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Law S, Kassam A, Beder M, Sediqzadah S, Levy M, Maher J. Impact of the Pandemic was Minor Compared to Systemic Decrease in Fidelity of Assertive Community Treatment Services- A Provincial Study in Ontario, Canada. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01375-1. [PMID: 38625457 DOI: 10.1007/s10488-024-01375-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/17/2024]
Abstract
Assertive Community Treatment (ACT) model is the gold standard in community psychiatry serving people with severe mental illness. With its outreach-based design, the pandemic has profoundly affected the operations and functioning of ACT. The Dartmouth ACT Scale (DACTS) provides a standardized comprehensive and quantitative way to evaluate ACT quality. Results could inform nature of impact and identify areas for improvement. Current online survey used DACTS during the pandemic in April-May 2021. Clinical and administrative leadership of the 80 ACT teams in Ontario, Canada cross-sectionally rated ACT quality one-year pre-Covid (2018-2019) and one-year post the start of Covid (2020-2021). The overall pre-Covid Ontario ACT DACTS fidelity was 3.65. The pandemic led to decreases in all domains of DACTS (Human Resources: -4.92%, p < 0.001, 95% CI [0.08-0.27]; Organizational Boundary: -1.03%, p < 0.013,95%CI [0.01-0.07]; and Nature of Services: -6.18%, p < 0.001, 95%CI [0.16-0.26]). These changes were accounted by expected lower face-to-face encounters, time spent with clients, reduction in psychosocial services, less interactions with hospitals and diminished workforces. The magnitude of change was modest (-3.84%, p < 0.001, 95%CI [0.09-0.19]). However, the Ontario ACT pre-Covid DACTS was substantially lower (-13.5%) when compared to that from a similar survey 15 years ago (4.22), suggestive of insidious systemic level loss of fidelity. Quantitative fidelity evaluation helped to ascertain specific pandemic impact. Changes were significant and specific, but overall relatively modest when compared to the larger system level drop over the last decade. There is both evidence for model adaptability and resilience during Covid disruption, and concerns over larger downward drift in ACT fidelity and quality.
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Affiliation(s)
- Samuel Law
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, St. Michael?s Hospital, Unity Health Toronto, Toronto, ON, Canada.
| | - Aly Kassam
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Michaela Beder
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, St. Michael?s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Saadia Sediqzadah
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, St. Michael?s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Matthew Levy
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, St. Michael?s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - John Maher
- Canadian Mental Health Association, Barrie, ON, Canada
- Ontario Association of ACT and FACT, Toronto, ON, Canada
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Landry H, Kingsbury M, Hamilton HA, Colman I. Psychological distress, non-medical use of prescription medications, and perceived unmet mental health care needs: a cross-sectional study of Ontario students. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1483-1492. [PMID: 36932238 DOI: 10.1007/s00127-023-02450-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE The non-medical use of prescription medications among adolescents has become a concerning public health issue. This study assessed the prevalence of the non-medical use of prescription medications in Ontario high school students, and explored the moderating effect of this use on the relationship between psychological distress and unmet mental health needs. METHODS Cross-sectional data for 4896 students, age 14-18, were drawn from the 2019 Ontario Student Drug Use and Health Survey. Psychological distress was measured using the Kessler-6 Distress Scale, unmet mental health needs were defined by self-report (yes/no), and non-prescription medication use was defined by self-reported frequency of use. Using logistic regression, we explored the effect of the non-medical use of prescription medications on the relationship between psychological distress and unmet mental health needs. RESULTS High proportions of Ontario students reported serious psychological distress (22%), some degree of unmet mental health need (38%), and/or non-medical use of prescription medications (13%). While there were strong associations between psychological distress and unmet mental health need, this association was weaker among those reporting non-medical use of prescription medications (OR = 3.3, 95% CI 1.9-5.7) compared to non-users (OR = 5.6, 95% CI 4.5-7.1). CONCLUSION Our findings suggest that Ontario students experiencing distress and using non-prescribed medications are less likely to identify a need for mental health support, highlighting the consequences of apparent self-medication through misuse of prescription medications. To assist in the redirection of adolescent perceptions of healthy coping strategies, population-based educational programming, with targeted promotion of both formal and informal mental health care resources, should be considered.
