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Seeing a Difference: Demonstrating the Impact of New Investments in Our Community Mental Health System

CAMH, CMHA Ontario, OFCMHAP, OMHF, MOHLTC
June 2007

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Executive Summary

Background

The Systems Enhancement Evaluation Initiative (SEEI) is a unique and exciting four-year research initiative that has brought together researchers, providers, decision makers, consumers and family members to explore the system impact of new mental health funding in Ontario. The SEEI includes nine studies of the changes over time in our community mental health system that have resulted from dramatic new annual funding for programs since 2004. The studies were initiated in two phases. Phase 1 includes the Impact Study, which looks at changes in use of hospitals and correction services by people with mental illness, and the Matryoshka Project, which explores effects on continuity of care of early intervention in psychosis programs and court support programs. These studies began in 2005. The Phase 2 Studies consist of seven smaller studies initiated in 2006. After two years of data collection and analysis by the Phase 1 Studies, we can begin to see some early change in the community mental health system.

SEEI has also developed the Ontario Mental Health and Addictions Knowledge Exchange Network (OMHAKEN) to support and inform the research. This 'network of networks' has already had involvement in the Phase 1 Studies and, as it develops, will provide a platform for linking the practice, policy, consumer and family communities to the research community to ensure research is relevant and applicable to the field.

This report is a second look at what is occurring in the province. An earlier glimpse of the system prior to the implementation of new funding was provided in the SEEI Update Winter 2007 newsletter (posted in the Mental Health and Addictions Portal on www.ehealthontario.ca). A more in-depth picture will be available in 2009, when we will report on the final results for both Phase 1 and Phase 2 Studies.

SEEI Interim Key Findings

Preliminary findings suggest that the additional $142 million Ontario has invested since 2004 in community mental health is making an impact in the following ways:

Ontario’s significant new investments in community mental health are resulting in new and enhanced programs, additional new staff and large numbers of new clients who have received service.
One of the most noticeable effects of the new funding is the revitalization it has brought to the field.
SEEI builds on previous community mental health research that provided evidence that community mental health programs are 'good investments.' (Making a Difference: Ontario's Community Mental Health Evaluation Initiative)
SEEI confirms that it takes time and many complex steps to get new funding into the system and to make programs fully operational.
When new programs are created, and increased numbers of clients are served, new demands are made on related mental health services.
Hospitals are an important provider of mental health services; with over 48,000 adult mental health admissions and 115,000 adult mental health ER visits annually. Compared to baseline, hospital admissions and visits to hospital emergency rooms increased during the study period. This may reflect unmet need combined with new case finding.
Recurrent use of hospital is a concern. During the baseline period, 15% to 24% of people returned to hospital at least once in the year following their initial visit. Over time, rates decreased modestly on two of five indicators of recurrent use – early return (within 30 days) to an ER after discharge and after an initial ER visit. There were declines in some of the other five indicators at the Local Health Integration Network (LHIN) level but not at the provincial level.
Police involvement with people with mental illness has increased in regions that can be monitored. However we do not have data to assess whether the increase in apprehensions is accompanied by a reduction in charges.
There has been an increase in the number of new early intervention clients and programs. There is also a considerable increase in the number of individuals served by court support services.
Early intervention programs are able to better identify their target population.
Since the new investments, case managers report an apparent increase in continuity of care with specific mental health services and supports for individuals using early intervention programs.
The growth in the court support programs may be straining the capacity of local systems.