Innovation Through Virtualization: Crisis Mental Health Care during Covid-19

Hensel, Jennifer; Bolton, James M.; Svenne, Danielle Carignan; Ulrich, Lori

doi:10.7870/cjcmh-2020-014

Cited by 7 publications

(4 citation statements)

References 5 publications

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“…Personal videoconferencing is now emerg ing as a viable modality of direct care de livery, removing the need for a traditional telehealth suite and allowing assessments to take place with individuals remaining in their homes or other accessible settings. As a result, some centres are innovating and pushing the usual boundaries for cri sis care delivery 175 , and virtual hospitalat home models may become a significant format for acute care in the future 176 .…”

Section: Remote Acute Care Deliverymentioning

confidence: 99%

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

et al. 2022

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Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with people in crisis. Evidence on best approaches to initial assessment and immediate management is particularly lacking, but some innovative models involving extended assessment, brief interventions, and diversifying settings and strategies for providing support are potentially helpful. Acute wards continue to be central in the intensive treatment phase following a crisis, but new approaches need to be developed, evaluated and implemented to reducing coercion, addressing trauma, diversifying treatments and the inpatient workforce, and making decision‐making and care collaborative. Intensive home treatment services, acute day units, and community crisis services have supporting evidence in diverting some service users from hospital admission: a greater understanding of how best to implement them in a wide range of contexts and what works best for which service users would be valuable. Approaches to crisis management in the voluntary sector are more flexible and informal: such services have potential to complement and provide valuable learning for statutory sector services, especially for groups who tend to be underserved or disengaged. Such approaches often involve staff with personal experience of mental health crises, who have important potential roles in improving quality of acute care across sectors. Large gaps exist in many low‐ and middle‐income countries, fuelled by poor access to quality mental health care. Responses need to build on a foundation of existing community responses and contextually relevant evidence. The necessity of moving outside formal systems in low‐resource settings may lead to wider learning from locally embedded strategies.

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Section: Remote Acute Care Deliverymentioning

confidence: 99%

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

et al. 2022

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“…As the COVID-19 pandemic unfolded, the CRC adapted its processes in order to provide the option of virtual crisis assessment services [ 18 ]. The walk-in facility remained open to ensure equitable population access, and the crisis line continued to operate in its usual capacity for brief support calls.…”

Section: Methodsmentioning

confidence: 99%

“…To adapt to the pandemic, the Crisis Response Centre (CRC) in Winnipeg, Canada rapidly virtualized the full spectrum of crisis services to keep individuals at home whenever possible [ 18 ]. This included conducting comprehensive mental health assessments (MHAs) virtually in a non-scheduled clinical setting for high acuity mental health presentations.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the uptake and associated factors for virtual crisis care during the pandemic at a 24-h mental health crisis centre in Manitoba, Canada

et al. 2022

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Background The coronavirus pandemic necessitated the rapid transition to virtual care. At a 24-h walk-in mental health Crisis Response Centre (CRC) in Winnipeg, Canada we adapted crisis mental health assessments to be offered virtually while the crisis centre also remained open to in person visits. Little is known about the sustainability of virtual visits in the presence of comparable in person care, and which visits are more likely to be done virtually, particularly in the crisis setting. Methods An analysis of visits to the CRC from the first local lockdown on March 19, 2020 through the third local wave with heightened public health restrictions in June 2021. Analysis of Variance was used to compare the proportion of visits occurring virtually (telephone or videoconference) during the first wave of heightened public health restrictions (lockdown 1) and subsequent lockdowns as well as the in-between periods. A binary logistic regression examined visit, sociodemographic and clinical factors associated with receipt of a virtual visit compared to an in person visit over the first year of the pandemic. Results Out of 5,357 visits, 993 (18.5%) occurred virtually. There was a significant difference in proportion of virtual visits across the pandemic time periods (F(4, 62) = 8.56, p < .001). The proportion of visits occurring virtually was highest during lockdown 1 (mean 32.6% by week), with no differences between the other time periods. Receipt of a virtual visit was significantly associated with daytime weekday visits, age, non-male gender, living further away from the CRC, no prior year contact with the CRC, and visits that did not feature suicidal behaviour, substance use, psychosis or cognitive impairment. Conclusions A large proportion of virtual care occurring at the outset of the pandemic reflects public anxiety and care avoidance paired with health system rapid transformation. The use of virtual visits reduced over subsequent pandemic periods but was sustained at a meaningful level. Specific visit, sociodemographic and clinical characteristics are more likely to be present in visits occurring virtually compared to those in person. These results can help to inform the future planning and delivery of virtual crisis care.

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“…In response to the decreased accessibility of in-person mental health services during the COVID-19 pandemic, Crisis Response Services in Winnipeg, Manitoba rapidly virtualized the delivery of a full spectrum of crisis care to individuals requiring urgent mental health services ( 10 ). Crisis Response Services is comprised of a 24/7 walk-in stepped care mental health crisis centre [the Crisis Response Centre (CRC); akin to a mental health-specific emergency department], a follow-up post-crisis care program, and the Crisis Stabilization Unit (CSU).…”

Section: Introductionmentioning

confidence: 99%

Providing crisis care in a pandemic: a virtual based crisis stabilization unit

Clavio¹

2023

Front. Health Serv.

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BackgroundWinnipeg, Canada operates a 16-bed subacute unit, the Crisis Stabilization Unit (CSU), for voluntary patients in crisis not requiring hospital admission. The virtual CSU (vCSU) launched in March 2020 as an adjunct to the in-person CSU during the COVID-19 pandemic, providing the same resources virtually, allowing patients to remain at home.MethodsProgram data were collected for vCSU admissions between April 1, 2020 and April 7, 2021 (n = 266) to examine patient characteristics and discharge outcomes. Data were retrieved from the electronic patient record (EPR) for both in-person and vCSU admissions during the same period for comparison (n = 712). vCSU admissions (n = 191) were summarized by patient demographics, clinical factors/outcomes, and compared on the same measures to in-person CSU admissions (n = 521) using binary logistic regression.Results30.1% of patients admitted to the vCSU received initial mental health assessment virtually (phone/videoconference), therefore receiving all care at home. Clinical symptoms at assessment included depression/anxiety (39.0%), psychosis/mania (2.7%), suicidal behaviour/self-harm (27.4%), psychosocial event/stressor (19.8%). Average stay was 4.9 days. Compared to the in-person CSU, vCSU referrals were associated with the absence of psychosis [odds ratio (OR).40, 95% confidence interval (CI).18–0.89] and no prior 1-year contact with referral site (OR.43, 95% CI.28–0.64). Those living farther away from the referral site were more likely to receive a vCSU referral.ConclusionThe vCSU model is feasible for a diverse group of patients experiencing mental health crises. Future work is needed to better determine who the model is right for and examine longer term outcomes.

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Innovation Through Virtualization: Crisis Mental Health Care during Covid-19

Cited by 7 publications

References 5 publications

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

Analysis of the uptake and associated factors for virtual crisis care during the pandemic at a 24-h mental health crisis centre in Manitoba, Canada

Providing crisis care in a pandemic: a virtual based crisis stabilization unit

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