The emergency department (ED) is often the first point of access to the health care system for young adults with acute mental illness, either because they do not have a primary care provider or access to their provider is not available in a timely fashion. Realistically, accessing the ED can be distressing to youth and young adults, and may induce feelings of helplessness and isolation. Lack of trust of the system, unfamiliarity with resources and procedures, and vulnerable living situations all contribute to the existing gap in supports for young adults. Over the last 5 years, the number of Canadian ED visits by young adults with mental health complaints increased by 50%. Add in a global pandemic and the numbers are staggering. The majority of discharged patients were diagnosed with anxiety/depression which may be amenable to an alternative model of care.
Mount Sinai Hospital’s RBC Pathway to Peers (P2P) program is an innovative, patient-centred, young adult focused compliment to care. Made possible through a generous $2 million donation from the RBC Foundation and the support of our ED and hospital administration, SREMI has partnered with Stella’s Place to develop, implement, and evaluate a novel, patient-centred, peer support model of care for young adults (16-29 years) presenting to the ED with mental health and addiction complaints.
Christine Bradshaw, an ED social worker at Mount Sinai, was hired to develop and manage this program. Her familiarity with the department and gaps in the system ensured her ability to help successfully launch this important program.
Our first peer support worker, Mahalia Dixon, was hired in January 2020. She completed her specialized Emergency Department Peer Support Worker training provided by Stella’s Place and our RBC P2P manager, Christine Bradshaw. Her start date in the ED was delayed due to COVID-19 regulations. During this time, she continued to work remotely from home, attending virtual team meetings with Stella’s Place and Christine, and worked on program brochures, resources lists and other documents to support working with young adults in the ED. Once the hospital moved into COVID-19 Phase 2 in May 2020, Mahalia began providing in-person peer support in our ED. Yolanda, our second peer support worker, joined our team in September 2020 and completed the same one-on-one ED/Peer training and shadowed Christine and Mahalia on multiple shifts. She has acclimated to our ED and has been a wonderful asset to the team.
Despite the COVID-19 global pandemic and delay in the start of the RBC P2P program, July 27 marked the 100th patient seen by our team. Our RBC P2P team have now supported more than 330 young adults in the ED. Unfortunately, many youth services are currently virtual due to the COVID-19 global pandemic. During these challenging times, having face-to-face, real-time connections in the ED provides the much-needed connection, help and support our young adults require. Our RBC P2P workers can identify a young person’s immediate needs (e.g. emotional, cognitive support, food, comfort, shelter) so they get the care they need at the right time. The program’s peer support workers are available in our Schwartz/Reisman Emergency Centre Monday through Saturday, to assist youth in navigating the mental health care system and connect them with community-based resources to enhance their long-term health.
Our RBC P2P champions have also been recognized as experts and advocates within the broader hospital system. Christine, Mahalia and Yolanda have been invited to join Mount Sinai’s stigma committee, bringing a youth perspective to help recognize bias and reduce barriers to ensure inclusive care for all patients. There has been terrific uptake of the RBC P2P program in our ED and feedback from staff has been overwhelmingly positive.