Access to Resources and Community Supports Program

Integrating Hospital- and Community-Based services

Decreasing visits to Hospital Emergency Departments

Toronto, ON: Many people experiencing a mental health crisis turn to emergency departments (EDs) such as North York General Hospital’s Charlotte & Lewis Steinberg Emergency for help. Treating mental health issues, however, often requires more than a hospital ED visit. Once stabilized in the acute care setting, it can be vital to receive follow-up care for non-life threatening issues in the community.

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It’s not unusual that we see people with mental health issues who have been suffering for a while and had no idea where to seek support or were discouraged by long waits to access both community- and hospital-based services

Sandy Marangos (NY Hospital)

 Director of Emergency Services and Mental Health at North York General

EDs are often the first stop for many people seeking mental health crisis supports – not always optimal for patients who do not need a hospital admission due to the busy, confusing and noisy environment. In addition, there is a real need to better equip people with the information and community-based follow-up supports to ensure that unnecessary repeat ED visits are minimized.

Better integration between community and hospital-based services is one way to ensure patients receive the best care. To achieve this end, North York General recently joined a partnership called the Access to Resources and Community Support (ARCS) program. Through ARCS, patients who may initially seek mental health treatment at North York General and Humber River Hospital’s EDs, but who do not need a hospital admission, are referred to Cota for community-based follow-up care, which it provides in collaboration with Toronto North Support Services and Bayview Community Services.

One of the key features of the ARCS program is its responsiveness. Within 48 hours of an ED visit for a mental health issue, a patient is contacted by a community-based worker who will offer immediate supports, coordinate community services and provide short-term case management, as may be required.

Our focus in the ED is to treat the immediate crisis at hand. This partnership really helps us ensure that patients receive prompt high quality care, follow-up in their community through a multidisciplinary approach. It also decreases their need to return to the ED

Sandy Marangos (NY Hospital)
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Officially launched in November 2016, ARCS is the revamped version of the Emergency Department Diversion Project, piloted by North York General in 2007. The key differentiation is the addition of Cota, an accredited community-based organization that has been supporting adults with mental health and cognitive challenges for over 40 years, as the lead community-based organization coordinating the ARCs program.

Cota is committed to service level integrations between community and hospital-based services. We believe that, done right, they lead to better coordination and transitions of care and result in improved patient experience and outcomes. We are very pleased to be involved in the ARCS initiative and feel confident that it will continue to have a positive impact in the lives of many patients

Paul Bruce (CEO, Cota)

These patients include *Li, who required further treatment after her visit to the Charlotte & Lewis Steinberg Emergency. Li initially received short-term case management through the ARCS program but then mental health issues returned so she reached out again to David, her Cota case manager. Through a combination of the right medication and community resources, Li was better able to find balance in her life. “It marked a turning point in the depression I went through,” Li says of her ARCS program experience.

According to Sandy, stories such as Li’s are common. “The ARCS program is all about linking patients with the right care, at the right, in the place,” she says. “By partnering with community agencies such as Cota, we are able to tackle a major health care challenge – mental health – and transition patients seamlessly from the acute care setting to support within the community.


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