Mental Health DocTalk

Your Questions Answered By Mental Health Physicians

A panelist of Island Health physicians and caregivers answer your questions about Mental Health and Substance Use (MHSU) services and needs within our hospitals. Dr. Will White, Dr. Alison Gregson, Sarah Smith, OT, and Jocelyn Barr, RN share their firsthand perspectives about the newly opened MHSU Sub-Acute Unit and how VHF donors can help equip the unit to heal local patients through the Victoria Hospitals Foundation’s newest campaign: Equipped to Heal.

The Top 6 Takeaways from this Mental Health DocTalk

The Sub-Acute Unit is a New Level of Care for Island Health

Dr. Alison Gregson: The Sub-Acute Unit is really exciting because its very novel in our healthcare system here in Victoria. It will provide a new level of care between acute care in-patient stays and outpatient community resources. This new level of treatment is focused on rehabilitation—improving social and occupational functioning—as people transition from acute care back into the community or for those already in the community who need more intensive rehabilitation support. This unit also addresses our capacity issues, adding an additional 35% more beds, which means people don’t have to be in crisis to access a higher level of care and we can get them better faster and back into the community.

What is Psychosocial Rehabilitation?

Dr. Alison Gregson: The idea behind psychosocial rehabilitation is that when people have psychiatric illnesses it really impacts their ability to function in various domains of their lives. We see this in terms of difficulties maintaining relationships that are healthy and fulfilling, vocation (work and volunteer), as well as leisure pursuits. These illnesses really impact these areas so when we are working with a patient on rehabilitation, we’re trying to restore functioning in those various domains.

Successful Reintegration of Patients Back into the Community is Key

Dr. Will White: Consider this analogy: people are like sailboats. Under normal circumstances they sail the seas, living their life and everything’s fine. But when people come to need hospital-based mental health care, it means their ship has been capsized or they’ve been washed up on the rocks. They’ve been battered. Their hull is leaking and their mast is broken. The hospital then, is the place where the ships get towed in and taken out of the water into the dry dock. There, we inspect the hull, find the leaks, and make the necessary repairs. Without this new level of care, we end up putting them back in the stormy waters on the open sea and say “Good luck! Hope it works out!” With a step down unit, we’re able to set the ships down in the water to see if their hull and mast holds up. See if they can do a few laps around the harbour in calm water before letting them out to sea. We can determine if our repairs were done correctly and then when we are confident, we can feel good about sending them out on open waters. And then people can hopefully go back to living their lives. That’s why such a program and this new level of care is just so vitally important.

Concurrent Disorders and How to Address Them

Dr. Will White: Concurrent disorders are when people have more than one problem at a time. But what really makes it challenging to help people is when you have a psychiatric illness and then you add an addiction onto that illness. You cannot address someone’s mental illness if you’re not addressing their addiction. The two are very tied together. It’s definitely an area where we can expand how we train people and how we adapt our programs to treat people with concurrent disorders. It’s a big issue but we as we make slow incremental progress hopefully we will get better.

Care Does Not Stop When a Patient is Discharged

Sarah Smith, OT: After discharge, if a patient is connected to the mental wellness day program, they have a recovery coach, which is a go-to person that helps facilitate them. Or that support person could come in the form of a case manager that’s able to assist that person in getting to their medical appointments or work for example. We also rely on social workers who do that too. And we have teams within our supported housing sites who also work under the psychosocial rehab model to provide patients with care after discharge.

Patients are Already Benefitting from the New Sub-Acute Unit

Jocelyn Barr, RN: We are very much admitting patients. We recently had up to 14 patients on our unit. In a given day we tend to be admitting about three patients and discharging three patients. On staff, we have nursing mental health addiction recovery workers, Occupational/Recreational Therapists and social workers. They work with our patients in three groups a day with ample patient involvement. We also have a peer support group which consists of people who have gone through the program and now come back in to provide peer support for our current patients. A lot of them are engaging with the service after they have been discharged so that has been absolutely amazing to see. That’s a complete feedback loop and that’s humbling.

About the Panelists

Dr. Gregson attended medical school at the University of Alberta in Edmonton, before completing her Psychiatry residency at UBC Vancouver. She has been in Victoria since August 2018, and focuses her time and expertise on inpatient and outpatient general psychiatry. In addition to clinical work, Dr. Gregson is highly involved in medical education, including medical students and residents. She has been the Associate Program Director for the UBC Psychiatry Vancouver Island training program since April 2020.

Dr. White has worked in the mental health and addiction field since the mid-1980s. He initially trained as an addiction counsellor, and later worked as a mental health therapist and program manager. He went to the University of Calgary where he trained in psychiatry and addiction psychiatry. From 2004 to 2020, he was the clinical medical director of inpatient psychiatry at the Foothills Medical Centre in Calgary. He joined us last year as an inpatient psychiatrist at the Royal Jubilee Hospital, and provides outpatient services at the Victoria Mental Health Centre. Dr. White was honoured in 2017 by the Centre for Addiction and Mental Health as one of “150 Leading Canadians For Mental Health” or “Difference Makers.”

As an Occupational Therapist for over 15 years, Sarah Smith’s trauma-informed and person-centered practice promotes and empowers individual’s participation in productive and meaningful activities of daily life and wellness. Sarah’s role within the psychiatric inpatient units include patient assessment, activation and engagement through psychosocial recovery based wellness and education groups, and triaging with patient’s circle of support and community agencies. Sarah has diverse experience working within Island Health, as an OT consultant, an educator, presenter, and an advocate for mental health awareness. Sarah is one of our recipients of the “Caring Spirit” award!

Jocelyn Barr attended Nursing School at College of the Rockies in Cranbrook BC, then moved to Victoria to complete her degree in 2012 with the University of Victoria. After working several years in withdrawal management for community mental health and addictions, she transitioned to acute care psychiatry. Over the course of 6 years, she worked on all in-patient units including psychiatric intensive care and psychiatric emergency. With the opportunity of starting a recovery-centered program, Jocelyn made the switch from direct patient care to a leadership role to pursue an alternative route to nursing practice. Jocelyn works in the new Sub-Acute Unit our campaign is supporting, and is passionate about a patient centered approach to wellness.

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