Video: Universal Mental Health Care Plan

Minister of Health Kim Wilson and Dr. Anna Neilson-Williams provided information on the Universal Health Coverage Acute Adult Mental Health Integrated Care Pathway initiative.

Speaking at a press conference today, Minister of Health Kim Wilson stated, “Thank you for joining us this morning as I and Dr. Anna Neilson-Williams, Chief of Psychiatry at the Bermuda Hospitals Board, share the key findings and recommendations of the recently completed first phase of work on the Universal Health Coverage Acute Adult Mental Health Integrated Care Pathway initiative.

“This will not be the first time you have heard me speak on the importance of ensuring all residents have access to quality and affordable health care. This includes care for those experiencing mental health challenges. The need for holistic and integrated mental health support continues to grow, and I would dare say that most members of our community know someone who is, or they are themselves, directly impacted by mental health challenges. It is for this reason that Acute Adult Mental Health was selected as one of the first three clinical areas of focus for the Ministry of Health’s Integrated Care Pathway initiative.

“An integrated care pathway is a multi-disciplinary approach that details the essential care steps for people with specific needs, in this case, adults experiencing mental health challenges. The pathway specifies the care provided from beginning to end and defines what happens, when, and who is responsible at each stage of the care journey.

“The Acute Adult Mental Health Integrated Care Pathway initiative is one of three undertaken by the Ministry of Health in 2023 – in addition to pathways already completed by the Bermuda Hospitals Board. Its work was driven by a multidisciplinary working group led by Dr. Neilson-Williams and supported by KPMG.

“The initiative provided the opportunity to better understand the current provision of acute mental health services in Bermuda, understand patients’ experiences of the available services, and identify both challenges and opportunities to be addressed or capitalized on to ensure effective, efficient, and patient-centered care that is reflective of best practices.

“Over a 16-week period, an extensive literature review was completed, including the review of over 20 studies, reports, and databases. In addition, broad stakeholder engagement was foundational to this undertaking.

“52 interviews were conducted with patients, family members, clinicians, mental health experts, law enforcement agencies, judicial representatives, and community members.

• A community-wide survey was undertaken and received 348 responses, providing 1,117 qualitative inputs.
• Three stakeholder workshops were facilitated, including one with patients and families with lived experiences. Participants also included clinical specialists, nursing staff, primary care physicians, allied health professionals, diagnostic professionals, family and social services, health visitors, and the non-profit sector.

“We are truly grateful to all who responded to the call for feedback, especially those patients and families who were willing to share their direct experiences of such a vulnerable aspect of their lives. The level of engagement on the part of the public was excellent. People were keen to connect and help formulate recommendations for improvements.

“This first phase of work on the Acute Adult Mental Health Integrated Care Pathway has surfaced those areas where, collectively, the Government, mental health service providers, and community-based organizations can come together to improve access to essential mental health services and strengthen the overall support for adults in Bermuda who are struggling with acute mental health issues.

“Thirty key challenges were identified in relation to the provision of acute mental health services on the island. Not surprisingly, this body of work confirmed that the need for mental health services in Bermuda is high and has increased since the Covid-19 pandemic. However, as is the case in other countries, mental health has received less policy attention than other health conditions. This work begins to address that state of affairs and creates a clear pathway for how to move forward.

“The report coming out of this integrated care pathway work makes it clear that systemic change is required to address the existing gaps and opportunities with mental health support. Seven areas for policy intervention have been identified, along with 20 recommendations to improve the Pathway and significantly improve mental health outcomes.

“This is the first phase of work on increasing access to and strengthening the provision of mental health care in Bermuda. It is a priority for the Government and fellow health sector stakeholders. The reality is, however, that this will not be a quick fix.

“To ensure momentum on this work continues, a working group is currently being formed to drive the next phase of work. This will include actioning the priority recommendations identified in the Integrated Care Pathway. It is important to note that the Government cannot implement all the recommendations – either alone or all at once. Nor can they be implemented by stakeholders working in silos. A holistic and collaborative approach is required between the Government, mental health service providers, community organizations, and other key stakeholders. We are committed to facilitating an environment where productive solutions can be developed and implemented for improved access to and quality of mental health support.

“Already, one of the organic outcomes of this working group coming together was the creation of the Alliance for Mental Health Advocacy [or AMHA]. This group aims to safeguard the rights of individuals grappling with mental health conditions. Ms. Barbara Belton-Brown is with us this morning as a representative of the Alliance. We look forward to engaging with the AMHA and all mental health stakeholders.

“The Adult Acute Mental Health Pathway outlines strategic measures to enhance access to mental health services, strengthen support systems, and reduce barriers that individuals facing mental health issues may encounter. It is a testament to our government’s determination to foster a society where mental health is a priority, destigmatized, and seamlessly integrated into our broader healthcare framework.

