London-led study shows small changes in care for patients leaving psychiatric hospitals can save money – and lives

Posted on in Health Delivery System

stthomastimesjournal.com – news/local
January 13, 2015.   By Randy Richmond, The London Free Press

Londoner Jeff Keutsch knows how it feels to enter a psychiatric hospital and how it feels to leave.

“Going in, terrified. Coming out, slightly less terrified, but still ­terrified.”

He’s hardly alone, as thousands of Ontarians face loneliness, substandard housing, poverty, and a high risk of suicide, confrontations with police and readmission after discharge from mental health wards.

But a $1.4-million, two-year, provincewide project led by London researchers has shown two simple measures — ensuring hospital staff remain involved with a patient until the person has solid community care, and providing a trained peer support worker — can save lives and cut the high cost to taxpayers of keeping people in hospital beds.

Keutsch, 40, spent five weeks in a London hospital that was part of the project and spoke at a news conference Tuesday about how help after discharge made a difference.

“It’s been a long road,” he said of his recovery. “I’m still kind of learning how to be myself. I think the program really works. And I’m proof. I haven’t been back (to hospital) since.”

The researchers are urging Queen’s Park to adopt the model, tested at nine hospitals, for the whole province.

“It should not be optional. It simply should be the way things are done,” said Cheryl Forchuk, a scientist with the Lawson Health Research Institute in London.

“When people leave hospital, it’s a very frightening, a very lonely experience” Forchuk said. “The traditional way we offer care is divided between hospital and community services. So there’s a gap often at that time, which is a time when people are most vulnerable.”

That gap became highlighted in London in November when a mentally ill man died after a fire in a crowded and deteriorating, unregulated group home.

The death of David Macpherson, 72, has led to questions about the province’s commitment to caring for ex-psychiatric patients and in London, and an effort from city hall to make changes in regulations.

Premier Kathleen Wynne, visiting London Tuesday, said the province would review what London politicians decide to do about the homes.

“We will work with that group and hope we can take some guidance from them,” Wynne said.

The issue goes far deeper than one tragedy, Forchuk said at the news conference about the Lawson project.

“When someone dies in a group home in a fire it hits the front page,” she said. “But the fact that over 40% of suicides happen the month after discharge . . . those don’t hit the front page.

“This is why we absolutely have to do it. People’s lives are at stake,” she said. “People are suffering. We have found a better way.”

The study implemented what’s known in the health-care world as the transitional discharge model, which has been well researched the past 20 years but not broadly implemented.

Nine hospitals in eight cities implemented the model starting in 2013 with money from the Council of Academic Hospitals of Ontario, itself funded in part by the province.

More than 580 mental-health patients were given a hospital worker and a peer supporter to help them after discharge.

Results of the project included facts, figures and feelings.

With better support ready outside the hospital, patients stayed on average 9.8 fewer days in hospital than before. Often patients are kept in hospital longer by staff and at their own request because support isn’t available, Forchuk said.

At $1,000 a day per patient, savings added up and would have more than paid for peer support workers Forchuk said.

Hospital staff reported fewer readmissions, though provincial data on readmissions isn’t available yet. Fewer readmissions would also save tax dollars.

Ex-patients reported feeling less overwhelmed, less lonely during the transition, and hospital staff and peer supporters reported feeling better about their work.

Ontario’s mental-health strategy includes supporting more peer support, and research “will help inform and guide our future planning,” Health Minister Eric Hoskins told The Free Press in an e-mailed statement.

But he stopped short of making a commitment to adopt the discharge model tested in the project.

randy.richmond@sunmedia.ca

— — —

THE HOSPITALS

London: London Health Sciences Centre, St. Joseph’s Health Care London

Toronto: Baycrest, Centre for Addiction and Mental Health

Ottawa: Hopital Montfort

Whitby: Ontario Shores Centre for Mental Health Services

Kingston: Providence Care

Hamilton: St. Joseph’s Healthcare

Thunder Bay: Thunder Bay Regional Health Sciences Centre

— — —

THE PROJECT

Nine hospitals use Transitional Discharge Model for 580 patients over two years.
Model ensures patients get care from hospital staff and peer-support worker after discharge.
Costly stays in hospital reduced, because community care stronger.
Staff reported fewer readmissions.
Patients, hospital staff, peer support workers all reported better results.

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