“Bell Let’s Talk” day brings the issue of mental health and wellness to the forefront of our minds. And one of the many important community outreach programs that is helping to address this issue as it relates to addiction is the Inner City Health and Wellness Program at the Royal Alexandra Hospital in Edmonton. This program uses an innovative approach for dealing with substance use issues along with the mental health and social factors that accompany them.
Since its launch in summer 2014, the number of patients served has increased ever year. Over the past year, approximately 1,000 unique patients from a variety of socio-economic backgrounds received services through the program’s Addiction Recovery and Community Health (ARCH) Team. Although it offers a range of interventions tailored to each individual’s needs, the program’s primary focus is providing excellence in addiction medicine and treatment.
Along with her team, Dr. Kathryn Dong, who is the program’s director, recognizes that substance use issues can often overshadow other, non-emergent health needs. Therefore, the program offers a full spectrum of services to patients, including in-hospital or out-of-hospital support, income support, housing, as well as identification (through a partnership with the AHS ID program).
Moving away from a traditional acute care model
Surprisingly, there aren’t many major hospitals currently offering specialist addiction services. “The acute care model has been traditionally focused on the management of an individual’s acute illness or complications, like treatment for pneumonia. In contrast, we now also start treatment for the long-term management of an individual’s substance use disorder, for example to help patients abstain from alcohol use which likely contributed to them getting pneumonia in the first place.” says Dr. Dong.
Dr. Dong also notes that another reason for this care model is that hospitals traditionally attempt to handle this issue by using an abstinence-based philosophy. There’s an expectation that patients are going to stop drinking or doing drugs once they’re admitted, but Dr. Dong says that’s not realistic. In the past, they’ve found that not properly managing this situation has led to a lot a conflict, with the end result being that patients leave the hospital without receiving the treatment they need. This is part of what Dr. Dong and her team are hoping to address through the Inner City Health and Wellness Program.
She also considers their program’s approach to be unique because of its focus on the social determinants of health. “We’ve decided to embrace all of that and understand that we are not going to get the outcomes we want around substance use if we don’t deal with the fact that an individual is homeless and has no legal source of income."
"We ask our patients how we can do better and listen to how we can improve,” says Dr. Dong. “We help to stabilize their social determinants of health and also offer key health promotion interventions that they may not have been able to access in a community setting.”
Looking through a harm reduction lens
Dr. Dong emphasizes the importance of harm reduction, one example of which involves providing clean supplies for patients still injecting drugs. Through taking this approach, it enables hospital staff to educate patients on how to manage their addiction-related behaviour while prioritizing keeping themselves — and their environment — safe. Safer management of addiction also means they can still receive treatment for their other health issues.
“There’s a huge amount of evidence behind harm reduction that has not been traditionally implemented in acute care settings,” says Dr. Dong. “Prior to ARCH starting, we were in this paradoxical place where hospitals were full of clean supplies and needles yet patients were sharing needles and using drugs in a very unsafe manner, despite the evidence of harm reduction in medical literature.”
Part of this approach will involve implementing a supervised consumption service set to open in spring of 2018. The goal is to keep patients safe while helping them stabilize and receive treatment.
The connection between mental health and addiction issues
When it comes to mental health and addiction issues, there is significant overlap. Dr. Dong says there are times when they’ll refer patients to psychiatrists and work closely with them to offer treatment and shared care. Severe substance use remains their priority, but they try to deal with mental health and addiction in parallel instead of sequentially. Dr. Dong contends that they need to look at both holistically in order to understand the full picture of a patient’s situation.
When asked about the long-term plans for the program, Dr. Dong is optimistic for its continued success. “We have transitioned to permanent AHS funding for our core team, and we are getting additional money from the Minister’s Opioid Emergency Response Commission.” She also says they’ll be doubling the size of their team in response to the escalation of opioid use in the province.
Proud to be a supporter
CWB helped fund the program during its creation, and continues to donate to the cause today. We are very proud to be helping Dr. Dong and her team address Alberta’s issues of mental health and its relation to substance use.