Objective

To develop an innovative initiative to improve (access to) somatic care for people with severe Mental Disorders (MD) and to facilitate (access to) mental health care for people living in the community.

Context

As in many countries, people suffering from (severe) mental disorders in Belgium are at increased risk of somatic pathologies such as hypertension, diabetes, chronic obstructive pulmonary disease, and transmissible diseases such as hepatitis B and C. Life expectancy is reduced by 15 to 20 years, mainly due to premature death from cardiovascular disease. These people experience difficulties in accessing quality somatic care, partly because of the overriding focus on mental disorders and persistent stigmatization. In addition, there is a persistent lack of integration and continuity between mental health care and primary care. People admitted to the hospital suffer from a lack of outpatient follow-up after discharge, and people suffering from MD in the community have difficulty accessing appropriate mental health care. Finally, in the Sint-Truiden region, the historical presence of Asster, a major psychiatric institution, has led to the settlement in the community of a large population of people suffering from mental vulnerability. Asster therefore joined forces with a local primary care practice and decided to develop an innovative initiative, the "Halmaal Home" (HH).

Methods

HH is guided by a steering committee made up of several stakeholders, such as representatives of all the mental health care organizations in the region, primary care organizations, the chief executive and medical director of the psychiatric hospital, and representatives of the local council and patient organizations. The initiative is recognized and financially supported by the Flemish government. Finally, the initiative is being supported by a consultancy agency in the development of its mission, vision, and action plan.

Results
The initiative is currently under construction and should start in April 2024. We want to focus particularly - but not exclusively - on people with severe long-term mental vulnerability. As such, we aim to position HH as an 'intermediary' point of care between the psychiatric hospital and the outpatient primary care environment, to strengthen and facilitate mutual collaboration. The interdisciplinary care team will comprise street nurses, practice nurses, physiotherapists, general practitioners, primary care psychologists, psychiatrists, and social workers. The street nurses will actively seek out homeless people in need of care. HH will also act as a 'hub' for referrals to other health and social care providers. Our service to primary care providers (GPs, nurses,...) will consist of advising on how to treat people with (severe) mental health problems and, if necessary, facilitating direct communication with and access to specialist mental health care. Our service to social and municipal services will involve facilitating communication with specialist mental health care and the timely provision of care appropriate to the situation and its urgency. Finally, we will also organize preventive activities on topics such as smoking cessation, healthy eating, and mindfulness. HH will also work closely with the neighborhood through initiatives such as neighborhood solidarity and quartering.

This oral paper will present a community-based transformative case study from the Cambridge North Dumfries Ontario Health Team (CND OHT), focusing on the transparent and collaborative approach to collecting and disseminating measures of progress, results and impact, and the benefits of this approach in a maturing locally-driven integrated care system. The CND OHT Community Mental Health and Addictions Clinic moved from co-design idea to doors open, in just three months. Over the course of the two-month pilot, 123 clients were served via 451 appointments, including virtual follow-up visits. This resulted in 23 emergency department diversions, redirecting appropriate mental health and addictions visits from the hospital. Of the 123 clients, 50% indicated that if the clinic did not exist, they would have gone to the emergency room, and 94% of clients felt that their immediate needs were adequately addressed by the clinic. Much of the success of the initiative was attributed to transparent and collaborative processes, rapid implementation, and the crucial involvement of patients and community members. Importantly, transparency extended beyond implementation, with detailed evaluation results and user-friendly infographics accessible on the Health Team's website, effectively communicating both the challenges and benefits of the program to the public. This commitment to openness not only facilitated a thorough understanding of the project's results and impact but also served as a valuable model for broader population health management initiatives. Attendees of this presentation will gain insights into the rationale behind transparent planning and evaluation, and will hear how this transparency can build trust and engagement in integrated care planning.

Background: The Canadian healthcare system tends to focus on older adults’ physical needs, which leads to missed opportunities for integrated mental health support, care and treatment. Health and social care providers who work in community settings develop trusting therapeutic relationships with their clients, often in home environments—providing many insights into personal circumstances. These providers are well-positioned to talk about mental health with their clients, but these conversations are often avoided due to lack of evidence-based resources and training to support skill-building, confidence, and relevant referral knowledge.

Aims: The overall aim of this study is to co-design and test an evidence-based approach to mental health conversations between providers, older adults, and family caregivers at the point-of-care in home and community settings across Canada. The objective for Phase 1 (presented at ICIC 2023) was to identify and adapt an evidence-based model describing mental health along a continuum. The objective for Phase 2 (focus for ICIC 2024) was to co-design point-of-care conversations rooted in the model from Phase 1. In Phase 3, the objective is to integrate the conversations into existing community care practices and test for feasibility.

Methods: Our pan-Canadian research team including a working group of experts-by-experience (n=30) is conducting a 3-phase participatory, mixed-methods study over three years. Phase 1 involved four online workshops (n=59) and surveys (n=1069) with aging Canadians to adapt an existing Mental Health Continuum model. Phase 2 involved 7 co-design workshops with home and community care providers (n=84) in rural and urban communities across Ontario, British Columbia and Nova Scotia. Through interactive ‘gamestorming’ activities, participants co-created resources, tools, education and training needed to facilitate mental health conversations at the point-of-care. Workshop artefacts and transcripts were analyzed using framework analysis. Phase 3 involves pilot and feasibility testing of the co-designed conversations from phase 2.

