Systems to Manage the Delivery of Mental Health Services Follow-up
Mental illness affects one in five Albertans during their lifetime. Severe and persistent mental illness is a chronic disease and should be treated like one. Even minor or episodic mental health problems can easily deteriorate into lifelong chronic illness, without proper and timely treatment. Mental illness is often experienced along with other chronic diseases and significantly complicates their treatment.
What we examined
With this follow-up audit, we applied the chronic disease management model to examine how well the health system meets the care needs of people with serious mental illness. We frame our findings within the model described in our September 2014 report on chronic disease management.
The key feature of that model is patient-centred care—care organized around the needs of patients rather than around the structure of the health system.
What we found
Treatment of mental illness in Alberta shows some movement in the direction of patient-centred care. In many cases these incremental improvements are driven by local Alberta Health Services staff and community service providers. However, the current framework of healthcare delivery does not support a coordinated, province-wide approach to providing patient-centred care.
AHS has made improvements in a number of areas we examined in our original 2008 audits. It has:
- made progress by better coordinating services offered through its community mental health clinics and addictions clinics
- improved processes at community mental health clinics to manage wait lists and reduce wait times for mental health programming
- partnered with several primary care networks to enhance mental health treatment available to patients at these clinics
However, the department and AHS still need to deal with shortcomings in Alberta’s mental health and addictions service delivery system. The formation of AHS as a single entity delivering health care in Alberta offered significant opportunities to integrate mental health service delivery across the entire continuum of care. These opportunities were largely missed. In our 2011 progress report we noted that the department and AHS planned to implement our recommendations from 2008, and were starting to take action in key areas.3 In 2014 we found that the momentum from 2011 was either lost or had failed to bring about significant change in the delivery of health care. Several key initiatives were discontinued or changed direction.
What needs to be done
With this follow-up audit, we replace 11 recommendations (see Appendix A) to the department and AHS with one new recommendation to the Department of Health and three to AHS. The department needs to provide the leadership and resources for fulfilling its goal of providing patient-centred care for Albertans who have mental illness or addictions. To provide patient-centred care, AHS needs to better integrate its services and eliminate gaps in the services it provides to individual patients.
Under patient-centred care, patients with severe and persistent mental health and addictions problems would benefit from:
- a single, comprehensive care plan
- a single health record, available to healthcare providers at the point of care
- teamwork among providers of different services to guide the patient along a single, clear, optimum care path
- active contributions by patients and their families to the care plan and the health record
- community housing support services that are an integral part of treatment
Why this is important to Albertans
Mental illness and addiction take a significant toll on the health of Albertans, and on the cost of providing health care. They also have a significant direct and indirect societal impact.