Walk-in Services: A Giant Step for Mental Health


The Burin Peninsula is one of the most scenic areas of the province. Breathtaking coastlines, sandy beaches, and deep, protected harbours are a draw for locals and tourists alike.

But those waters ran deeper than many realized – as the past couple of years have seen an unprecedented number of suicides in several of the close-knit communities. As people in the area struggled to come to grips with these tragedies and try to understand why they were happening – the issues of mental health and mental health services – were brought into sharp focus.

Eastern Health took swift action, in keeping with its renewed focus on both mental health and addictions and access to primary health care. Community consultations held a year ago, by Eastern Health and the provincial Office of Communication and Public Engagement, in Grand Bank, St. Lawrence, Burin and St. Bernard’s – revealed that mental health was the number one concern on the peninsula.

 “We were losing loved ones, husbands and wives, sons and daughters and mothers and fathers in our communities on the Burin Peninsula to suicide at an alarming rate,’” says Diane Dunphy, a social worker with Eastern Health’s Mental Health and Addictions Program in Marystown. “The community impact was overwhelming.”

Diane Dunphy, a social worker with Eastern Health’s Mental Health and Addictions Program, speaks to the Burin Peninsula Community stakeholder group in Grand Bank, March 2018.

Dunphy, who has worked in the field of mental health for 28 years, says the impact on the community in general, was also deeply felt by the health-care professionals working in the area.

“We lost a colleague to suicide,” she adds. “As a mental health team, we were called upon to provide debriefing sessions with staff at that time, which was very emotionally difficult.”

At that time, residents of the Burin Peninsula felt they couldn’t get mental health supports when they needed them most – and community agencies who referred clients to Mental Health and Addictions Services, felt there was really no purpose in sending a referral because of the long waitlists. Health-care professionals in the area couldn’t disagree.

Derrick Dunne is a Primary Care Paramedic with the Grand Bank/Fortune Ambulance Service. In his 20 years on the job, he’s seen firsthand the toll taken by mental illness.

“I’ve seen way too many suffer and leave this world too early – especially in recent years,” he told a community session on mental health services held recently in Grand Bank. “It’s also taken a toll on us in Paramedicine.”

Derrick Dunne, a paramedic with the Grand Bank/Fortune Ambulance Service, speaks to the Burin Peninsula community stakeholder group in March 2018.

Diane says the staff in Eastern Health’s Mental Health and Addictions Program staff understood the frustration – because they felt it themselves:

“As a team, we felt overwhelmed and maxed out to capacity. We knew our service was not meeting the mental health and addiction needs of our communities; we knew the community was not happy with our long wait times; and we knew we were not seeing clients when they really needed help – but we felt powerless and hopeless as to how to make changes.”

So…first things first. Or as Mental Health and Addictions Manager Evelyn Tilley says: “When people start listening – things start to change. Change is possible.”

With that in mind – and in response to the residents’ number one need – in August 2017, Eastern Health partnered with town councils and community agencies on the to form the Burin Peninsula Coalition for Mental Health & Wellness. The Coalition is in keeping with Eastern Health’s priority on mental health and addictions services, outlined in its Strategic Plan: Lighting the Way: Navigating Together – and its objectives were very clear:

  • to improve access to services through promotion of local services and identification of resource needs;
  • to promote mental health and addictions awareness with the goal of reducing stigma and improving quality of life; and
  • to develop a community action plan for addressing suicide through prevention, intervention and post-suicide strategies.

Walk-in, single-session mental health counseling known as DoorWays, had been introduced in several places around the eastern region throughout 2017. The no referral/no wait approach was working well for people who felt they needed to see someone right away – and gave the folks on the Burin Peninsula an idea:

What if all the mental health services could be changed from an appointment-based service to a 100% walk-in service?

As wonderful as that sounded for their patients – the staff felt it would be impossible, according to Mary Williams-Fewer, another mental health social worker on the Burin Peninsula.

“This was initially resisted by clinicians, as we couldn’t see how it could work,” Mary said. “Our work week involved clinics on Mondays, walk-in clinic on alternate Tuesdays, clinics again on Wednesdays, team and psychiatry meetings on Thursdays, and outreach clinics on Friday. We couldn’t see beyond needing to do ‘more with less.’

It felt daunting. Hopeless. Completely unmanageable.”

