Trellis Mental Health and Developmental Services of Canada: Fred Wagner, Executive Director

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Fred-Wagner-thumb1During a time of shrinking budgets, rising costs, and increased pressure to perform to quality standards, strategic partnerships are becoming an integral part of most healthcare organizations’ future plans. Even in Canada, where funding comes mostly from government sources, budgets struggle to keep pace with the increased need for services.

“Healthcare organizations can no longer look only at their own needs and strategic future; they have an obligation to develop a system that provides better healthcare,” said Fred Wagner, executive director of Trellis Mental Health and Developmental Services of Canada. “The field has changed in terms of accountability, with more focus on outcomes and the value achieved from each specific dollar.”

Developing partnerships to create a better system

Trellis provides a full range of services for all ages, from children to seniors, with mental-health issues or developmental challenges in three counties in Ontario. The organization has about 179 employees from disciplines including psychiatry, social work, youth workers, nurses, and others. Trellis offers case management, community outreach to the homeless, court support, and family services, along with traditional office visits.

Part of Trellis’ goal, especially with young people, is to begin providing care at the first episode of psychosis to improve functioning and help prevent detrimental effects into adulthood. This involves partnering with schools and having behavioral-health workers at the schools to better serve students and their families.

“Having teams for early psychosis intervention is exciting because it helps change the trajectory of disease,” Wagner said. “For example, if you get involved early with someone who has a diagnosis of schizophrenia, ensure they’re getting support, get the family involved, you can stall or reduce some of the secondary effects that come with mental illness, such as not working or living in poverty. We are starting to see different outcomes for people with this early intervention program, which places a tremendous emphasis on collaboration, integration, and education.”

In addition to community partners, Trellis felt the need to search for corporate partners to make the organization more financially sound. Wagner said Ontario has a significant deficit, and healthcare organizations were told that they would not receive any revenue increases over the next two years.

“We have to look down the road at strategic partnerships to practice our mission more efficiently and effectively,” Wagner said. “We need to partner up to adequately address complex problems such as mental health.”

He said the provincial government has looked for ways to deliver services more efficiently and has decided to move additional dollars into community-based healthcare and away from hospital care, an initiative that is indicative of healthcare’s overall future.

In April, Trellis’ Board of Directors merged with the Grand River Branch of the Canadian Mental Health Association. By combining resources, the two organizations are now able to provide more seamless care across the region, offering residents better access to care and the ability to maintain a higher standard of care.

“We are pleased with the progress we have made in bringing the two organizations together and look forward to delivering the promised benefits to residents,” Wagner said.

Leveraging technology to contain costs

With more emphasis on community care and a recovery model rather than treatment, Trellis has focused on using technology for an increasingly holistic view of mental-health care. Trellis has an electronic health record and is looking at ways to integrate its system with other organizations to share information more easily.

Trellis has also begun using a common assessment tool for mental health that can easily be shared with other organizations. A patient can fill out the assessment at a walk-in appointment at Trellis, but if they go to another health organization, they can have access to that assessment to help coordinate care.

A major challenge for Trellis has been to recruit and retain qualified mental-health professionals. Ontario has a shortage of psychiatrists, and with budget cuts or freezes, it’s difficult to offer competitive salaries.

To help combat this problem, Trellis has been a heavy user of Ontario’s telemedicine system, one of the most sophisticated in the world. Staff at Trellis are able to consult with psychiatrists or providers hundreds of miles away to assess and diagnose patients, saving the organization money and making up for shortfalls in recruitment.

Trellis is also evaluating the use of tablets so that providers have access to patient information at the point of care.

Properly managing time is vital to becoming more efficient and in cutting costs, so Trellis has looked at a few options for increasing productivity and meeting patient needs. One way is by offering more walk-in clinics. Setting up appointments creates a lag from when a person calls and when they can be seen that has the potential to be detrimental for patients with mental illness.

“When people are motivated and saying they have an issue that needs to be addressed, we should cut down on the time it takes to assist them,” Wagner said. “We are trying to get away from the notion of pre-arranged appointment times.”

Wagner said technology is one of the biggest changes he has seen in his 25 years of working in mental health.

“It has a tremendous impact on how we do business,” he said.

The forming of strategic partners is also a pendulum swing. No longer can an organization operate in a silo; it must make tough decisions in the best interests of the system and in providing holistic care to patients, Wagner explained.

“The process of bringing two organizations together is not without significant challenges, but taking bold steps to improve healthcare service delivery is required if we wish to improve healthcare outcomes for residents and provide better value for the healthcare system as a whole.”

-by Patricia Chaney

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