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Affiliation(s)
- Hannah Landry
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 308C, Ottawa, ON, K1G 5Z3, Canada
| | - Mila Kingsbury
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 308C, Ottawa, ON, K1G 5Z3, Canada
| | - Hayley A Hamilton
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 308C, Ottawa, ON, K1G 5Z3, Canada.
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
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3
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Gatov E, Strudwick G, Wiljer D, Kurdyak P. E-Mental Health Services in Canada: Can They Close the Access Gap? Healthc Policy 2023; 19:40-48. [PMID: 37695705 PMCID: PMC10519335 DOI: 10.12927/hcpol.2023.27159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
With significant unmet needs for mental healthcare in Canada, there is a growing interest in e-mental health (e-MH) services to meet gaps in access. While the policy window appears to be open, it is unclear how best to implement e-MH services due to health system barriers that create unmet needs in the first place. We explore the financing, organization and delivery of Canadian mental health services and discuss the promise of e-MH services for alleviating access barriers, highlighting increased policy attention during the COVID-19 pandemic. We consider how evidence-based e-MH services have successfully scaled in other publicly funded healthcare systems and note potential issues in the Canadian context.
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Affiliation(s)
- Evgenia Gatov
- Candidate Health Services Research - Health Informatics Institute of Health Policy, Management and Evaluation University of Toronto Toronto, ON
| | - Gillian Strudwick
- Associate Professor Institute of Health Policy, Management and Evaluation University of Toronto Senior Scientist and Chief Clinical Informatics Officer Centre for Addiction and Mental Health Toronto, ON
| | - David Wiljer
- Professor Institute of Health Policy, Management and Evaluation University of Toronto Executive Director Education, Technology and Innovation University Health Network Toronto, ON
| | - Paul Kurdyak
- Medical Director Performance Improvement Centre for Addiction and Mental Health Professor and Co-Director Division of Adult Psychiatry and Health Systems Department of Psychiatry University of Toronto, Toronto, ON
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4
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Darker CD, Nicolson G, Reddon H, O'Connor K, Jennings R, O'Connell N. Barriers and facilitators to the implementation of an early intervention in psychosis service in three demonstration sites in Ireland. BMC Health Serv Res 2023; 23:653. [PMID: 37337176 DOI: 10.1186/s12913-023-09585-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/20/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Programmes for early intervention (EIP) in psychosis for people experiencing a first episode of psychosis (FEP) have been found to be both clinically and cost effective. Following the publication of a new EIP model of care (MoC) in Ireland, the aim of this research is to describe how people participated in and responded to the MoC including service users, family members, HSE clinical staff and HSE management. METHODS Qualitative design using the UK Medical Research Council's process evaluation framework. Purposive sampling techniques were used. A total of N = 40 key informant semi-structured interviews were completed which included clinical staff (N = 22), health service managers and administrators (N = 9), service users (N = 8) and a family member (N = 1). Thematic analyses were conducted. RESULTS Unique features of the EIP service (e.g., speed of referral/assessment, multidisciplinary approach, a range of evidence-based interventions and assertive MDT follow up) and enthusiasm for EIP were identified as two key factors that facilitated implementation. In contrast, obstacles to staff recruitment and budget challenges emerged as two primary barriers to implementation. CONCLUSIONS The findings from this research provide real world insights into the complexity of implementing an innovative service within an existing health system. Clear and committed financial and human resource processes which allow new innovations to thrive and be protected during their initiation and early implementation phase are paramount. These elements should be considered in the planning and implementation of EIP services both nationally in Ireland and internationally.
