Program evaluation of a team-based approach addressing mental health and addictions in a Canadian urban centre

Background

Canada is experiencing an evolving crisis involving the intersection of mental health issues and polysubstance use.  Opiate, benzodiazepine, and methamphetamine use are increasing in prevalence while alcohol use remains endemic in most communities. Similarly, there has been a surge in mental health diagnoses across the country spanning demographic categories.  Both these trends have been exacerbated by the COVID pandemic.

At the same time, there has been an increasingly constrained ability by the Canadian health care system to cope with growing demand. Scarcity with respect to human resources has become the norm.

It is well-established that multidisciplinary teams are highly effective in delivering mental health and addiction care.  The question remains, however: How best to deploy a multidisciplinary team?

Over the past four years, a community health centre in urban Canada has launched a team-based approach to address this constellation of issues.  The program is led by nurses and the physician has a consultative role, which reduces costs and expands capacity while still providing high levels of service.  The care journey is tailored specifically to the individual’s needs.  

One component of the program involves continuous quality improvement to find out what is being done right and where improvements can be made, which is in part why this study was undertaken.

Methods

This program evaluation examines a unique team-based approach based in community, where nurses provide the bulk of the care.  The study provides a comparison of overall capacity, time to access, as well as frequency and character of contact with a previous primarily physician-driven model, juxtaposed with the current nurse-driven approach where physicians perform a more consultative role.

Data analysis involved interrogating the electronic medical records over two points in time, in order to establish a picture of the two different models.

 Results

Results revealed that capacity and access were improved with the introduction of this model.  By providing an increase in service provision through safely increasing the scope of nursing practice, a wraparound holistic model was easier to realize.  

In addition to managing concerns around mental health and additions, participants were more readily offered concurrent management of chronic diseases, STBBI testing and treatment, antepartum care, etc.  

Conclusion

While the components of this model are not new, the integration into a comprehensive wraparound service that permits delivery of services to individuals with complex needs, ranging from mental health to addiction to chronic disease to socioeconomic challenges has remained elusive. This model has proven successful at increasing access and enhancing capacity.

More research is required to understand participants’ level of satisfaction with this model.  Furthermore, cost-effectiveness analyses must be undertaken to assess the fiscal ramifications of further disseminating this approach.