St. Joseph's Healthcare Hamilton (ON)

  • Peter Bieling, Operational Service Manager, Mood Disorders and Geriatric Psychiatry Programs, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
  • Victoria Madsen, Change Management Manager, Administrative Department, St. Joseph's Healthcare Hamilton, Hamilton, Ontario

Implementing a "Navigator" Model in Emerging Mental Illness

Psychiatric disorders rank among the most frequent causes of disability, impairment, and mortality in Canadians. Research has shown that the origins of mental disorders are in childhood and adolescence, and suggests our system of care be better organized to treat people early. This is because many of these disorders can become chronic, and often keep people from being able to work or achieve important social milestones. We contend that a focus on youth will bring the full force of psychiatric intervention closer to the source of the developing difficulties and thus prevent cases of serious mental illness.

This intervention project (IP) sought to establish a youth-based clinical program aimed at reducing psychiatric morbidity through early identification and treatment. In addition, this program is intended to provide a framework for answering future questions related to program evaluation and effectiveness.

Through a review of the relevant literature we determined that it was not possible to locate an evidence based model of care for trans-diagnostic early intervention. Also, there are limited models to draw on in early intervention for mental health. However, we did find that newly diagnosed mental disorders have some  similarities to cancer in that such disorders will require ongoing monitoring to exacerbation; brings with it stigma, fear, and denial; and the variety of types of diagnoses, interventions, and delivery systems is complex in both areas. A number of challenges could be resolved if we employed a navigation model pioneered in oncology.

Common to change projects in large organizations, individual services in this health care system have shown a resistance to the prospect of introducing a new service that requires a deviation from the status quo. Important in the process of change was integration of feedback from the stakeholders. 

Through this IP we established that the Navigator Model of Care is a viable service structure to implement in a Mental Health system. The key innovation in this design is a patient navigator approach.   

This model was designed to 1). Shorten wait times for screening and specialized care, 2). Reduce confusion about ‘what’s next for me’, 3). Have the Navigator stay involved throughout specific episodes of care, 4). Emphasize functioning and quality of life, and 5). Insert into pre-existing mental health services, and connect with both primary and specialized services.

In this new model of care, the Navigator will 1). Assess the needs of patients to enable the most appropriate provision of services in a timely and effective manner, 2). Offer comprehensive guidance on which service(s) and in what combination will be most helpful, 3). Track and evaluate the trajectory of patients across different clinics and the associated outcomes, and 4). Have authority to access the right level of care, ensure continuity of care, and improve communication of all health professionals during service delivery and follow-up.

This IP has the potential to change, and hopefully enhance, care for emerging mental illness in the city of Hamilton and region which includes 3 million people as well as inform the evidence base on early intervention and train future practitioners in the area.