The Canadian Institute for Health Information has released the Hospital Mental Health Services in Canada 2003-2004 report on general hospital and psychiatric hospital care.
30% of general hospital stays involved a primary or secondary mental illness diagnosis, and one in three of those patients were readmitted within a year of discharge. An additional one third of patients with a mental illness had a higher risk of readmission within a year compared to non-mental illnesses.
The risk of readmission was highest among individuals with co-occurring substance related disorder and schizophrenia. Alcohol and drug abuse had an especially negative impact on the course of schizophrenia, and the effectiveness of antipsychotic meds.
Of all hospital days, most (57.8%) were spent in psychiatric hospitals, especially for patients diagnosed with schizophrenia and psychoses (36.6%), organic disorders (defined here as senility, Alzheimer’s, and other psychotic conditions that are brain-based; I’d argue that all psych disorders are brain-based), and “other” mostly comprised of developmental disabilities. The latter are counted as “other” since they’re not considered psychiatric disorders, but they are brain disorders that require care, and institutions that provided specialized care have been mostly closed down.
“Readmission for a mental illness is often linked to a disruption in outpatient treatment and rehabilitation and may signal instability or a recurrence of severe symptoms of a disease,” says Nawaf Madi, CIHI’s Program Lead for Mental Health and Addictions. “This is an area of concern for health planners, because, among other things, treating a patient in hospital is significantly more expensive than treatment at the outpatient or community level.”
Organic disorders affecting the elderly, like Alzheimer’s and dementia, will occur more frequently with the aging population and demand for beds in both acute care and psychiatric hospitals is not going to decrease. Canadians, please write to your MLA, and MP.
Assertive Community Treatment (ACT) is evidence-based treatment in the community involving a team of caregivers who interact with the patient in their home environments, providing key support 24/7. It is especially beneficial for schizophrenia, and could replace much of the institutional care now gone. ACT was designed in the early 1970s for that very reason, appearing in the first round of deinstitutionalization that accompanied antipsychotic drug marketing and patient activism.
Universal health care does work in many ways and is a fundamental Canadian value. But with soaring costs and few voices to protect the mentally ill (healthcare workers and organizations are paid/funded by the government and mostly stay silent), it seems the provinces are trying to make mental health care all but disappear. Trouble is, people don’t disappear too, they keep showing up in acute care readmissions.
Part two tomorrow on the Arctic situation.
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One Comment to
“Readmissions”
It’s a shame how the government takes part in this. Unless someone at the government takes a step, Canada’s dual diagnosis treatment for the mentally ill will be all futile.
-Megan
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Last reviewed: By John M. Grohol, Psy.D. on 3 Dec 2006
