Designing Integrated Models of Care
The MPA is creating collaborative models of clinical care to support patients across the lifespan, with co-occurring mental and physical illnesses.
Through reforms in clinical care, those at risk of becoming high users of the health care system will be identified early and offered preventive or, if necessary, expedited and integrated treatment. Early identification will eliminate unnecessary medical consultations and testing. Advanced screening and associated diagnostic tools informed by Institute research will be delivered by health and medical professionals who themselves trained at the Institute.
Improvements in integrated clinical care will greatly reduce human suffering arising from inadequately treated co-morbidities. System-wide, this will aid significantly in the sustainability of health care in Ontario through new design.
In those instances where long-term medical care becomes necessary, patients will receive treatment by integrated psychiatric and medical care teams. These teams will create and deliver treatment plans built upon best evidence and clinical guidelines, again developed by the Institute’s research teams. Specialized clinical services will also be created to address the specific needs of those in the vulnerable 16-to-24 age cohort.
Clinical care priorities include: improvements to screening and referral; integrated medical psychiatric assessment; and testing of inpatient and outpatient models. These efforts will be ongoing with more than 1,000 patients across the three clinical care sites.
Beyond the period of formalized health care, patients will continue to be assisted with referrals to community resources including social work, housing and legal services that will help prevent repeated medical interventions.