When senior staff at one of the country’s leading mental health hospitals looked at the lengthy wait times for the facility’s outpatient care, they decided to take an unusual step to address the issue: reducing the number of programs the hospital offers.
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hospital → lead → programs
The Royal, located in Ottawa, used to run 17 different mental health programs, such as for anxiety disorders and mood disorders.
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Royal → locate → disorders
But members of the hospital’s senior leadership team say this led to siloed services that had different admission criteria, contributing to a backlog of patients who waited around two years to receive care.
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who → say → care
Some patients qualified for more than one program, for instance if they were struggling with both anxiety and substance use, further complicating how patients received care.
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patients → qualify → care
Then, in January, the mental health hospital moved to deliver just three.
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hospital → move → three
The programs now include a general psychiatry stream for patients who live with a range of mental health concerns, including mood, anxiety, obsessive-compulsive, trauma and personality disorders.
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who → include → mood
Lastly, the integrated forensic program provides specialized treatment for patients who have come into contact with the criminal justice system or who are at risk of doing so.
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who → integrate → risk
The changes have already proven to be effective, along with other measures including hiring a dozen more psychiatrists and centralized data tracking on patient demand to better inform service delivery.
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changes → prove → delivery
Since the beginning of the year, the Royal increased the number of outpatients seen from 407 in January to 800 in June.
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Royal → increase → June
The number of patients waiting for care has also declined by 62 per cent from 1,498 to 574.
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number → wait → 574
“We are providing more access to patients,” said Maiko Schneider, the hospital’s senior medical officer and deputy chief of staff.
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Schneider → provide → staff
Dr. Schneider said the hospital can now see outpatients within about three to four months.
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hospital → say → months
Previously, the wait list was so long that many of the city’s care providers stopped referring patients to the hospital all together.
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many → stop → hospital
In the hospital’s annual report for 2024-25, it described how “long wait times, fragmented services, and the continued shortage of primary care providers have created a system under pressure.
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times → describe → pressure
“
Too often, it added, people turn to emergency departments because they have nowhere else to go.
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they → add → nowhere
Dr. Schneider said patients who do not receive timely care become more difficult to treat, and often have more dysfunctional lives and struggle in the community.
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who → say → community
The Royal’s new approach to improving patients’ access to care could serve as a roadmap for other institutions looking to reduce wait times while also facing financial constraints.
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approach → improve → constraints
Cara Vaccarino, the Royal’s president and chief executive officer, said most hospitals are facing significant structural deficits.
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hospitals → say → deficits
The Royal reported a $6.5-million deficit last March.
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Royal → report → deficit
She said that while it can be a daunting proposition for hospital leaders to be ambitious and bold in this climate, that cannot “deter us from innovating, from advancing.”
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that → say → us
On Sept. 21, the Royal is scheduled to open an urgent-care clinic where patients who are in distress can be seen by psychiatrists.
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who → schedule → psychiatrists
The hospital’s former urgent-care clinic shuttered in 2000 amid efforts in Ontario to streamline health care services.
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clinic → shutter → services
At the clinic, patients would be admitted to hospital if needed or could have up to six outpatient appointments, said Stephanie Carter, executive director at the hospital.
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Carter → admit → hospital
The goal is to eventually scale up clinic services to include evening and weekend coverage.
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goal → scale → coverage
Ms. Vaccarino said the Royal has drawn lessons from the Centre for Addiction and Mental Health in Toronto, such as tracking patient intake to inform program delivery.
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Royal → say → delivery
CAMH is Canada’s largest mental health teaching hospital and also operates an urgent care clinic.
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CAMH → operate → clinic
“A lot of us, including myself, worked at CAMH for a long time,” she said.
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she → include → time
“CAMH actually undertook a lot of the changes we’re doing now quite some time ago.”
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we → undertake → changes
At the Royal, Ms. Vaccarino said her team’s approach is to be “relentlessly focused and dogged.”
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approach → say → Royal
“We are not rocket scientists,” she said.
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she → say → ?
“We’re just doing the right thing.”
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We → do → thing
She speaks from personal experience.
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She → speak → experience
When she was just 10-years-old, her mother, Joan, died by suicide.
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mother → die → suicide
Ms. Vaccarino shared how her mother encountered stigma and isolation while she was navigating what is now known as treatment-resistant depression.
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what → share → depression
“That kind of loss changes you forever,” Ms. Vaccarino wrote in an op-ed last year, describing the experience as her “guiding force.”
“I knew – even then – that I would spend my life working to ensure no other child had to lose a parent to an illness that could, and should, be treated with the same urgency and innovation as any physical health condition.”
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that → change → condition
The Aporia
