According to the World Health Organization, one in four people in the world will be affected by mental or neurological disorders at some point in their lives. Around 450 million people currently suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide. And within the mental health care system, there is an urgent need to reduce unsafe acts.
Patient and provider safety in mental health facilities is a serious concern. In the United States, 1500 suicides take place on inpatient psychiatry units in the United States each year and up to 47% of mental health care providers have experienced violence at work. Suicide is not the only metric for patient safety in psychiatry, which has other unique patient safety issues, such as violence and aggression; suicide and self-harm; seclusion and restraint; and absconding and missing patients.
“Most types of adverse events in psychiatry are harm to self or to others. People can feel isolated when clinicians are unable to intervene in the best way possible Our goal is to make sure our clients trust their care team so they can communicate if they are not in a good place,” explains Monica McAlduff, RPN, BHSc, MA, Director, Mental Health and Substance Use, Vancouver Coastal Health.
To help reduce unsafe acts against both patients and providers, Vancouver Coastal Health (Canada) helped create the Patient Safety Movement Foundation’s Actionable Patient Safety Solutions on Mental Health and Collaborative Care Planning.
Collaborative care planning is a tool used to help patients recognize when they are reaching levels of acute psychiatric distress. This self-recognition translates into preventing patients from reaching a point of crisis where they are at risk to harm themselves or others. Collaborative care planning refers to the combined efforts of staff and patients working together to set and achieve health goals and involves greater patient involvement in the planning, delivery, and evaluation of care. Ideally, it leads to better treatment by focusing on improving and maintaining health rather than just dealing with problems as they arise (Victoria State Government, 2012).
“In acute mental health you often have people with major mental illness who may face difficulties throughout the day, and have developed their own unique ways to cope that a clinician might not be aware of,” says McAlduff.
She continues, “For example, a client may become agitated and need to pace. If a clinician doesn’t know this, perhaps they suggest to the client that they return to their room, which would inadvertently trigger the client by preventing them from engaging in their preferred coping strategy. Collaborative care planning is very empowering for patients because we walk them through their feelings and help them. It helps both the clients and the clinicians because it helps us identify how to help each client as an individual.”
Collaborative care for anxiety and depression is one of the most well-evaluated interventions in mental health in primary care. It’s been shown to be both clinically effective and cost-effective for a variety of mental health conditions, in a variety of settings, using several different payment mechanisms.
At Vancouver Coastal Health, a process for standardized collaborative care planning has been developed alongside a culture of safety in acute mental health. Data collection is currently underway, with plans to share the tool and procedure with other mental health programs within and beyond VCH. One notable statistic collected thus far is that VCH has had no suicides since Collaborative Care Planning was implemented in July 2017.
“In acute psychiatry, we want to empower our clinicians to respectfully interact with our clients so that the clients feel safe and can focus on healing. We feel that creating a culture of safety is vital to that goal,” says McAlduff.
To create a culture of safety, Vancouver Coastal Health’s Mental Health and Substance Abuse department at Vancouver General Hospital has implemented a variety mandated training which includes new educational pamphlets and a pilot program with the Aboriginal Wellness Team.
“Continuous training shows the organization values the staff’s development. There’s so much to know in a healthcare system training like this really reminds our staff why they went into healthcare.”
For more information on the APSS for Collaborative Care Planning, please visit: https://patientsafetymovement.org/actionable-solutions/challenge-solutions/mental-health/collaborative-care-planning/
 Mills, P.D., King, L., Watts, B., & Hemphill, R. (2013) Inpatient suicide on mental health units in Veterans Affairs (VA) hospitals: avoiding environmental hazards. Am J Med 35(5) 528-536. Retrieved from: http://dx.doi.org/10.1016/j.genhosppsych.2013.03.021
 Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative care for depression and anxiety problems.Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD006525. DOI: 10.1002/14651858.CD006525.pub2.
 Unützer, J., Harbin, H., Schoenbaum, M., & Druss, B. (2013). The Collaborative Care Model: An Approach for Integrating Physical and Mental Health Care in Medicaid Health Homes. Health Home.