1. Mental Health Services and Long Term Care
February 12, 2009
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Long Term Care Administration

2. 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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Long Term Care Administration

3. 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
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Long Term Care Administration

4. 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
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Long Term Care Administration

5. 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
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Long Term Care Administration

6. 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
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Long Term Care Administration

7. 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").
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Long Term Care Administration

8. 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.
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Long Term Care Administration

9. 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 $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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Long Term Care Administration

10. 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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Long Term Care Administration

11. 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.
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Long Term Care Administration

12. 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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Long Term Care Administration

13. 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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Long Term Care Administration

14. 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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Long Term Care Administration

15. 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.
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Long Term Care Administration

16. 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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Long Term Care Administration

17. 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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Long Term Care Administration

18. 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.
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Long Term Care Administration