Puzzle Pieces: Part 1

Tackling a complex issue can be like building a puzzle. Sometimes the first step is to find the pieces.

In my last blog, I introduced you to the Community of Interest (COI) for Racialized Populations and Mental Health and Addiction. Last year, the COI’s goal was to better understand how and why racialized communities in Ontario use the emergency department (ED) for mental health and addictions services. We also wanted to showcase promising and innovative practices that benefited racialized communities, service providers and the health system. To learn more about the COI and this work, please read my previous blog here: One Room, Many Voices, One Conversation.

We decided to focus on ED use because it is a priority issue for individuals, communities, service providers and policy makers. The ED is a critical access point to the mental health system for many marginalized communities, including racialized groups. At the same time, the province is developing strategies to reduce avoidable ED visits as they increase health system costs.

Our first challenge was to identify existing knowledge on the topic. To do this, we conducted a literature review; sector survey to identify promising practices across Ontario; consultations with service providers and people with experience of racialization and mental health issues; and a think tank event with keynote addresses, a speakers’ panel, and discussion groups.

Each step along the way, we added more pieces to the puzzle.

Although there isn’t much Canada-focused literature on this topic, we learned some interesting things.  First, many parts of our health system do not collect race-based data, which makes it challenging to know how different populations use the ED (and other health services).  That being said, research studies point to a relationship between marginalization and frequent or repeat ED visits[1].  In addition, some racialized groups are overrepresented in police- and paramedic-accompanied visits to the ED[2].

Our sector survey revealed a number of promising and innovative practices at the community-level including:

• Community and hospital collaborations increase access to primary care and mental health services and decrease ED visits for racialized populations[3]
• Peer support in the ED to improve the patient experience[4]
• Protocols used by different police services to improve mental health-related interactions[5]

In Part 2. I’ll explore what we learned from the consultations and the actual think tank event itself.

[1] http://eenet.ca/wp-content/uploads/2013/03/COI-Think-Tank-Backgrounder-March-2013.pdf

[2] Ibid

[3] http://eenet.ca/wp-content/uploads/2013/06/WHIWH-Promising-Practice_FINAL.pdf

[4] Frank Fournier. (2013) “Peer Support in the Emergency Department: Value, Challenges, Opportunities.”Allocution présentée le 26 mars 2013 à Toronto, Ontario, lors d’une séance de réflexion sur l’utilisation du service des urgences par les populations racialisées de l’Ontario en prise avec des problèmes de santé mentale et/ou de dépendances.

[5] http://www.hsjcc.on.ca/Resource%20Library/Policing/Ontario%20Police%20Emergency%20Department%20Protocols%20-%202013.pdf