Mental health clients in the province are getting a much-needed ‘safety net’ upon re-entering their communities thanks to a novel Western-led initiative. The Transitional Discharge Model bridges the hospital and community for benefits to both individuals and the health system.
This transition is complex and can be challenging for people who have been diagnosed with a mental illness, said Nursing professor Cheryl Forchuk. The first days and weeks following psychiatric discharge are high-risk periods for relapse, with 43 per cent of suicides occurring within the first month post-discharge.
As many clients are between care providers at this time, they are vulnerable to emergency room visits and readmission to hospital.
“To have a mental illness is an extremely painful and extremely lonely experience,” said Forchuk, a scientist and assistant director at Lawson Health Research Institute. “To have come into hospital, many people talk about this being one of the darkest periods of their life. It is a very difficult experience.
“Then, to leave hospital and go back to the community, where some of that scary stuff happened before, and family and friends already feel stretched, is a very frightening experience. There has been a gap at this very time when so many people are vulnerable in this way.”
The Transitional Discharge Model is designed to close that gap. It provides seamless support as clients make this transition and ensures hospital inpatient staff members continue to provide care until the client is connected with a community care provider.
After prior studies established the Transitional Discharge Model as a best practice, it was deployed in nine hospitals across Ontario in April 2013, with more than 580 clients participated in the implementation project.
Along with St. Joseph’s Heath Care and London Health Sciences, other participating hospitals included Baycrest (Toronto), Centre for Addiction and Mental Health (Toronto), Hôpital Montfort (Ottawa), Ontario Shores Centre for Mental Health Sciences (Whitby), Providence Care (Kingston), St. Joseph’s Healthcare Hamilton and Thunder Bay Regional Health Sciences Centre.
Forchuk and her team undertook a $1.4-million two-year study, funded by the Council of Academic Hospitals of Ontario’s (CAHO) Adopting Research to Improve Care Program, to gauge the model’s success. The results were released on Tuesday.
They show benefits to all parties – clients, inpatient staff, community peer supporters – as well as the health system itself. Among the findings:
- Clients’ length of stay in hospital was reduced by an average of 9.8 days (74.2 to 64.4 days). The average cost for one day of hospital stay for a patient is $1,000;
- Staff reported fewer client readmissions;
- Clients reported feeling less overwhelmed and lonely, and more reassured, during the transition;
- Clients built more personalized care relationships with inpatient staff and peer supporters, tailored to the type, degree, and frequency of care each individual needed; and
- Inpatient staff and community peer-support groups reported an improved understanding of each other’s services, resulting in stronger working relationships and more opportunities to leverage resources to respond to the needs of local client populations.
“We have consistently found improved outcomes with the Transitional Discharge Model, and have learned more about strategies for implementation in this project,” Forchuk said. “I would like to see this approach become the standard of care across the province.”
Karen Michell, CAHO executive director, expects the success stories to grow as the model expands to other hospitals across the province.
“We have done what we set out to do – ensure there was a seamless safety net, along with the relationships, for people who are leaving a hospital-based setting and going back into the community, with peer-support in place from consumer survivors themselves,” Michell said. “Ultimately, the Transitional Discharge Model does provide better quality care and a better client experience.”
Forchuk added it’s important to remember mental health clients are at a daunting point in their lives when returning to their communities and this project demonstrates when they are most vulnerable the health-care system needs to step up.
“We came about because people are suffering through this process and we have to help find a better way,” she said. “Through this project we have found a better way and we really feel this should be widely implemented.”