The 130th Annual Meeting of APHA

Abstract #45639

Janet Durbin, MSc¹, Paula N. Goering, RN, PhD², Dianne Macfarlane, MA¹, and Christina Tess Sheldon, MSc¹. (1) Health Systems Research and Consulting Unit, Centre for Addiction & Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada, (416) 535-8501, Janet_Durbin@camh.net, (2) Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada

In preparing for mental health system restructuring, needs-based planning projects were recently conducted in six psychiatric hospitals in the province of Ontario. A standardized, validated approach was developed to assess needs of current patients and identify how to meet these needs in the least restrictive setting. While this approach was employed across all facilities, adaptations ensured that project findings addressed local stakeholder concerns. This paper describes the project methodology and summarizes results. A second paper identifies lessons learned and discusses how project findings have influenced local planning. The methodology involved three steps: development of a five-level continuum of care; assessment of patient need using a standardized tool - the Colorado Client Assessment Record; and patient assignment to a level of care based on need. In total, 2536 psychiatric hospital patients were assessed, including 1252 inpatients, 1099 outpatients and 185 patients in hospital-operated residential care. Among inpatients, only 11% were considered to need ongoing inpatient care. Another 40% were recommended for high support residential treatment and over 1/3 were recommended for independent community living with intensive support. Among outpatients, most of whom were currently receiving moderate levels of support, 13% were identified as needing residential treatment and another third as needing intensive community support. About 40% of the patients in residential care were assessed as needing a higher level of care and 1/3 were recommended for independent community living with intensive support. Variation across facilities reflected current availability of community supports in the jurisdiction and stage in restructuring.

Learning Objectives:

• 1.Describe the five levels of care used in this planning project and criteria for mapping patients into each level.
• 2.Recognize the diversity of need of current psychiatric hospital patients, and the services and supports required in a reformed mental health system to enable them to function in the least restrictive setting.

Keywords: Mental Health System, Planning

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.