MENTALLY ILL VISIT HOSPITAL MORE OFTEN
Incidence highest in Quebec, new study finds
OTTAWA •
One in seven patients in Canadian hospitals has a mental disorder, and despite a trend to treat them in the community, people with psychiatric illnesses make up one-third of all days spent in hospitals.
A new national report shows that, in 2002-2003, people being treated for depression, mania, anxiety, psychosis and other mental health problems accounted for more than 190,000 hospital stays, and stayed more than 7.7 million days. That represents 6% of all hospital stays that year.
A further 9% of stays involved people with a “secondary” psychiatric diagnosis, meaning they were treated for something else but there was an associated mental illness — such as a patient with heart disease who was also severely depressed.
Together they accounted for one-third of the total number of days patients spent in Canadian hospitals. People with mental illness stay in hospital, on average, more than twice as long as other patients. And most were hospitalized during the most productive years of their lives, between ages 25 and 55.
More people were admitted for mood disorders, such as depression and biopolar disorder (manic depression), than any other diagnosis. The exception was the Northwest Territories, where alcohol and drug-related disorders sent more people to hospital.
Across Canada, schizophrenia and psychotic disorders accounted for 21% of hospital stays among the mentally ill; 14% were alcoholor drug- related disorders.
Overall, Quebec had the highest number of hospital stays for mental illness, with more than 3.8 million days, followed by Ontario at more than 1.8 million.
“Frankly, I’m flummoxed,” said Dr. Joel Paris, chairman of the department of psychiatry at Montreal’s McGill University. “I’m very surprised by the number.”
Most psychiatric hospitals in Quebec have closed or been “vastly reduced in bed space,” he said, and the emphasis has been on treating people in the community. The report found the median length of stay in a general hospital in Quebec for a mental illness was 59 days, versus 13 days in Ontario and 15 in British Columbia.
“I know there are problems [in Quebec] about long-stay patients, mostly psychotic people who have nowhere to go. My question is, how come they don’t have the same problem in other places?
“ Are a few people like that throwing the statistics out? Do we have insufficient alternative places to house people?”
What does not surprise him is how many hospital days people living with a psychiatric illness fill.
“Sit in any emergency of any large hospital and they will tell you the psychiatric clientele is one of their major users.” A large U.S. study published in June found that, in general, half of all people would have a diagnosable mental illness in their lifetime; one-third will have one in any year.
The report, released yesterday by the Canadian Institute for Health Information, found the rate of hospitalization for a mental disorder in Canada has fallen over the past decade. So has the average length of stay, dropping from 66 days to 41 over the same period.
But mental illness still “represents a significant proportion of the activity within hospitals,” says Brent Diverty of CIHI.
Mood disorders and schizophrenia, a biological brain disease that can cause hallucinations and delusions, accounted for the most hospitalizations for a mental illness among male patients.
For women, it was mood disorders such as bipolar disorder.
Among those with a mental illness, 15% of hospital stays involved youth aged 15 to 24; 38% involved those aged 25 to 44.
Psychiatric hospitals accounted for nearly 46% of all hospital days counted in the survey.