The Children’s Mental Health Care Program (CMHCP) at London Health Sciences Centre (LHSC) provides a comprehensive range of services including emergency /crisis response, ambulatory care (outpatient and day treatment), and acute inpatient care.
There are a full range of sub programs including rapid crisis response, mood and anxiety, traumatic stress and eating disorders and psychiatric consultation to the community and to all of the sub programs.
The CMHCP is well established across the child and adolescent trajectory and more recently we have extended this trajectory to early maternal child (infant) through a Perinatal Mental Health Program in partnership with Women's Services at LHSC, and the extension of our age of service to 18 years to initiate a Transition Mental Health Program that addresses the vulnerability of transition age youth as they move into adulthood.
Philosophically and practically, we believe that early intervention and effectively addressing mental health concerns and emerging mental illness, along with boosting resilience in young people and their families, is of vital importance in preventing adult morbidity
Together with other Child and Adolescent Mental Health Services across the country, we have experienced increased demands for service with increasing complexity of presentation and utilisation of the Emergency Room as a point of access.
Program statistics affirm a more than doubling in the visits for youth under 18 years of age to the Paediatric Emergency Room over the past 10 years. This is not accounted for by a shift in service to 16 and 17 year olds as the increase is similarly represented in the younger age group. We have approximately a thousand referrals to outpatient services annually and we became very concerned at the growing elective waiting list (14 months at its longest).Through a wait list strategy funded by our Children’s Hospital Foundation, this wait has been reduced to 7 months with a range of 0-333 days reflecting the prioritization of more urgent cases.
Another focus of increasing demand is in Adolescent Eating Disorders with more admissions to Paediatrics of patients with serious medical compromise; we are then consulted, participate in re-nourishing and initiation of mental health treatment and ensure follow up to recovery. We have four inpatient beds for treatment of Adolescent Eating Disorders, Day Treatment and Ambulatory Family Based Treatment. Our waiting list for weekly specialised inter-professional assessment has grown to 5 months with a monthly urgent slot which is always filled.
By way of finding solutions, we optimise access and treatment capacity locally and regionally through deliberate strategies to integrate our hospital and community mental health services. Our academic Division of Child and Adolescent Psychiatry serves to build collaborative relationships and clinical programs.
Specifically at LHSC, we have a contract with the Ministry of Community and Social Services that allows 24/7 access by case workers in all of their Children’s Mental Health Agencies in the region to have direct consultation access to the Child and Adolescent Psychiatrist on-call. All full- time academic divisional Child and Adolescent Psychiatrists participate in this on-call schedule.
We have close working relationships with our paediatric colleagues particularly in relation to Emergency Care and Eating Disorders.
We recognize the importance of working with all paediatric subspecialties and family medicine and the duality of physical and mental health as well as their social determinants.
As we innovate we are presently piloting a Quick Response Clinic (QRC) in partnership with our paediatric emergency colleagues to enable them access to urgent psychiatry consultation and up to 3 session follow-up with a mental health professional.
We very much ascribe to the principle of working within collaborative relationships and providing care that is innovative and optimizes hospital and community resources.
