Gaps in inpatient psychiatry for Ontario youth
A first of its kind benchmarking survey was used to evaluate the state of inpatient psychiatry settings and services for youth at hospitals across Ontario, as published in the Journal of the Canadian Academy of Child and Adolescent Psychiatry. On average, the province's services are comparable to other settings internationally, helping youth with the most severe and complex mental health problems, but also show similar signs of inconsistency across settings in the types and quality of inpatient care.
"There is no rhyme or reason for these discrepancies throughout the province," said Dr. Stephanie Greenham, co-author, psychologist and clinical researcher at the Children's Hospital of Eastern Ontario (CHEO) and Clinical Professor with the School of Psychology at the University of Ottawa. "The planning and staffing of inpatient psychiatry units appears locally determined, but as the demand for mental health services skyrockets, youth and families' needs would seem to be better met by adopting a more organized and systematic approach to inpatient care."
Twenty-five hospital-based programs specifically for children and youth requiring hospitalization for a mental health crisis responded to the first provincial benchmarking study of its kind to describe unit characteristics, services, and patient characteristics. Data were collected for a one year period, and included information from the Ontario Network of Child and Adolescent Inpatient Psychiatry Services (ONCAIPS) directory and the Ministry of Health and Long Term Care (MOHLTC) website.
Respondents identified suicide risk as the most prevalent problem precipitating admission, while all settings admitted youth with mood, anxiety and psychotic disorders. Services were predominantly geared toward brief, acute crisis rather than longer term, planned treatment, and the majority of admissions were for adolescents rather than children. There were inequities across settings in access to psychiatry, availability of interdisciplinary staffing, criteria for who gets admitted and who does not, types of treatments provided, rates of involuntary admissions, and tracking of clinical outcomes.
"The study findings confirm that inpatient services are an important and valuable component in Ontario's continuum of mental health services, particularly for children and adolescents with the most severe risks and problems," said Dr. Joseph Persi, co-author and psychologist at the North Bay Regional Health Centre in Sudbury and Adjunct Professor at Laurentian University. "The study leaves us with areas for improvement but also some unanswered questions. One of the most important of these questions, in light of surging admission rates, is 'Are there ways that we can address problems earlier in a manner that reduces the need for hospitalization?'"
ONCAIPS is advocating for provincial best practice standards and planning to help improve access, service quality, and staffing consistency across Ontario. Their steering committee will draft such guidelines for review at its annual general meeting in Ottawa in October 2014.