Episode 5: Improving Access to Care (NS)
April 22, 2021 – By using virtual care, Nova Scotia Health was able to provide flexibility and reach to reduce wait times for non-urgent mental health and addictions supports and services in Cape Breton and the rest of Nova Scotia. This e-mental health innovation resulted in improved access and availability where more Nova Scotians were able to be connected with the right care, where, and when they needed it.
Follow Us
Episode Notes:
Resources
- Mental Health Mobile Crisis Team – call 1 888-429-8167
Loretta O’Connor: Welcome to the Promising Practices podcast. This is the fifth of a 13-episode series on mental health and addictions. This podcast series is an initiative of Canada’s Premiers. The aim is to highlight innovation and share promising practices that are underway in each province and territory. In each episode, we introduce you to experts in the field and learn more about innovative practices and programs. The goal of Premiers is that this podcast reduces the stigma associated with mental illness and addictions, and also enables a more focused and collaborative approach by provinces and territories.
My name is Loretta O’Connor. I head up the Council of the Federation Secretariat, an organization that supports the work of Canada’s Premiers. If you are listening, or you know someone who is struggling, help is available. Please reach out for help if you need it.
Today, we are in Nova Scotia or Mi’kma’ki, the traditional territory of the Mi’kmaw People. Recognizing that mental health issues were on the rise in the province, even before they were exacerbated by COVID-19, Nova Scotia’s Premier committed to a proactive approach to dealing with mental health and addiction issues. In this episode, we travel to Cape Breton Island – to Nova Scotia’s Eastern Health zone – to hear about an initiative to reduce wait times for mental health and addiction services.
First, we welcome the Premier of Nova Scotia, Iain Rankin, to tell us about the province’s recent work to increase access to services. We’ll also hear from the Minister of Health and Wellness, and the Office of Mental Health and Addictions, Zach Churchill, who will introduce the subject of this week’s podcast.
Premier Iain Rankin: Mental illness is a serious issue in Nova Scotia and across Canada. We’re increasingly aware of the impact of mental health on our physical health and our daily lives, but more must be done. After becoming Premier I laid out my vision for Nova Scotia. This is one in which Nova Scotians receive improved access to the help they need. Modernizing health care is a priority for me, and we are increasing healthcare spending in key areas such as mental health and addictions.
The past year has been extremely difficult for many Nova Scotians, and the need for mental health and addiction services has never been greater. Personally, I know that mental health struggles can be extremely challenging, and can place great strain on individuals and their families. One of my closest friends is a police officer. He has worked in a number of really challenging communities. The things he has seen, the experiences he’s had have contributed to his chronic post-traumatic stress. This is something he manages, and something that reminds me of the challenges with which Nova Scotians must live every day.
I worry about those Nova Scotians who are struggling, and that is why my government is making important investments in mental health care. Our government is investing $336.5 million this year in mental health, an increase of $20 million, which represents the largest expenditure in this area in the province’s history. This includes $1.5 million to establish the new Office of Mental Health and Addictions and a $12.3 million increase for new mental health programming, including:
- single brief intervention sessions to provide rapid access to mental health supports,
- withdrawal management hubs to support Nova Scotians with substance-related harm and addictions,
- and e-mental health options to increase access for Nova Scotians to services and supports.
We believe these investments are an important next step in improving mental heath care in Nova Scotia and ensuring that Nova Scotians have the access to the care they need. But we know that more must be done. It will be done. The pandemic exacerbated longstanding disparities. This included historical injustices and highlighting the greater vulnerabilities faced by marginalized communities. We know we must also level the playing field, and ensure we create a more just and equitable society, including in health care.
Our creation of the province’s first Office of Mental Health and Addictions is meant to signify a more proactive approach. Under the leadership of the Chief Mental Health and Addictions Officer, this new Office will provide the leadership and coordination across agencies, departments and partners to improve programs, access, and improved health outcomes. I am committed to enhancing our healthcare sector to better meet people’s needs, prepare for tomorrow and achieve greater wellbeing for all. Over the past year, Nova Scotians have demonstrated unprecedented strength, resilience, and a commitment to putting people first. I have heard from Nova Scotians in every part of the province that they want better mental health care for themselves, their friends and their families.
