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Taking Stock: New Report on Mental Health and Addictions Services in Ontario

Health Quality Ontario and the Institute for Clinical Evaluative Services have released a new report exploring the quality of the province’s mental health and addictions services.

I believe that we talk more openly and more knowledgeably than ever before about mental health and addiction. People like Clara Hughes have been great Canadian role models in fostering more open dialogue. On the board of my own small Family Health Team, I have been inspired by Vassilios Apostolopoulos whose challenges with mental health led him to being disbarred from practicing law and homeless for a period of time. Similarly I have had a deep respect for the openness of my colleague Rick Glazier, whose son struggled with mental health and addiction and died at 18 from an accidental drug overdose.

There are also concerted local and system efforts to try and improve care for people who have mental health and addiction problems. Through the Adopting Research to Improve Care (ARTIC) program, Health Quality Ontario (HQO) is pleased to support two initiatives in this field: the Depression and Alcoholism – Validation of an Integrated Care Initiative DA VINCI) and the Mentorship, Education and Training in Addiction: Primary Care-Hospital Integration (META:PHI) program.

Despite all these important steps forward, stigma remains. There are also gaps in our knowledge and within the system to care for people with mental health and addiction.

To address some of these gaps, HQO and the Institute for Clinical Evaluative Sciences (ICES) have created Taking Stock, a report on the quality of mental health and addictions services and care in Ontario. ICES and HQO hope this report will support the work of the province’s Mental Health and Addictions Leadership Advisory Council and their report Better Mental Health Means Better Health and help guide the Ministry of Health and Long-Term Care’s Open Minds, Healthy Minds strategy. We also hope the report will be broadly read and shed new light on the current impact of mental health and addiction in Ontario.

We know that about two million people across the province are affected by a wide variety of mental illnesses and/or addictions each year. There are also many more who are family, friends and colleagues of those with mental illness and/or addiction who are also affected.

As I said in our recent media release, while Ontarians have various mental illness and addictions services available to them, there is not a comprehensive mental health system in place to provide services when and where they are often needed most. A recent survey from 2012 showed that one-third of Ontarians who identified as needing mental health or addictions services reported not getting help or having their needs only partially met. Taking Stockalso shows that one-third of emergency department visits for mental illness or addiction are by people who have not been assessed and treated for these issues by a physician in the last two years. These stats suggest that there are a range of opportunities to further improve the quality of care for those with mental health and addictions problems.

Taking Stock also reveals that some population groups aren’t receiving the same quality of mental health care as others, especially when it comes to follow-up visits, assessment and outpatient contact. The report shows that people with the lowest incomes in Ontario are less likely to have a follow-up visit with a physician seven days after leaving the hospital following admission for mental illness or addiction (26.9% have a visit, compared to 32.5% of people in the highest income bracket). People from rural areas who are hospitalized for a mental illness or addiction are also less likely to have a follow-up with a physician within that same time frame (23.1% have a visit compared to 30.4% of people living in urban cities). Young people (42.7% of people aged 16 to 24) are more likely to visit the emergency room without prior outpatient contact with a physician for mental health or addiction care. And immigrants are more likely to receive their first assessment for a mental illness or addiction in a hospital emergency department (38.6% are assessed for the first time compared to 32.5% of non-immigrants). The number of psychiatrists per residents in different areas of Ontario differs widely.

These statistics show us just some of the areas where our mental health system can improve. That said, there are also areas of the mental health system that have improved. Taking Stock also shows that Ontarians no longer have to wait as long for addiction treatment programs. The average wait time for community addiction treatment programs improved to 16 days in 2012/13 – down from 26 days in 2008/09 – and 42 days in 2012/13 for residential addiction treatment programs, down from 49 days in 2008/09.

I agree with Dr. Paul Kurdyak, lead ICES scientist on the report, who says in the media release, “Finding ways to improve access to care will not only improve the immediate mental health of Ontarians, it will also ease the future burden of care needs for individual patients and their families, as well as for the system overall.”

In this video, one of the people profiled in Taking Stock shares his journey of what life is like with schizoaffective disorder following his diagnosis at age 17. Gord’s story drives home the importance of improving access to care.

Echoing the sentiment, Apostolopoulos says he was lucky in getting help when he did. But luck shouldn’t have anything to do getting early and effective treatment.

Going back to my own practice, I don’t think I’ve ever had a day in my family medicine clinic or when I’ve worked shifts in the emergency department where I didn’t see a number of people with mental health and/or addiction issues. Sometimes it was the main reason for a patient coming to seek care, often however, it surfaced only through careful conversations and as we formed a trusting doctor-patient relationship. In these hundreds of interactions, just how pervasive the impact of mental health and addictions became quite clear to me. Taking Stock presents this reality and paints a very vivid picture of the state of mental health and addictions services across Ontario and their impact on our population.

While we know there is a lot of work to do in this area, it is our hope that this report, along with others such as The Mental Health of Children and Youth in Ontario: A Baseline Scorecard by ICES, will inspire the development of new ways for the health system and services to reach everyone with mental illness and addiction – because we are all effected by mental health issues, whether we have one or not.

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