Mark Snaterse has served as Alberta Health Services' Executive Director for Addiction and Mental Health, Edmonton Zone, for the past nine years.
It's a big job that touches the lives of thousands of people every day.
From his 6th floor office on 108 St., a short walk from the iconic Dome atop the Alberta Legislature Building, Snaterse oversees dozens of programs that deliver specialized inpatient or community-based addiction and mental health services for the young, the old, and everyone in between.
Snaterse, who has a clinical background in psychiatric pharmacy practice with a focus on acute adult mental health, forensic psychiatry and geriatric psychiatry, oversees a program with roughly 3,000 AHS staff members and 240 psychiatrists along with his dyad partner and Zone Clinical Department Head, Dr. Pierre Chue.
Only a handful of private companies in the Edmonton region are larger than that.
"Most of the psychiatrists who work in our programs are also part of the Department of Psychiatry at the University of Alberta," says Snaterse, who has also served as an Adjunct Clinical Professor with the Faculty of Pharmacy.
"Since (current Psychiatry Department Chair Dr. Xin-Min Li) was appointed, we've been meeting almost weekly. There's very little we can do without engaging and involving our psychiatrists and bringing them on board with us. It's vitally important that the academic vision and programs of the Department of Psychiatry is aligned with, and supportive of, the clinical programs administered by AHS."
Improving coordination and communication between hospitals, clinics and other mental health service providers across the Zone is a major focus for both of them, says Snaterse.
"Having a communication and engagement strategy is critical for Xin-Min, and it's also critical for me. We both struggle with that. For Dr. Li, his psychiatrists work all over the Zone, in different inpatient units, emergency departments, outpatient clinics, community practices and sometimes in private practice," he explains.
"It's the same with my program. We're geographically distributed in a hundred different locations. So when you offer a huge breadth of programs that span everything from primary care to specialized community care, to acute care, tertiary, and quaternary services, it's hard to ensure that everybody is on the same page."
That fragmentation has also posed challenges for those seeking help with addictions or mental health issues, he notes.
"Although we deliver a lot of services, the public really struggles to find the right service for them. It's not unusual for patients and their families to have to tell their story five or six times before they get into the right team for them. Nobody is aware of all the services AHS provides," he says.
"Right now, we have a whole bunch of 'front doors.' But those front doors are not very well coordinated, and even after you get inside one of those doors, no one is really aware of all the services that are available across our system."
In other words, he says, the mental health and addictions system he oversees for AHS in the Edmonton area doesn't currently function as a well-integrated system, but as a series of often disparate and disconnected services.
"We have a whole bunch of service providers, programs and people doing really great things. We have a tremendous number of great doctors, nurses, therapists, psychologists, social workers and treatment teams. But we're not really behaving as a coordinated system," he says.
Snaterse and his team have been working hard to fix that, beginning with the launch of an electronic medical record.
"Now, instead of every individual psychiatrist, therapist, or counsellor having their own paper-based chart that only they see, we have an enterprise-wide electronic medical record that everyone has access to. That was a huge enabler for us," he says.
That was just the first step, however. Over the next five years, AHS intends to roll out its Connect Care electronic records system, a consolidated province-wide clinical information system that will give healthcare providers in every corner of Alberta access to the same comprehensive system of patient information.
By providing healthcare staff in all locations with a complete picture of each patient's health care history, AHS hopes to foster best practices and better patient outcomes right across the system.
"Edmonton is where we'll start rolling it out in about two years - specifically on the University of Alberta Hospital campus," he says. "Once it's fully implemented over the next five years, Connect Care will provide instant access to vital information for inpatients, outpatients, community services, ambulatory services, addictions, mental health - everything. Every hospital and every clinic will rely on the same electronic medical record."
Snaterse sees another key element of his campaign to improve the quality and coordination of mental health and addictions services coming to life in the next year: Anderson Hall.
By January of 2019 a new 24/7 Access Centre - exclusively dedicated to addictions and mental health patients - is slated to open its doors in the renovated Anderson Hall building, located directly across the street from the Royal Alexandra Hospital's Emergency Department, at 10959 102 St.
"It's important to understand what it is, as well as what it isn't. We're not branding it as a Psychiatric Emergency Department, and we're not branding it as a Mental Health Urgent Care Centre. For now, we're referring to it as 24/7 Access," Snaterse explains.
"We want it to be a warm, welcoming environment and an alternative for many people to a hospital Emergency Department. A lot of people who go to an Emergency Department aren't necessarily in a mental health crisis, but don't know where else to go. And most of our doors in the community close at 4:30 p.m. on weekdays. So potentially, we think 40-45% of people who currently try to access care in a hospital Emergency Department could more appropriately be offered services in a location like this."
A lot of work needs to be done first to make Snaterse's vision a reality, of course. Various working groups have been formed to address such issues as developing protocols for Emergency Medical Services (EMS), Edmonton Police Service (EPS), RCMP and a vast number of other programs and agencies.
"The ambulances will need to know who to bring to Anderson Hall versus an Emergency Department. Police also convey a lot of people under the Mental Health Act to hospital, but some of those people can be better served at Anderson Hall. So we'll need to work with our partners to help them understand what it's all about."
As Snaterse envisions it, Anderson Hall will be a place where those with mental health or addictions issues can seek advice or information 24 hours a day, seven days a week. Family physicians will be able to refer their patients to Anderson Hall where their needs will be assessed by qualified staff, and they'll get streamlined access to the service in the Zone that is most appropriate for their needs.
It's also important to ensure that patients are offered choices and are involved in the decision-making around the service that they receive, he says.
The new 24/7 Access will occupy the entire main floor of Anderson Hall. Staffers will also occupy one of the upper floors of the 50-year-old building.
"We'll have a little bit of new money for this, but most of it involves moving existing teams there from other locations. Right now we have a 24/7 crisis team, a community stabilization team, police and crisis teams, an urgent community clinic, and people who handle intake, all in different locations and attached to different services," he says.
"We're going to take many of those clinicians and relocate them into this building. We are actively recruiting psychiatrists who may have an interest in being part of this exciting new service. We still have to identify all of the people who will be involved, but when we first looked at how many staff in our system are predominantly involved in intake, we found almost 40 people performing that role."
Once it's up and running, Snaterse expects Anderson Hall's on-site staff to include psychiatrists, nurses, addictions counsellors, mental health therapists, social workers, peer support workers and other specialists.
"The work we're doing at Anderson Hall is to create a welcoming, well-staffed physical environment with a clinical team that's highly skilled and aware of everything we offer across the Zone," he says.
"But the real culture change will involve the rest of our community programs. They'll need to give up the autonomy to pick and choose who comes into their programs. If we're going to do a comprehensive assessment at Anderson Hall, we don't want that patient or family to have to retell their story when they see the next psychiatrist or therapist," he adds.
"We want the receiving clinician to build on the assessment that's already been done, so our patients and families can receive the specialized care they need faster."