Registed Nurses' Association of Ontario

Minister Hoskins - Re: Stable peer support funding

Minister Hoskins - Re: Stable peer support funding

Dear Eric,

RNAO appreciates your ongoing leadership to improve the health and well-being of all Ontarians through Patients First: Action Plan for Health Care, and the Open Minds, Health Minds: Ontario's Comprehensive Mental Health and Addictions Strategy. We are writing to you today about the need for stable peer support funding for individuals being discharged from psychiatric facilities.

RNAO was delighted when you addressed nursing leaders from across the province on Feb. 23, 2017, at the Registered Nurses' Association of Ontario's (RNAO) Queen's Park Day, and reminded us that "we can't have health without mental health." Indeed, we applaud the government's investments in mental health programs and services within the 2017 Budget, as well as subsequent announcements to address the opioid crisis, and respond to First Nations youth suicides in northern Ontario.

To further the province's objective of improving health outcomes and commitment to health system transformation that is evidence-based, person-centred, equitable, and cost effective, RNAO recommends stable provincial peer support funding for individuals being discharged from psychiatric units. This model was brought forward and supported by  RNAO's membership as a resolution at our 2016 Annual General Meeting and is consistent with the findings recommendations of the Mental Health Commission of Canada.

Ontario was making significant headway in that area with the implementation of The Transitional Discharge Model (TDM) - an evidence-based "made-in-Ontario" peer support model that has been in practice since 1992. TDM's purpose is to support successful transition and reintegration of individuals discharged from psychiatric facilities with a mental illness. Two features of TDM are: 1) the overlap of hospital and community staff until a therapeutic relationship is established with a community care provider; and 2) support from a trained peer who has lived experience of making the transition to community. Preliminary evaluations of TDM in Ontario found reductions in length of hospital stay, reduced hospital readmissions, improved quality of life, and improved social relations. In 2004, the Scottish Parliament declared TDM as a best practice due to the dramatic reduction in readmission rates when implemented in Scotland. A two-year provincial study (2011-2013) funded by the Council of Academic Hospitals of Ontario (CAHO) examined nine hospitals implementing TDM. Results found a reduced average length of stay of 9.8 days, and as shown in Appendix 1, savings from TDM were $2,907,416 per site annually. If the TDM continued to be implemented just across the participating wards at the nine hospitals, the potential savings were estimated to be $31,360,000 per year in hospital days.

Despite these positive results, many of the implementation sites were closed once the CAHO research study was completed due to lack of funding. Or, as the London Free Press described the closures at London Health Sciences Centre, "It's cheap, effective-and out of cash." Not only were the savings that were anticipated by continuing the pilot implementation projects lost, there was a wasted opportunity to scale up TDM across Ontario as a standard of care. If TDM was implemented province-wide, the estimated potential net savings in hospital days would be $632,201,920. While these monetary savings are significant, the real value of TDM  is helping vulnerable people undergoing a complex transition process when they are at increased risk of suicide following in-patient hospital discharge.

The lead researcher for the CAHO TDM study, Cheryl Forchuk, notes, "The greatest impediment to implementation has been the inadequate funding of the peer support aspect of the model." The Mental Health and Addictions Leadership Council (MHALC) identifies the following four components of a person-centred system: accessible; high-performing; equitable; and recovery orientated. Partnering with people who have lived experience is an essential element in the transformation from a biomedical-orientated system into a person-centred system. MHALC describes a "truly recovery-oriented system as follows":

In such a system the individual is viewed, not simply as a passive recipient of care, but as an engaged partner in their own recovery. Likewise, there is a broadly shared belief - held by individuals, families and caregivers - that treatments and supports are not an end in themselves but, rather, part of the journey toward recovery, with self-sufficiency as the final goal. Thus, recovery speaks to the importance to all people of leading a meaningful life as part of the community, to have a home, a job, friendships and community connections, and to contribute.

Stable funding for peer support coordinators through mental health consumer survivor initiatives is a cost effective way to: support patients being discharged from psychiatric facilities; create job opportunities for people with lived experience who can share their journey of recovery; and promote cultural change of organizations, systems, and society towards an authentic recovery orientation.

In keeping with the goal of Patients First, improved health outcomes and system cost-savings, RNAO urges the provincial government to reinstate the TDM in the nine initial sites, with the goal towards implementation across the entire province.

Thank you for considering this evidence in support of the Patients First agenda.

With warm regards,

Doris Grinspun, RN, MSN, PhD, LLD(hon), O.ONT                      
Chief Executive Officer, RNAO                            

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Letter to Minister Hoskins re: Stable peer support funding423.15 Ko
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