Image
The Royal provides specialized mental health care but what exactly does that mean?
The Royal is often asked which types of mental illnesses – and which patients – we treat. As a specialized mental health facility, we have a specific place in the health care system.
In much the same way that the University of Ottawa’s Heart Institute is a centre of excellence for those in need of unique treatment programs for complex cardiac disease, The Royal’s role is to treat people with complex and serious mental illnesses that are often resistant to conventional treatments.
Similar to the notion that someone with a mild heart arrhythmia does not need the services of the Heart Institute, not everyone with a mental illness needs the care provided by The Royal. In an effort to distinguish which patients with mental illnesses are the most appropriate candidates for treatment at The Royal, Chief of Staff and Psychiatrist-in-Chief, Dr. Rajiv Bhatla described three different scenarios for major depression. Only one of the three patients would require care from The Royal.
In the first scenario, the patient has been diagnosed with major depression and responds well to treatment. Their family physician, possibly with the assistance of a psychiatrist, can ably manage their depression and they require no additional care.
In the second scenario, however, the person with major depression does not respond well to the initial treatment, becomes suicidal and requires secondary care. That person is admitted to an emergency room, becomes a short-term inpatient, is treated and leaves relatively stable. That person can often return to the care of a family physician or psychiatrist who is capable of managing their treatment so that they can achieve and maintain good mental health.
The third case is one that involves a much more complex level of treatment and occurs when the patient does not respond to initial treatment. In that scenario, the person who suffers from major depression has tried a number of medications and cognitive behavioural therapies without success. Medication management becomes complicated and other treatments and expertise that are only available through specialized mental health care are now required. That person’s next step is a referral by his or her family physician (or hospital) to The Royal.
While a patient may require treatment at The Royal at a particular time in his or her journey, Dr. Bhatla underlined the need to move away from associating people and their needs with one particular institution.
"While patients can be stabilized, their status is not static. Patients need to be able to move according to their level of need. Once stabilized in secondary or tertiary care, a patient can access services at different levels through different parts of the system."
“This is why we take discharge planning so seriously at The Royal. It’s all about ensuring patients have the right level of care after their treatment at The Royal is complete.”
While care is provided at The Royal on an inpatient basis, a number of our specialized care programs are offered in outpatient clinics and through community-based programs.
“Part of our responsibility as a large, specialized tertiary health care provider is to do what we can to outreach to people and communities that may not easily have access to mental health care,” Dr. Bhatla said. “That is why we have community teams that service people outside of these four walls coupled with technology like telepsychiatry that enables us to do consults outside of this centre.”