As of the spring of 2023, the Ministère de la Santé et des Services sociaux (MSSS) wishes to replicate a mobile mental health clinic pilot project at other CIUSSSs and CISSSs in the province in order to reduce waiting times for services in the network. audience.
This model, which will initially be the subject of pilot projects in six other CISSS/CIUSSS, will be inspired in particular by the psychological support formula in the event of a crisis that has proven its worth at the CIUSSS de l’Est-de-l’Île. -de-Montréal, the Resolution project. Made up of a mobile mental health crisis management team, it offers immediate, intensive, at-home, personalized support and, with some exceptions, without medical intervention.
According to the MSSS, more than 20,000 people in Quebec currently have no access to care or follow-up by a professional specializing in mental health. Many of them therefore find themselves on waiting lists for up to 24 months. “These delays put the lives of some people at risk,” said Kim Simard-Tremblay, head of the Resolution mobile team. When a person is in a crisis situation, it is not in a week, in months, it is now that we must act. The Resolution Project formula, which allows follow-up for several weeks directly in the home of the individual in crisis, is proof of very conclusive results.
In two years, the number of requests for the mobile crisis management service has jumped by 30%, reaching 9,414 consultations in 2021, or 1,000 more people per year. Nearly a quarter of its users live with psychosocial problems and 17% have suicidal thoughts. “I will never have the data of all those who have been saved. These are all cases that we will not see in the coroner’s reports. Every day, that’s what we do, make sure that these people don’t get caught up in these files, ”explains Kim Simard-Tremblay.
Specialized educator Manon Levasseur, who has more than 30 years of experience in the field, including several in a crisis center, agrees and believes that residential services are not the only solution. “Since working for Resolution, the results are more concrete. I closed two files yesterday, and I saw real progress among individuals. Intensive home follow-up with users makes all the difference. »
The first offer of its kind in Quebec
In a crisis situation, emergency rooms in Quebec have most often become the automatic way to try to consult a doctor. According to Mme Simard-Tremblay, this option, although important, sometimes remains incomplete for people living with mental health problems or who are in a period of psychological imbalance, since the majority of situations will require more or less long-term follow-up. “Going to the emergency room, coming out with a prescription, is far from solving all your problems,” she says.
In Quebec, there are also crisis centers managed by various community organizations. There are 21 centers offering services to people in psychological distress, seven days a week, 24 hours a day. Like the Resolution mobile team, these centers complement psychiatric emergencies, which they often help relieve. The Resolution mobile team project is, however, the only service that offers intensive and personalized follow-up for up to 12 consecutive weeks.
I’ll never have the data of everyone we saved. These are all cases that we will not see in the coroner’s reports.
Since the start of the COVID-19 pandemic, the mental health clientele has changed. “Two years ago, our patients were mainly people who had already received a mental health diagnosis. Today, we talk a lot about psychosocial issues, where many have felt unsettled,” she adds. The vast majority of users who have used the mobile team since the pandemic are people with no history of mental health problems.
The duty also met a young woman at her home who had had suicidal thoughts, but who had no diagnosed mental health disorder, during the visit of the worker Manon Levasseur who was trying to restore her confidence in her morning rounds . “I know you have this strength in you, you have to trust yourself”, encourages Mme Levasseur with empathy.
Rethinking psychological help in crisis situations
Two weeks away from the holiday season, an often difficult time for many vulnerable people, the phone does not stop ringing during the visit of the Homework. The 22 dedicated mental health specialists who make up the team act independently and without the presence of a doctor or psychiatrist, which greatly reduces wait times. “This is proof that we can respond to many users in high levels of crises without a doctor,” says Kim Simard-Tremblay. “We just need the person to call us,” she adds with conviction.
According to the head of the Department of Psychiatry at the CIUSSS de l’Est-de-l’Île-de-Montréal, Dr.r Lionel Cailhol, a project like Resolution “can very well be replicated in other establishments and above all allows for immediate, human intervention, and indirectly reduces the waiting time for psychological support”.
Two years ago, our patients were mainly people who had already received a mental health diagnosis. Today, we talk a lot about psychosocial issues, where many have felt destabilized.
The service is deployed in three parts on the territory of the CIUSSS de l’Est-de-l’Île-de-Montréal.
The first component, that of the telephone line, is where the person in a crisis situation can call at any time and discuss quickly with a qualified and available worker. Personal meetings are planned in a second time with a member of the team at home, and the third component, this one only if necessary, is the accommodation located at the Émile-Nelligan Crisis Center, on the territory of the CIUSSS. of the East-of-the-Island-of-Montreal.
Targeted regions
According to a written response from the office of the Minister responsible for Social Services, Lionel Carmant, the mental health showcase projects inspired by Resolution, but also other experiences in Quebec and around the world, will first be implemented in the CIUSSS de la Capitale-Nationale, the CIUSSS de la Mauricie-et-du-Centre-du-Québec, the CIUSSS Centre-Ouest-de-l’Île-de-Montréal, the CIUSSS Centre-Sud-de-l’Île- de-Montréal and finally in the Integrated Health and Social Services Centers (CISSS) of Outaouais and Laval.
As with the team behind this success, it will be necessary, according to Kim Simard-Tremblay, that the new teams carry out intensive follow-up in the community, with qualified and multidisciplinary workers to reproduce the winning formula of the east from Montreal.