Canada must provide care continuity for mental health/addiction patients
With World Mental Health Day this week, now is a suitable time to discuss mental health and addiction from an overall, health-care system perspective.
A study conducted for The Mental Health Commission of Canada estimates that one in five Canadians are affected annually by a mental health or addiction challenge. By age 40, half of the population will have experienced or presently have a mental illness. About one in 25 adults suffer a severe mental illness each year sufficient to significantly impact their ability to go about their daily lives.
Patients who struggle with mental health and addiction interact with the health-care system on a significantly more frequent basis than the average Canadian. There are many points of care delivery — in addition to their primary care physician, these individuals interact with a wide range of mental health care providers including psychiatrists, psychologists, addiction counsellors, social workers, psychiatric nurses and sometimes many more.
In the community, they may have case managers, social workers and rehab providers. If they suffer an acute mental illness, relapse, overdose or experience anything requiring immediate treatment, there are visits to hospital emergency rooms, lengthy stays in mental health clinics and residential withdrawal management programs.
Mental health and substance — use disorders seldom occur in isolation. Patients frequently suffer with both and may also have a number of general medical illnesses especially chronic diseases such as heart disease, diabetes and cancer. Managing the multiple conditions, long lists of medications, and grappling with the impact of the condition itself, mental health patients are more likely than others to accidentally omit important medical information or report it incorrectly to their care providers.
Given these realities, improving the quality of care for patients depends on the effective collaboration of all the providers involved. Providers need to share the information they gather about patients in a shared care plan.
When it comes to informationsharing in our system, consider that 16 per cent of Canadians with chronic conditions (of which mental health and addiction was near the top of the list) report they have undergone unnecessary repeat procedures, according to the Orion Health Chronic Care Index, (a survey of Canadians with chronic conditions). Similarly, 18 per cent reported they had experienced medication errors. Given the risks associated with those unnecessary procedures and medication errors, there is still much room for improvement.
The survey also showed that much of our health care delivery system is fragmented into multiple silos that do not work well together. This is not unique to Canada — it is the case in all countries. Care fragmentation reveals itself in many ways, including a lack of communication between specialists and primary care physicians. Add into the mix the wellknown lack of connection between different EHRs, plus the lack of any technology in some community settings and it’s easy to see how patients with mental health challenges may be poorly served.
As a primary care physician, I know that much can be done to improve care for patients suffering from mental health issues by co-ordinating services across all points of care. This community-focused health model has been an aim for years around the world, and it makes sense, both economically and from a health perspective.
Care coordination is extremely useful in improving the health and quality of life for those with mental health problems who are most at risk of falling through the cracks. It is not a new idea — community nurses have practised and promoted its use for years
Continuity of care is only possible with integration of information across the community and use of a single care plan that links the efforts of all providers involved in the care of each patient. Complete information is key to proper decision-making, especially in health. With care coordination and shared electronic health records, practitioners can have access to the information they need to make the most informed decision and reduce the chance that people fall through the cracks.
Digital health technology has the ability to change the quality of patient care for people suffering with mental health and addiction challenges, as well as all chronic conditions. When health care providers have access to complete patient information from the entire care continuum, there is a better quality of life for all.