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Affiliation(s)
- C D Darker
- Discipline of Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - G Nicolson
- Health Promotion and Improvement Department, HSE Health and Wellbeing, 1st Floor Old National Ambulance Training Building, St Marys Hospital Campus, Phoenix Park, Dublin 20, Chapelizod, D20 TY72, Ireland
| | - H Reddon
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - K O'Connor
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
- Rise, South Lee Mental Health Services, Cork & Department of Psychiatry, University College Cork, Cork, Ireland
| | - R Jennings
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
| | - N O'Connell
- Sexual Health and Crisis Pregnancy Programme, HSE Health and Wellbeing, Strategy and Research, 89-94 Capel St, Dublin 1, Dublin, D01 P281, Ireland
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5
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Chapdelaine A, Vasiliadis HM, Provencher MD, Norton PJ, Roberge P. Cost-effectiveness of transdiagnostic group cognitive behavioural therapy for anxiety disorders v. treatment as usual: economic evaluation of a pragmatic randomized controlled trial over an 8-month time horizon using self-reported data. Psychol Med 2023; 53:1-13. [PMID: 36695038 DOI: 10.1017/s0033291722003920] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND This economic evaluation supplements a pragmatic randomized controlled trial conducted in community care settings, which showed superior improvement in the symptoms of adults with anxiety disorders who received 12 sessions of transdiagnostic cognitive-behavioural group therapy in addition to treatment as usual (tCBT + TAU) compared to TAU alone. METHODS This study evaluates the cost-utility and cost-effectiveness of tCBT + TAU over an 8-month time horizon. For the reference case, quality-adjusted life years (QALYs) obtained using the EQ-5D-5L, and the health system perspective were chosen. Alternatively, anxiety-free days (AFDs), derived from the Beck Anxiety Inventory, and the limited societal perspective were considered. Unadjusted incremental cost-effectiveness/utility ratios were calculated. Net-benefit regressions were done for a willingness-to-pay (WTP) thresholds range to build cost-effectiveness acceptability curves (CEAC). Sensitivity analyses were included. RESULTS Compared to TAU (n = 114), tCBT + TAU (n = 117) generated additional QALYs, AFDs, and higher mental health care costs from the health system perspective. From the health system and the limited societal perspectives, at a WTP of Can$ 50 000/QALY, the CEACs showed that the probability of tCBT + TAU v. TAU being cost-effective was 97 and 89%. Promising cost-effectiveness results using AFDs are also presented. The participation of therapists from the public health sector could increase cost-effectiveness. CONCLUSIONS From the limited societal and health system perspectives, this first economic evaluation of tCBT shows favourable cost-effectiveness results at a WTP threshold of Can$ 50 000/QALY. Future research is needed to replicate findings in longer follow-up studies and different health system contexts to better inform decision-makers for a full-scale implementation.
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Affiliation(s)
- Alexandra Chapdelaine
- PRIMUS Research Group, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e avenue Nord, local Z7-3004, Sherbrooke, Québec, J1H 5N4, Canada
| | - Helen-Maria Vasiliadis
- Université de Sherbrooke - Campus de Longueuil, Charles-Le Moyne Research Center, 150 Place Charles Lemoyne, Longueuil, Québec, J4K 0A8, Canada
| | - Martin D Provencher
- École de psychologie, Pavillon Félix-Antoine-Savard, 2325, rue des Bibliothèques, Université Laval, Québec, Québec, G1V 0A6, Canada
| | - Peter J Norton
- The Cairnmillar Institute, 391-393 Tooronga Rd, Hawthorn East, Victoria 3123, Australia
| | - Pasquale Roberge
- Department of family medicine and emergency medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e avenue Nord, local Z7-3004, Sherbrooke, Québec, J1H 5N4, Canada
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Forchuk C, Serrato J, Lizotte D, Mann R, Taylor G, Husni S. Developing a Smart Home Technology Innovation for People With Physical and Mental Health Problems: Considerations and Recommendations. JMIR Mhealth Uhealth 2022; 10:e25116. [PMID: 35486422 PMCID: PMC9107043 DOI: 10.2196/25116] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/10/2021] [Accepted: 02/22/2022] [Indexed: 11/30/2022] Open
Abstract
Smart home technologies present an unprecedented opportunity to improve health and health care by providing greater communication and connectivity with services and care providers and by supporting the daily activities of people managing both mental and physical health problems. Based on our experience from conducting smart technology health studies, including a smart home intervention, we provide guidance on developing and implementing such interventions. First, we describe the need for an overarching principle of security and privacy that must be attended to in all aspects of such a project. We then describe 4 key steps in developing a successful smart home innovation for people with mental and physical health conditions. These include (1) setting up the digital infrastructure, (2) ensuring the components of the system communicate, (3) ensuring that the system is designed for the intended population, and (4) engaging stakeholders. Recommendations on how to approach each of these steps are provided along with suggested literature that addresses additional considerations, guidelines, and equipment selection in more depth.