I want Nova Scotians to know I am listening. That the Minister of Health and Wellness is listening. We care deeply about this issue and about the health of Nova Scotians. I am confident that by working together, we can achieve the vision of mental health and wellness for all.
Minister Zach Churchill: Mental illness and addictions impact all of us, and we know that when people do not get the care they need, there are significant impacts to those individuals, to their families, to our communities, which impact our economy and our society overall. None of us are immune to mental health illness or addiction. It can strike unexpectedly just like any other illness or disease. In any given year, one in five people in Nova Scotia will personally experience a mental health problem or mental health illness. And together we do have a collective responsibility to take action to improve and address the mental health of our families, friends, our neighbors and our colleagues.
Investments in mental health and addictions have been made to ensure services are available to all Nova Scotians as part of the publicly funded health care system. We have improved access and service times by hiring more staff for our intake and crisis lines, and for our community-based mental health and addictions services. We've also added virtual care services including what we call MindWell-U and Therapy Assist Online. As Minister of Health and Wellness and Mental Health and Addictions, one of the top priorities in the department is improved mental health outcomes for Nova Scotians, and we do continue to make some significant improvements with the additional investments that we’ve made. However, we still know that more needs to be done and that we have to do better here in the Province.
Wait times is one area that we're actively working to improve because we want to ensure that Nova Scotians have access to services more quickly when they need it. Samantha Hodder, who is the Senior Director of the Mental Health and Addictions program and Dr. Andrew Harris, he's the Senior Medical Director for our Mental Health and Addictions program, along with their teams are leading the way forward to reduce wait times in the province. And together they've committed to enabling people with mental health disorders, including addictions, to manage their conditions and work towards recovery. And they do share a vision with our Government in which all Nova Scotians who need mental health and addictions care receive the right care from the right provider at the right time and place. And bringing that vision to life, I know has not been a small feat, but Sam and her team have an incredible focus and are implementing a five-year plan to do just that. And they call it Direction 2025.
And we are seeing success with reduced wait times here in the province. And I want to assure Nova Scotians that anyone who is in crisis and requires emergency care, are seen right away. Wait times for people who are triaged as needing urgent care have improved substantially since 2018. Clients are seen within the seven-day national wait time standard. Wait times for non-urgent cases have also improved dramatically in Nova Scotia, with most Nova Scotians who are receiving these services getting them within the 28-day national wait time standard. That has been a reduction of 86% in our wait times. So, we've moved from the wait time being close to 210 days to 29 days for non-urgent cases. And I want to thank the frontline health care workers for working with us to make this possible and for always providing these services and working hard to meet the needs of people in our community. You know, their compassion, commitment and hard work really is inspiring and deserves our many thanks.
You’ll hear more shortly from Sam Hodder and Dr. Harris on their work in the Cape Breton Regional Municipality to reduce wait times, better meet people's needs, and provide better care, and make a difference in people's lives. Building on previous investments, the Cape Breton wait times initiative targeted poor wait time performance and this included wellness check-ins with clients waiting to re-triage and offering brief interventions as required and earlier appointments with community clinicians. It worked to identify and address chronic vacancies in Cape Breton's mental health and addictions clinics, with targeted job advertising and promotion and it has really worked to maximize capacity and scheduling for our clinical teams in the area.
While Cape Breton is a success story, we know we cannot rest on our laurels here. Our work to address gaps in services and break down barriers to care in all areas of the province is really only ramping up.
Dr. Andrew Harris: My name is Andrew Harris. I am the Senior Medical Director for the Nova Scotia Health, Mental Health and Addictions program of care. I'm a psychiatrist and I work at the QE2 hospital complex in Halifax and my work as a consultation liaison psychiatrist so mainly working in the medical surgical critical care services for the six hospitals based in Metro.
