Mental Health Services and Long Term Care

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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 Groups
• Individuals 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 Definition
• The 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

• Dementia
• Delirium
• Disorders Due to Medical Conditions
• Psychoactive Substance Use Disorders
• Schizophrenia
• Delusional (Paranoid) Disorder
• Other Psychotic Disorders
• Mood Disorders
• Anxiety Disorders

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Major Categories of Mental IllnessDSM IV
Classification

• Somatoform Disorders
• Dissociative Disorders
• Sexual Disorders
• Sleep Disturbances
• Facticious Disorders
• Impulsive Control Disorders
• Adjustment Disorders
• Personality Disorders

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Mental Health Reform

• Tailoring services to needs
• Providing 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 Facts

• What 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 Services
• Psychiatric hospitals
• Psychiatric units within hospitals
• Community Mental Health Programs
• Day Hospitals
• Shortage 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 Services
• Assertive Community Treatment (ACT)
• Multidisciplinary team, on call (24/7), small
  case loads and delivers treatment and
  rehabilitation in the persons 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 Community
• 3,600 Psychiatrists in Canada
• General 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 Principles
• Comprehensiveness
• Defining the target population
• Community outreach
• Availability and flexibility
• Support 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 Developments
• Schizophrenia drugs improve symptoms apathy,
  withdrawal and lack of motivation.
• Mood stabilizers, aggressive and behaviour
  disturbance medications.
• Some medications help treat the symptoms of
  Alzheimers Disease not covered by PharmaCare.

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Recent Developments in Mental Health Services

• Best Practices
• Assertive Community Treatment (ACT)
• Round the clock support
• Community based services
• Supports tailored to the individual
• Involvement 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.