ABSTRACTS - World Psychiatric Association

American countries, that the majority of adults with common mental
disorders do not seek care for mental health reasons. However, examination
of administrative databases as part of an effort to establish a
Canadian national mental health surveillance system like for diabetes,
provide a different picture of primary and specialist de facto
system. CCHS 1.2 showed, over the course of one year, that about 5%
of Canadians, with little variation across provinces, reported seeing a
general practitioner for mental health reasons; and that about 40%
reported seeing a health professional for mental health reasons if they
showed symptoms of DSM-IV anxiety, depressive or substance abuse
disorders. However, examination of physician billings administrative
databases in five Canadian provinces indicated that over 15% of the
population were identified with a mental disorder, essentially anxiety
or depressive disorders, in the course of one year. Over the course of
3 to 5 years, nearly one third of the population was identified. The latter
is closed to lifetime prevalence of common mental disorders. In
the urban area of Montreal, a city of 1.8 million inhabitants, administrative
databases used for surveillance and planning allowed to delineate
that primary care general practitioners were solely involved for
the majority of people identified with anxiety disorders and half of
those with depressive disorders, but that specialist services were
involved in over 80% of those diagnosed by at least one physician
with schizophrenia. The implications of the findings will be discussed:
a) the myth in Canada that primary care general practitioners
do not identify and treat the majority of their patients with common
mental disorders; b) the ‘de facto’ Canadian system where patients
with the most severe disorders are seen by specialists and where
depression is the condition in which most shared mental health care
seems to occur; c) the fact that challenge for mental health care based
in primary care is not detection, but quality of care, including access
to all forms of potentially effective treatments.
ZS9.3.
IMPLEMENTING MENTAL HEALTH REFORM
IN CANADA: DEVELOPMENT OF COORDINATED
ACCESS TO HOSPITAL AND COMMUNITY
SERVICES
R. Milev, K. Carmichael, A. Mathany, P. Kennedy
Department of Psychiatry, Queen’s University, Kingston,
Ontario, Canada
According to government policies, mental health care in Canada is
seen as a continuum of services, provided at three levels: first line
(primary), intensive, and specialized (tertiary) services. Given the
numerous providers of mental health services, it is sometimes challenging
to achieve the integration required for a seamless and efficient
care. We examine the process used to develop a system-wide coordinated
access to mental health and addiction services in a geographically
defined area in Ontario, Canada. Development of a common
referral form and release of information consent form were amongst
the first steps completed to implement coordinated access. Commitment
to the principle of “best fit/match” introduced a review process
to ensure that, with very few exceptions, individuals referred for mental
health or addiction services received care from one or more of the
service providers. Some outcome measures, such as wait time for an
appointment, patient and referral sources’ satisfaction etc., have been
monitored. Common standards for initial risk assessments, and routine
clinical examinations will be determined as the work progresses.
A variety of measures to ensure patient flow, such as regular review of
patient loads, step-down to other services or primary care etc., assure
the ability of each service to provide the most efficient care.
ZS9.4.
EVALUATING MENTAL HEALTH REFORM
IN CANADA
H. Stuart, T. Krupa, M. Koller
Department of Community Health and Epidemiology, Queen’s
University, Kingston, Ontario, Canada
By the late 1960s, Canada’s asylum bed capacity had reached its
zenith, with almost 77,000 beds. Over the next two decades, these
were reduced by 70%. Health ministries were increasingly investing
in general hospital psychiatric beds and community based services. In
2001, in preparation for a second wave of bed closures, the Ontario
Ministry of Health funded a series of surveys to assess the system’s
capacity to provide additional community services to patients scheduled
for resettlement. In our region, only about a third of clients
received an intensity of care that matched their clinical needs. Agencies
subsequently received additional funding to enhance intensive
community based services and supports. In 2006, we replicated our
original study to determine whether clients were receiving more
appropriate care and using fewer hospital resources following the
receipt of funding for system enhancement. This paper highlights the
methods used to evaluate system-wide reforms and summarizes the
findings from these evaluations.
ZS9.5.
THE MENTAL HEALTH REFORM AND TEACHING
OF PSYCHIATRIC RESIDENTS
R. Tempier
University of Saskatchewan, Canada
The new Mental Health Commission of Canada (MHCC) has recently
launched three key initiatives: an anti-stigma campaign, a national
strategy for mental health and a knowledge exchange centre (KEC).
The anti-stigma campaign should be based on strong education principles
and will last for the next 10 years, aiming to show that mental
illness is an illness like others. The KEC should bring to the public
evidence-based best practice information on areas of need. Psychiatric
residents, according to the Royal College of Physicians and Surgeons
of Canada (RCPSC), should identify and appropriately respond
to stigma, long-term illness and rehabilitation. The RCPSC states that
psychiatrists need to be proficient in systems of care and delivery, and
that residents should be skilled on how to address the increasing need
for psychiatric services to work more closely with primary care
providers. Finally, as medical experts, future psychiatrists will be
health advocates advancing the health and well-being of patients,
community and populations and have a leadership role in mental
health services. We will envision on whether the MHCC, and the possible
consequent reforms that could potentially follow, will have an
impact on psychiatric education, and if yes, what will be the magnitude
of such an impact.
128 World Psychiatry 8:S1 - February 2009