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