Ontario region devises gateway to mental health services

One in five Canadians will be affected by mental illness in their lifetimes, but the hodge-podge of services the healthcare system offers is difficult to access and navigate. To tackle this, the Mississauga-Halton Local Health Integration Network (MH LHIN) has developed an innovative solution that integrates its one-Link initiative, led by Halton Healthcare, with a Novari e-referral system.

The two systems work in concert to weave together the triage and screening processes to ensure clients are sent to the right providers – psychiatrists, psychologists, behaviour and addiction therapists, peer mentors, supportive housing and employment programs – based on just one up-front session with a service coordinator.

Implemented about two years ago, one-Link is the MH LHIN’s central intake initiative for coordinated access to services within the 10 Mississauga Halton LHIN-funded addiction and mental health service providers.

Referrals from primary care providers, along with health and community service providers, are sent to one-Link as a single access point. Each referral is triaged and screened by a service coordinator to determine the right care at the right time and at the right place.

Part of the initiative yet to be activated is a self-referral mechanism to further simplify access.

The initiative tackles a fundamental problem in the healthcare system: Not all mental health clients have conditions severe enough to warrant a referral to a psychiatrist.

“We can divert those psychiatric referrals to self-management programs, behavioral therapy, and other types of therapy that have really good, validated clinical outcomes that can be delivered sooner and at a lower cost,” says Zoe Gordon, one-Link’s manager.

But this complexity increases the burden on primary care providers who need to refer patients. Many doctors confess they’re bewildered by the array of alternative mental health services available, says Gordon.

“One of the biggest barriers our physicians have identified is that they don’t know where to send their patients. There are too many services, and they can’t keep up with who does what. One-Link takes care of that work by screening out who needs to go where.”

Referrers need only to describe their reason for a referral in the central intake’s one-page form and fax it to one-Link, where it’s converted electronically and uploaded into the Novari e-referral system.

An appointment with a one-Link service coordinator is set up to complete a 30-minute session to determine the level of care and type of service needed. The outcome of the screening is then routed through Novari and the patient’s information is transmitted to the selected specialist or service provider to schedule an appointment.

The system is set up to send alerts if a client isn’t seen within 30 days or if other issues come up.

Wait times have gone down dramatically since the Novari system went live in June 2016. “Our wait times went down from a 37-day wait for screening in March 2016 to our current three-day wait,” says Gordon, adding that one-Link refers to individuals seeking addiction and mental health services as ‘clients’ rather than ‘patients’.

The one-Link team spent a year implementing the initiative and establishing standardized processes with its partners.

A Novari e-referral system, already utilized for managing referrals to diabetes services in the Mississauga Halton LHIN region, was later integrated for addiction and mental health services.

The solution enables the flow of referrals between the requesting provider, one-Link and the receiving programs. All parties are able to see the live status of the referral at any given point in the referral process. The technology reduces processing time by 300 percent compared with manual fax/paper processes.

In addition, the solution has also helped cut costs substantially, says Gordon. “In the past, every single patient who was referred from a primary care physician was sent to see a psychiatrist. These are the highest-cost providers in the mental health system, and they typically have very long waiting lists. Wait times were skewed in that many people wouldn’t benefit, nor did they need that level of intervention.”

One-Link also helps facilitate access to all the different levels of mental health support services that are available across the LHIN, and gives clients more options. “This is particularly helpful for individuals who may not be willing or ready to start taking medication but are ready to try a non-medication based intervention in their illness management.”

Long-term, the solution will also provide epidemiological insights that will help the LHIN improve management of mental health costs and outcomes.

“One-Link is breaking new ground by bringing to light accurate data about the true addiction and mental health needs and costs in our region,” says Gordon. “Over the next few years, we can really build a case for increased funding around the services that work best.”

The LHIN is planning to make improvements to the solution in the near future to boost its efficiency. In the next phase, the fax step will be eliminated, and doctors will be able to access the Novari eRequest system directly to schedule a screening appointment when the referral is made.

“Right now, the referral is still faxed in and then uploaded into Novari, but that was deliberate,” says Gordon. “We want to work with primary care providers over time to ensure they’re working well with the technology.”