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Mental health patients struggle to find timely services in Windsor Essex, questioning is heard

People with depression, suicidal thoughts or severe mental illness can have a hard time getting timely support once they are discharged from a Windsor Essex hospital, a local investigative panel heard on Monday.

Jurors are considering the circumstances of Matthew Mahoney’s death during the second week of the coroner’s investigation. The 33-year-old man with schizophrenia had numerous interactions with the local healthcare system before he was shot and killed by police on March 21, 2018.

For someone like Mahoney, accessing community support can take anywhere from six months to a year, said Jonathan Foster, vice president of emergency services and mental health at Windsor Regional Hospital (WRH).

“We struggle to usually find timely services for our most vulnerable patients,” Foster said.

He said this was a problem in 2018, and it’s still a problem today.

In 2020, WRH opened a Mental Health Assessment Unit – an extension of the emergency department – designed and staffed specifically to assist these patients. From 7 a.m. to 11 p.m., patients have access to a psychiatrist, registered psychiatric nurses, and a social worker. Outside of those hours, some of these positions are on call.

“We struggle to usually find timely services for our most vulnerable patients,” says Jonathan Foster. (Chris Ensing/CBC)

Most hospitals in Ontario provide inpatient and outpatient mental health services, but WRH does not. They rely on community partners to continue care once they are discharged from the hospital.

This can cause communication to be lost and make it more “difficult to coordinate” when it comes to continuity of patient care, Foster said.

“We’ve struggled for a long time to find treatment programs” for people with suicidal risk factors, Foster said. “We don’t have the resources to help people over a long period of time.”

Make community mental health resources more efficient

One solution, he said, is more funding to add resources.

But Foster also said that community organizations should study how to allocate resources, eliminate overlap and improve efficiency.

He said the hospital’s mental health unit was “nearly complete on most days” with between six and 15 people coming out and coming in each day. Average length of stay is 14 days.

In recent years, more people are getting mental health services in a hospital. For many, this is the first time they have done so.

“Overall, the complexity and severity of the diseases we see have increased as well,” Foster said.

Prior to Mahoney’s death in 2018, the hospital was using a paper-based record-keeping system. It is now digital and the system notifies anyone who has gone back to hospital or visited multiple times with mental health concerns.

The hospital is making internal changes

The hospital also made some changes internally after a quality review of the circumstances surrounding Mahoney’s care.

I started doing follow-up care as soon as the patient left the hospital, and Foster said that had a positive effect.

Following Mahoney’s death, the Community Outreach and Support Team (COAST) began providing WRH with the names of the top 10 high-risk patients in the community, and a working group to develop a pathway for high-risk and low-insight patients to socialize.

A five-person jury will now examine all aspects of Mahoney’s death. It can also make more recommendations to help prevent future deaths.