Mental Health Substance Use

Community approach to psychosis care aims to lower hospital readmissions

A new approach to the treatment of psychosis will enable clients living with the condition to receive treatment in local community clinics rather than in hospitals.

The Treatment Optimization of Psychosis (TOP) Collaborative is a partnership with the BC Centre for Excellence in HIV/AIDS (BC-CfE) at St. Paul’s Hospital and Vancouver Coastal Health’s Mental Health and Substance Use Services.

Teams from the VCH region will come together virtually to share, measure, and implement best practices in treating psychosis in the community. They will partner over 12 months to connect people living with psychosis to the best possible treatment, care and monitoring in their own communities, while raising awareness of effective treatment of the medication clozapine.

Psychosis the main reason for readmission to acute psychiatry

Psychosis affects over 51,000 people across BC, or about one in 100, from all walks of life and socio-economic and cultural backgrounds.

Within VCH and Providence Health Care (PHC), psychosis is the number one cause of readmission to acute psychiatry within 30 days of discharge. TOP can potentially improve the health of individuals and decrease the use of acute care as research indicates that for appropriately selected patients, clozapine is associated with 18.6 fewer in-patient days per year per client treated.

Clozapine treatment severely underused in BC

Clozapine is the only treatment approved by Health Canada for people who live with treatment-resistant psychosis (TRS). Compared with other medications, clozapine is about twice as likely to succeed in reducing their symptoms. However, a small percentage of people may have side effects and require extra supports. TOP is designed to help teams develop the expertise to offer this treatment to all clients who could benefit from it.

The TOP team found the medication was severely underused in BC compared to other jurisdictions and seeks to change this. For example, in Australia and New Zealand clozapine usage is estimated to be about 30 per cent in TRS, but only 17 per cent here.

Hardeep Thind, Coastal Regional Manager, British Columbia Schizophrenia Society says, “It’s really important for families to have good, accurate information – I believe providing this training will assist frontline staff and help them be more confident in sharing information on clozapine.”

Bob Chapman, Interim Vice President of Vancouver Community for VCH, says, “We know that many people living with mental health challenges often receive other treatments before the ideal option. This quality-improvement initiative will bring greater awareness of the efficacy and safety of medication and help to ensure that health-care practitioners can best support their clients who may benefit from optimized treatment options.”

Improved care for those with psychosis

The TOP Collaborative will follow the same approach as it shifts initiation of psychiatric care from hospital to community settings, build capacity at each participating community mental health and substance use team in the VCH region, and improve the quality of care for clients living with psychosis.   

The scope of TOP is large, as all VCH community adult mental health and substance use teams, Assertive Community Treatment, and Early Psychosis Intervention teams will be included in the collaborative. Strathcona, the West End, Kitsilano, South, North East, Grandview-Woodlands, Ravensong, Early Psychosis Intervention, Vancouver Coastal Assertive Community Treatment teams, and Sechelt Mental Health and Addiction Services will each send several delegates for learning events and have these delegates disseminate the knowledge they gain.

This piece was originally published on the website.