In 2002, the Champlain District Mental Health Implementation Task Force focused on creating partnerships that would make people’s transition between the hospital and the community easier. It found that roughly three quarters of emergency room visits resulted in the person returning home without support services in place. This means that the person would not have the necessary supports should they find themselves in crisis in the near future. The task force also found that 50% of all repeat visits to the Emergency Department (ED) occur within five days of the first visit.
Moreover, per the American Psychiatric Association, the rate of suicide is highest following the first week of discharge (2006). The Canadian Mental Health Association in 2013 reported data from recent studies conducted in England, indicating that “55% of completed suicides happen within the first week of discharge and up to two weeks after release as a psychiatric inpatient (CMHA 2013).”
The aim of the program is twofold: First, this program ensures that patients identified as being at risk of suicide are contacted by a specialist from the Ottawa Distress Centre (ODC) by telephone in the 24 to 72 hours following an Emergency Department visit or a hospital stay following treatment of a mental health and/or addiction issue. Second, this follow-up contact aims to help people navigate the often stressful transition from the hospital back into the community.
The objectives of the patient phone call includes: a) ensure that the patient’s functional level is adequate; b) ensure that the patient has accessed community partners responsible for follow-up care and/or services as per their discharge plan; c) adjust the type or level of service necessary to meet the patient’s needs; d) review discharge planning, including medication adherence; e) discuss adequacy and effectiveness of coping strategies and f) explore and/or review a crisis safety plan if distressed.
Should the person require immediate professional support, a transfer to the local mobile crisis team can be made. In an emergency, the outreach staff may also call 911 on the patient’s behalf. These processes aim to create a tighter safety net during the transition between the point of discharge and the destination of discharge; a time when the patient is stable, but remains vulnerable.
When a person discharged from the ED or the mental health unit for a mental health issue at Hôpital Montfort, they are informed that they will receive a follow-up call from a Wellness Check specialist at the Ottawa Distress Centre. Subsequently an electronic fax, containing the patient’s contact information is sent to the Distress Centre. The specialist makes three attempts to reach the patient, Monday to Friday between 9:00 am and 7:00 pm, 24 to72 hours post discharge. At the end of the phone conversation, the patient is invited to call the bilingual Crisis Line 24/7 (also a program of the Distress Centre of Ottawa and Region) should they require further and future support. In some circumstances where the patient has presented suicidal ideations in the ED or the inpatient unit, and continued to struggle, a second outreach contact will be made one week later.
Continuous monitoring and impact evaluations are underway. The results will be presented in subsequent sections of this document.