Full Report

MENTAL
HEALTH
Clinical engagement
Engagement in the Mental Health pilot was generally
very strong, with many clinicians demonstrating
strong support for pathway development and
implementation. All of those involved in the project
who responded to a survey said that they would
recommend implementation of the pathways in
other Health Authorities (insert reference to final
MH survey). In focus groups that were conducted
with pilot teams, they demonstrated a strong
knowledge of the pathways and worked together
as a cohesive team to problem-solve case scenarios.
However, full buy-in to the use of the pathways was
not initially achieved with one of the teams, as became
obvious when a client passed through the system
without being processed according to the pathway.
This event reinforced the utility of the pathways for
the team and served as a key opportunity to reengage
commitment to the project. The pilot lead worked
quickly to re-train staff on the use of the pathways to
ensure that all staff, including locums, were properly
informed of the project and the pathways. 99 Fully
reoriented to the project, staff effectively processed the
next patient according to the new pathways. The team
now demonstrates appreciation for the project tools
and support for their continued use.
The determination of the pilot lead helped
build team appreciation for project tools
and support for their continued use.
Working with existing resources
The Department tapped into existing resources to
carry out this improvement project, incurring minimal
hard costs (approximately $3,500) for graphic design
and printing of the pathways. 100 Additional in-kind
costs to support pathway development, training and
focus groups included a significant amount of staff
time. Since completion of the pilot, the Department
has obtained funding to hire a part-time staff to help
with the expansion of the CDM mental health project
beyond the piloting sites.
Exploring potential savings
Mental health and addictions are pressing issues within
Canada. According to the Centre for Addiction and
Mental Health, about 20% of Canadians will experience a
mental illness in their lifetime. Huge economic costs are
associated with this rate of occurrence. Mental illness is
the number one cause of disability in Canada, accounting
for 30% of disability claims and an estimated $51
billion in costs to the Canadian economy per year. 101
In its 2012 budget, the Government of NWT allocated
$1.15 million to support mental health and addictions initiatives
above and beyond the $9 million spent each year
to support mental health and addictions programming. 102
Mental health clients account for 18% of unique patient
hospitalizations in the NWT, 50–59% of discharges, 26% of
bed days and 22% of costs each year, or $15.3 million.
The mental health IP highlighted two activities with
potential for cost-savings in NWT: facilitating information
sharing and streamlining care pathways.
Regarding information sharing, one study 103 found that
when doctors at emergency departments “voluntarily
accessed patient medical records through a health
information exchange (HIE), they reduced the number
of hospital admissions and diagnostic tests and reduced
costs by almost $2 million during a 13-month period.” 104
Data was accessed by physicians in only 7% of cases,
yet the information sharing still contributed to an
estimated net savings of $1.07 million across a medical
population of 1.2 million. They study indicated 400 fewer
client admissions during the period (August 2007 to
August 2008). In addition, fewer tests were ordered,
possibly because previous test results were available. 105
The UK has examined the National Institute for Health
and Care Excellence (NICE) guides as care pathways and
a means to integrate and re-shape care. In a report, the
NHS noted that the guides could result in cost savings
as they reduce acute care bed use while increasing
quality of care, and could lead to shorter hospital stays. 106
Streamlining care pathways was also found to improve
client outcomes and cost savings in orthopaedics, where
average hospital stays decreased from 5.1 days to 3.2. 107
Making the Case for Change
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