Feature: Nursing Week 2020

A new model for individuals facing mental-health challenges offers smoother transitions back into the community following hospitalization – all while saving the health-care system millions of dollars annually, according to a Western researcher. “Take somebody who comes in for a psychiatric admission. While admitted, the hospital gives them a place of reprieve and, ideally, a sense of safety,” Nursing professor Cheryl Forchuk said. “At discharge, however, they are going back to that spot where there was so much stress. “It’s a scary time. Even if they are in a better place – feeling less depressed, less anxious – they’re going back into a situation where things were very difficult the last time.” Forchuk’s transitional discharge model looks to address this problem by focusing on both professional and personal supports as a way to create a seamless transition back into community. “We know that first month out of hospital is where they are most vulnerable,” she said, pointing to the period’s high rates of suicide. “Yet, the way our services are traditionally organized, there is often a gap between when they say goodbye to that inpatient unit and when they say hello to their community provider.” Forchuk’s transitional discharge model depends on a “safety net of relationship” to help people get through this period. The model depends on two parts.

1. A professional, trusting relationship in the community for the individual. Although some connections are made quickly, referrals to a community agency can take weeks. That presents a critical gap between leaving the hospital and seeing that person the first time.
2. Peer support. There is real value in striking a relationship with someone who has made a similar successful transition.

“When you think of the tough points in your life, your relationships with other people get you through it. This is just an example of one of those tough periods in life,” she said. “We’re talking about a population that may have less social support than the general public. With more serious and long-term mental illness, the social network is primarily made up of professional help and family. What’s missing is often the friend.” Forchuk developed the model from conversations with patients. “This is what patients wanted. I still have drawings they did – images of bridges consistently came up. I would ask them what the bridges are; they would tell me the bridges are people,” she explained. “Having professional staff and a friend who has gone through a similar journey. Those are bridges to getting people through that difficult period from hospital to community.” This transitional discharge model is used by more than 100 hospitals across the country. Forchuk continues to evaluate the model’s cost-effectiveness. In nine Ontario hospitals, she is comparing data on re-admissions, length of stay and hospitals spending at three points in time – prior to, after four months and after eight months of the model’s implementation. “And the numbers don’t lie,” she said. In eight months following implementation, the average length of stay decreased by almost 10 days. She found a total savings of more than $3.3 million over that same time. She added if every psychiatric ward in the province would implement this model, she estimates it could save the system $66 million per year. “It was cheaper because people left hospital earlier and came back in less often,” she said. “Why do we want to put people in a risky situation where they don’t have the support? Why do we want to pay extra money to put people in that risky situation?”