Excellence in EMS Integration Award: This award recognizes a non-EMS organization that has developed and implemented a partnership with EMS organizations that have demonstrated enhancement of patient experience of care, improved patient outcomes, or reduced the cost of healthcare.

NIAGARA EMS Mental Health and Addictions Response Team (MHART)

Since 2010, the Niagara Region of Ontario, Canada had been experiencing an increased demand for emergency health services, reflective of evolving patient needs, as evidenced through increasing call volume to Niagara Emergency Medical Services (NEMS) and hospital emergency department visits. Collectively, these factors were placing a non-sustainable demand on available resources.   

As a result, in the spring of 2018, NEMS engaged in strategic program development with the goal of developing a Mental Health and Addictions Response Team (MHART) to better address low acuity mental health and addictions calls in the community. More specifically, MHART is made up of an Advanced Care Paramedic and Mental Health Registered Nurse who respond together to 911 emergency calls in the community, perform mental health assessments, and intervene correspondingly. The team is mandated to provide holistic, patient centered, multidisciplinary care which builds alternate pathways to care, reduces stigma through outreach, and coordinates follow up care for opiate overdoses occurring within the communities of Niagara.    

MHART has been implemented as a partnership, with paramedics and vehicles provided by Niagara EMS and mental health nurses provided in-kind by three partner organizations - Niagara Health, Welland McMaster Family Health Team, and Quest Community Health Centre.   

The MHART team services the entire Niagara Region, and operates 7 days a week between 9:30am and 9:30pm.    Program objectives include:    

• Respond to patients in personal crisis, whether medical or mental health, to provide the best pathway for their treatment and care 
• Provide direct referrals to community and hospital based resources, supporting integration and collaboration between local partners
• Respond to active overdose calls as well as follow-up with post-overdose patients, encourage addiction treatment and referral to community resources, and provide harm reduction guidance and materials 
• Help reduce stigma associated with mental illness and substance misuse by providing an enhanced medical response to 911 calls, and create an opportunity to work closely with our police services to ensure mental health is treated as a health and medical issue

Organization Overview
Given MHART's successful implementation as a partnership between local healthcare organizations, this nomination is to recognize the three organizations who each donate mental health nurses in-kind to Niagara EMS to support the program:   

• Niagara Health - a regional healthcare provider with multiple hospital sites across Niagara, and a growing network of community-based and virtual services. Provides a wide range of inpatient and outpatient services to residents including Acute Care, Cancer Care, Cardiac Care, Complex Care, Emergency Care, Kidney Care, Long-Term Care, Mental Health and Addictions.   
• Quest Community Health Centre - a non-profit charitable organization providing primary health care, health promotion, and community capacity building to residents of the Niagara Region. Staff include a wide range of interdisciplinary health care providers working in a shared care team model. Focus is on the delivery of client-centred holistic health care that seeks to remove barriers to care, as well as address the Social Determinants of Health.    
• Welland McMaster Family Health Team - a healthcare organization that includes a team of family physicians, nurse practitioners, registered nurses, social workers, dietitians, and other professionals who work together to provide health care for their community. Family Health Teams focus on chronic disease management, disease prevention, health promotion, and work with other health care organizations, such as public health units. As a team, they develop the best possible care plans for the health and wellness of patients.

Date of Implementation: MHART was implemented as one of the Niagara EMS mobile integrated health teams in July 2018.

Number & Demographics of Patients/Members
Since the launch of MHART in Q3 of 2018, Niagara EMS has been tracking the number of mental health & addictions related 911 calls assigned to this team on a quarterly basis.  They have consistently responded to between 350-400 calls each quarter.

Assigned calls have been more variable since the onset of the pandemic in March 2020, but the MHART team has continued to operate given the increased importance of mental health related issues during COVID.

In terms of demographics, although the MHART team can and will respond to 911 calls from residents of all ages, abilities and backgrounds, local data has shown the majority of our mental health calls come from the youth and young adult age cohort.

Description of Outcomes / Utilization / Change
Ultimately, the System Transformation being undertaken by Niagara EMS will help alleviate demands in the Niagara Ambulance Communication Service, the community, and the hospital system by diverting patients to the most appropriate point of contact and level of care. Overall emergency response times will improve as more critical, time sensitive resources can be better allocated.   

Quantitative Outcomes/Utilization Change:     

• Since 2019, Niagara EMS has witnessed a 6.9% decrease in transports of mental health patients to the Emergency Department despite an 8.1% increase in the number of mental health related 911 calls - meaning these patients are accessing real time alternative, more appropriate health care.    
• Niagara EMS has also been tracking the number of times an ambulance was diverted by the MHART team. They have consistently been able to divert an ambulance on between 75-80% of their responses to mental health related 911 calls.     
• More than 500 referrals have been made to community health and social services by MHART team members, and over 350 Naloxone kits have been distributed to help support the opioid overdose crisis.    
• With statistical significance, it has been shown that MHART decreases the frequency of mental health 911 calls for those repeat callers of 911 who have called with mental health issues greater than 3 times.  Thus, patient involvement with MHART will often lead to a decrease in their future calls.       

Patient Story:   

MHART responded to a ‘Priority 1’ emergency call for shortness of breath, being the closest available unit to the emergency. Upon arrival, patient was a middle aged female and a local business owner who was experiencing a situational crisis with anxiety. Patient had taken an Ativan prior to MHART arrival to help with her anxiety.  The MHART crew was able to de-escalate the patient, supporting her with calming exercises. Once calm, the patient accepted referrals to community supports. It was then discovered that the patient was also a patient of one of MHART’s mental health nurses. MHART obtained consent and coordinated a counselling appointment right then for the patient at the family health team's office - which was greatly appreciated.    

Patient was also referred to the crisis line and provided a Community Mental Health Association (CMHA) coping card with various exercises for calming which she could do on her own in the future. MHART followed up with the patient the next day to see how she was doing, and was able to confirm her appointment for the following Monday.    

During this 911 call, MHART was able to cancel fire dispatch, ambulance dispatch, and ultimately averted a visit to the Emergency Department, while providing the patient with the right care, at the right time and place, by the right provider.

Supporting Links
Niagara EMS received temporary funding to expand our MHART team during the COVID pandemic, due to increased demand for mental health emergency services.  Link to media article on temporary expansion:   https://niagaraatlarge.com/2021/01/23/niagara-region-expanding-ems-services-to-address-people-struggling-with-mental-health-addiction-homelessness/     

Link to Niagara EMS website with more info about our Mobile Integrated Health Teams, including MHART:  https://www.niagararegion.ca/living/health_wellness/ems/mobile-integrated-health-teams.aspx