The key to an effective P.E.I. mental health system is to make it client-centred and focus on early intervention, says a Nova Scotia mental health expert.
Registered psychologist and social worker Todd Leader laid out his vision for a better system in his book, It’s Not About Us: The Secret to Transforming the Mental Health and Addiction System in Canada.
Leader, who has consulted with Health P.E.I. for about three months, gave a public talk Wednesday at UPEI. At the core of his approach is a system designed around the client every step of the way.
“If the client was my mother or my son, how would I want this part of the system to work? It’s a personal question, not a professional question. Whatever the answer is, that’s the definition of a client-centred system,” said Leader.
“If at every step of the client’s journey through the program, they ask that question, they’ll end up designing policies that are efficient for the client.”
The title of Leader’s book means the system is about the users, not the workers, who must deal with inconvenience for the sake of the client.
Transforming the system “doesn’t happen without struggle and without pissing people off,” Leader said.
The P.E.I. government consultant said Health P.E.I. is “completely committed to this kind of approach and are trying to figure out the process to make that transition … I give them kudos for embracing the concept and starting the journey.”
The talk was attended by three MLAs. Health minister Rob Henderson was not among them.
Leader’s strategy was implemented in the South Shore Health Authority in Nova Scotia and resulted in wait times dropping from eight months to four to six weeks, without any new funding.
Leader stressed that the clients of the mental health system are the entire public, not just those who use it or those who are mentally ill.
“The mandate is not to provide services – it’s to improve health,” he said.
His plan addresses that by incorporating social and emotional learning into the school curriculum, reducing demand over time.
“There is tons of scientific evidence that if we teach our kids to understand and manage their emotions, those kids grow up with lower rates of mental illness and addiction. If we ignore this part of it, we are always going to have a capacity problem.”
Among Leader’s ideas to increase the supply to meet the demand is removing clinicians from non-clinical meetings, which would free up appointments and reduce wait times.
“It’s about picking apart every single part of the path and maximizing the use of resources for the sake of the client.”
Dr. Sarah Stewart-Clark, the organizer of the #HowManyWade mental health advocacy campaign, said reading Leader’s book gave her new hope for the future.
“In many ways it aligns with the asks in our campaign and I think it's an exciting direction for the province to go in.”
The Facebook campaign publicized stories from 100 families whose needs are not being met by the system and has helped make mental health a hot topic in the Island’s political discourse.
Stewart-Clark said Leader’s vision is finally an answer to the urgent need that has existed for many years. She agrees with Leader that proactive intervention to prevent personal crisis is “desperately needed.”
Part of Leader’s focus is on making the system easier to navigate and access. He said sitting in waiting rooms, not knowing what number to call for help and not having a “warm, compassionate person” answer that phone are all examples that can make the user’s condition worse.
“Waiting rooms are harder on mental health patients than others. It reinforces their low self-esteem and causes the issue they’re there to treat.”
His solution in Nova Scotia was to instruct all mental health professionals to drop everything and meet clients at their appointment time.
Stewart-Clark cautioned the province must deal with the current backlog of users in crisis before it can move forward with Leader’s approach.
“We're not exactly in a place to adopt that plan fully until we address the reality that on the spectrum of mental illness, we are far on the side of severe crises because individuals have not had care for so long.
“The system has been ineffective for so long and we need to address that first.”
We have to be careful about making assumptions. It has been said that the Province must fix the backlog before fixing the system. That's like saying we have to drive our car further before getting it running right. The way to fix the backlog is to transform the system. Organizations and services that are using traditional models, are usually incapable of catching up, while still using those traditional approaches. The changes and innovations have be done first, as they then increase the capacity to become more efficient and effective. The cart cannot come before the horse.
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