TORONTO -More than one in three Canadians treated in hospital for some form of mental illness are back in hospital within a year of their discharge, says a report that raises questions as to whether patients with psychiatric disorders are getting appropriate care.
The report released Wednesday by the Canadian Institute for Health Information looks at admissions to general hospitals in 2003-04 among Canadians with a range of psychiatric diagnoses - from depression and schizophrenia to bipolar and personality disorders.
"It was interesting to note that patients who were admitted for mental illness were more likely than were those admitted for other types of health conditions or diseases to be readmitted within a year," said Ian Joiner, manager for rehabilitation and mental health at CIHI.
"About 37 per cent of people with mental illness were readmitted within a year, and that compares to just over 25 per cent that were readmitted following admission for other types of disease or conditions," he said from Ottawa.
What the CIHI data don't show is why more than one-third of people treated in regular hospitals for mental illness are rebounding back to the wards.
Joiner suggests such readmissions could result from disruptions in services individuals are receiving in the community "or it may signal some type of instability or worsening of the symptoms that the person's experiencing."
Yet, the institute also found that the number of Canadians entering hospital for psychiatric treatment has declined in the last decade.
"We've noticed over the last 10 years that the use of hospital in-patient services for mental health is changing," Joiner said. "People are staying less time in hospital. (In 2003-04, average stay overall for mental illness was 35 days, down from 66 days in 1994-95.)
"They're staying shorter times in hospital and fewer people are being admitted to hospital for mental health services, so it's likely they're receiving other services in the community."
At least, that's the hope.
"But when you've got this revolving door," commented Steve Lurie, executive director of the Toronto branch of the Canadian Mental Health Association, "it suggests that what is probably happening is that people are going into hospital and they're being discharged - and then they aren't connected to anything in the community."
While Lurie concedes that community mental health services have been increased across the country in the last 15 to 20 years - making a difference in the number of hospital admissions and readmissions - it's still a case of the glass being "half-full."
"The problem is we haven't done enough of it," he said, noting that a Senate committee in May called for a $5-billion investment over 10 years to boost community services and supportive housing for Canadians with mental health issues.
And, Lurie stressed, such programs work.
In Ontario, for instance, the provincial government has funded more than 70 assertive community treatment (ACT) teams, each of which includes a psychiatrist, nurses, occupational and other therapists as well as peer support for individuals.
In the year before being hooked up with an ACT team, the average client spent 76 days in hospital; after getting involved with a team, the average hospital stay dropped by about 80 per cent, said Lurie, noting that of 3,500 people enrolled for such care, almost two-thirds didn't need to go to hospital at all.
"We know when you have community mental health service, like case management, supportive housing, crisis intervention and assertive community treatment teams in place, you can see dramatic reductions in readmissions."
Patients with a primary diagnosis of mental illness account for six per cent of all hospitalizations in Canada, while another eight per cent involve patients with a non-psychiatric primary diagnosis and an associated mental illness, CIHI figures show.
Elizabeth Lin, a researcher at the Centre for Addiction and Mental Health in Toronto, said that between one in five and one in three Canadians are affected by a psychiatric condition each year.
"Mental illness is not uncommon," she said. "And how individuals who have mental illness . . . cope is partly a matter of what kind of help they're able to get and what kind of support, not only from specialized care services but from where they live, where they work and who they connect with."
"We also need to enlist larger portions of the society. We need to make sure that family and friends and community are aware of what's going on and how to be helpful. We need to make sure there are workplace supports in place for individuals who get depressed or mentally ill while they're in a job."
"So it can't be just a hospital solution, because that's not going to work."
CIHI's findings should be of interest to those planning the future health-care infrastructure, in part because treating a patient in hospital is much more expensive than providing out-patient or community-level programs.
Lurie said his association estimates that just implementing ACT teams has saved Ontario's health system about $82 million in reduced hospitalization a year. And with hospital beds costing a minimum of $500 a day in Canada, the average 16.9-day stay for a patient with clinical depression or bipolar disorder noted by CIHI tallies up to at least $8,500. (The average stay for schizophrenia was 60 days, or a minimum of $30,000.)
"We need to focus on how to put enough services in the community so that people can get the help early, so they don't need to go in hospital," Lurie said. "But at the same time, how do you make sure that if they do go in hospital that there are services that can support them when they come out so they don't have to return?"
