Innovation Through Collaboration. The Forensic Transitional Rehabilitation Housing Program

Transcription

1 Innovation Through Collaboration The Forensic Transitional Rehabilitation Housing Program November 2013 Paul Secord CMHA Durham Rob Adams - DMHS Mark Rice Ontario Shores

2 Where TRHP began Ministry of Health funded initiative Provincial Program with a local focus Development of partnerships with community service providers: Canadian Mental Health Association Durham Durham Mental Health Services

3 Fundamental Principles Support the community reintegration of forensic patients that require increased transitional support Involvement of community mental health agencies Partnerships required Forensic programs to provide resources and support Maintain flow through to longer term housing supports

4 How it Evolved Development of local housing and community support models Development of service agreements between hospital and community agency Integration of services > Ontario Shores to provide on-going resources and supports to the community

5 Our Experience Two distinct TRHP models with CMHA and DMHS Needed to meet the needs of our complex and difficult to discharge patients High Support co-operative living housing model High Support Independent living model

6 Flow Through Clients must move from TRHP to longer term housing options within months CMHA preferred access to rent supplement units DMHS preferred access to a variety of supportive housing (high/medium/low)

7 Target population Complex diagnostic profile = specialized resources required to meet all client needs Previous unsuccessful community placements Long stay hospitalizations and/or several hospitalizations Index offences that create barriers to community placement with traditional services

8 Index Offence Profile

9 Number of Patients Unsuccessful Community Placements Number of Placement Attempts

10 Number of Patients Hospital Length of Stay TRHP Residents Years in Hospital

11 Working Together

12 TRHP High Support House

13 TRHP Apartment

14 Strengths Integration with Forensic Outpatient Services and community agencies Intensity of service can be varied easily Focused use of Forensic Transitional Case Manager (FTCM) pre-engagement on inpatient unit Seamless readmission of patients when required

15 Strengths Increased flow within Forensic program = Forensic Assessment Bed capacity TRHP Provincial Community of Practice Flexibility to develop unique TRHP models with community partners Direct MOH access and support (accountability supplements)

16 Cost Comparison Bed cost per day Ontario Shores = $ CMHA unit = $87.00 DMHS residential bed = $208.00

17 Case Example - CMHA 26 year old male Index Offence: Assault with Weapon, Arson, Threaten Death Diagnosis: Schizophrenia, Paranoid Type Antisocial Personality Traits Polysubstance abuse LOS in Hospital (General Forensic Unit): 1 year LOS in TRHP (current): 18 months

18 Case Example - CMHA Numerous hospitalizations since 2006 History of medication non-compliance Decompensation is rapid when using substances Previous 2 community placements (2010 and 2011) were not successful Benefits from wrap around services to meet specific needs

19 Case Example - DMHS 28 year old female Index Offence: Assault x2 Diagnosis: Schizoaffective Disorder Substance Use LOS in hospital (General Forensic Unit): 4 years LOS in TRHP: 5 months

20 Case Example - DMHS Numerous hospitalizations since 2002 Non-compliance with treatment Treatment resistant with on-going positive residual symptoms Failed community placement in 2011 Requires prompting/monitoring and active engagement

21 Future Implications Lack of longer term housing options Bottlenecking within the system Residential zoning restrictions to create NCR supportive housing Need to create more specialized service models for specific populations (ie. Dual Diagnosis)

22 Questions?