Ontario's mental health care evaluated

For the first time, Ontario hospitals have common information to help assess the quality of in-patient mental health care, with the release of a new Hospital Report by the University of Toronto-based Hospital Report Research Collaborative.

Hospital Report 2004: Mental Health is part of an ongoing series of reports on hospital care funded by the Ontario government and the Ontario Hospital Association. The researchers compiled the report after analysing data from a variety of sources.

"Including mental health in the hospital report series is a big step forward in acknowledging the treatment needs of those with mental illness," says Dr. Elizabeth Lin, who led the research team along with U of T Department of Psychiatry colleague Dr. Janet Durbin.

The report examines the overall performance of 11 psychiatric hospitals and 45 acute-care facilities in all five regions of Ontario: the north, the east, the Greater Toronto Area, the south and the southwest. In total, these facilities provide almost 1.5 million days of psychiatric care, about 25 per cent of the total days of hospital care provided in Ontario. The results are reported by region, not by individual hospital; the next mental health report in the series, slated for 2007, will provide performance data for individual hospitals.

"The introduction of this first-of-its-kind report on mental health is a positive step forward in enhancing these services across the province," says Hilary Short, president and CEO of the Ontario Hospital Association. "This report demonstrates yet another way Ontario hospitals are working with the government to lead accountability in the country."

"Overall, the news is good," agrees George Smitherman, Minister of Health and Long-Term Care. "The findings in this report indicate that for the most part patients are receiving quality mental health care. But there is always room for improvement, particularly in the area of mental illness, which for too long in our society has received neither the attention nor the understanding it requires, and that our patients deserve."

In general, the care being provided by Ontario hospitals conforms with the aims of mental health reform. However, the report identifies four key areas where more progress is possible.

Patient participation:

About 75 per cent of clients participate in discharge planning.

79 per cent of facilities/programs have clients or families represented on their steering and advisory committees. Continuity of care:

Most hospitals have partnered in some way with community providers to improve patient care, but only 52 per cent of discharged patients receive medical follow-up in the community within 30 days of discharge.

22 per cent of discharged patients are either readmitted within 30 days or visit the emergency room. Regional variation:

Regional variation in performance is considerable; while each region demonstrated strengths and weaknesses, the north scored lowest in many areas. Delivering evidence-based care:

Hospitals offer considerable support to staff for continuing education and training; but only about half the programs/hospitals report routine use of standardized care delivery approaches based on best practices.

Only 27 per cent of facilities use feedback from clients to improve program quality.

"This report provides information that will enhance our understanding of mental health care across the province," says Cliff Nordal, president and CEO of St. Joseph's Health Care in London, one of the participating hospitals. "While researchers acknowledge that there is more work to be done in future years to enhance the quality and meaningfulness of the data used to evaluate mental health care, this report is a clear signal that good progress has been made."

While highlighting areas where hospitals perform well, the data also point to areas where improvement is necessary. The suggestions for improving care include:

Regions and the province need to ensure that a continuum of supports is in place to assist clients upon discharge.

Hospitals need to improve the implementation of standardized, evidence-based approaches for delivering care.

Increased consumer participation in care planning should be promoted.

Strategies are needed to increase access to community care in the north.

"All five regions have strengths and weaknesses, so the hospitals have opportunities to learn from each other," says Dr. Durbin. "There is room for improvement provincewide and we hope these data will provide hospitals with a starting point."

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CONTACT:

Dr. Janet Durbin
Department of Psychiatry
U of T Public Affairs
416-535-8501, x 6229
Janet_Durbin@camh.net
or
Elaine Smith
U of T Public Affairs
416-978-5948
elaine.smith@utoronto.ca

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