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Affiliation(s)
- Cheryl Forchuk
- Mental Health Nursing Research Alliance, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Jonathan Serrato
- Mental Health Nursing Research Alliance, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
| | - Daniel Lizotte
- Department of Computer Science, Western University, London, ON, Canada
| | - Rupinder Mann
- Research Informatics Department, Lawson Health Research Institute, London, ON, Canada
| | - Gavin Taylor
- Information Technology Services, London Health Sciences Centre, London, ON, Canada
| | - Sara Husni
- Mental Health Nursing Research Alliance, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
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7
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Individuals to Systems: Methodological and Conceptual Considerations for Addressing Mental Illness Stigma Holistically. Int J Ment Health Addict 2022; 20:3368-3380. [PMID: 35345872 PMCID: PMC8944180 DOI: 10.1007/s11469-022-00801-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/09/2022] Open
Abstract
Mental illness stigma is a complex public health issue that creates barriers for clients needing access to quality mental health services. Most research focuses on interpersonal stigma with emerging research examining intrapersonal and structural stigma in the healthcare setting. This commentary focuses on how to address the gaps in the existing research to elicit greater organizational/structural change in healthcare systems and positive health outcomes. It describes key components of a 5-year multiphase study that aims to explore and address multiple levels of stigma holistically among stakeholders including physicians, nurses, protective services staff, and patients/families in an emergency department setting. Unique to this study is the inclusion of a patient research partner who will be positioned as a co-designer throughout the project. The goal of this study will be to explore, address, understand, and evaluate interventions that mitigate stigma in healthcare at both the individual and structural/organizational levels.
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8
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Bartram M. 'It's Really About Wellbeing': a Canadian Investigation of Harm Reduction as a Bridge Between Mental Health and Addiction Recovery. Int J Ment Health Addict 2021; 19:1497-1510. [PMID: 34790080 PMCID: PMC8578070 DOI: 10.1007/s11469-020-00239-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Recovery is a key concept driving system transformation in both the addiction and mental health sectors, with shared roots in advocacy and a shared focus on hope in the face of stigma, self-determination and meaningful lives. Nevertheless, while mental health recovery is possible even with on-going symptoms, addiction recovery generally starts with or leads to abstinence. This disconnection undermines coherence at the policy level and exacerbates fragmentation between services and supports in the mental health and addiction sectors in Canada and internationally. At the same time, harm reduction, which does not require abstinence, has been gaining ground in the Canadian addiction sector. This qualitative policy study explores the potential for harm reduction to bridge the gap between mental health recovery and addiction recovery in the Canadian context, drawing on diverse experiences from the mental health and addiction sectors. The findings could be adapted internationally to address similar policy challenges.
