5.6 QUALITY OF TREATMENT SERVICES

MENTAL ILLNESS

Key Messages

In general, mental health clients are satisfied with the services they receive. System navigation is mentioned as a barrier, but as clients connect to one service they are often referred within the system as needed.

Clients’ suggestions to provide client-centered care include: being compassionate, caring, supportive, respectful, easy to talk to and non-judgemental. Examples of poor care include: being rushed, judged or having someone trivialize their concerns.

Although time to access services is felt to be improving, this remains an issue to be addressed. Clients perceive a gap between visiting the emergency department for an acute need and then being able to access non-crisis community-based treatments for mental illness.

Using Experience as Data

This section is informed by the experiences of a group of people in Lambton County, most of whom have sought help for mental health problems and have used mental health services. Mental health services include those provided at the hospital, by family physicians and other primary care providers, by community-based services (such as the Canadian Mental Health Association) and by psychologists and other therapists in the county. There were 39 participants in this survey, and while we believe that their experiences are broadly representative of those in Lambton County, they should not be taken to replace the experience of any one person, and they should not be interpreted with respect to the quality of services delivered by any one agency.

“Overall, accessing mental health services has made things better for me and I will never regret going to get help. Talking to someone, and learning more about it will never make it worse.”

– Community member

Client-Centered

For the most part, mental health service users appeared to be satisfied with and very much appreciative of the services they had received. Many reported that services had helped them in terms of understanding their mental health conditions, learning how to “cope” or manage their conditions and being able to speak to someone about their conditions. These in turn led to improvements in their mental health and quality of life.

“Learning how to deal with our mental health issues in a productive way has made our lives so much better!  We are truly thankful to everyone who has helped us along our journey.”

– Community member

“The first time a counsellor told me “You know, I think we need to talk more about that.” or “You feel like that constantly, and you don’t have to.” was probably the biggest impact on me. My normal, painful as it was, was not carved in stone. Just having someone listen and believe me and giving me the opportunity to trust them to give me help was so huge.”

– Community member

Much of the feedback service users provided on their experiences with local mental health services related to the importance of the attitude and demeanor of service providers. The important qualities identified included: compassionate, caring, supportive, respectful, non-judgemental and easy to talk to. For those with negative experiences, they reported that the service provider made them feel unimportant, stupid or that they rushed into diagnosis without adequately listening.

“I think it’s important that the people are kind and easy to talk to. I would rate CMHA a 5 out of 5 because I find the people extremely easy to talk to and be around.”

– Community member

“Most important thing isn’t the diagnosis but having someone to talk to and feel unjudged. To feel confident in your care when you leave the building. My care worker I’d rate a 1 being lowest out of 10. She was unempathetic and had terrible body language suggesting to me that I was stupid or concerns were inadequate.”

– Community member

“I have called into the Sarnia-Lambton-Kent crisis lines many times when I’ve been at my lowest during afterhours. Remembering my name (one operator even called me by a nickname which immediately made the conversation feel more natural), and addressing me in a calm, interested manner is always important. The genuine goodbye is important too. When I was at my lowest, just hearing someone say “Be safe and please call back if you need to, we’ll be here”, saved my life once or twice. For anyone specializing in mental health, I think the biggest thing that they can do is remind the person in crisis that someone is there and thinking about you, or validating that what you’re feeling is scary but not permanent.”

– Community member

“[Psychiatrists] should listen to the patient and not rush in to stating a diagnosis. Take as many appointments as is necessary to come up with their diagnosis and make a plan with the patient on how best to deal with their problems.”

– Community member

“The group supports do not have an open and inviting atmosphere. It feels cold and like a drop in for those with lower coping ability. Those of us who are high functioning do not feel as though we NEED or FIT in those environments.”

– Community member

Timely Access

Based on service user feedback, timely access to services emerged as a critical area for future improvement. On the one hand, it was acknowledged that “quick fixes” such as the crisis helpline and urgent care via family doctors and the emergency department are readily available. Further, it was felt to be relatively easy and quick to “get something started” at CMHA. At the same time, there are protracted timelines to access psychiatrists, psychologists and mental health programs offered by the various community partners.

“It’s easily accessible. Lots of help lines and specialists are readily available through ER for a quick fix.”

– Community member

“Bluewater Health and CMHA have done wonders since I’ve moved back to Lambton County. It’s easy to go into CMHA and get started with something that same day. I think what’s hard is the wait time. When you are emotionally at an all-time low, it’s hard to make that first step in the first place. To take that first step and then have to wait a month to see a psychologist, psychiatrist (or) social worker is the most brutal thing ever. It would be great if there was a bridging program of some sorts to get people from registry to programming.”

– Community member

“Sometimes it’s difficult just to get in to see your doctor (often 2-3 weeks for an appointment at my family doctor). I think for more urgent situations it may be better to access some immediate support through the crisis nurse. However with that, there’s often a long wait at the emergency room which can be difficult to manage for someone who needs immediate support. Also long-term support is hard to get given the lack of psychologists within the community and waiting lists for services through CMHA.”

– Community member

“Therapy through CMHA and SCCYS has a long wait period. Emergency counselling or drop-in is great for the immediate problem but not for healing.”

