Community Mental Health

From First Principles

Armin Moradi

2023-03-02

Thank you
Background
Too much
Cost
All talk?
Aspire Mental Health Foundation
Help!
Q/A?
Thank you

Thank you

Thank you all!

Background

Since I started residency some 3 4 years ago, certain themes have come up in day to day practice. I'd wager most, if not all, of us have at some point in our careers noticed the lack of mental health resources in the community. If headlines are anything to go by, it appears things are not getting better. In fact, they are getting worse, with the pandemic aftermath not helping the situation.

My own experience has been painful as well. When I'm on call, I see a fair number of people each night and many of them would really benefit from counselling. So, I'm ready to tell them exactly what they need, and they're ready to hear what will revolutionize their lives forever…and that's where things come to halt. I look at the list, see that all resources are maxed out on capacity. So I get the patient home and do my dictation and go home.

At this point, it's easy for me to blame the system. I'm only an employee, what am I supposed to do. But there is always that nagging feeling somewhere around my visual cortex in the far back, maybe little bit of my temporal lobe gets involved as well. Reminds me, I need to get checked out for my hallucinations as well.

Anyway, I go home, and I think did I really do what I could? Or did I just do the bare minimum that's expected of me. We do so much amazing work for the people who need our services, can we do a bit more for people who need mental health services, but maybe not psychiatric services per se? We have got to be able to leverage our position to help these people.

Current solutions

Mental Health Clinic
Catholic Family Services
The Caring Place
Family Services Regina

Mental Health clinic

Intake triaging
Public, free
Comprehensive

Mental Health Clinic is the most prominent resource we have. They have quite a lot of programs.

intake program: patients can get started with MHC through either physician referral or just by calling in to complete an intake assessment. The assessment is comprehensive and targets both services offerred at MHC and elsewhere.
COAST team
Adult community program for the severely distressed
Individual counselling that is short term and goal focused
DBT groups
Online wellbeing course through UofR (I didn't know this was associated with MHC)
Psych assessment
Community Recovery Services
Adult Psychiatry.

That's a looooong list. Trying to support all these services is amazing. But the waitlist is equally as astounding. If we could resize MHC and make it infinitely bigger, we'd have no problems.

Catholic Family Services

Family oriented
Free and sliding scale

Family Services Regina

Focused on family

The Caring Place

Individual and group
Support groups
Sliding scale

Done

Too much

Cost

80%

All talk?

Talk is cheap, show me the code

– Linus Torvalds (inventor of Linux)

Aspire Mental Health Foundation

Aspire

Evolution

Aspire foundation is a registered charity organization officially started as a non-profit in November 2021. Then became a charity in July 2022 (that's how long the paperwork took). It's taken a long time to put things in order, but it feels great to be able to finally talk about it.

Aspire foundation is an attempt to alleviate the burden I've talked about by taking a slightly different approach and taking inspiration from other industries and how they operate. The intention is to improve access to the most vulnerable section of the population and be a driving force for improvement in the state of mental health here in Regina. We're not doing anything revolutionary or radical, Aspire is an evolution in terms of the process, and will continue to evolve to match the needs of the community and fill the gaps.

Core

Every penny to the patient
Prioritize MVPs

There are 2 core tenets that drive every decision: every penny counts, and prioritize MVPs.

Every penny to the patient
- we don't have front desk staff: it might seem like an odd choice, but we simply don't need one right now. Each staff wage can provide 2 full courses of CBT per month, that's 2 patients that can be served in the community.
- Is it thoughtfulness or frugality? It doesn't matter, the end goal is services for patients and that takes priority. If a dollar can go between process or patient, patient comes first. And that attitude applies throughout all processes. As a result, Aspire has extremely simplified processes which are highly efficient.
- For example, the operational cost so far has been $15/month. Yup, that's one five. That's how much is spent on keeping things going. That includes phone, fax, hosting, website, videoconferencing, and other operational costs. This is the kind of efficiency I think we should strive for when we're dealing with such an overload of demand, and it is this efficiency that I hope will enable us to make a significant impact in the community.
The second goal is to prioritize Most Vulnerable Patients. They are our MVPs, they are the most important, the goal, the center of attention. That essentially means always leaving room for the most vulnerable.

How will we achieve these goals?

Triage

First and foremost, the foundation's services are intended to be deployed for those most in need. So, we've opted to start with a referral process from physicians including psychiatrists and family physicians who have identified mental health issues severe enough to warrant immediate or prioritized attention. Referrals are received through fax, and will go through an intake interview to elaborate on specific needs. If the services are already offered elsewhere and the waiting list is not too long considering patient's status, then we'll help them navigate the process with what is already out there and integrate them into the system that exists. Duplicating effort is not helpful in this case as we want to fill gaps. If that's not the case, and I suspect most of the referrals are going to be in this category, we'll provide the services, of course free of charge, but only to those who need the financial assistance. Again, we want to fill gaps, not duplicate effort.

