'Get it done': Manitoba should adopt Ontario mental health model focused on peer support, advocate says

Bonnie Bricker says researchers in Ontario have already designed a blueprint Manitoba could follow to support psychiatric patients after they leave the hospital.

Transitional discharge model focuses on connections in vulnerable period after patients leave hospital

Robyn Priest runs Live Your Truth, a Winnipeg-based company dedicated to helping create a network of mental health peer support workers. (Aidan Geary/CBC)

When Robyn Priest felt ready to give up, it was the quiet support of others who had once felt the same way that most helped her healing.

"It just gives you some hope that there's a way through it," Priest said.

"It really was being able to talk to someone who had been there … who had experienced that kind of feeling, that lack of hope, and they had got through it and [were] living their lives."

It's been 10 years since Priest last attempted suicide. Since then, the Winnipegger has created her own business, Robyn Priest: Live Your Truth, to help others living with mental illness.

Although some days are still tougher than others, Priest said she's in a better place with her mental health now.

The support that helped Priest rebuild is what mental health advocate Bonnie Bricker says she wants to see embraced in Manitoba hospitals, including in the vulnerable days after patients leave following psychiatric discharge.

Bonnie Bricker wonders what the transitional discharge model, piloted in Ontario, might have done for her son Reid. (Erin Brohman/CBC)

And, she says, there's already a blueprint for how to do it: the transitional discharge model, a two-pronged approach to discharge planning that was piloted in hospitals across Ontario in 2013. Bricker wants to see it introduced in Manitoba, too.

Her son Reid died by suicide in October 2015, at age 33, shortly after being released from the hospital where he went for help.

"Manitoba doesn't need to reinvent the wheel," Bricker said.

"[Lawmakers have] got all the information that you could possibly need. Just push 'go.' Get it done."

'A safety net of relationships'

In Winnipeg, people in mental health crises can access professional, compassionate care 24 hours a day, seven days a week at the Crisis Response Centre at 817 Bannatyne Ave. or by calling the mobile crisis service at 204-940-1781.

The transitional discharge model was developed in Ontario, in part by Dr. Cheryl Forchuk. She is the Beryl and Richard Ivey Research Chair in mental health, a distinguished professor at Western University's Arthur Labatt Family School of Nursing, and assistant director at Lawson Health Research Institute in London, Ont.

The model, which has been piloted in Ontario and the U.K., involves a two-pronged approach for how to discharge mental health patients from the hospital, Forchuk said.

Its focus is on peer support and continued connections with the health-care workers who provided in-patient care.

"If you think about it, most of us heal in relationships, and when there's a disruption of relationships, there's a disruption in care," Forchuk said in an interview on CBC Radio's Up To Speed.

"Over and over again, we hear clients refer to this approach as being a safety net of relationships — that they feel safer going out and knowing that they've got people that they can call upon."

The weeks after someone with a mental illness is discharged from psychiatric care are a vulnerable time, Forchuk said.

A 2009 study published in the U.K.-based peer-reviewed journal Psychological Medicine followed 238 psychiatric patients who died by suicide. It found that 43 per cent of suicides occurred in the first month following discharge, and 47 per cent before the patient's first follow-up appointment.

Research has found 90 per cent of individuals who die by suicide have a mental or substance use disorder. However, the vast majority (95 per cent) of people who live with mental illness or addiction do not die by suicide.

In the transitional discharge model, hospital staff continue to work with discharged psychiatric patients until they've built up trust with a community-based care provider. If the patient doesn't have one, the hospital clinician goes to in-person meetings between the new provider and the patient.

If the patient does have a community-based care provider, that person comes into the hospital before the patient is discharged to help plan.

At the same time, patients are matched with a peer-support worker with common interests, usually tracked down through local mental health groups, she said. The two can stay connected however they want, Forchuk added — oftentimes, it's trips to get coffee or meetups at the gym.

"It's the idea of both a professional relationship and a friend to help over that transition period," she said.

'Your life matters'

The model has been used in various centres around the world since the early 1990s, and was most recently piloted in nine Ontario hospitals from 2013 to 2015 through a grant from Health Quality Ontario, the province's health quality watchdog.

Priest said she'd "1,000 per cent" support the introduction of the model or something like it in Manitoba, and her business would be happy to help organize peer-support workers.

"It's kind of like giving back, to be able to support other people who are still trying to work their way through how to be able to live a great life, even knowing they might have a diagnosis," she said.

Bonnie Bricker said she wonders what something like the transitional discharge model could have done for her son.

"[People] need to be in a caring atmosphere that says, 'Your life matters. Whether you live or die matters to us. We want to give you hope,'" she said. 

"What message do we send when we don't do that?"

If you're experiencing suicidal thoughts or having a mental health crisis, there is help out there. Contact the Manitoba Suicide Line toll-free at 1-877-435-7170 (1-877-HELP170) or the Kids Help Phone at 1-800-688-6868.

With files from Kim Kaschor, Ismaila Alfa and CBC Manitoba's Up To Speed