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Mental Health Services and Long Term Care
February 12, 2009
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Mental Health Services and LTC Introduction
Mental Health Services User GroupsIndividuals with chronic mental disorders such
as schizophrenia and recurrent affective disorders, who by the very nature of their illnesses generally require ongoing care.
Elderly who reside in long term care facilities and in the community.
Other populations with special needs, individuals with a developmental handicap.
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Introduction
Mental Health DefinitionThe capacity of the individual, the group and the
environment to interact with one another in ways that promote subjective well-being, the optimal development and use of mental abilities, the achievement of individual and collective goals consistent with justice and attainment and preservation of conditions fundamental equality
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Major Categories of Mental IllnessDSM IV Classification
DementiaDeliriumDisorders Due to Medical ConditionsPsychoactive Substance Use DisordersSchizophreniaDelusional (Paranoid) DisorderOther Psychotic DisordersMood DisordersAnxiety Disorders
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Major Categories of Mental IllnessDSM IV Classification
Somatoform DisordersDissociative DisordersSexual DisordersSleep DisturbancesFacticious DisordersImpulsive Control DisordersAdjustment DisordersPersonality Disorders
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Mental Health Reform
Tailoring services to needsProviding services that are sensitive to gender,
culture and race and to the special needs of vulnerable groups
Enabling people with mental health problems to remain in the community, using hospitalization only when clinically necessary
Providing more community and informal supports and integrating them with other services
Ensuring equitable access to services
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Canadian Mental Health AssociationFast Facts
Who is affected?Mental illness indirectly affects all Canadians at some
time through a family member, friend or colleague.20% of Canadians will personally experience a mental
illness in their lifetime.Mental illness affects people of all ages, educational and
income levels, and cultures.Approximately 8% of adults will experience major
depression at some time in their lives. About 1% of Canadians will experience bipolar disorder
(or "manic depression").
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Canadian Mental Health AssociationFast Facts
What causes it?A complex interplay of genetic, biological,
personality and environmental factors causes mental illnesses.
Almost one half (49%) of those who feel they have suffered from depression or anxiety have never gone to see a doctor about this problem.
Stigma or discrimination attached to mental illnesses presents a serious barrier, not only to diagnosis and treatment but also to acceptance in the community.
Mental illnesses can be treated effectively.
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Canadian Mental Health AssociationFast FactsWhat is the economic cost? The economic cost of mental illnesses in Canada for the
health care system was estimated to be at least $7.9 billion in 1998 - $4.7 billion in care, and $3.2 billion in disability and early death.
An additional $6.3 billion was spent on uninsured mental health services and time off work for depression and distress that was not treated by the health care system.
In 1999, 3.8% of all admissions in general hospitals (1.5 million hospital days) were due to anxiety disorders, bipolar disorders, schizophrenia, major depression, personality disorders, eating disorders and suicidal behavior.
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Current Mental Health Services
Hospital Inpatient ServicesPsychiatric hospitalsPsychiatric units within hospitalsCommunity Mental Health ProgramsDay HospitalsShortage of acute beds, harms mentally ill
living on the streets, who might do better in a community setting.
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Current Mental Health Services
Community Based ServicesAssertive Community Treatment (ACT)Multidisciplinary team, on call (24/7), small
case loads and delivers treatment and rehabilitation in the person’s home.
Greater Vancouver Mental Health Society, outreach programs: drop in centre, mobile emergency services (health care professionals and police work together.
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Current Mental Health Services
Physician Practices in the Community3,600 Psychiatrists in CanadaGeneral Practitioners can bill for providing
mental health services which accounts for 75% of billable sessions.
MDs and Psychiatrists combine for 9%Psychiatrists alone provide 10% Most common services is psychotherapy
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Mental Health Issues and the Elderly
Fundamental PrinciplesComprehensivenessDefining the target populationCommunity outreachAvailability and flexibilitySupport for caregivers
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Services to LTC Facilities for the Elderly
8% - 68% facility residents have mental disorders (depending on research study)
Dementia, depression, or another organic brain syndrome most common.
Lack of psychiatric care in LTC facilities.Psychotropic drugs were over used.OBRA 1987, Nursing Home Reform Act,
stopped physical and chemical restraints.
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Recent Developments in Mental Health Care
Pharmacological DevelopmentsSchizophrenia drugs improve symptoms:
apathy, withdrawal and lack of motivation.Mood stabilizers, aggressive and
behaviour disturbance medications.Some medications help treat the
symptoms of Alzheimer’s Disease – not covered by PharmaCare.
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Recent Developments in Mental Health Services
Best Practices
Assertive Community Treatment (ACT)Round the clock supportCommunity based servicesSupports tailored to the individualInvolvement of consumers and family in
all aspects of service delivery
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Obstacles/Barriers to the Delivery of Mental Health Services
Lack of public awareness and concern to the delivery and availability of mental health services.
The continuing stigma in society with regard to mental illness.
Limited funding for mental health services.Limited psychiatrists, shortages in LTC.Lack of adequately trained mental health
professional staff in LTC.
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Obstacles/Barriers to the Delivery of Mental Health Services
Fragmentation of services and lack of linkage across the continuum of care.
Lack of education and training for general health care professional on mental health issues.
Lack of knowledge amongst health care professionals about psychiatric and mental health services, where and how they can be accessed.