The triaging stage will determine the problem area. There are specific patient selection criteria for type of therapy. I've found the criteria to be quite detailed as well, and includes things like ethnicity, age, occupation, and others. I won't pretend to understand every criteria for every type of therapy, but we have people who, in fact, do. Evidence-based patient selection will be paramount in the triaging stage.

The triage stage doesn't end there. The patient's status will be frequently revisited to see if the patient continues to be in need of services or another service will be more appropriate. This will enable the flow of higher volume of patients who need the services the most. It will essentially raise the minimum mental health state of the community which is a core goal of Aspire. It also ties nicely into our goal of filling the gaps as whenever there is a service being offered that's appropriate, the patient will be helped to integrate into that service.

It's important to note, everything that I just talked about is flexible. The entire foundation is based on flexibility and rapid response to community, and more importantly, individual needs.

Efficiency

Introspection by metrics
Low friction
Continuous micro-optimization

Metrics will be the basis on which efficiency is built. Continuous micro-optimization is a driving force which pushes us ever closer to 100% efficiency. And in order to get there, we need to look toward the tech industry again. The tech industry is notorious for continuously optimizing processes to make them as efficient as possible. It's part of the tech culture to make minute, seemingly inoccuous changes the culmination of which make an impact. That's the goal here as well. We want to how efficiently we are using our resources, how many patients we are serving, how long does it take for them to get better, how satisfied are they with their progress, and whole slew of other data that are important to answer this question: are we doing a good job?

There are also no blanket standards or processes. This is an idea taken from the developer operations industry. The flexibility allows us to adapt to the needs of community faster, filling in gaps instead of providing a set of services that are constant. Processes are designed from the bottom up, rather than taking a top-down approach. That translates into flexibility in operation and makes for faster responses to the needs of each patient and even the community as a whole.

Can we achieve 100% efficiency? I think we can get very very close.

All of this sounds nice, but how do we know we're on the right track?

Transparency

Accountability

Will it work?

I think so!

An adventure

Help!

psychologists and counsellors
lots of patients
but no funds to connect the two

The foundation needs your help! It's a registered charity, so please donate, income tax receipts will be provided for any contribution you make. I would encourage everyone to adopt a patient. Each patient costs anywhere from $960 for simpler cases requiring 8 CBT sessions to $3000 for 15 sessions by a registered psychologist. This is excluding operational costs the amount of which you already know: $15. The good news is, you get to choose how much of your contribution goes toward what. If you want 100% to go toward sessions, or if you want 90% for sessions and 10% to support the foundation's underlying costs, or if you make a donation specifically to keep the foundation running, that's all up to you. If you don't specify, we'll give it all to patients (again, our MVPs) and whatever's truly left over will fund the survival of the charity itself so it can do what it does best.

Help!

Volunteer
Ideas

There are tons and tons of volunteer opportunities as well. If you think you can help people in the community in any form or shape, we'll be happy to support you in any way possible.

If you have an idea that you think might benefit the community or patients, or even for 1 specific person, please don't be shy. The whole purpose of this organization is to help whoever we can. There are certainly no small feats.

And looking inward, if you have expertise in triaging patients, designing stationary, or know how to raise funds, or anything else, we need you! The opportunities are endless to do what you want to do, and we definitely want you to do what you're passionate about, nothing else. This whole thing is a passion project.

As a result of all this work, if we can help one person be happier than they would otherwise be, I'd be happy. That's all I would ask for, but that's not all I'm hoping for. I know we can do better. I know we can do so so much better.

Let's do it!

donate@aspirefoundation.ca
aspirefoundation.ca
fax: (306) 992-2919
phone: (306) 992-9022 (voicemail)

So, let's do it. Let's pool our resources, our expertise, our compassion, and our drive to make Regina a better place with happier people. I know we can do it.

And let's do it now, spread the word, check out the website although it's not 100% finished, I'm still working on that, oh and another thing, if you enjoy writing about mental health, please write what you're passionate about, whatever that you think helps your patients and I'll post it on the website and now everybody can use it. This is an opportunity for us on the front line to make a difference for our own patients. We see them every day, we know them, we know we can help them, and this is how we, on the front line, can make it happen.

I know so many of you have the drive and passion, I have spoken to some of you over the past year and you know who you are, and I've heard, time and time again, that you want to help, but you don't know where to start. Shoutout to nurses on 1D, I know what you're up to, I know your frustrations with the system, and I know some of you have mentioned that you'd volunteer, and that was last year when Aspire was just an idea. Now it's here. Let's do it!

I will not believe for a second that any of you got into your line of work not thinking about helping others. I'm frustrated, you're frustrated, we know we need more, and we are doing all we can, but I believe if we put whatever resource is left, we can do so much more when we are together. So let's do what we set out to do when we got into job. Let's not blame the system, but become the system. Let's

Anyway, where was I, yes, send your patients who are in need and don't have the finances or the means, and donate today! Right now, in fact! You can donate through e-transfer, online through canadahelps.org if you prefer credit card, and of course cheque, cash, homing pigeons, etc.