Ministry of Health and Long-Term Care Priorities Mental Health & Addiction: Understanding Emergency Department Use by Racialized Populations

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1 Ministry of Health and Long-Term Care Priorities Mental Health & Addiction: Understanding Emergency Department Use by Racialized Populations Expert think tank session March 26, 2013 Presenter: Anne Bowlby, Manager, Mental Health and Addictions Unit, Ministry of Health and Long-Term Care

2 Presentation Overview Gaps and Opportunities Lack of Demographic Data HEIA MHA Strategy 4+ Strategic Investments Service Collaboratives Community Health Links Ministry Strategies ED Wait Time Strategy Comprehensive Mental Health and Addiction Strategy (MHA Strategy) Ministry Priorities/ Broader society shifts Ontario s Action Plan for Health Care 2

3 Ministry Priorities Ontario s Action Plan for Health Care The Ministry of Health and Long-Term Care (MOHLTC) released the Action Plan for Health Care in January The action plan has three priorities: 1. Keeping Ontario Healthy Smoke-Free Ontario Childhood Obesity Cancer Screening 2. Fast Access to Stronger Family Health Care Local Integration and Family Health Care at the Centre of the System Faster Access and Focus on Quality in Family Health Care House Calls 3. Right Care, Right Time, Right Place More Home Care for Seniors Ontario Seniors Strategy Funding Reform: Patient-Based Funding for Hospitals Moving Procedures into the Community Expanded Scope of Practice Pharmacists 3

4 Ministry Strategies Ontario s Wait Time Strategy In 2011/12, there were 50,902 admissions to hospital via emergency with any diagnosis of a mental and/or behavioural disorder. Of these admissions, 72.9% had a main diagnosis of a mental and/or behavioural disorder. Ontario s Wait Time Strategy was developed to improve access to key health services and reduce the time spent in emergency rooms (ER). The government s goal is to improve public access to surgeries and procedures delivered to Ontarians; implement new initiatives to improve ER processes; and create a system of accountability through transparent reporting of wait time information. Enhancements in the community mental health and addiction services with increased funding and strong policy direction Funding to address ED wait times (i.e. eating disorders and early psychosis intervention standards) LHIN priorities to address unplanned visits to ED within 30 days for mental health or substance abuse disorders 4

5 Ministry Strategies: Open Minds, Healthy Minds: Ontario s Comprehensive Mental Health and Addictions Strategy In June 2011, the government released Open Minds, Healthy Minds: Ontario s Comprehensive Mental Health and Addictions Strategy. The goals of the Strategy are: Improve mental health and well-being for all Ontarians Create healthy, resilient, inclusive communities Identify mental health and addictions problems early and intervene Provide timely, high quality, integrated, person-directed health and other human services. The first three years of the Strategy focus on children and youth. Results to date include: Over 720 new mental health workers across the province in the health, education and children s mental health sectors A system that is building collaborative capacity on the front lines to support children and youth with mental health issues Development of an evaluation framework and scorecard for mental health 5 and addictions

6 Strategic Investments Service Collaboratives This Strategy committed to creating 18 service collaboratives to support coordinated services for children, youth and adults, including a focus on children and youth in transitions from inpatient to outpatient settings, between health and justice systems, and from child-focused to adult services. Service collaboratives are groups of service providers from diverse sectors working together to plan and deliver a seamless continuum of mental health and addiction services in a region or community, based on identified need. Led by the Centre for Addiction and Mental Health, the first four service collaboratives have been established and have prioritized their local system gaps: Thunder Bay enhancing community linkages and MHA supports for Dennis Franklin Cromarty high school students Ottawa continuity of care for high risk youth in service transitions Simcoe/Muskoka coordination of care for transition-aged youth (14-24) London transition from hospital/emergency to community services for youth with MHA The second set of service collaboratives has been initiated in Durham, Hamilton, Frontenac/Kingston, Peel and Waterloo/Wellington and are in the process of confirming membership and beginning assessments of system gaps. 6

7 Strategic Investments Community Health Links Challenge Patients with the greatest health care needs make up five percent of Ontario's population but use services that account for approximately two-thirds of Ontario's health care dollars. (Patients with chronic diseases; mental health issues etc.) A recent study found that 75 per cent of seniors with complex conditions who are discharged from hospital receive care from six or more physicians and 30 per cent get their drugs from three or more pharmacies Community Health Links Community Health Links are networks of providers in a community, including primary care, hospital, community care. They are charged with coordinating plans at the patient level Health Links are designed around, and accountable for system-level metrics established by the province. Their initial focus is on the high users, as this segment of the population use a disproportionate amount of care at a cost which is not sustainable, nor appropriate for their needs Opportunities for alignment with Mental Health and Addiction are being explored given that many of the complex patients have mental health conditions 19 Early Adopter Health Links have been established with the goal of covering the province over the next few years Short Terms Goals and Objectives Creation of individual care plans for complex patients identified within the Community Health Link catchment area Regular access to a primary care provider for all unattached complex patients identified as part of the Health Link catchment area Long-term goals and objectives Over time, better access and care for patients will result in improvements such as: Reduced unnecessary hospital admissions and re-admissions within 30-days of discharge Reduced avoidable Emergency Department visits for patients with conditions best managed elsewhere Better patient experience 7

8 Gaps and Opportunities Health Equity Impact Assessment (HEIA) Why take action on Health Equity? There are legal and ethical reasons for addressing health equity. There are cost and value implications for our broader health and social services. It addresses a Ministry priority of improving quality in care Enhancing the health of the most vulnerable reduces health disparities and addresses the above priorities. What is the HEIA tool? HEIA is a structured method and practical tool to include equity in health planning and decision making It helps to address and anticipate any unintended health impacts that a plan, policy or program might have on vulnerable or marginalized groups within the general 8 population.

9 Gaps and Opportunities Policy rationale collecting new data on specific groups You cannot manage what you don t measure If you do not know a gap or issue exists, you cannot change it or take action Evidence-based policy making relies on data and strong reliable information. If no data exists or is readily available, there is a the potential to miss the differing needs of particular groups. Collecting data on all groups, particularly vulnerable groups provides a baseline and future measure for change Once needs are measured and understood, then targeting resources or programs specifically to addressing disadvantaged populations or key access barriers is an option 9

10 Gaps and Opportunities Ministry and Government Challenges Designing and delivering appropriate types of service bundles Getting the right balance between large scale, efficient delivery of services across the province while still addressing the needs of smaller and/or vulnerable or marginalised populations Changing the status quo addressing the broader societal shifts 10

11 Questions/issues for consideration today How should we ask for key demographic information in the emergency department? How do we get over our politeness of not asking those sensitive questions in the emergency department? How do we convey to Ontarians that collecting demographic information in the emergency department is important? Are there unintended consequences of asking for demographic information in the emergency department? If so, how do we mitigate these risks? How do all stakeholders address the broader societal shifts and address the needed changes to the system? 11