Reducing wait times and avoiding unnecessary use of high-cost mental health services through a Rapid Access and Stabilization Program: protocol for a program evaluation study.

BACKGROUND: Emergency psychiatric care, unplanned hospital admissions, and inpatient health care are the costliest forms of mental health care. According to Statistics Canada (2018), almost 18% (5.3 million) of Canadians reported needing mental health support. However, just above half of this figure (56.2%) have reported their needs were fully met. In light of this evidence there is a pressing need to provide accessible mental health services in flexible yet cost-effective ways. To further expand capacity and access to mental health care in the province, Nova Scotia Health has launched a novel mental health initiative for people in need of mental health care without requiring emergency department visits or hospitalization. This new service is referred to as the Rapid Access and Stabilization Program (RASP). This study evaluates the effectiveness and impact of the RASP on high-cost health services utilization (e.g. ED visits, mobile crisis visits, and inpatient treatments) and related costs. It also assesses healthcare partners' (e.g. healthcare providers, policymakers, community leaders) perceptions and patient experiences and satisfaction with the program and identifies sociodemographic characteristics, psychological conditions, recovery, well-being, and risk measures in the assisted population. METHOD: This is a hypothesis-driven program evaluation study that employs a mixed methods approach. A within-subject comparison (pre- and post-evaluation study) will examine health services utilization data from patients attending RASP, one year before and one year after their psychiatry assessment at the program. A controlled between-subject comparison (cohort study) will use historical data from a control population will examine whether possible changes in high-cost health services utilization are associated with the intervention (RASP). The primary analysis involves extracting secondary data from provincial information systems, electronic medical records, and regular self-reported clinical assessments. Additionally, a qualitative sub-study will examine patient experience and satisfaction, and health care partners' impressions. DISCUSSION: We expect that RASP evaluation findings will demonstrate a minimum 10% reduction in high-cost health services utilization and corresponding 10% cost savings, and also a reduction in the wait times for patient consultations with psychiatrists to less than 30 calendar days, in both within-subject and between-subject comparisons. In addition, we anticipate that patients, healthcare providers and healthcare partners would express high levels of satisfaction with the new service. CONCLUSION: This study will demonstrate the results of the Mental Health and Addictions Program (MHAP) efforts to provide stepped-care, particularly community-based support, to individuals with mental illnesses. Results will provide new insights into a novel community-based approach to mental health service delivery and contribute to knowledge on how to implement mental health programs across varying contexts.

The Health and Psychosocial Profiles of Adults Who Sought Mental Health and Addiction Specialty Services Through a Centralized Intake Process in Nova Scotia in 2020 and 2021.

OBJECTIVES: (1) To calculate the proportions of people who sought mental health and addiction (MHA) specialty services in Nova Scotia, overall and by sex and age. (2) To describe the health and psychosocial profiles of the MHA Intake clients. (3) To identify factors associated with acceptance for MHA services. METHODS: The data of the Nova Scotia MHA Intake clients aged 19 to 64 years old in 2020 (N = 10,178) and in 2021 (N = 12,322) were used. The proportions of unique clients in the general population were calculated based on 2021 census data. The percentages of primary presenting concerns, the presence and frequency of psychiatric symptoms in the past month, suicide risk levels, current or past provisional psychiatric diagnosis, medical problems, and psychosocial stressors were calculated. Logistic regression was conducted to identify factors associated with the acceptance of MHA services after the assessment. RESULTS: It was found that 1.48% and 2.33% of Nova Scotians aged 19 to 64 contacted the MHA Intake in 2020 and 2021. Over 66% were self-referrals, followed by physician referrals (28.34%). Mood (28.3%), anxiety (25.17%), and substance use (19.81%) were the top three presenting concerns for the contact. Many clients had a current or past provisional psychiatric diagnosis (58.7% in 2020, 61.8% in 2021). Among the clients, 74.67% and 68.29% reported at least 1 psychosocial stressor in 2020 and 2021, respectively. The clients with a current or past psychiatric diagnosis, suicide risk, and 2 or more psychosocial stressors, those who lived outside of Central Zone, and who had employee assistance program benefits/private insurance, were more likely to be qualified and accepted for MHA services than others. CONCLUSIONS: The Intake clients have complex health and psychosocial profiles. Future studies are needed to monitor the trajectories of the clients to reduce inequities in receiving MHA services and improve client outcomes.

A cross-sectional study of the relationship between frequency of cannabis use and psychiatric symptoms among people seeking mental health and addiction services in Nova Scotia (2019-21).

