1. Schizophrenia Care in the Community for Adults
Find out why a particular quality standard was created and the data behind it
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2. Why a community schizophrenia quality standard is needed
Schizophrenia is a severe, chronic mental health condition that usually begins in late adolescence or early adulthood
In Canada, about 1 in 100 people have schizophrenia
People with schizophrenia face a number of physical health risks related to their condition and die about 15 to 20 years earlier than the general population, often from chronic respiratory or cardiovascular disease
This deck includes data that will highlight the burden of schizophrenia in Ontario and where gaps in care may exist
Sources: Sources: American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington (VA): The Association; Health Canada. A report on mental illnesses in Canada: chapter 3, schizophrenia [Internet]. Ottawa (ON): Health Canada; 2002 [modified 2012 Mar 26; cited 2017 Dec]. Wahlbeck K, Westman J, Nordentoft M, Gissler M, Laursen TM. Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. Br J Psychiatry. 2011;199(6):453-8.

3. People with schizophrenia are often disproportionately affected by homelessness, or are precariously housed
Source : Groupe de recherche sur les politiques de santé mentale. « Mental illness and pathways into homelessness: proceedings and recommendations », Toronto (Ontario), 1998.

4. Nearly 12% of patients revisited the emergency department for a mental health or addictions condition within 30 days of a previous emergency department visit for schizophrenia, and this proportion has not improved since 2006.
Percentage of patients who revisited the emergency department for a mental health or addictions condition within 30 days of a previous emergency department visit for schizophrenia, in Ontario, 2006 to 2014
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5. The percentage of patients who revisited the emergency department for a mental health or addictions condition within 30 days of a previous emergency department visit for schizophrenia ranged from 9.3% to 16.6% across LHIN regions.
Percentage of patients who revisited the emergency department for a mental health or addictions condition within 30 days of a previous emergency department visit for schizophrenia, in Ontario, by LHIN region, three-year average for 2012 to 2014
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6. The percentage of patients who were readmitted to hospital for a mental health or addictions condition within 30 days of a previous hospital discharge for schizophrenia ranged from 9.1% to 16.2% across LHIN regions.
Percentage of patients who were readmitted to hospital for a mental health or addictions condition within 30 days of a previous hospital discharge for schizophrenia, in Ontario, by LHIN region, three-year average for 2012 to 2014
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7. Fewer than 3 out of 10 people hospitalised for schizophrenia in Ontario have a follow-up with a family doctor or psychiatrist within 7 days of discharge

8. The percentage of patients who had contact with a family doctor or a psychiatrist within seven days of a previous hospital discharge for schizophrenia varied across LHIN regions from 15.0% to 41.3%.
Percentage of patients who had contact with a family doctor or a psychiatrist within seven days of a previous hospital discharge for schizophrenia, in Ontario, by LHIN region, three-year average for 2012 to 2014
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9. How will the schizophrenia quality standard address these gaps in care?
Together, we can improve the quality of care for people living with schizophrenia in the community. That’s why Health Quality Ontario, in collaboration with health care professionals, people living with schizophrenia, and caregivers, has developed this quality standard outlining what what high-quality health care looks like for aspects of care that have been deemed a priority for quality improvement in the province.
While this quality standard addresses care for people who have already been diagnosed with schizophrenia, the importance of having responsive services that ensure all Ontarians with schizophrenia can receive a diagnosis cannot be overstated
For a quality standard that addresses care for adults with schizophrenia who present at the emergency department or are admitted to hospital, see the Schizophrenia: Care for Adults in Hospitals quality standard

10. Schizophrenia community quality standard: quality statements
Care Plan and Comprehensive Assessment
Treatment With Clozapine
Continuation of Antipsychotic Medication
Physical Health Assessment
Self-Management
Cognitive Behavioural Therapy for Psychosis and Other Psychosocial Interventions
Family Education, Support, and Intervention
Promoting Physical Activity and Healthy Eating
Access to Community-Based Intensive Treatment Services
Promoting Smoking Cessation
Housing
Assessing and Treating Substance Use Disorder
Antipsychotic Monotherapy
Treatment With Long-Acting Injectable Antipsychotic Medication
Employment and Occupational Support

11. How can the success of this standard be measured?
How Can Success Be Measured Provincially
How Can Success Be Measured Locally
Percentage of adults hospitalized for schizophrenia who have had an unplanned hospital readmission for a mental health or addictions condition within 30 days of discharge (See slide 5)
Percentage of adults with schizophrenia who report unmet care needs (suggested stratification: type of need)
Percentage of adults with schizophrenia who report living in stable housing for the past year
Percentage of adults hospitalized for schizophrenia who had contact with a trained mental health physician:
Percentage of adults hospitalized for schizophrenia who had contact with a trained mental health professional:
Within 7 days of hospital discharge (See slides 6 and 7)
Within 7 days of hospital discharge
Within 28 days of hospital discharge
See the Schizophrenia: Care in the Community for Adults Measurement Guide for more information on how to calculate these indicators

12. For more information: Website: hqontario.ca/qualitystandards
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