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Affiliation(s)
- Mary Bartram
- Faculty of Law and the Institute for Health and Social Policy, McGill University, Charles Meredith House, 1130 Pine Avenue West, Montreal, Quebec H3A 1A3 Canada
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Poss J, Mitchell L, Mah J, Keefe J. Disparities in Utilization of Psychiatry Services Among Home Care Clients: The Tale of Two Canadian Jurisdictions. Front Psychiatry 2021; 12:712112. [PMID: 34603103 PMCID: PMC8484907 DOI: 10.3389/fpsyt.2021.712112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022] Open
Abstract
Publicly funded home care in Canada supports older adults in the community to delay institutional care, which results in complex care populations with multimorbidity that includes mental health problems. The purpose of this study is to examine prevalence of psychiatric diagnoses and other mental health symptoms among older clients in two publicly funded Home Care (HC) Programs and their psychiatry service utilization (psychiatrist visits) after being admitted to home care. This retrospective cohort study examines clients age 60 years and older in the two Canadian provinces of Manitoba (MB), specifically the Winnipeg Regional Health Authority (WRHA) (n = 5,278), and Nova Scotia (NS) (n = 5,323). Clients were admitted between 2011 and 2013 and followed up to 4 years. Linked data sources include the InterRAI Resident Assessment Instrument for Home Care (RAI-HC), physician visit/billing data and hospital admission data. Both regions had similar proportions (53%) of home care clients with one or more psychiatric diagnoses. However, we observed over 10 times the volume of psychiatry visits in the WRHA cohort (8,246 visits vs. 792 visits in NS); this translated into a 4-fold increased likelihood of receiving psychiatry visits (17.2% of WRHA clients vs. 4.2% of NS clients) and 2.5 times more visits on average per client (9.1 avg. visits in MB vs. 3.6 avg. visits in NS). The location of psychiatry services varied, with a greater number of psychiatry visits occurring while in hospital for WRHA HC clients compared to more visits in the community for NS HC clients. Younger age, psychotropic medication use, depressive symptoms, dementia, and having an unstable health condition were significantly associated with receipt of psychiatry visits in both cohorts. Access to psychiatric care differed between the cohorts despite little to no difference in need. We conclude that many home care clients who could have benefitted from psychiatrist visits did not receive them. This is particularly true for rural areas of NS. By linking the RAI-HC with other health data, our study raises important questions about differential access to psychiatry services by site of care (hospital vs. community), by geographical location (MB vs. NS and urban vs. rural) and by age. This has implications for staff training and mental health resources in home care to properly support the mental health needs of clients in care. Study results suggest the need for a mental health strategy within public home care services.
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Affiliation(s)
- Jeffrey Poss
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Lori Mitchell
- Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Jasmine Mah
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Janice Keefe
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada.,Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, NS, Canada
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10
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Moroz N, Moroz I, D'Angelo MS. Mental health services in Canada: Barriers and cost-effective solutions to increase access. Healthc Manage Forum 2020; 33:282-287. [PMID: 32613867 DOI: 10.1177/0840470420933911] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this article, an overview of the barriers to accessing mental health services in Canada is provided and the recent federal funding commitments toward increasing the availability of evidence-based and cost-effective solutions to improve access to mental health services are highlighted. Barriers pertain mainly to costs, not knowing where to get help, excessive wait times, and insufficient funding. Through the Common Statement of Principles on Shared Health Priorities agreement, action is being taken by all jurisdictions in Canada to increase community-based mental health promotion programs and early interventions, especially those targeting children and youth. A growing body of evidence is demonstrating how specific community and primary care-based interventions are both effective and cost-effective. These integrated community solutions, shown to be effective for increasing access to appropriate services for patients while saving costs to the healthcare system, would benefit from the recent funding investments put in place by the federal government.
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Affiliation(s)
- Nicholas Moroz
- 33498The Conference Board of Canada, Ottawa, Ontario, Canada
| | - Isabella Moroz
- 33498The Conference Board of Canada, Ottawa, Ontario, Canada
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11
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Wiktorowicz ME, Di Pierdomenico K, Buckley NJ, Lurie S, Czukar G. Governance of mental healthcare: Fragmented accountability. Soc Sci Med 2020; 256:113007. [PMID: 32464418 DOI: 10.1016/j.socscimed.2020.113007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/31/2020] [Accepted: 04/18/2020] [Indexed: 12/01/2022]
Abstract
Within international healthcare systems the neglect of mental health and challenge in shifting from institutional to community care have been recurrent themes. In analysing the challenges, we focus on the case study of Canada by exploring the manner in which health law and policy evolved to inhibit community-based mental healthcare, and compare the resulting funding landscape from an international perspective. The historical institutionalist analysis draws on the literature and healthcare finance data. As a spending statute, the Canada Health Act defines the terms on which the federal government finances publicly insured provincial healthcare. Despite the goal to support physical and mental well-being by removing financial barriers to access health services, exclusion of community care offered by non-physicians (such as psychotherapy) from the terms of the Act inhibited its fulfilment. Diminished federal transfers deepened the disincentive for provinces to establish community care: mental health declined from 11 to 7 percent of provincial healthcare spending from 1979 to 2014. Governance oversight was passed to provinces whose competing demands on diminished resources limited their capacity to extend care. Accountability was found fragmented as neither government stepped-in to ensure the continuum of care, even as federal transfers were restored and evidence of cost-effectiveness grew. Although American and Canadian funding patterns are similar, other OECD countries invest between 13 and 18 percent of healthcare expenditures on mental health. Lessons from the Canadian case are the manner in which its federal structure and intergovernmental dynamics shaped health policy, and the importance of ensuring representation from a range of perspectives in policy development. Federal financial incentives were also found to profoundly impact the expansion of community-based mental healthcare. Evidence shows that public insurance for community supports would reduce healthcare expenditures and employer productivity loss, resulting in savings of $255 billion over 30 years.
