5TH ANNIVERSARY NATIONAL MENTAL HEALTH AWARDS
Category: Community Capacity
Award Winner: Capital District Health Authority (Halifax, NS and surrounding areas)
BRINGING PEOPLE TOGETHER TO CREATE A CULTURE OF COLLABORATION IN MENTAL HEALTH SERVICES
BACKGROUND
In any given year, one in five people will experience a mental health problem or illness, which means that directly or indirectly, mental illness touches every Canadian and every Canadian family.
Addressing such a widespread issue requires an equally broad response. A growing body of evidence points to the value of active participation of individuals with lived experience and the members of their circle of support in assessment, planning, implementation, the evaluation of individual clinical treatment, and policy and program development.
Collaboration and engagement can also have a significant impact in areas like continuity of care, shared leadership, recovery and satisfaction with services provided.
OVERVIEW
In 2009, the Capital Health Mental Health Program committed to improving its mental health services through collaboration among people living with mental illness, and their family, friends, service providers and others in the community. The Consumer, Family and Provider Initiative was a multi-faceted internal cultural shift seen as integral to improving outcomes in the lives of people living with mental health problems and illnesss as well as those of their families & friends. “This required creating organic engagement opportunities between clinical team members, policy makes, senior leaders, the patients and their loved ones,” explains Laura Ankcorn, Quality Leader for the Capital Health Mental Health Program.
In this new approach, collaboration is integral to decision-making about mental health treatment, and to program and policy planning and evaluation. Changes in policy, committee membership, and many levels and types of education and skill-building are facets of this initiative.
The strategic approach centres on embedding collaboration throughout the Capital Health Mental Health Program, creating and implementing guidelines to share information, supporting the various education needs of the individual experiencing a mental health problem, as well as family and provider groups and staff. As part of the approach, there is an evaluation of the impacts and outcomes to ensure first the health domains of the individuals and their families, as well as the success of the collaborative nature of the initiative.
The Quality Steering Committee acts as an executive body to the Mental Health Program Quality Council and has Consumer, Family and Provider representatives from the Mental Health Program and
the Department of Psychiatry, Dalhousie University.
The Mental Health Quality Council is a group comprised of 25 - 30 front-line providers, psychiatrists, managers, family members, consumers and community partners. The Quality Council oversees and actively promotes evaluation and quality improvement in the Capital Health Mental Health Program and is an integral component of the quality framework with a clear accountability loop through its structure.
Eight Quality Teams, composed of approximately 5-15 members each, are responsible for identifying gaps and innovating on new models of care delivery. They implement initiatives that focus on key aspects of their representative services including those identified by the Quality Council in the areas of Forensic Services, Recovery and Integration, Community Care, Specialty Services, Acute Care, Crisis Support, Developmental Disorders and Seniors. “With expertise and varied viewpoints from the Council, teams obtain valuable feedback while sharing lessons learned in an open, collaborative environment,” Ankcorn says.
The following initiatives were identified as tools able to bring this priority of collaboration to life in our day-to-day work.
Involvement of citizens on the Quality Council, Teams and Committees:
Citizens apply to participate with different components of quality work through the Healthy Minds Cooperative, a partner organization. They are placed on teams and committees based on their experience and interests. Healthy Minds Co-operative provides orientation, training and ongoing support to these citizens. In addition, the Cooperative provides a variety of peer-based mental health services to people and their families, and also provides input into the design, development, delivery and evaluation of the Capital Health Mental Health Program.
To date, there have been 35-40 consumers and families serving in various capacities and providing expertise, advice and information from their perspective. “It has really evolved,” Ankcorn notes. “The uptake has been one of the biggest shifts in our culture.”
Feedback and Experience Action Team (FEAT) – soliciting feedback:
The Capital Health Mental Health Program actively seeks opinions, ideas and suggestions by providing multiple opportunities for feedback and participation in decision-making processes.
Surveys, for example, were developed by the Feedback and Experience Action Team, a group composed of consumers, family members, care providers and representatives from community groups. In-patient and out-patient surveys for consumers and for families and friends were conducted and are available in each of our service areas. “The surveys were developed based on focus groups designed to solicit what was most important to the groups to be surveyed in a meaningful and effective way. Very simply, we wanted to find out what people wanted to tell us about their care,” says Ankcorn.
Vision, Mission, and Guiding Principles:
A bold statement of “duty of care to families” was embedded in the Vision, Mission and Guiding Principles of the Capital Health Mental Health Program.
Cornerstones of Collaboration (Triangle of Care):
Guiding principles around our shared understanding of consumer, family and provider collaboration had been created and it has since been used as a basis for ongoing conversations.
Information Sharing Guidelines:
The guidelines were created to support increased understanding of privacy and confidentiality in health care, and to reinforce the value and benefits of exploring how we share information. The guidelines include practical approaches to help ensure we include conversations about why, what, with whom and when health information is shared with members of the individual’s circle of support.
This was followed by the development of a comprehensive education package with the support of the UK-based Meriden Family Programme (specialists in family-based mental health care), and an intensive series of educational offerings to the Capital Health Mental Health Program, the families and the community.
