If the Urgent Service Access Team, or USAT for short, sounds like the name of the next blockbuster superhero squad, well, that’s not far off the mark for people living in Niagara Region looking to access mental health services.
“USAT is a joint effort among several agencies to implement a creative initiative that addresses individuals with mental health, addictions and concurrent disorders who go to the emergency frequently,” explains Coletta McGrath, Executive Director, Quest Community Health Centre. “For Quest and CHCs generally – our philosophy of service is very much about interdisciplinary service delivery, and we saw that as a key feature of the model that would address this issue.”
“There’s a huge gap in what these clients are looking for, and what the ER is intended to provide,” adds Jenny Stranges, Program Director at Quest CHC. “So the question was: How can the CHC support those needs, and redirect individuals so that their needs are being met in a more holistic way. It was identified that client needs included things like primary health care, housing support, and food security – more around the social determinants of health, which the hospital wasn’t designed to handle.”
The USAT program is a true collaboration, a joint initiative of Canadian Mental Health Association, Niagara Branch; Community Addictions Services of Niagara, the Niagara Health System, and Quest Community Health Centre, which acts as a sort of hub of primary health care for the team. Senior managers from each agency set out to build a network of interwoven services between hospital, addictions, mental health services, and primary health care in the Niagara area. The goal was to better address the care of a client population whose needs are often misunderstood by the system and poorly met. And because superheroes need wheels, the team got mobile, too, utilizing a Quest CHC van and Primary Health Care outreach services to maximize access, meeting clients where they are, and when they are able to, a client-centred approach that addresses barriers to good mental health and wellbeing at their sources, where possible.
The USAT program has already had some early successes: a 50 percent reduction in visits to the hospital emergency department by participating clients; the expansion of services to two new sites, for a total of six, to better serve the large, dispersed area of the Niagara Region; and most of all, improved care for clients, with a satisfaction rate of 100 percent, and surveys that show reduced anxiety about accessing primary care, and reduced barriers due to transportation issues. All of that was done while serving 227 individuals in 2015, for a total of 2,960 visits, with an average wait time of just one day.
Successful transformative change lies in working in harmony. Both McGrath and Stranges are quick to give credit to the teamwork that went into planning USAT, and the collaboration that continues to help USAT along with mental health and substance abuse services evolve, growing stronger and more responsive.
“It’s important to note that we sat down with the hospital and jointly wrote the proposal that went to the LHIN,” Stranges notes. “And they were very supportive of shifting to a more preventive approach, and a health and wellness-oriented kind of model,” adds McGrath. That positive collaborative planning led to another innovation, the creation of a transfer pathway from the hospital to the community that sees discharged emergency patients introduced directly to USAT before leaving acute care, in order to bridge initial short-term gaps and to begin working on filling longer-term ones.
Heather Scott is Program Director for Mental Health and Addictions at the Niagara Health System, and has spent the last dozen years of her career looking at mental health programs through the lens of hospital and acute care. Now, she also sits at the USAT Project Management Team table. Scott’s experience has helped guide the program in these early days by addressing barriers to services, developing strategies to prevent people from landing back in the emergency department, and helping to smooth pathways so client needs can be more readily and quickly addressed. Working with USAT and Quest on smoothing discharge pathways, for instance, has made a significant difference for people, she says, who often have long lists of needs that hospitals cannot meet.
“No agency provides everything. Say somebody needed a family doctor, they needed cognitive behavioural therapy, they needed a medication review, they needed housing help – one agency is not going to do all of that,” Scott says. “That’s where USAT steps up, the team starts putting those connectors in place and acting as the system navigator for the client, while at the same time providing short-term support and care.”
Scott believes hospital, primary health care, mental health agencies and community services all have specific roles to play in placing clients at the centre of their own plan of care, but that individual organizations can only achieve their ends – better client outcomes and experiences with the health system – if they are working together.
“You really have to look at all of this like a system. It cannot be individual agencies. And that system involves all aspects of it: mental health agencies, hospitals, primary care, police, social services, soft services – all of it,” Scott says. “We’ll do our job at the hospital, and we have some out-patient services that can help you, but ultimately you’re going to get well in the community.”