AHE'S 'Ambition 2023' Plan Calls For Major Enhancements in Addictions & Mental Health Patient Care, Including new Day Hospital

It started in the spring of 2017 with a simple challenge from Dr. Verna Yiu, President and CEO of Alberta Health Services.

1 June 2018

It started in the spring of 2017 with a simple challenge from Dr. Verna Yiu, President and CEO of Alberta Health Services.

Her directive? Make Alberta Hospital Edmonton (AHE) more relevant and responsive to individuals and families in the Edmonton Zone who are grappling with complex addictions and mental health challenges.

"Dr. Yiu added one other thing," recalls Dr. P.J. (Patrick) White, AHE's Medical Director. "She said the status quo is not acceptable."

With their marching orders in hand, White and AHE's team of roughly 40 psychiatrists rolled up their sleeves and went to work.

"Our physicians held a retreat on the west side of the city. We looked at where we want Alberta Hospital to go and how can it can play a leading role in this Edmonton-wide Zone initiative," says White, a former Alberta Medical Association (AMA) President, former Canadian Psychiatry Association (CPA) President, and a past Chair of the University of Alberta's Department of Psychiatry.

"Dr. Daniel Li chaired the retreat. He did a hell of a great job and that's where many of our ideas first came about," he explains. "They have since germinated and changed a bit. But that was really the foundation for Ambition 2023, our strategy to create a wide and comprehensive template for addiction and mental health in the Edmonton Zone."

AHE's physicians subsequently drafted a strategic roadmap that they shared with Zone stakeholders during the summer and fall of 2017.

Working groups were formed and their preliminary work was shared with key officials at AHS and the Department of Psychiatry over the past few months, including Dr. Verna Yiu; Mark Snaterse, AHS Executive Director for Addiction and Mental Health, Edmonton Zone; Dr. Pierre Chue, AHS Clinical Department Head for Addictions and Mental Health, Edmonton Zone; and Dr. Xin-Min Li, Chair of the U of A's Department of Psychiatry. The feedback was extremely positive, says White.

"Our core strength at Alberta Hospital Edmonton is dealing with the chronically mentally ill, but Ambition 2023 is widening the template here, into the Zone and the broader community. This is an Edmonton-based Zone initiative, and we need everybody on board. We want other physicians to buy into the process," he says.

"We have explored many different treatment modules with one common focus - to better serve the needs of patients and their families. I've been here at Alberta Hospital since 1989, and this is the most excited I have ever been about what we're doing here."

A proposed Day Hospital that's expected to open its doors on the AHE site by November is the first of several tangible outcomes that will flow from Ambition 2023. Significant planning for additional services is also underway in a variety of other areas, including emotional dysregulation; early intervention with youth; PDD (People with Developmental Disabilities); concurrent disorders; neuropsychiatry, and neuromodulation.

Ambition 2023 is built around five "pillars" or key priorities, says White, including the following:

An Addiction & Mental Health Day Hospital on the AHE site. It will offer seven-day-a-week daytime programming for more acutely ill patients, offering an alternative to inpatient hospitalization and providing group and individualized support for an average term of three weeks. The new Day Hospital will also offer new Repetitive Transcranial Magnetic Stimulation (rTMS) technology.

Neuropsychiatry & Neuropsychology: Clinicians across the Zone are working to advance an initiative known as the Edmonton Neuro-Cognitive Disorders Enterprise (ENCoDE). Their goal is to address a major gap in diagnostic, treatment and monitoring services available to individuals with psychiatric disorders linked to cerebral pathology. In addition to neuro-cognitive testing, ENCoDE also aims to provide significant advances in therapeutic innovations.

Redefining Tertiary Care in Psychiatry: Physicians and staff in Tertiary Care have broadened the scope of Ambition 2023 to ensure that it revitalizes their rehabilitation services. This includes realigning rehabilitation treatment, programming and clinical processes to better meet the needs of those with intellectual disabilities and/or mental health issues. The rehabilitation service will place greater emphasis on community integration and shift away from long-term care.