Samantha Hodder: My name is Sam Hodder, I'm the Senior Director for the Mental Health and Addictions program with Nova Scotia Health. And I co-lead this program with Dr. Andrew Harris, who as the senior Medical Director for Mental Health and Addictions along with the chiefs of psychiatry across the province and the mental health and addictions directors under our under our provincial planning. One of the key components of that was around improving both access and availability. There wasn't one single strategy essentially, that could be done to make those improvements across Nova Scotia, or specifically within the Cape Breton area.
Dr. Andrew Harris: Cape Breton has, for some time, struggled with a resource issue. They also are challenged by some of the distribution of services. It's a large geographic area with a significant population and doesn't have some of the infrastructure that we're fortunate to have in Central Zone with transportation, bus services and things like this. So, it really does address a number of things that have been chronic issues for Nova Scotians living in Cape Breton over many years.
Loretta O’Connor: Nova Scotia Health is responsible for providing health services to Nova Scotians. The agency operates hospitals, health centres and community-based programs across the province, organized into four geographic zones. Each zone delivers local programs and services, provides local clinical and operational leadership for health care, and supports provincial planning. The Eastern Zone – where our story takes place – covers Cape Breton Island as well as the areas around Guysborough and Antigonish. The other three zones are Central Zone which encompasses the Halifax area, the province’s eastern shore and West Hants; the Northern Zone which encompasses Colchester-East Hants, Cumberland and Pictou areas; and the Western Zone which covers the Annapolis Valley, South Shore and South West Nova.
Samantha Hodder: One of the things that happened during COVID-19 was an acceleration of virtual care offerings. People and the providers became much more comfortable with offering therapy, much the way that we are today, doing this podcast and a virtual space. And we have known and had that in our plan for some time in relation to increasing virtual care options. Pre-pandemic, or pre-state of emergency within Nova Scotia, we had about 8% of our services being offered in a virtual space. And during the peak time of the pandemic, we were up towards around 70% of service being offered virtual. And we've kind of stabilized around about a 50% mark right now.
Dr. Andrew Harris: In regards to our e-mental health services, two-fold. One, one was to address real time, difficulties with resources in the zone. And secondly, as part of a broader strategic plan to introduce and integrate e-health services more broadly, within the mental health and addictions continuum. So that's the larger, overriding goal.
Samantha Hodder: So, you'll see now on the provincial website that we have a standard set for wait times. So, an urgent referral that calls through intake, we've made it a priority that all urgent referrals are to be seen within that seven-day target. And we're really pleased to say that specifically within Eastern Zone and in the Cape Breton area, that 100% of those referrals are seen within that seven-day period of time. And we've set a standard for 28 days for non-urgent, and that was an area that we needed to have some significant improvement, not just in Cape Breton Regional Municipality, but right across the entire province. And we've made some significant strides in relation to improving access to actually meet that target. So, we created a team called the clinical virtual care team, essentially, as a bit of a pilot or demonstration, a team that could flex the resources across the province to wherever there might be an increased need.
Dr. Andrew Harris: For example, we developed a sort of a mobile service to address when we have increasing needs. So, when our wait times go up in one area of the province such as Cape Breton, we're able to mobilize our teams virtually to be able to provide service to people. So, we had that happen recently, we had some additional resource available in Western Zone and they were able to export that virtually to Eastern Zone to help them out over a couple of week period and we're able to very quickly address some of the wait times that we've been experiencing in Eastern Zone.
Nadine Wadden: My name is Nadine Wadden, and I am the Director of Mental Health and Addictions for the Eastern Zone of Nova Scotia Health. My home base is in Sydney, Cape Breton.
Mireille Bourgeois: And I'm Mireille Bourgeois and I'm a social worker and clinical lead, and I live in Chéticamp.
David McPhee: I'm David McPhee. I'm team lead for the clinical virtual care team.
Nadine Wadden: As director of the zone, access to care within our adults, community mental health and addictions clinics has been a priority of ours for quite some time, pulling together with the support of my co-medical leader, our Chief of Psychiatry, as well as our senior leaders, Sam and Andrew, to really make this a priority for not only Eastern Zone, but for our province.
