TANGOS, COMPLEXITY AND KIERKEGAARD

– THE JOURNEY OF COLLABORATION

Nick Kates, MB.BS, FRCPC MCFP (hon) Professor

and Chair,

Dept. of Psychiatry and Behavioural Neurosciences

McMaster University

QI Advisor Hamilton Family Health Team

On any

journey its

important

to get off

to the

right start

Raising a cake is easier than

flying a child to the moon

The Tango as a metaphor for collaboration???

Maybe a better metaphor for the

relationship between CMHC and

issues all health care systems

face

Søren Kierkegaard

I see it all perfectly;

there are two possible

situations – one can

either do this or that.

My honest opinion and

my friendly advice is

this: do it or do not do

it – you will regret

both”

Life can only be understood backwards;

but it must be lived forwards

“More than at any

other time in history,

humankind faces a

crossroads. One path

leads to despair and

utter hopelessness, the

other to total extinction.

Let us pray we have

the wisdom to choose

correctly.”

Woody Allen

So I hope to…

Look backwards to understand where we’ve been

Look forward to the journey ahead

Integrate some of the themes of the last two days

Some themes from the Conference

Partnerships with consumers

Collaboration with community partners

Access and equity

Equity

Youth and transitions

Early detection

Trauma

Novel approaches to skill enhancement

Addictions, or the relative lack thereof

Innovative treatments within primary care

How to colour co-ordinate jelly beans

Understanding it

backwards – the

journey so far

Life can only be understood backwards;

but it must be lived forwards

Collaborative MH Care is now Being accepted as an integral part of practice

Being included in provincial / RHA planning

Producing increasing evidence

Expected by consumers

Consistent with many aspects of health system reform

Facing increasing expectations

Better Collaboration can enable us to:

Improve communication

Provide mutual support

Coordinate care plans

Share responsibility

Solve problems together

Share information / resources / expertise

Use resources more effectively

Evaluate and plan services more comprehensively

Model effective behaviours for learners

Benefits for Individuals Symptom Improvement

Functional Improvement

Reduced Disability Days

Increased Workplace Tenure

Increased Quality-Adjusted Life Years

Increased Compliance with Medication

People like being seen in primary care

More accessible

Less stigmatising

Benefits for the system Improves access – especially for underserved

populations

Can eliminate barriers

Improves communication

Increases co-ordination and

continuity of care

Decreases fragmentation of care

Enhances the experience for the consumer and the

provider

An increasing number and variety

of successful projects

Projects aimed at different populations Children

Homeless

Seniors

SPMI

First nations communities

Individuals with substance abuse problems

Other settings Canadian Forces

Student health

Workplace

Shelters

Physical health care of the mentally ill

CPA and CFPC

Established a unique working partnership – modelled collaboration

Increasingly involved in each others activities

Collaborative Forums

Working group

Website

Conference

ANNUAL CONFERENCE

Rogers Diffusion of

Innovation Theory

The Tipping Point

The Tipping Point

The 2011 Position Paper

There had been changes in the world around us since 1977

Changes

From proving it works to exploring its potential

From physicians / physician to broad partnerships

From doing for consumers to doing with consumers

From quantity of care to quality of care

From setting up models to building capacity

GOALS OF COLLABORATIVE PROJECTS

Improve

outcomes

Increase

capacity

Enhance the provider

experience

Improve

access

Enhance the

person’s experience

GOALS OF

COLLABORATION

Ways of working together

• Things that any mental health service can do

• Increasing the skills / training of primary care providers (and mental health workers)

• Visits to primary care

• Integration of mental health services in primary care - and primary care services in mental health services

7 Strategic Directions

Define and support the role of primary care within the

mental health system

Build the capacity of primary care to deliver effective

mental health care (primary mental health care)

Introduce system changes to support collaboration

Demonstrate relevance to problems health systems face

Emphasise quality as a driver of change

Increase and spread new knowledge

Increase the skills of future providers

IHI’s Triple Aim

Better health for populations (better health)

Better experience of seeking / receiving (providing) care (better care)

Sustainable and cost efficient

(better value)

And all at the same time

The position paper can be

seen as a bridge between

where we’ve been and

where we could be heading

Even if it sometimes feels

like we’re trying to cross

that bridge while its still

under construction

The 2011 Position Paper

Living it

forwards –

where should

we be going

Life can only be understood backwards;

but it must be lived forwards

TRANSITIONS

Across the system

Child to adult

Between services

(TRAM)

Emergency to ?

Primary care is often

the only constant

Ensure they are active

partners

Develop clear care

plans – give a copy to

the person

EARLY DETECTION AND

INTERVENTION Primary care key

Benefits from support with

Detection

Diagnosis

Monitoring

System navigation

Early intervention

Relapse prevention

Trauma (ACEs)

Across the age span

Adapting models for

different populations

INCREASING THE CAPACITY -

PRIMARY MENTAL HEALTH CARE New skills

New approaches to care

Self-management support

Primary Mental Health

Care is not just Mental

Health Care in a Primary

Care Setting

INCREASING THE CAPACITY - PRIMARY

MENTAL HEALTH CARE

Mental health providers

need to be able to

unbundle their skills and

tools and repackage

them / adapt them to a

different setting

And be well prepared to

work in primary care

CONSUMER PARTNERSHIPS

As partners in

their own care

Re-designing

services based on

a person or

family’s

experience

PARTNERS IN YOUR OWN CARE

New relationship

Support self-

management

Peer support

There’s always a plan

Preparing for a visit

EXPERIENCED-BASED DESIGN

Person- centred care

Learn from the

person’s experience

Listen and be willing to

change accordingly

Consistent theme in this

conference

MANAGING COMPLEX

CONDITIONS

Integrate physical and

emotional care

Decrease ED visits

Self Management Support

Address co-morbidities

What Makes People Healthy / Unhealthy? Estimated Impact of Determinants of

Health on the Health Status of the Population

Social and Economic

Environment

50%

Physical

Environment

10%

Biology and Genetic

Endowment

15% Health Care System

25%

COMMUNITY PARTNERSHIPS

New partnerships

Integrating community

services within primary

care settings

Community projects

Assist with system

navigation

EXPLORE THE USE OF NEW

TECHNOLOGIES Email

Telephone backup

Skype

Tele-psychiatry

Social media

Text

Web-based therapy

Web sites

Hamilton

Tiger Cats

win the

2014 Grey

Cup?

IHI’s Triple Aim

Better health for populations (better health)

Better experience of seeking / receiving (providing) care (better care)

Sustainable and cost efficient

(better value)

And all at the same time

End of the first phase of ……