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Affiliation(s)
- Mary E Wiktorowicz
- York University, School of Health Policy and Management, Toronto, Canada; Dahdaleh Institute for Global Health Research, York University, Canada.
| | | | - Neil J Buckley
- York University, Department of Economics, Toronto, Ontario, Canada
| | - Steve Lurie
- Canadian Mental Health Association, Toronto, Canada
| | - Gail Czukar
- Addictions and Mental Health Ontario, Toronto, Canada
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12
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Palay J, Taillieu TL, Afifi TO, Turner S, Bolton JM, Enns MW, Smith M, Lesage A, Bakal JA, Rush B, Adair CE, Vigod SN, Clelland S, Rittenbach K, Kurdyak P, Sareen J. Prevalence of Mental Disorders and Suicidality in Canadian Provinces. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:761-769. [PMID: 31619055 PMCID: PMC6882072 DOI: 10.1177/0706743719878987] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is limited information to guide health-care service providers and policy makers on the burden of mental disorders and addictions across the Canadian provinces. This study compares interprovincial prevalence of major depressive disorder (MDD), bipolar disorder, generalized anxiety disorder (GAD), alcohol use disorder, substance use disorders, and suicidality. METHOD Data were extracted from the 2012 Canadian Community Health Survey-Mental Health (n = 25,113), a representative sample of Canadians over the age of 15 years across all provinces. Cross tabulations and logistic regression were used to determine the prevalence and odds of the above disorders for each province. Adjustments for provincial sociodemographic factors were performed. RESULTS The past-year prevalence of all measured mental disorders and suicidality, excluding GAD, demonstrated significant interprovincial differences. Manitoba exhibited the highest prevalence of any mental disorder (13.6%), reflecting high prevalence of MDD and alcohol use disorder compared to the other provinces (7.0% and 3.8%, respectively). Nova Scotia exhibited the highest prevalence of substance use disorders (2.9%). Quebec and Prince Edward Island exhibited the lowest prevalence of any mental disorder (8.5% and 7.7%, respectively). Manitoba also exhibited the highest prevalence of suicidal ideation (5.1%); however, British Columbia and Ontario exhibited the highest prevalence of suicidal planning (1.4% and 1.3%, respectively), and Ontario alone exhibited the highest prevalence of suicide attempts (0.7%). CONCLUSIONS Significant interprovincial differences were found in the past-year prevalence of mental disorders and suicidality in Canada. More research is necessary to explore these differences and how they impact the need for mental health services.
