Flattening Ontario’s mental-health curve

Posted on July 25, 2022 in Health Delivery System

Source: — Authors:

TVO.org – Agenda segment, May 5, 2021Health care in crisis, Part 5: A social worker on rising mental-health issues

TVO.org speaks with the Ontario Association of Social Workers’ Deepy Sur about burnout, easing the load on hospitals, and getting people the right help at the right time

Gurney: Let’s talk about that. Let’s talk about stopping admissions into our struggling hospitals. Keeping people out in the first place but still making sure they’re cared for. What role can you play there?

Sur: So much of what social workers — with the right expertise in the right spot for the right moment — can do is about hospital avoidance and admission avoidance. In that study I told you about early, we had 92 avoided admissions, and that was just one hospital over the pilot period. That would have meant cost avoidance of $1.4 million annually. That’s a significant return on investment. It’s a real validation of putting someone in place at high-volume times, not just to wait, but to actively seek out patients and families who need support during peak times — or times when there isn’t someone available at an ER to deal with a crisis or navigate a complex issue like substance use, psychosis, the need for psychiatric intervention. A social worker can help avoid this and place less burden on the emerg. Wait times would go down. Admissions would go down. We would have better planning for discharging patients into care, and that could mean less burden on long-term care, too.

We know that a large proportion of emergency-department visits are from people who are there with what we would call “social care” needs, including non-emergency mental-health concerns and issues related to addiction, poverty, homelessness, domestic violence, dementia, caregiver fatigue. We’ve seen data showing a 45 per cent rise in these visits to ERs in recent years. That’s huge. Social workers in the right place would make a huge difference.

Gurney: A few years ago, I was with my son at a rural ER. That was a whole debacle. But one thing I remember was seeing a young woman there, in some kind of … well, I don’t want to be insensitive. She was very clearly experiencing a mental-health crisis of some kind, a significant one. And I obviously don’t know the background. But I remember thinking, unless this is a total surprise, a bolt from the blue, the fact that she’s here, with some freaked-out people, friends or family, who have brought her here, this is a failure in the system that happened well before this moment.

Sur: That’s right. And a social worker is the right person for that. They have the training and expertise. They’re a navigator for a patient in the system. And imagine what happens when one isn’t there. The nurses and doctors there, they’re being asked to make those decisions. Everyone else in the ER, you’re waiting longer for care while they try to deal with that. A social worker could quickly step in, work with that patient, decide if she could be safely discharged or referred elsewhere or if a hospital-based intervention is required. The system would move faster. You were there with your son. Imagine what the stress being at the hospital was for him.

Gurney: Ha. He had his iPad. He was fine. It was my stress. I coped by pacing.

Sur: Well, you had your coping mechanism. Imagine you’d been there for a panic attack or a psychotic break, and there’s no one there trained specifically to help you.

Gurney: You just used an interesting term. “Navigator.” So we’ve talked about how you guys can stop admissions from happening. And I guess navigation is how you handle patients once they’re in.

Sur: Right. A navigator is someone who guides a patient through the system. The system is incredibly complex and not intuitive. There are also cultural barriers, language barriers; you might be dealing with ableism. It might just mean connecting them to the right professionals in the community to keep them out of hospital. Mental health and substance issues are best handled in the community, with supports. The hospitals are not the best place for this kind of care.

In some cases, you might be linked to another hospital program that’s outpatient based, but, generally, the navigator’s goal is to move someone through the system safely. You can’t just discharge someone to free up a bed. Who’s at home for these people? Do they have any care in the community? Are there elder-care issues or language barriers? Do they have the financial means to access the care that will help them find success? If someone has been injured and now has physical issues to deal with, are they set up for that? For instance, if they’re being sent home, can they get safely up the stairs? Imagine being sent home or taking someone home, and you’re terrified you can’t do the stairs, and there’s no one to support you. Social workers think proactively about what a person actually needs at discharge, helps them get those supports lined up, advocates for the best safety and care for that patient and family, and makes sure everyone is comfortable and prepared for what comes next.

Gurney: Assuming an ideal workflow here — I know life isn’t ideal, but hypothetically — let’s say someone in a hospital has a social worker as a navigator, and they are able to go home, on the understanding they’ll still need support. Does that navigator remain involved, or do they hand the patient over to someone else in the community?

Sur: It depends on what part of the system you entered and what the continuing support is. You might continue to have a relationship with a social worker in the hospital. Or you might be connected with someone in the community. Social workers are everywhere. You might see one at your doctor’s office. Or at a community-care centre. For a child, they might be connected to one at a school. A lot of parents have been very stressed out about kids going back to schools, and there’s definitely support in the schools for these children.

Gurney: I don’t think I have much more for you here. This is great stuff as always and really builds on our earlier chat. I guess my last question is this. We have a real crisis unfolding in the hospitals right now. We can talk structural reforms and optimal systems, but we have a crisis now. What can you guys contribute in, say, the next six months that will help us survive those six months?

Sur: Connect social workers and family physicians and integrate them. This is already being done in some cases. But, by and large, lots of people still don’t have access. Lots of doctors still don’t have access to a mental-health professional who can help with complex patients. So connect social workers where people present with the most complex mental-health issues: hospitals and acute-care facilities, family physicians and care teams, and schools. This is where the most support is needed to get people treatment for complex conditions, and on the other end of the spectrum, with more moderate needs, to divert people into better care before they go to the ER.

Imagine you don’t have family support, and you don’t know where to go. You’re having a terrible depressive time. Maybe you’re dealing with caregiver distress; maybe you’ve had a terrible life circumstance occur, like grief, or maybe COVID isolation is just too hard. You’re not sure where to go; you don’t have a primary-care doctor, so you decide to head to the emergency, keep yourself safe, and try to get some support. And imagine being met with a social worker within the first hour of your visit instead of 20 hours later. I don’t know what else to say. Connect social workers to care teams and to patients. We aren’t super-individuals who expect to do everything ourselves. We want to be part of teams. We work best when we’re embedded with other care professionals, and they do their job best when they get to do what they’re best at while we do what we’re best at.

Gurney: All right: one follow-up, and then I’m letting you go. What’s stopping us from doing that? Policy? Leadership? Money?

Sur: It’s probably a couple of things. We need to advocate for stable and protected funding. The entire system is under huge pressure, and our funding is not always protected and can be diverted. Also, it’s often the first to be overlooked for the same reasons. But, also, mental health has stigma. If it’s not protected funding, that’s very difficult.

And the second reason is, the system’s kind of designed to work in silos, right? Our hospitals are not always well-connected to our community supports and vice versa. So there is something to be said about how we reconnect our systems. With all the virtual care, I’d love to see work put into better connections between systems. We didn’t even touch on rural and Indigenous care in remote areas. So it’s really going to be a lot of hard work to make sure everyone is connected.

This interview has been condensed and edited for length and clarity.

Matt Gurney is a journalist in Toronto.


Tags: ,

This entry was posted on Monday, July 25th, 2022 at 10:49 am and is filed under Health Delivery System. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.

Leave a Reply