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Aideen Carroll and Lisa Crawle
Aideen Carroll, (L), Nurse Educator at UHN’s Centre for Mental Health, and Lisa Crawley, Nurse Manager for UHN’s Inpatient Psychiatry Unit. (Photo: UHN)

For years, mental and physical health were treated separately.

For patients in the Inpatient Psychiatry Unit at Toronto General Hospital (TG), that meant having to move to another unit if they had a physical health condition needing attention.

But that's changing. For the past couple years, TG's Inpatient Psychiatry Unit has been working on integrating mental and physical health, achieving some inspiring results that offer a snapshot of what the future of mental health care could look like.

"Historically, we would only treat the mind, but patients don't leave their other organs in the elevator when they come here," says Aideen Carroll, Nurse Educator at UHN's Centre for Mental Health.

"We need to treat the whole person."

Aideen says the nursing staff in the Inpatient Psychiatry Unit realized patients needed physical interventions and care for the mind and body, as many of the patients have multiple conditions. 

About a decade ago, the Canadian Institute for Health Information found that Canadians reporting symptoms of depression also reported experiencing three times as many chronic physical conditions as the general population. 

Ultimately, Aideen says, the nursing team has learned the right patient needs to be at the right place at the right time.  

In December 2018, UHN's Strategic Plan – "A Healthier World" – was released. One of its priorities speaks volumes to some of the goals UHN's Centre for Mental Health (CMH) is working on: to "lead the integration of physical and mental health to establish new standards of care, as health and well-being require both."

The Inpatient Psychiatry Unit has been working on this integration by skilling up the nurses, who now routinely complete IV's, blood work, blood transfusions, telemetry (the equipment used to track a patient's heart rate, blood pressure, breathing and other vitals), complicated wound dressings, and more, based on the patient's needs. This provides more integrated healthcare for patients within the unit.

"If someone is in hospital for treatment for schizophrenia and also requires telemetry, we can now provide telemetry without having to relocate the patient for the test and bring them back to the unit," Aideen says.  

Other hospitals are taking note

Within the past year, staff from the Centre for Addiction and Mental Health (CAMH), St. Michael's Hospital and Lakeridge Health have visited UHN's Inpatient Psychiatry Unit to learn best practices in integrated care, as patient demand for this type of care increases across the system. 

Lisa Crawley, Nurse Manager for the Inpatient Psychiatry Unit, says this change towards integrated care has evolved slowly as patient needs became more obvious and staff education and equipment were added to support it.

Some challenges remain

Despite the interest from other hospitals, Lisa says there are still areas for improvement that would make this change more efficient and seamless.

"Do you have a budget to bring in the equipment that you would now use?" Aideen says.  "Are your staffing levels able to manage with these more complex patients that are going to come in."

Moving forward

Change requires a team effort, she says, adding that a first step is addressing barriers to providing excellent patient care.

"I think it's also about addressing our own stigma," Aideen says. "I remember for years I would always hear you can't have an IV pole in an inpatient psychiatric unit because it's a potential weapon, but it may not be. 

"Instead, we now ask: 'What does that individual patient need?'"

Lisa says UHN is on the threshold of a huge cultural shift in seamlessly blending physical and mental health, while simultaneously identifying and breaking down the barriers between them. 

"No more are psychiatric patients going to be seen as being locked away in a unit somewhere; they're going to a hospital for treatment of an illness," Aideen says. "And maybe this will help with stigma as well, because it's about crushing those barriers.

"These are illnesses like any other."​

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