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Affiliation(s)
- Joshua Palay
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tamara L Taillieu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tracie O Afifi
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarah Turner
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Murray W Enns
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mark Smith
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Alain Lesage
- Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada.,Research Centre, Montreal University Mental Health Institute, Montreal, Quebec, Canada
| | - Jeffrey A Bakal
- Patient Health Outcomes Research and Clinical Effectiveness (PHORCE) Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Brian Rush
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Carol E Adair
- Department of Community Health Sciences, Cumming School of Medicine, Calgary, Alberta, Canada.,Department of Psychiatry, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Simone N Vigod
- Department of Psychiatry, Women's College Hospital and Research Institute, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Steven Clelland
- Knowledge, Performance and Integrated Planning, Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Katherine Rittenbach
- Addiction & Mental Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada.,Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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13
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Diminic S, Bartram M. Does Introducing Public Funding for Allied Health Psychotherapy Lead to Reductions in Private Insurance Claims? Lessons for Canada from the Australian Experience. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:68-76. [PMID: 29925270 PMCID: PMC6364136 DOI: 10.1177/0706743718784941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Provincial and territorial governments are considering how best to improve access to psychotherapy from the current patchwork of programmes. To achieve the best value for money, new funding needs to reach a wider population rather than simply replacing services funded through insurance benefits. We considered lessons for Canada from the relative uptake of private insurance and public funding for allied health psychotherapy in Australia. METHOD We analysed published administrative claims data from 2003-2004 to 2014-2015 on Australian privately insured psychologist services, publicly insured psychotherapy under the 'Better Access' initiative, and public grant funding for psychotherapy through the 'Access to Allied Psychological Services' programme. Utilisation was compared to the prevalence of mental disorders and treatment rates in the 2007 National Survey of Mental Health and Wellbeing. RESULTS The introduction of public funding for psychotherapy led to a 52.1% reduction in private insurance claims. Costs per session were more than double under private insurance and likely contributed to individuals with private coverage choosing to instead access public programmes. However, despite substantial community unmet need, we estimate just 0.4% of the population made private insurance claims in the 2006-2007 period. By contrast, from its introduction, growth in the utilisation of Better Access quickly dwarfed other programmes and led to significantly increased community access to treatment. CONCLUSIONS Although insurance in Canada is sponsored by employers, psychology claims also appear surprisingly low, and unmet need similarly high. Careful consideration will be needed in designing publicly funded psychotherapy programmes to prepare for the high demand while minimizing reductions in private insurance claims.
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Affiliation(s)
- Sandra Diminic
- 1 School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,2 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia.,3 Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada
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14
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Wiktorowicz M, Abdulle A, Di Pierdomenico K, Boamah SA. Models of Concurrent Disorder Service: Policy, Coordination, and Access to Care. Front Psychiatry 2019; 10:61. [PMID: 30837903 PMCID: PMC6389671 DOI: 10.3389/fpsyt.2019.00061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/28/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Societal capacity to address the service needs of persons with concurrent mental health and substance-use disorders has historically been challenging given a traditionally siloed approach to mental health and substance-use care. As different approaches to care for persons with concurrent disorders emerge, a limited understanding of current models prevails. The goal of this paper is to explore these challenges along with promising models of coordinated care across Canadian provinces. Materials and methods: A scoping review of policies, service coordination and access issues was undertaken involving a review of the formal and gray literature from 2000 to 2018. The scoping review was triangulated by an analysis of provincial auditor general reports. Results: Models of concurrent disorders service were found to have evolved unevenly. Challenges related to the implementation of models of collaborative care and local networks that foster service coordination and policy accountability were found to inhibit integrated care. Conclusion: Emergent models of coordinated care were found to include collaborative care, regional networks with centralized access to care, clinical information-sharing, cross-training, improved scope of care to include psychologists and alignment of physician incentives with patient needs to better support patient care.
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Affiliation(s)
- Mary Wiktorowicz
- School of Health Policy and Management, York University, Toronto, ON, Canada
| | - Aber Abdulle
- School of Health Policy and Management, York University, Toronto, ON, Canada
| | | | - Sheila A Boamah
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
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15
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Stewart AM, Sunderji N, Vasa P, Jansz G, Ion A, Ghavam-Rassoul A. The collaborative chronic care model for mental health should be implemented in Canada. CMAJ 2018; 190:E839. [PMID: 29986861 DOI: 10.1503/cmaj.69289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ann M Stewart
- Family physician, assistant professor, Department of Family and Community Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Nadiya Sunderji
- Psychiatrist, assistant professor, associate scientist, St. Michael's Hospital, University of Toronto, Li Ka Shing Knowledge Institute, Toronto, Ont
| | - Priya Vasa
- Family physician, Department of Family and Community Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Gwen Jansz
- Family physician, assistant professor, Department of Family and Community Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Allyson Ion
- Research coordinator, School of Social Work, McMaster University, Hamilton, Ont
| | - Abbas Ghavam-Rassoul
- Family physician, assistant professor, Department of Family and Community Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ont
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16
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Affiliation(s)
- Erin Russell
- Assistant Editor (Russell), Deputy Editor (Patrick), CMAJ
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