Mental health patients 'struggle to find timely services' in Windsor-Essex, inquest hears

People with depression, suicidal thoughts or severe mental illness can have trouble getting timely support once they're discharged from a Windsor-Essex hospital, a local inquest jury heard Monday. 

Jurors are examining the circumstances of Matthew Mahoney's death during the second week of a coroner's inquest. The 33-year-old man with schizophrenia had many interactions with the local health care system before being shot and killed by police on March 21, 2018.

For someone like Mahoney, accessing community support can take six months to a year, said Jonathan Foster, VP of emergency services and mental health for Windsor Regional Hospital (WRH).

"We struggle to find timely services typically for our most vulnerable patients," said Foster.

That was a problem in 2018, he said, and it's still a problem today. 

In 2020, WRH opened a mental health assessment unit — an extension to the emergency department — designed and staffed specifically to help those patients,. From 7 a.m. until 11 p.m., patients have access to a psychiatrist, two registered psychiatric nurses and a social worker. Outside of those hours, some of those positions are on-call.

Most hospitals in Ontario offer both in-patient and out-patient mental health services, but WRH does not. They rely on community partners to continue care once discharged.

Foster said this can cause a disconnect and make it more "difficult to coordinate" when it comes to continuity for patient care.

"We, for a long time, have struggled to find treatment programs" for people with suicidal risk factors, said Foster. "We're not resourced to help people over a long period of time."

Making community mental health resources more efficient

One solution is more funding to add resources, he said.

But Foster also said community organizations should examine how they allocate resources, eliminate overlap and improve efficiencies.

The hospital's mental health unit is "close to full on most days" with between six and 15 people being discharged and admitted each day, he said. The average length of stay is 14 days.

In recent years, more people are accessing mental health services at the hospital. For many, it's their first time doing that.

"Overall, the complexity and severity of the illnesses we see has gone up as well," said Foster.

Before Mahoney's death in 2018, the hospital was using a paper record-keeping system. Now it's digital and the system flags anyone who has come back to hospital or visited many times for mental health concerns.

Hospital makes internal changes

The hospital also made some changes internally following a quality review into the circumstances around Mahoney's care.

It started doing follow-up care once a patient leaves the hospital, and Foster said that's having a positive impact.

After Mahoney's death, the Community Outreach and Support Team (COAST) started providing WRH with the names of the top 10 high-risk patients in the community, and a working group to develop a pathway for high-risk and low-insight patients in the community.

A jury of five will now examine all aspects of Mahoney's death. It can also make further recommendations to help prevent future deaths.