Intensive Home Treatment for Acute Mental Disorders: An Alternative to Hospitalization
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In 1978, I became the medical director of a general hospital psychiatric unit serving the twin cities of Kitchener/Waterloo in southwestern Ontario, Canada. Over the next four years, population growth accelerated, and more psychiatrists joined the department, both of which resulted in increasing pressure on beds. We reached a point where patients had to wait a dangerously long time to be admitted.
The provincial Ministry of Health policy was clear: no more funding for hospital beds only funding for community programs. I couldn’t see a way forward. An acute day hospital did not seem feasible; most of our patients were too ill to reliably attend, and public transportation is poor. There were no workable models for a crisis residence at that time.
Posted: Jan 15, 2021 4:00 AM ET | Last Updated: January 15
Paramedics transport a patient to Mt. Sinai Hospital in Toronto on Thursday. With hospitals in Montreal under strain from COVID-19, doctors in Quebec and Ontario are now reviewing triage protocols that will help them to decide who gets access to critical care if there is a shortage of beds.(Evan Mitsui/CBC)
Index Santé, however, reported significant regional differences in emergency room attendance on Monday morning. A large number of emergency rooms in Montreal, the Laurentians and in Montérégie saw more patients than their capacity allowed, and several dozen people remained on a stretcher for more than 48 hours. The highest attendance was reported at Montreal’s Hôpital Santa Cabrini in Rosemont-La Petite-Patrie, with 155 per cent capacity. Hôpital du Suroît in Salaberry-de-Valleyfield was second place with at 141 per cent capacity, followed by the Montreal General Hospital (129 per cent), and Hôpital de Mont-Laurier (120 per cent). In the Quebec City region, the average occupancy rate for emergency rooms was 72 per cent Monday morning.
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The occupancy rates of Quebec’s emergency rooms dropped slightly over the past three days, according to figures posted Monday morning on the Index Santé website.
As of early Monday, the average occupancy rate stood at 81 per cent compared with the 102 per cent reported last Tuesday and Friday and the 101 per cent and 100 per cent averages reported on Wednesday and Thursday respectively.
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The occupancy rate dropped over the weekend, as was the case the first weekend of 2021 before rising slightly last week.