Developing a best practice model for mental health crisis care: A community-engaged approach

Petra Meijer

Impact

  • The project explored alternative destinations for mental health emergencies other than the emergency department. Alternative Destinations such as CMHA are now possible in some areas and will likely be expanded, partly based on the pilots that the research focused on.

  • Middlesex London Paramedic Services and the multidisciplinary team of researchers brought extensive academic and frontline experience across care sectors to implement policy changes, workshops and training to provide emergency mental health care services.

  • These improved models of care have major improvements in the quality-of-care provision and continue to make an impact in the community and acute care sectors.

  • The research was part of a 3 year project that received the Natural Sciences and Engineering Research Council Canada (NSERC) College and Community Social Innovation Fund (CCSIF) grant of $360,000 in 2021.

  • Ontario

  • Studentship

  • Humber College

  • Middlesex London Paramedic Services

  • Mitacs

  • 2021-2022

  • Racialized Community, Indigenous Communities, Immigrant/Newcomers, 2SLGBTQI+

About the Project

The project analyzed data from the Middlesex-London Paramedic Service (MLPS)’s alternate destination program, which offers individuals in crisis the option of transport to a crisis centre instead of an emergency department (ED). The project’s objective was to enhance the quality of emergency mental health support, with particular attention to individuals from underserved and marginalized populations, including those of lower socioeconomic status, Black, Indigenous, and other racialized communities, 2SLGBTQ+ individuals and immigrants. The project was part of a 3-year project that explored and examined care models to mental health 911 calls, and seeks to create a framework and training programs for practitioners in the field.

Methodology

The researcher first conducted a scan of past and current projects on mental health and addictions alternative destinations and collaboration with community partners. MLPS provided the researcher with the data they compiled over a three year period of the implementation of their alternative destination for 911 mental health emergency calls. The data included quantitative data from electronic patient care records and qualitative data from surveys to patients. Along with the evaluation reports prepared for the MoH, the researcher analyzed the business cases of the project, reports of interviews with patients and paramedics, annual evaluations by the MLPS, reports by the MoH, news media, and reports from CMHA Middlesex. Data were also provided through the intake form completed by paramedics at the CMHA, CMHA patient outcome reports, and post-assessment follow-up. These data sources were each read through at least once and then systematically reviewed. These data were examined in relation to how the pilot goals were met, namely impacts on ambulance visits and offload delays to the ED, paramedics’ ability to manage MHA calls, and patient experiences. We also carried out a critical analysis of the nature of the program, informed by a ‘social determinants of health’ framework and the critical mental health literature.

Findings

The research showed that MLPS’ Alternate Destination Protocol offers an important and effective alternative to ED transport and care. Offering a non-medical care destination, outside of a hospital, with non-medical, supportive mental healthcare professionals is an important step in a de-medicalized approach to mental health and mental healthcare. The ability of the alternate destination site to provide care extending beyond medical care offers the potential to meet patients’ social and material needs. Such follow-up and connection to more appropriate resources may not only address the particular emergency that led the person to encounter paramedic services but may actually prevent future crises.

The findings from this study have implications for paramedic services in Ontario. The MLPS and their collaborating organizations identified goals of both reducing pressure on EDs and improving the quality of care for those experiencing MHA needs. As paramedic services and EDs face substantial and increasing pressures in Ontario, doubtless, the goal of reducing these pressures on both services is significant. As identified by the experience of the MLPS Mental Health and Addiction Alternate Destination Protocol, offering an alternative care destination other than ED services improved these pressures and associated costs. Crucially, with a goal of improving care experiences and options for those experiencing mental health and addiction-related emergencies, this program offered improvement to patients’ autonomy, their options for care, and a non-medicalized approach that centred more around supportive care and means of addressing patients’ relevant SDOHs.

Project Outreach

  • MLPS’ model has inspired other paramedic services to develop and implement similar models of care

  • Based on MLPS and other services’ experiences, the Ministry of Health has expanded their Patient Care Models to include and ‘Alternative Destination’ model to enhance care for people experiencing a mental health emergency and reaching out to 911.

  • Similar alternative destinations for mental health emergencies have been developed in Ottawa and Essex-Windsor

Resources Created