– Community member

“Need Red Cross transportation or other transportation to be covered for people to attend CMHA for appointments and other para-medical appointments. Right now, this coverage is only for medical appointments.”

– Adult mental health care worker

What participants defined as ‘timely’ varied depending on the situation. There was an expectation for immediate access to a service provider in cases of “severe crisis” involving suicidal tendencies. In other non-emergency cases, the general view was that 2 to 3 weeks was an acceptable wait time. Providing interim support during wait time was valued, particularly given that people describe that it “takes courage to ask for help”. Interim support could take various forms such as using the crisis line, short-term support groups and having a case worker that checks in.

“Someone in severe crisis, such as experiencing suicidal tendencies or rages should not be sitting in the emergency room for several hours waiting to speak with a crisis nurse.  We need more crisis staff on duty.”

– Community member

“I think an acceptable wait time is about 2-3 weeks. I think that a social worker or someone to check in with while waiting for your appointment would be a good idea.”

– Community member

“While waiting for more extensive supports, the client can attend groups, designed to provide some assistance, to keep them on the care plan. I would even suggest a worker be assigned to them, that they could meet with once a week or biweekly depending on the need, to discuss living situation, stresses. An online “pen pal” could provide assistance and support online, even to those in rural areas.”

– Community member

Wait times for community-based mental health services are not readily available and are not consistently measured across the province. This was identified as a critical gap in Ontario and a provincial task force has recommended this as a high priority indicator for development (MHASEF Research Team 2018a).

An indirect measure of access is the proportion of mental health and addictions related emergency department visits that represent an individual’s first contact for mental health and addictions care.

In 2014, 42% of children and youth (0-24 years) in Lambton who went to the emergency department for a mental illness had no prior contact with a physician for reasons related to mental health or addictions. This is similar to the provincial average (45%) (MHASEF Research Team 2017b). In particular, a large proportion of children and youth in Ontario who presented with substance use disorders (54%), anxiety disorders (40%) or deliberate self-harm (39%) had their first mental health and addictions-related contact in the emergency department (MHASEF Research Team 2017a).

While comparable data is not available for adults in Lambton, 31% of Erie St. Clair LHIN residents (16 years and older) who went to the emergency department for a mental illness had no prior contact with a physician for mental health and addictions. This is similar to the Ontario average (33%) (MHASEF Research Team 2018b).

30-40%

Emergency Department was the first point of contact for mental health and addictions care for 30-40% of Lambton Residents

Efficient and Co-ordinated

Once service users made initial contact with one service and were therefore “in the system”, they were made aware and referred on to the variety of mental health services and supports on offer in the county and beyond.

“I was hospitalized after having a break down.  My doctor and the health care team helped me get the community help I needed and still need.”

– Community member

“We spoke to our primary care physician and got a referral to Pathways, which led us to St Clair Child and Youth Services, and they referred him to CPRI in London.”

– Parent

“I have never had any problems finding help. Sometimes it takes a bit to get the ball rolling but once you’re a part of the system things go well.”

– Community member

Readmission to inpatient care may be an indicator of relapse or complications after an inpatient stay. Once stabilized, an individual is discharged, and subsequent care and support are ideally provided through outpatient and community programs. High rates of 30-day readmission could be interpreted as a direct outcome of poor coordination of services after discharge (Canadian Institute for Health Information n.d.)

In 2015, 12% of Lambton residents discharged from hospital for a mental illness were re-admitted within 30 days. This is equal to the Ontario and Canadian averages. This percentage has been stable locally, provincially and nationally since 2009 (Canadian Institute for Health Information n.d.).

There are ongoing partnerships by mental health providers in Lambton County to coordinate care for patients with mental illness. For example, between April 2016 and December 2017, 69% (552/801) of youth that were assessed by the Bluewater Health emergency department were referred back to the community. Of these referrals, 24% (134) were referred to the Advanced Access Appointments at St. Clair Child and Youth Services and 18% (99) were referred to Walk-In at St. Clair Child and Youth Services (Source: Bluewater Health).

7 in 10 youth who were assessed by Bluewater Health emergency department were referred to community mental health services

7 in 10 youth who were assessed by Bluewater Health emergency department were referred to community mental health services

Effective and Equitable

We do not have robust data on the effectiveness of mental health services in terms of treatment outcomes. For example, what are the recovery rates among people with mental illness in Lambton County? Do they differ by types of services provided? Do they differ by other factors (social support, etc.)? Is there a decrease in emergency department visit rates among those receiving treatment in the community?

Similarly, we do not have extensive data about equity and mental health. While we have demonstrated that poor mental health is related to social determinants of health such as income and gender, the extent of inequities related to mental health could be further explored. Characterizing whether local mental health programs and services are effective and equitable is an area of opportunity for improving collaboration and data collection with community partners.

“I would like to see a continued push and shift in supports and acceptance for LGBTQ2IA individuals, continued conversation in everyday life regarding mental health, shifting of funding to further increase supports in the areas of mental health.”

– Adult mental health care worker

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PROMOTING MENTAL HEALTH