Mireille Bourgeois: And I guess that's where we came in as clinicians in terms of doing things a little bit differently. And my role is really getting clinicians comfortable with offering a new type of service in terms of Zoom therapy sessions, but just in terms of getting more people on board, more clinicians offering that type of care, and then also partnering up with the virtual care team in terms of building those relationships and getting more options out there for treatment.
Nadine Wadden: Knowing that we would need a multi-prong strategy, we were continuing to recruit and offering – of course – relocation incentives and we'll always need that resource at home base. But what else could we do to really provide a service that's dynamic and can respond to the needs and not have to be relocated and home-based? David, I know that you can really speak to what that meant in terms of partnering with our clinicians that are home-based in Cape Breton, and also providing that unique opportunity to work together, regardless of where you were based in a province.
David McPhee: Yeah, I think that was the real key behind the clinical virtual care team. It was sort of in the mind of the health authority for a number of years, and then COVID really sprung us into action. And so, when we formed as a newly formed team, we had to figure out where to go. And when we're, you know, in thinking looking at things like the waitlist was, was a big determining factor of where we went first, and being able to do CBT group training together as one team. And I think that was really important that we all paired up where there was four Eastern Zone clinicians. And four clinical virtual care team clinicians, we started right from the ground up of developing protocols in developing referral process and work with intake as well to have the clearest path into our services for providing CBT groups. And just knowing that, as that group work is definitely a comparable and in some cases in some groups like anxiety, and even better outcomes result in CBT protocols that are done in a group setting.
Mireille Bourgeois: And that brings up another point in terms of in-person appointments still being required, in some cases, and needing to kind of collaborate on those things to make sure that the client is getting the care that they need, in the right place at the right time. So, you know, if they do meet that criteria that they do need in-person, we can offer that we can partner with the clinical virtual care team.
David McPhee: It's interesting, because the initial focus was to, for the wait time specifically for there, but we noticed when we were taking people in from intake, that we're hitting a lot of the rural places. And I think that was really the story that I heard quite a bit, that rural Cape Breton and Antigonish- Guysborough area, that there was a lot of folks in those areas that may have had a difficulty in getting to appointments, and just thinking about travel and those so that convenience was a huge aspect of what we heard from folks in the group, I think one client even said, you know, I'm more comfortable to be at home and experience this type of, of group, this type of CBT group than having to go out and, and find and go to a clinic or a hospital.
Nadine Wadden: Geographical barriers to care have still existed. And in, you know, pushing through that in terms of needing to provide accessible service in this type of way, I think is groundbreaking. And it has been the first time that we've been able to reduce our wait times and in the way in which we have,
David McPhee: I think the other learning pieces definitely were around, you know, how this work is done, you know, especially on the intake and, and referral processes that we went over as a team. I think those are also important, important learning lessons as well to try to get good referrals in and try to get and good connection and where those clients end up in those pathways. And a lot of effort was done in the straightening those out. And there's a lot of trial and error to figuring out how those pathways were going to happen. So, I think that was also an important key learning to take throughout the province as well.
Nadine Wadden: Really, I think a lot of the work that we did with our provincial center for education, training and learning, establishing that partnership with that team. And those advanced practice leads that really provided guidance and input on the content and evidence that went into the cognitive behavioral groups for depression, anxiety in ensuring that that will remain consistent and that is the standard of care that individuals can expect.
Dr. Andrew Harris: We have been able to collect information collect data on how our programs operate. So, we are able to essentially understand who is asking for service from mental health and addictions program. And because we can do that as an entire province, we're actually able to sort of then design a provincial-wide, a single unitary mental health system that is equitable across all four zones within Nova Scotia and provides access to regular services, to e-health services and to the specialty services, which at the current time, are largely clustered in Central Zone in the academic teaching centers. It's one of the advantages for Nova Scotians that we do have the single health authority, or two health authorities – IWK and NSH – but within NSH, we have a single health authority that has governance over the entire the entire provincial health care system.
Samantha Hodder: This has created this opportunity to lean in to the Cape Regional Municipality area. And so what we had done was essentially recontacted patients that had been waiting for a period of time, I think, essentially then had still left sort of opportunity for clinicians to still be doing face-to-face care, but decreased our waits and improved our access.
