beds and nearly $1.5 million to staff them.
Converting the voicemail system to live crisis lines at 4CC, would cost about $15,000 initially with the addition of staff at $200,000 annually and would include call forwarding to multiple sites.
In conclusion, the authors write, “The expectation is that access to services will improve, response times will decrease, and there will be enhanced accountability and transparency in the provision of crisis response services.”
While the two reviews include a comprehensive model for the LHIN to follow to improve services, they are being treated as recommendations only.
The documents will inform future planning, said Katie Croninwood, director of strategic communications with the Central East LHIN.
“They [the reports] didn’t go as formal presentations to the [LHIN] board. Those were projects we had initiated as the senior team to engage those organizations to do that environmental assessment to come up with those recommendations,” she said in an interview with the Echo. What went to the board was a presentation called Central East LHIN Mental Health and Addictions System Review by a consultant, Deloitte LLP.
That report says the region needs to ready itself for a 10 per cent population growth by 2025 with an increase in cases of mental health and addictions issues.
That document is far more wide ranging than the crisis review documents, but includes fewer tangible details. It sets out as a goal supports that are readily accessible with “no wrong door” for accessing services.
Croninwood says this process takes into account the crisis services review.
“Those community crisis reports rolled into that [Deloitte] document so it was an input into that document along with a whole bunch of other things: national studies, international studies, direction from the ministry,” she said.
The LHIN is now putting the structures in place to work on two projects: an opioid strategy and centralized access model.
“It kind of then goes back to the crisis services [review] because it’s saying, no door is a wrong door,” she said.
“Those two reports roll into the Deloitte report. The Deloitte report went to our board … our board now has approved moving forward with the development of that Central East LHIN Regional Mental Health and Addictions Plan.”
As for whether the specific recommendations from the reviews will be implemented as they were presented, Croninwood said that hasn’t been decided.
“You can well imagine there’s recommendations that come to the LHIN from all sorts of different partners to meet all sorts of different needs and it’s a question of how you take those in, what are the funds that are going to support it … and how do you assess all of these different needs in the overall geography?”
She pointed to a new initiative of the LHIN, sub-region planning tables, which are devised to decentralize decision-making to a local level. In the Highlands, the planning table covers Haliburton County and City of Kawartha Lakes.
The planning tables will be composed of service providers, public health staff, caregivers and patients.
“We come at it from that overarching mental health and addictions plan that was informed by the work that … [was done] on community crisis. That comes into the plan,” she said.