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Canadian Journal of Community Mental Health special issue on SEEI — discharge planning and crisis-case management studies

March 24, 2011

The Canadian Journal of Community Mental Health has released a special supplement issue focused on the Systems Enhancement Evaluation Initiative (SEEI). SEEI evaluated the impact of a $167 million investment made by Ontario’s Ministry of Health and Long-Term Care (MOHLTC) towards community mental health services in the province. Mental Health Notes continues to explore the articles from the special issue, today looking at studies involving community-based discharge planning in acute mental health care, and community-based integrated crisis-case management services.

The first study evaluated a new in-reach model of discharge planning for delivering seamless care to people leaving hospital after an acute care mental health admission. Implemented at Bluewater Health and CMHA Sarnia-Lambton Branch, the discharge planning service was remodeled and relocated from a hospital to a community-based setting. In the new in-reach model, the discharge planner is based with the community service, and visits the hospital daily to meet with all admitted clients to offer discharge services. The evaluation consisted of two components: a retrospective review of administrative data, and a prospective collection of data from people being discharged from the in-patient service to the community. The researchers found that the use of community-based discharge planning services was associated with a 36 percent reduction in the readmission rate in the first month after leaving the hospital, and overall readmission rates were also lower. As well, readmission rates were 40 percent lower in the year following the change in service delivery model. Moreover, basing discharge planning services within the same agency that also provides housing advocacy, case management and other community-based mental health services offered clients a direct connection to these services at discharge. The community-based discharge planning model developed for the Sarnia/Lambton area therefore fulfilled the goals of the agency. The findings may also be relevant to other acute care mental health services.

The second study evaluated a community-based crisis service that used systems enhancement funding to: develop timelier crisis services, increase mobile capacity, and broaden the scope of the crisis service to address the follow-up needs of individuals served. The program developed an innovation in service delivery: a transitional case management model integrated with crisis services. Researchers evaluated the extent to which the new service led to expected and desired changes in service delivery patterns, using existing databases to compare the old and new models. The results suggest that the new model did lead to the expected changes in service utilization patterns. Particularly, the new model demonstrated: a significant increase in service capacity; a dramatic increase in the number of mobile crisis visits provided; improved access to a broader community population; more appropriate patterns of service delivery (i.e. fewer days of crisis service); and improved crisis resolution at discharge. Rankings of acceptance of the new crisis service by the local service network varied greatly across service sectors, with police, hospitals and community health agencies being most satisfied, and non-health social services and educational institutions being least. Qualitative comments included the need for more crisis beds; more attention to the needs of people with addiction problems who also have psychosis; difficulties associated with individuals who refuse assistance; the need for more psychiatry services; and the need for more and better organized access to mental health resources in the community.

The next issue of Mental Health Notes will profile the last set of articles in the SEEI special issue that examine the implementation and outcomes of a court outreach program for people with severe and persistent mental illness.

See “An Evaluation of Community-Based Discharge Planning in Acute Mental Health Care,” Canadian Journal of Community Mental Health(2010; 29 [Supplement 5]: 111-124), available atwww.metapress.com, and “An Evaluation of a Community-Based, Integrated Crisis-Case Management Service,” Canadian Journal of Community Mental Health (2010; 29 [Supplement 5]: 125-137), available at www.metapress.com. Full contents of the SEEI Special Supplement Issue of the Canadian Journal of Community Mental Health are available at www.metapress.com.

For more information about SEEI, contact Heather Bullock at heather_bullock@camh.net.

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