Consultation and Training for Family Work:
Meriden was consulted to evaluate our current environment in relation to collaboration and to make recommendations based on the foundations of their program and leading best practice. They provided training and ongoing support to staff and managers in relation to Behavioural Family Therapy or family work, which is a clinical intervention in which clinicians work with the client and their family, usually in the family home, around practical issues such as skill building, relapse prevention, wellness planning. Family Education and Support , also known as Families Matter in Mental Health, is an 11-week program for families, co-led by family members and clinicians, to give those in attendance practical skills to help with coping and dealing with their loved one with a mental illness.
The Mental Health Foundation of Nova Scotia partnered with us to fund this component through generous donations made by local businesses and citizens in the community.
Consumer, Family, Provider report:
A report with a series of recommendations was completed following several focus groups and evaluation processes to solicit input from providers, consumer and families regarding the educational and support needs that were required to truly implement the collaborative change that had been envisioned.
CHALLENGES AND OPPORTUNITIES
Time was one of the key factors in making progress – we needed the time and patience to truly listen, understand and appreciate each person’s perspective and contribution to the overall work. This was most evident in the development of the information sharing guidelines. The process, expected to take four months, took the better part of a year. A number of sensitive issues needed to be explored, and it took time for team members to agree on solutions. Family members, for example, were concerned about how much of their experiences they should share with staff because they might put their loved ones at risk of unnecessary scrutiny. “We were embarking on a broad-scale cultural shift, and we knew change would take time and careful planning,” Ankcorn explains.
Access to required financial resources to support the contribution of expertise was another key element of success. Start-up costs for the initiative were accommodated through regular operational funding. Critical financial support came through the generosity of Mental Health Foundation of Nova Scotia donors. This provided the means to launch a comprehensive approach, including training and supervision, in the new model of care. Without the initial and continued support from the Foundation we would not have been able to dedicate staff and resources to make these positive changes.
As with many initiatives in which volunteers are engaged, recruitment and retaining members is a challenge. Although the retention rate is impressive with almost 75 per cent of those involved continuing on with the work in some capacity, members have dropped out for a variety of reasons, such as frustration with the pace of noticeable progress, or because the schedule required a
significant level of commitment, or for personal reasons of their health or needing to focus time and energy with a loved one. “You have to be ready for this to happen,” says Susan Hare, Chair of the Quality Council. “We say that this is an open invitation, so you can step back, and you are still welcome to return to the work when you are able.”.
This initiative would not have been successful without the co-leadership of the Capital Health Mental Health Program and Dalhousie University’s Department of Psychiatry, and the generous donation made by the Mental Health Foundation of Nova Scotia and their supporters.
INNOVATION
Adopting a collaborative approach – one that includes engaging individuals with lived experience and members of their family or circle of support in the decision-making process – is the core of the program’s strategy. This focus has had a direct impact on how we work with services users of the Capital Health Mental Health Program and will be instrumental in the health and recovery outcomes for individuals and their families as the work continues to grow. This approach would not have been possible without the contribution and commitment of the Health Minds Cooperative, which continues to play a key role in recruitment, support, addressing concerns and matching citizens with teams.
It is a novel approach to have individuals with lived experience and family members participate in the creation of satisfaction surveys, including analysis and recommendations, as a way to find out what people have to say about their care. “Nothing about us without us” has become a motto that has informed this work.
MAKING AN IMPACT
One of the key outcomes for the initiative has been guidelines for sharing information, completed in June 2012, which help lay the ground rules for important conversations about mental health. The guidelines also outline and update definitions (such as “persons living with a mental illness,” “circle of support,” “providers” and “triangle of care”) to ensure a common understanding among various groups. The development process involved consumers, legal, psychiatry, front-line staff, managers and family members.
“The guidelines addressed one of the major barriers that Meriden had found in their first consultation, which was how we deal with confidentiality in mental health,” Ankcorn explains. “We tended to be overly cautious in maintaining confidentiality. The guidelines have provided a basis where people can feel comfortable sharing information.”
A report that evaluated and made recommendations about the support and education needs of consumers, families and providers is leading to a more comprehensive approach, including the creation of a work group that will develop and implement a model to provide education and support to families.
The Capital Health Mental Health Program has begun working with other health districts in Nova Scotia to help them replicate the collaborative approach in their areas. It has the potential to
become a province-wide, and even national, initiative. Other regions have also shown interest in the information-sharing training sessions.
LEARNINGS AND INSIGHTS
Strong consumer and family voices, combined with committed leadership at all levels of the organization, have been integral to the success of the approach. “From the top to the bottom, the system needs to be committed or it just won’t work,” Ankcorn says.
Identifying “community champions” early on was the key to building early attachment to the approach.
“We want people to know they have an equal part in the community. They will always have that opportunity,” says Karen Gilmore, the Executive Director of the Healthy Minds Cooperative.
THE FUTURE
The group will continue to use the survey model to discover what the mental health community is looking for, and to assess impact and outcomes. “I think that this [approach] started to shift what the possibilities were,” Hare says. “It’s important to evaluate where you are and look at where you could be, and creating the steps to get there.”
“You can’t put an end date on it,” Ankcorn adds. “It’s not a project, it’s a commitment. It’s a complete shift of culture.”
By Séamus Smyth and Cathy Nickel Mental Health Commission of Canada
