Mental Health Services and Long Term Care February 12, 2009 22/04/2017 Long Term Care Administration

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. 22/04/2017 Long Term Care Administration

Long Term Care Administration 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 22/04/2017 Long Term Care Administration

Major Categories of Mental Illness DSM IV Classification Dementia Delirium Disorders Due to Medical Conditions Psychoactive Substance Use Disorders Schizophrenia Delusional (Paranoid) Disorder Other Psychotic Disorders Mood Disorders Anxiety Disorders 22/04/2017 Long Term Care Administration

Major Categories of Mental Illness DSM IV Classification Somatoform Disorders Dissociative Disorders Sexual Disorders Sleep Disturbances Facticious Disorders Impulsive Control Disorders Adjustment Disorders Personality Disorders 22/04/2017 Long Term Care Administration

Long Term Care Administration 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 22/04/2017 Long Term Care Administration

Canadian Mental Health Association Fast 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"). 22/04/2017 Long Term Care Administration

Canadian Mental Health Association Fast 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. 22/04/2017 Long Term Care Administration

Canadian Mental Health Association Fast 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. 22/04/2017 Long Term Care Administration

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. 22/04/2017 Long Term Care Administration

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 person’s home. Greater Vancouver Mental Health Society, outreach programs: drop in centre, mobile emergency services (health care professionals and police work together. 22/04/2017 Long Term Care Administration

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 22/04/2017 Long Term Care Administration

Mental Health Issues and the Elderly Fundamental Principles Comprehensiveness Defining the target population Community outreach Availability and flexibility Support for caregivers 22/04/2017 Long Term Care Administration

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. 22/04/2017 Long Term Care Administration

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 Alzheimer’s Disease – not covered by PharmaCare. 22/04/2017 Long Term Care Administration

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 22/04/2017 Long Term Care Administration

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. 22/04/2017 Long Term Care Administration

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. 22/04/2017 Long Term Care Administration