“The report on the Acute Adult Mental Health Integrated Care Pathway will be made available for download on www.healthstrategy.bm shortly following this press conference. I urge the members of our community and all stakeholders to take the time to review the findings and recommendations and be a part of the journey of strengthening this aspect of Bermuda’s health system.

“Before closing, I want to express my sincere gratitude to the professionals in the mental health sector, community partners, and stakeholders who have contributed their expertise and insights to the development of this pathway. Your commitment has been invaluable and together, we are forging a path toward a more compassionate and resilient Bermuda.

“As we move forward let us embrace this moment as a catalyst for positive change. I encourage open dialogue, collaboration, and active participation from all sectors of our community during the implementation process. Your input is crucial in shaping the final stages of implementation, ensuring that the Adult Acute Mental Health Pathway aligns with the diverse needs of our population.

“Let us reaffirm our shared commitment to building a healthcare system that not only promotes physical wellbeing but also nurtures the mental wellbeing of every individual. Together we are laying the foundation for a Bermuda where healthcare is truly universal, leaving no one in the shadows of neglect. Thank you.”

Dr. Anna Nielson-Williams stated, “It is a privilege to share the results of the initial work undertaken on developing the Acute Adult Mental Health Integrated Care Pathway. The approach taken was thoughtfully developed and implemented to ensure the best possible outcome in the long-term for our community. The process itself, with the stakeholder workshops and interviews, cultivated a stronger level of collaboration between services. The overwhelming response to the public survey reflects a high level of interest in mental health. Importantly, the stakeholder workshops, interviews, and surveys also created the opportunity for the voices of those with lived experiences and their families to be directly heard and their feedback incorporated into the findings and recommendations. The importance of the learning that came out of this cannot be overstated.

“I don’t think we initially appreciated how complex it was for people to initially enter and receive mental health services and support. In Bermuda, there are currently 21 different access points for people to enter the Care Pathway, which makes the coordination of care a challenge. Working together to create an integrated care pathway for acute adult mental health provided an opportunity to discuss the ways in which services should be better coordinated, with the patient and family’s experience in mind. This exercise also helped point to important service gaps, mainly around prevention, community care, and housing.

“The unfortunate reality is that mental health carries with it a stigma… one that all too often acts as a barrier to those suffering with mental health challenges in seeking out the support they need. This was one of the two main barriers to accessing mental health care in Bermuda that were identified. The other was cost… the inability to cover copays within the primary care setting, or, in the case where an individual has no health insurance, the total cost of service and/or medication represents an overwhelming barrier to access in Bermuda. The prohibitive cost forces people to wait before they receive care. This can result in more acute health situations that require more intensive, in-patient treatment or services, which is both very costly and very difficult for patients.

“Our work surfaced important service gaps in Bermuda that need to be addressed. For example, there are currently no public, early intervention mental health services available in the community. There is also a lack of adequate housing options for hospital discharge, which can lead to poor patient health outcomes.

“The final report highlights seven priority areas for intervention, including:

• designing and implementing public preventive and early intervention services,
• expanding information about existing services,
• raising awareness around mental health and addressing issues of stigma,
• ensuring privacy of services,
• integrating mental health assessment and care into the community,
• improving insurance coverage for mental health-related expenses, and
• striving to provide culturally appropriate care.

“Bermuda’s annual mental health expenditure per person is significantly higher than other jurisdictions. The 20 recommendations included in the final report represent opportunities to improve patient experience while in the care pathway, while also offering the much-needed cost-saving opportunities.

“All are important; however, I would like to highlight the following three, which represent considerable opportunities for Bermuda to improve the health of its population.

“It is recommended that:

• a public repository of mental health resources be created to ensure members of our community can easily find what mental health services are available and where,
• a national mental health strategy for Bermuda be developed, and
• a “one-stop shop” clubhouse be opened in Hamilton, which is a community-based center designed to create a supportive and inclusive environment where people with mental health conditions can come together to socialize, learn skills, and access various services.

“There has been increasing public sentiment about the need for mental health to become a key public health priority. This initial work on the Integrated Care Pathway for Acute Adult Mental Health is a recognition of the need for improved mental health care. It has provided a springboard and an initial way forward for all stakeholders to continue working together to strengthen this component of Bermuda’s overall health system.

“Before I hand off the microphone to Minister Wilson, I would like to express my personal thanks to everyone who has been involved in this work to date, in particular those with lived experiences and their families. Without the willingness of all stakeholders to engage in transparent conversation and debate, we would not have been able to develop the future state care pathway and service map. It has been, and will continue to be, my privilege to work alongside both my fellow working group members, and the diverse group of stakeholders as we continue on this journey of strengthening mental health care in Bermuda. Thank you.”

The Acute Adult Mental Health Integrated Care Pathway Report follows below [PDF here]:

The Acute Adult Mental Health Integrated Care Pathway Service Map follows below [PDF here]:

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