Young Adults: The Edmonton Zone Addiction and Mental Health program is committed to a delivering a broad scope of services targeting youth and young adults. As a key part of this, Alberta Hospital offers a unique acute care unit for patients aged 16 to 26 which complements a web of community-based young adult services. Further inpatient enhancements at AHE are planned, including an age-appropriate psychiatric intensive care unit.

Targeting Treatment-Resistant Psychosis: AHS Addiction and Mental Health and the U of A's Department of Psychiatry are working jointly on an evidence-based holistic treatment for treatment-resistant psychosis. Although still in its early stages, this work will build on existing work in the Zone, and focus on assessing change readiness, new referral processes and criteria, and establishing appropriate scales for assessment and monitoring.

Research and teaching are also central themes of the Ambition 2023 strategy with direct linkages to the Department of Psychiatry and other academic partners. Alberta Hospital aims to enhance its teaching and learning focus by pursuing research, funding and published work opportunities.

"This work is going to continue for many years, so this is just the beginning.
About 50 per cent of our medical staff here are locally trained, while the remaining 50 per cent of our medical graduates are from other jurisdictions. So we've had a constellation of ideas coming together from different jurisdictions around the world, including our own, and that has fermented into the Ambition 2023 plan," says White.

"All the psychiatrists here are really invested in how effective Alberta Hospital has been, and very conscious of the difference that Alberta Hospital has made throughout the Edmonton region and the northern part of the province. Our physicians also realize we have got to be forward-thinking, innovative, and looking at new ways of doing things."

The new Day Hospital - a first for the Edmonton Zone - has already received a funding commitment from Alberta Health.

"Dr. Daniel Li has been Chairing our Day Hospital initiative and we're moving very quickly on that front. We've just received $600,000 to renovate the lower part of 12 Building (on the Alberta Hospital site) where the Day Hospital will be located. There is another sizeable amount of money coming, in the range of $2 million, to set up the program and recruit staff," says White. "I will be in the process of recruiting three physicians to run this program and related medical leadership for it as well."

The Day Hospital will target patients who are acutely mentally ill but not at risk. Such patients may have a major depressive disorder, a severe anxiety disorder or a psychosis, but are not suicidal or engaging in self-harm. The Day Hospital may also be an appropriate intervention for clients on the elective admission wait list as well as those requiring ECT (Electro-Convulsive Therapy) or rTMS (Repetitive Transcranial Magnetic Stimulation) on an outpatient basis.

"Inpatient care is expensive. We have a finite number of beds and there is huge demand for those beds. The vision here is that a Day Hospital will be a viable treatment alternative for a sizeable number of patients. It will also relieve the strain on our hospital emergency departments, particularly for Emergency Inpatients (EIPs), so it should provide greater satisfaction to our patients and make economic sense as well."

Like similar facilities in Calgary and Vancouver, the Day Hospital will be staffed by a multi-disciplinary team including psychiatrists, psychologists, social workers, occupational therapists and others, with an emphasis on rapid transition within a 30-day treatment framework.

"The initial vision with Ambition 2023 was to have two Day Hospitals, one here at Alberta Hospital and the other in the city. Funding was only available for one at present, but additional funding may be available if the Day Hospital makes clinical and economic sense. So it is essential for this initial Day Hospital to make clinical and economic sense."

Another element of Ambition 2023 calls for six beds to be allocated at Eight Building on the Alberta Hospital campus for a treatment resistant psychosis program, led by Dr. Zahid Latif, Dr. Alfonso Ceccherini-Nelli, and Dr. Karthikeyan Ganapathy.

"In addition, three of our psychiatrists have taken up the initiative in developing an emotional dysregulation program, or a DBT (Dialectical Behaviour Therapy) program, and we have already had our Hope and Wellness Day Program up and running for three years," he notes.

"So just to reiterate Dr. Yiu's statement to us a year ago, the status quo is not acceptable. We can't stand still. We can't be a barrier to change. Physicians can block change, but we can also drive change, and when physicians work together with a common purpose they can make a huge difference. That's what we're doing."