Dr. Andrew Harris: There's a lot to be learned from, from providing effective mental health services to Cape Breton, which we can apply to other areas of the of the province. Some areas of Northern Zone are equally as remote with fewer large population centers. We have been cognizant that in other parts of Canada, in Ontario in Alberta, where services are extended out to other communities that are in the far north, that this has been the sort of the evolution of mental health and addictions care. And so, Cape Breton has allowed us to look into the applicability of mental health and addictions e-services for these types of populations living distant from large, large urban centers.
Samantha Hodder: You know, the beginning of our conversation was all about virtual care. And we heard very early on when we had essentially accelerated virtual care offerings, that access to technology – there's barriers to that, right. And so, you know, you kind of can't do virtual care if you don't, or participate within that if you don't have like a data plan on your phone, or you may not have a phone or that sort of thing. So, we had essentially partnered up with the Nova Scotia Mental Health Foundation to launch a sort of an initiative called Be the Link.
Jill Chappell: My name is Jill Chappell, and I'm the Marketing and Communications lead at the Mental Health Foundation of Nova Scotia. The foundation is a registered charity that aims to increase financial support to community initiatives that provide hope and eradicate the stigma surrounding mental illness and addiction. And that is through community organizations and programs throughout Nova Scotia from one end of the province to the other.
Indirectly, all of the community programs that we support across the province are really geared towards reducing pressure on the mental health and addictions program in Nova Scotia Health, including the wait list. Be the Link was created by the Mental Health Foundation in response to the COVID-19 lockdown. So, the Mental Health Foundation of Nova Scotia put out the call to Nova Scotians to help put technology in the hands of people who really needed it the most, and major donors responded in a really big way, including Bell, Manulife, Medavie, and BMO. And in partnership with Nova Scotia Health, the Mental Health Foundation of Nova Scotia was able to respond to a number of Nova Scotians, who were suffering from isolation and loneliness, we were able to put cell phones and SIM cards into the hands of inpatients as well as outpatients who were completely cut off from their lines of support, family members, their friends, their clinicians, their peer support groups. If they didn't have a cell phone or an iPad or a data package to go with that, they had no way of sort of staying the course. And now we've expanded the Be the Link program, what we thought was going to just be a single round of grants actually turned into a second round this year. And now we've noticed there's even more need with twice as many applicants the second time around. And this time around, we've seen even more applicants from marginalized and more racialized communities. Human connection is really what matters most and as human beings we all need to feel supported and loved and validated. We need to know that we're not alone. And that's something I think that we can all identify with feeling throughout the last year. It's really about keeping Nova Scotians feeling healthy. It's about making people feel equal and worthy and connected to their loved ones and the world around them. I would say there's really no time more important to feel that way than when you're struggling with your own mental health.
Samantha Hodder: Yeah, we're just going to continue to refine and monitor and evaluate. We know that we will likely continue to see more people reaching out for help and more people reaching out for service, which is actually what we want.
Dr. Andrew Harris: We were actually quite happy that once people have been able to access mental health services, they're usually quite happy with the service they received. Our continued struggle is with access. And we've done quite a number of things over the last few years to improve that access through our sort of accessibility, single number contact through our e-health strategies, but I think that's probably where we can continue to sort of look for new and innovative solutions to improve access.
Loretta O’Connor: Thank you for that overview of how wait times were reduced in Cape Breton. What an excellent model for other jurisdictions who are facing similar challenges.
If you are listening in Nova Scotia and are in crisis, or someone you know is in crisis, please call 911, go to the Emergency Room of your local hospital, or contact the Mental Health Mobile Crisis Team.
Join us again next week, where we will learn about Québec’s experience in implementing a network of psychological health scouts throughout the province. Québec’s team of 150 social and community workers reach out to the most vulnerable in society to provide early intervention for psychosocial problems such as domestic violence, suicide, addictions, and child and elder abuse. The team members aim to gain the trust of citizens and ensure that anyone who needs help or support, is not forgotten.
So, please join us again next week for another promising practice in the field of mental health and addictions.