Results: An adapted model called the Mental Health Continuum for Aging Canadians (MHCAC) resulted from Phase 1. Phase 2 results include: 1) A conversation map to guide decisions to support tailoring of mental health conversations to an older adults’ unique circumstances (e.g., family caregiver presence; length of time on service; involvement of other providers); 2) A MHCAC toolkit including design blueprints for physical (e.g., magnets, pamphlets), digital (e.g., videos, podcast) and allegorical (e.g., living plants representing client well-being) formats; and 3) An implementation framework identifying foundational elements consistent across workshops (e.g., in-service training on MHCAC for providers) and variations by geography (e.g., paper-based preferences for rural sites, climate concerns for coastal provinces). Phase 3 findings are forthcoming and will be a focus for ICIC 2025.

Learnings: Engaging experts-by-experience in co-designing applied care solutions is essential to producing knowledge that fits the real-world context. A multidimensional strategy rooted in consistent evidence, but with room for flexibility in approach, is necessary to enable mental health conversations at the point-of-care that will meet and respond to the diverse needs and circumstances of Canada’s aging population.

Next Steps: Phase 3 is underway and will be ongoing through 2024 with 15 collaborating community organizations across Canada.

Background: Addressing suicidal behaviors (i.e., ideation or thoughts, planning, or attempt) among youth is increasingly complex and often requires a comprehensive and integrated approach to care. Integrated youth services (IYS) are a growing model of care in which youth can access a range of non-stigmatizing health and social services all delivered within a single location. In British Columbia (BC), Foundry is one of the largest IYS networks in Canada. To date, little is known about the demographics and help-seeking behaviors among youth experiencing suicidal behaviors in IYS. In this study, we examine service patterns and characteristics of youth reporting suicide ideation to better understand and address their IYS care needs.

Methods: We used cross-sectional data from Foundry from May 2018 to January 2023, which includes linked demographic, health, and physician-reported survey data aggregated from 13 IYS centres across BC. Survey data is collected during an initial visit to Foundry. Descriptive statistics and bivariate analyses by various demographics, geographic, and service use variables were compared by youth who reported having suicide ideation (SI) within the ‘past month’ of their visit as compared to youth who reported ‘never’ having SI. Standardized differences (SD) were calculated to determine statistical significance between groups. We examined the proportion of youth reporting SI coming to Foundry by month over the study period. We also examined these trends by certain subpopulations such as gender, sexual identity, race, and age group.

Results: A total of 8,347 individuals were included in the study. Of this sample, a total of 6,021 (72%) had reported any lifetime SI. A total of 2,975 (36%) individuals reported having SI in ‘the past month’. We found that youth experiencing SI were more likely to be gender diverse (13% with SI vs. 4% without SI), identified as sexual minorities (45% vs. 22%), Indigenous (11% vs. 8%), insecure housing (8% vs. 4%), and reported as having ‘not always lived with their parents’ (42% vs. 30%) as compared to youth who never had SI. On average, youth reporting SI in the past month had more contact with Foundry services than those without SI (9.1 vs. 5.5 visits), and had accessed other mental health services in the last year (43% vs. 21%). Youth with SI in the past month also had higher distress scores (as measured by the Kessler Psychological Distress score), with 77% having a score over 30 (i.e., ‘likely to have a severe mental health disorder’). We found no substantial change in the overall proportion of youth reporting suicide ideation over the study period, but trends by subpopulations revealed slight increases in the proportion of ‘past month’ suicide ideation among girls and visible minority groups in the last 1-2 few years.

Discussion: Many youth seeking IYS services reported having suicide ideation (or thoughts), particularly within the past month of the visit, indicating a major opportunity for low-barrier, early intervention. Our findings characterize those who may be disproportionately impacted and their current help-seeking behaviors within IYS to identify service gaps and needs for targeted intervention.

Introduction:
While issues concerning mental health are of great importance, they often overshadow physical problems faced by people with mental ill-health. Cancer is one of the most common causes of death among this population.
Target audience
The CO-CAPTAIN project presents valuable insights for policymakers, professionals, and academics invested in understanding integrated cancer care.
Involvement of Stakeholders in the Project:
Active participation of various stakeholders will define the CO-CAPTAIN project in the first phase of the project. In this first phase, a qualitative study design has been conducted interviewing key stakeholders to identify cancer care inequalities and barriers but also points to be strengthened, guide the co-design sessions of the features of model for primary cancer prevention.
Intervention:
The CO-CAPTAIN project aims to outline a sound knowledge translation strategy to prevent cancer for individuals with mental ill-health by implementing and upscaling navigation services to overcome cancer care inequalities and deliver cost-effective primary cancer prevention for individuals with mental ill-health conditions.
Results:
The qualitative interviews will help analysing the specific health needs and the barriers for accessing and benefit from cancer primary prevention services and programs for individuals with mental at system, provider, and individual levels. Results from the interviews are being analysed with qualitative analysis methodologies and the results of the co-design will be anticipated by April 2024.
Lessons Learned for the International Audience:
CO-CAPTAIN addresses the strengthening coordination and continuity of care adopting tailored cancer prevention strategies in mental health services, to overcome potential barriers that prevent individuals with mental ill-health from finding the most appropriated care, as a crucial step for delivering high-quality preventive cancer care services. It addresses unique challenges across diverse local contexts, offering valuable lessons for an international audience grappling with similar issues with fragmented care systems and groups with complex needs.
Next Steps:
After co-adapting the features of the patient navigator for cancer prevention tailored to the specific needs of individuals with mental ill-health and identify implementation strategies for the local communities in the 4 pilot sites, CO-CAPTAIN will conduct a pilot implementation of the intervention for cancer prevention in Austria, Greece, Poland, and Spain.