Mental-health response team in Ottawa is reducing visits to emergency rooms

Geoffrey Smith crouched in front of an elderly patient, holding her hands before asking her to do some deep breathing and calming exercises.

“I just want you to concentrate on the sound of my voice,” said Mr. Smith, a primary care paramedic with the Ottawa Paramedic Service. “Let everything else slowly disappear.”

The woman was shaking and struggling to catch her breath. Mr. Smith stayed with her, reminding her they were in no rush. It took nearly 10 minutes before she started to breathe normally and was able to answer questions about the severe mental distress that prompted her 911 call.

It’s an unusually slow pace, considering paramedics are often facing time pressures, rushing to transport patients to the hospital so they can get to the next emergency.

But Mr. Smith is able to take his time with this patient because he’s part of a team specially created to improve the response to mental-health-related 911 calls. Launched in March, 2022, the Mental Wellbeing Response Team is reducing the number of patients who have to go to the emergency room and improving outcomes for individuals experiencing a mental-health crisis.

During its first year, only 35 per cent of the 337 patient calls answered by MWRT teams ended up in the hospital. Eight months into its second year, only about 30 per cent of the 376 patient calls handled by the MWRT have required transport to a hospital, resulting in thousands of hours in eliminated or reduced waiting times for patients.

There’s only so much emergency rooms can do for people experiencing a mental-health challenge that requires continuing, long-term support, Mr. Smith said.

“You feel like you’ve done so much for somebody bringing them to the hospital and you walk away from it but the reality is that often, they’ll sit in that wait room for eight to 12 hours and then they come out with the exact same problems.”

Under the MWRT program, a specially trained paramedic and social worker team up to answer mental-health emergencies, riding in a modified ambulance that has discrete signage and no flashing lights or sirens.

The paramedic assesses the patient’s medical condition while the social worker connects them to programs and services as well as follow-up appointments after the initial dispatch. The Ottawa Paramedic Service, which receives an average of 25 mental health-related calls a day, recently invited The Globe and Mail to observe one of the teams.

In an interview, program lead Logan Martin said she felt compelled to create the program after responding to several devastating 911 calls that left her feeling unsure about her own mental well-being. One involved a woman who had been experiencing severe depression and suicidal thoughts. She and her family had called 911 in the past, but then faced a months-long wait for intensive treatment. Ms. Martin, who was pregnant at the time, was one of the paramedics who responded after the woman died by suicide and felt devastated by what the woman and her family had experienced.

Ms. Martin realized that something had to change. She enrolled in a program for addressing addictions and mental-health issues and eventually created the Mental Wellbeing Response Team. For now, the initiative is limited to a rotating roster of one team that operates from 9 a.m. to 9 p.m. seven days a week. The hope is that eventually this will be expanded, as the lone team on service often has to turn down multiple calls each shift.

Ottawa paramedic chief Pierre Poirier said he supports trying new approaches like MWRT.

“Just doing the same thing as what we did five years ago harms the patient, harms our community, so we have to think of ways of doing something different,” Mr. Poirier said in an interview. “This is really just one of the initiatives that we have to look at.”

While the MWRT does end up taking some patients to the hospital, the program has allowed many individuals to receive treatment and follow-up while remaining at home.

In the case of the elderly patient, after Mr. Smith was able to help her regain control of her breathing, he and Cindy Gill, a social worker at the Ottawa Hospital, determined that she required hospital care. But instead of waiting in the emergency room, they were able to take her directly to the psychiatric emergency service.

During that same shift, Mr. Smith and Ms. Gill answered calls from three additional patients and successfully treated them at home. They had to turn down another three calls from the emergency dispatcher.

Last year, there were more than 1,800 “level zero” events, during which there were no available ambulances to answer emergency calls, in Ottawa. The year before, there were 750 level zero events.

One of the reasons for the increase is the backlogs in emergency rooms. By law, paramedics must remain with their patient at the hospital until care is transferred to the hospital, which means they spend hours – in some cases, almost entire shifts – waiting to off-load a patient.

Other jurisdictions are experimenting with similar models to address the same issues. The government of Prince Edward Island has partnered with Medavie, a non-profit health provider, to create the Mobile Mental Health Response Service, which offers a telephone number people can call day or night to get help with a mental-health or addiction challenge. Field teams, which include a paramedic and mentalhealth worker, can make inhome visits for people who are experiencing an immediate crisis. Since the program was launched in 2021, they have answered more than 7,000 calls and have visited more than 1,000 people in their homes. Almost none required transport to a hospital after the field team visit, said Matthew Crossman, vicepresident of operations for Medavie Health Services.

“It’s making sure everyone is doing everything they can to wrap support around those patients,” he said.

In Ottawa, Ms. Martin recognizes that the MWRT program isn’t enough to fix the system, but is hopeful that this initiative and others that she and her colleagues are working on will result in better outcomes for people in need.

“A big goal of this is to provide people the right care at the right time and the right place,” she said. “And often, that’s in the community and not at the hospital.”