BACKGROUND: Cannabis use may be a modifiable risk factor for mental health problems; however, the role of cannabis use frequency in population seeking mental health and addiction services remains unclear. This study aimed to: 1) compare the prevalence and functional impact of psychiatric symptoms among frequent, infrequent, and non-users of cannabis; and 2) evaluate the associations between cannabis use frequency and functional impact of psychiatric symptoms in help-seeking individuals. METHODS: Data from the Mental Health and Addictions (MHA) Central Intake system in Nova Scotia, Canada was used. Participants aged 19-64 who received MHA Intake assessments from September 2019 to December 2021 with complete information about substance use were included (N = 20,611). Cannabis use frequency over past 30 days was categorized into frequent (>4 times a month), infrequent (≤4 times a month), and non-use. Psychiatric symptomatology consists of five domains: mood, anxiety, psychosis, cognition, and externalizing behaviors. Multivariate ordinal logistic regression was used to examine the associations between cannabis use frequency and functional impact of psychiatric symptoms. RESULTS: Frequent and infrequent cannabis users had a higher prevalence of psychiatric symptoms in each domain than non-users, while no significant differences were found between frequent and infrequent users. Frequent cannabis use was associated with greater functional impact of psychiatric symptoms in each domain compared to non-users, while infrequent use was only associated with greater functional impact of externalizing behaviors. CONCLUSION: Frequent cannabis use is associated with increased prevalence and functional impact of psychiatric symptoms among adults seeking mental health services.

The role of referral pathway to early intervention services for psychosis on 2-year inpatient and emergency service use.

This study examined the relationship between terminal referral source and subsequent urgent health service use in a Canadian early intervention service (EIS) for psychosis. Administrative health record data of emergency and inpatient mental health service use over a 2-year follow up from entry to EIS were retrospectively analyzed (n = 515). Negative binomial regression models were used to assess for the relationship between referral source and care outcomes. Compared to those referred from primary care services, the rate of urgent health care use was significantly greater for individuals referred to early intervention services from urgent care services while accounting for social and occupational functioning and psychotic symptom severity. Findings suggest that those referred from urgent services may be at an increased risk for subsequent urgent health care use while attending EIS for psychosis. Further research examining this relationship while incorporating additional relevant predictors is needed.

Augmenting Mental Health Support for Patients Accessing Different Degrees of Formal Psychiatric Care through a Supportive Text Messaging Program: Protocol for a Randomized Controlled Trial.

Patients feel more vulnerable when accessing community mental health programs for the first time or after being discharged from psychiatric inpatient units. Long wait times for follow-up appointments, shortage of mental health professionals, lack of service integration, and scarcity of tailored support can weaken their connection to the health care system. As a result, patients can present low adherence, dissatisfaction with treatment, and recurrent hospitalizations. Finding solutions to avoid unnecessary high-cost services and providing tailored and cost-effective mental health interventions may reduce the health system burden and augment patient support. We propose implementing an add-on, supportive text messaging service (Text4Support), developed using cognitive-behavioural therapy (CBT) principles to augment mental health support for patients attending to or being discharged from psychiatric care in Nova Scotia, Canada. This randomized controlled trial aims to investigate the effectiveness of Text4Support in improving mental health outcomes and overall mental well-being compared with usual care. We also will examine the intervention's impact on health services utilization and patient satisfaction. The results from this study will provide evidence on stepped and technology-based mental health care, which will contribute to generating new knowledge about mental health innovations in various clinical contexts, which is not only helpful for the local context but to other jurisdictions in Canada and abroad that are seeking to improve their health care.

Examination of the impact of COVID-19 public health quarantine measures on acute mental health care services: A retrospective observational study.

This study assesses for the impact of Covid-19 public health quarantine measures on acute care psychiatric admissions, by comparing admission data from the quarantine period to a comparator period. A chart review was conducted for all admissions to an urban acute care psychiatric centre from Mar 22 - June 5 2020 (quarantine) and January 5 - Mar 21 2020 (comparator). Data was collected on the number of admissions, demographics, patients' psychiatric history, characteristics of admissions, discharge information, patients' substance use and social factors. Data was analyzed using a student's t-test for continuous variables and Chi squared analyses for categorical variables. Results demonstrated 185 admissions during quarantine and 190 during the comparator, with no significant differences in the distribution of admissions across time periods. There was a significantly greater frequency of admissions in the 35-44 age bracket and admissions involving substance use during quarantine. Additionally, admissions during quarantine were significantly shorter, with increased frequency of involuntary status and use of seclusion. The data suggests a vulnerability specific to individuals in their 30-40s during quarantine and demonstrates a need to better understand factors impacting this group. It also suggests that quarantine is associated with changes to substance use, potentiating high acuity illness requiring admission.