The Joule Innovation grant program offers funding, professional support and mentorship to physicians and medical learners making a difference in health care. This is the first in a series of stories about the 2020 recipients and their innovations.
When the Manitoba government declared a state of emergency on Mar. 20, 2020, Dr. Jennifer Hensel saw it as an opportunity. The pandemic lockdown offered a chance for the psychiatrist and her team at the Crisis Response Centre (CRC) — a 24-hour, walk-in mental health crisis centre in downtown Winnipeg — to explore virtual mental health care.
“When COVID hit, it was the perfect opportunity to say ‘Hey, we can do this. Let’s look at how we can build something unique and impactful during this time when we need to keep people away from our health care facilities.’” — Dr. Jennifer Hensel, psychiatrist
The inspiration for her care model came from her previous work on outpatient virtual mental health care and her involvement with a medical virtual ward as an Innovation Fellow with the Women’s College Hospital Institute for Health System Solutions and Virtual Care in Toronto.
Since her arrival in Winnipeg in 2017, Dr. Hensel has been working to create local virtual services but has faced technology barriers, and resistance and concerns about privacy and confidentiality. The onset of the pandemic, however, blew everything open.
“A lot of those barriers were immediately removed,” explains Dr. Hensel. “So, overnight we were able to say, ‘let’s start doing virtual appointments, let’s start offering care in this way to our clients.’”
Making the shift
The goal of the CRC’s virtual ward was to limit a client’s physical contact with the crisis clinic and the hospital but still provide them the same level of care.
Someone seeking mental health support would:
- have an initial consult, conducted either on the premises or by phone or video where possible;
- be directed to the psychiatric team for further evaluation, which could also occur virtually, if their crisis was deemed severe enough; and
- be referred to the virtual ward if they needed further psychiatric support without the immediate need for a hospital admission.
“At that point, they are part of our ward, they have a ‘bed’ on our virtual unit and we work with them every day, just like we would if they were in the hospital,” says Dr. Hensel.
Psychiatric support on the ward might include daily goal setting with the patient, multiple check-ins per day if needed, medication management and even “curbside” drop-offs in special circumstances, and access to the clinic’s 24-hour crisis support line. Admitted patients also have access to virtual psychoeducation classes.
After three or four days, most patients’ crises have stabilized and they can be discharged to other outpatient services. In some cases, a patient’s condition deteriorates to the point where a hospital admission is unavoidable.
Once the ward was up and running, Dr. Hensel and her team found that certain types of patients greatly benefitted from the virtual nature of the service, including:
- postpartum women, who don’t want to leave their newborns;
- people who work or act as a caregiver; and
- people experiencing their first mental health crisis, often in their teens or early twenties, who are reticent about contact with the mental health system.
So far, the virtual ward has avoided hospital admissions in more than 80% of its patients – a huge cost savings. According to the Canadian Institute for Health Information, each crisis hospital admission in Manitoba costs about $5,000.
Dr. Hensel and her team have also proven they can work virtually with a high-risk population.
“A large proportion of individuals admitted to our virtual mental health ward have suicidal behaviour or are presenting with very serious mental health symptoms. To demonstrate that virtual treatment is possible, is a success,” she says.
The 2020 Joule Innovation grant program provided $500,000 to support physician-led innovations in the areas of sustainable health care, physician health and wellness, health care solutions and access to care.
Building a sustainable model
Dr. Hensel plans to do further evaluation of the program, to learn which patients benefit most and what happens after discharge. She’d also like to build out the technological components, to improve the ward’s capacity to admit more patients.
Ultimately, she’d like to see it expand to the rest of the province.
“There’s a huge need in rural Manitoba for mental health support and this is a concept that I think could help to close that gap,” says Dr. Hensel.
“We’ve done something amazing, but it could be so much better. I’m excited about using the Joule Innovation grant to build a comprehensive model and then finding a way to sustain it. It’s the future of health care.”