Ottawa Public Health (OPH) has released its report on the Status of Mental Health in Canada’s capital as of 2018. The goal was to produce a local surveillance report on the state of mental health across the population of Ottawa. The methodology used was a population-based model of health. The model was created by the Public Health Agency of Canada (PHAC) and known as the Positive Mental Health Surveillance Conceptual Framework.
Mental Health and Mental Illness:
An important distinction is made in the report between mental health and mental illness. The report focuses on mental health, not mental illness. Mental health is defined as being the spectrum of emotions, thoughts, and feelings that everyone experiences. Mental illness on the other hand is a diagnosed disorder that affects the way a person thinks, feels, and/or behaves. The two conditions are not mutually exclusive. A person with a mental illness may have good mental health and those without a diagnosed mental illness can have poor mental health.
Why Worry About Mental Health:
The report opines that positive mental health is associated with the following:
- Better overall health;
- Resilience to life’s challenges;
- Reduced suicidal thinking and depression;
- Substance abuse.
A further concern is that poor mental health can lead to mental illness and addiction. Mental illness in Canada is a significant social problem as:
- 1 in 5 Canadians are affected by mental illness annually;
- The burden of mental illness and addictions in Ontario is more than 1.5 times that of all cancers;
- 23% of Canadian parents care for a child with mental illness;
- 4,405 suicides were recorded in Canada in 2015
- The cost of mental health in Canada was estimated at 50 billion in 2011.
Rising Demand for Psychosocial Care:
They report a growing demand across Ontario for mental health and addiction care in both the community and hospital settings. Their numbers for children and youth in Ottawa are as follows:
- A 25% increase in visits to physicians including family doctors, pediatricians and psychiatrists between 2006 and 2015;
- A 56% increase in emergency department visits at hospitals especially for anxiety disorders;
- Increases in return visits to emergency departments;
- Low follow rates by patients following discharge.
Physicians Bear The Brunt:
Although mental health care is provided from a variety of providers Ontario’s doctors face the brunt of these care needs. Using Ontario Health Insurance Plan (OHIP) billing data, the utilization rates for physicians was determined to be as follows:
- In 2015, 162,496 Ottawa residents made 728,938 outpatient visits to physicians;
- The largest age group to do so was between the ages of 45 and 64;
- Visits by those between 15 and 24 rose by more than 10% between 2006 and 2015
- In 2016, 11,185 Ottawa residents made 17,790 visits to the emergency departments of hospitals for mental health or addiction concerns;
- This was a 46% increase in visits since 2006;
- This was the result in more than a doubling of visits by those between the ages of 15 and 24 years.
Clinical Practice Standards:
The result is an ever increasing demand for psychosocial care from physicians. The trend is found throughout Ontario and likely across the country.
The CPSO, in its quality assurance and review program, has in effect set standards for these care issues. It asks its assessors to evaluate and rank the practitioner as having been found to have acted appropriately, acted appropriately with some needed recommendations, or to identify concerns as follows:
- Counselling sessions are (i.e. include the physician’s input and also information regarding the patient’s response and future care plans)…
- In reference to specific clinical situations, patients are referred to support groups…
- Recognition and management of family violence or abuse is…
- Utilization of local social services/agencies in the community is…
- Patient education materials and resources are available to patients…
- Psychotherapy sessions (i.e. include documentation of critical interventions, the physician’s input, the patient’s response, future care plans, frequency of sessions, etc.) are…
- Diagnostic assessments – formulations are…
- Provisional diagnosis consistent with current DSM or ICD criteria (considering co-morbidities and differential
- Mental status examinations are…
- Management of suicidality is…
- Management of homicidal risk is…
- Management of doctor-patient relationships (i.e., boundaries, transference, counter-transference, etc.) is…
- Termination planning is…
- The use of psychotropic medication(s) is…
Clearly, there is a prevalence of psychosocial problems at the level of primary care in Ontario. An appropriate remedy is critical but is hampered by the resources, time, and skills available. A holistic approach appears necessary. Knowledge of the expected standards of care and the community resources that can provide them is critical to providing an appropriate response.
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