But with minds open to possibilities – they gave it a try! With the expert guidance of a process improvement team, working in tandem with community stakeholders – and experimenting with how to think differently – the mental health services on the Burin Peninsula embraced change.

And it worked!

Mary Williams-Fewer, a social worker with Mental Health and Addictions on the Burin Peninsula, has more capacity and flexibility to spend with clients under the new approach.

Drastic grass roots changes have taken place in a matter of months:

 Post change

  • Same day access: no wait time – no wait list
  • No referral necessary. No appointment necessary
  • Everyone gets priority now…not just clients in crisis
  • Service is client-centered
  • Zero patient ‘no shows’ and zero cancellations.

So what exactly is being offered now on the Burin Peninsula?

Walk-in Services:

Grand Bank: Monday to Friday: 9:30 a.m. to 3:30 p.m.

Marystown: Monday to Friday: 9:00 a.m. to 3:30 p.m.

St. Lawrence: Monday: 9:00 a.m. to 3:30 p.m.

Placentia West Clinic: Monday: 9:00 a.m. to 3:30 p.m.   Phone: 709-443-2100

Eastern Health has also partnered with groups such as Richard’s Legacy Foundation to provide ASIST training in suicide interventions to health-care providers on the Burin Peninsula – and Mary Williams-Fewer offers presentations on Post Traumatic Stress Disorder to first responders such as paramedics, including tools and tips to enhance and maintain their own mental health and wellness.

And in January 2018, Newfoundland and Labrador led the country with its participation in the national Roots of Hope initiative – a suicide prevention program, launched in Grand Bank.

A partnership between the Mental Health Commission of Canada, the Provincial Government and Eastern Health, the project will draw on community expertise and guidance from mental health experts across the country. With an initial investment of $1.98 million, its goal is to reduce the impacts of suicide by offering new mental health services and supports to people on the Burin Peninsula.

“It’s so good to know the mental health services that are available to our patients – there is so much more to offer that can benefit them,” says Paramedic Dereck Dunne. “There have been tremendous improvements, although there is still a way to go because the stigma is still there. But hopefully, we can build on what we’ve started.”

If the numbers are any indication, the new approach has made a big difference – both in access and quality of care.

From December 1, 2017 to April 20, 2018, there were more than 800 visits to the new walk-in service in Marystown, Grand Bank and St. Lawrence. The number of new clients totaled 310.

But perhaps the most significant change has to do with suicide – the mental health issue that prompted much of the change in the first place.

Before the walk-in services were increased, the top three issues that patients experienced were (1) Depression (2) Anxiety and (3) Suicidal thoughts or attempts.

Since the new approach – suicidal thoughts or attempts has dropped back to the 6th presenting issue. Although this is early on, and data is still being collected – it is fair to say that people are accessing our services earlier now – when they need it – and not when they reach a crisis point.

Not surprisingly, response from residents of the Burin Peninsula has been very positive – with comments such as:

 This walk-in service is the best thing mental health has ever done on the Burin Peninsula.”

  “I feel like me and my son have hope with all the options provided today.”

As for the employees of the Mental Health and Addictions program, they’re enthusiastic, and newly-inspired to do the work in their chosen field. Diane Dunphy says as front-line clinicians they feel ownership of this new approach to care because they were a part of the process of creating the change. And that’s made all the difference.

“On the Burin Peninsula, we have done what we thought was impossible – putting our old service on its head and creating a brand-new delivery model that is a client-centered, with no wait time,” she added. “It’s a service we’re proud to say we helped develop at the grassroots level with our community partners.

We were encouraged not only to ‘think outside the box’ – we got rid of the box altogether. WOW!”

The last word goes to a woman who is many ways has put a face to the mental health crisis that erupted on the Burin Peninsula. Natalie Randell is a resident of Grand Bank who lost her husband to suicide in December of 2016.

She has become a tireless advocate for increased mental health and addictions supports and continues to share her experience – working with health-care professionals and the general public – in an effort to prevent others from going through what she has.

“We were unable to change the outcome in my situation – but maybe together, we can change someone else’s. You all give me hope.”

Natalie Randell shares the experience of her husband’s suicide with the Burin Peninsula community stakeholder group in March 2018.

This is National Mental Health Week. If you or someone you know is looking for more information about services, please visit http://www.easternhealth.ca/WebInWeb.aspx?d=1&id=2106&p=74

This story was written by Deborah Collins, a communications manager with Eastern Health, based in St. John’s.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s