Abstract
Objectives
Providing emergency mental health services for populations in remote rural areas of Canada is challenging. Program needs are distinct. We describe the emergency mental health workload and service needs at the Sioux Lookout Meno Ya Win Health Centre (SLMHC) in northwest Ontario.
Methods
Emergency department (ED) data were collected for mental health, addiction and self-harm diagnoses (MHA) in 2018/2019. Comparisons were made to similar sized provincial hospitals and EDs. Mental health admissions data from Oct 1, 2018 to Dec 31, 2019 were manually collected from hospital medical charts for demographics, suicide attempts/ideation and frequency of applications for Form 1 psychiatric assessment.
Results
The volume of MHA ED visits as a percentage of total ED visits was 4 times higher at SLMHC when compared to both the 67 other Ontario level C hospitals (< 100 beds) and the 15 level C hospital with a similar volume of ED visits (15,000–20,000), (15% vs 4%). Self-harm presentations were 308 at SLMHC versus an average of 42 ± 37 at the 15 level C hospitals with a similar ED volume. From Oct 1, 2019 to Dec 31, 2019, there were 49 patients requiring a Form 1, with an average wait time of 55 h before transfer to a schedule 1 facility.
Conclusion
There is an increased level of mental health, addiction and self-harm presentations in this northern ED. Lack of alternative resources indicate the need for the development of an integrated model of mental health care service. Reliance on the ED for crisis management indicates the need for the development of more regionally relevant models of care.
Résumé
Objectifs
Fournir des services de santé mentale d’urgence aux populations des régions rurales éloignées du Canada est un défi. Les besoins du programme sont distincts. Nous décrivons la charge de travail d’urgence en santé mentale et les besoins en services au Sioux Lookout Meno Ya Win Health Centre (SLMHC) dans le nord-ouest de l’Ontario.
Méthodes
Des données sur les urgences ont été recueillies pour les diagnostics de santé mentale, de toxicomanie et d’automutilation (MHA) en 2018/2019. Des comparaisons ont été faites avec des hôpitaux provinciaux et des services d’urgence de taille similaire. Les données sur les admissions en santé mentale du 1er octobre 2018 au 31 décembre 2019 ont été collectées manuellement à partir des dossiers médicaux des hôpitaux pour les données démographiques, les tentatives/idées de suicide et la fréquence des demandes d'évaluation psychiatrique du formulaire 1.
Résultats
Le volume de visites aux urgences du MHA en pourcentage du total des visites aux urgences était 4 fois plus élevé au SLMHC par rapport aux 67 autres hôpitaux de niveau C de l’Ontario (< 100 lits) et aux 15 hôpitaux de niveau C avec un volume similaire de visites aux urgences (15 000–20 000), (15% contre 4%). Les présentations d’automutilation étaient de 308 au SLMHC contre une moyenne de 42 ± 37 dans les 15 hôpitaux de niveau C avec un volume d’urgence similaire. Du 1er octobre 2019 au 31 décembre 2019, 49 patients ont nécessité un formulaire 1, avec un temps d’attente moyen de 55 heures avant le transfert vers un établissement de l’annexe 1.
Conclusion
Le nombre de cas de santé mentale, de toxicomanie et d’automutilation est en augmentation dans cette urgence du nord. Le manque de ressources alternatives indique la nécessité de développer un modèle intégré de service de soins de santé mentale. Le recours aux services d’urgence pour la gestion des crises indique la nécessité d’élaborer des modèles de soins plus adaptés au niveau régional.
Similar content being viewed by others
References
Canadian Mental Health Association Province. Rural and northern community issues in mental health. 2009. Available at: https://province.cmha.ca/wp-content/uploads/2009/09/cmha_on_rural_northern_mental_health_issues_20090827.pdf Accessed 14 Aug 2020.
Matsumoto C, Madden S, O’Driscoll T, Lawrance J, Jakubow A, Loewen K, Kelly L. A 5-year retrospective study of Emergency Department use in Northwest Province: a measure of mental health and addictions needs. CJEM. 2016. https://doi.org/10.1017/cem.2016.387.
Mental Health Commission of Canada. The case for diversity: building the case to improve mental health services for immigrant, refugee, ethno-cultural and racialized populations. Ottawa: Mental Health Commission of Canada; 2016.
Bellamy S, Hardy C. Understanding depression if aboriginal communities and families. Prince George PB. National Collaborating Centre for Aboriginal Health. 2021. https://www.nccih.ca/docs/emerging/RPT-UnderstandingDepression-Bellamy-Hardy-EN.pdf
Cianconi P, Bagus C, Lesmana J, Ventriglio A. Mental health issues among indigenous communities and the role of traditional medicine. Int J Psychiatry. 2019;65(4):289–99.
Livingston M, Laslett A, Dietze P. Individual and community correlates of young people’s high-risk drinking in Victoria. Aust Drug Alcohol Depend. 2008;98(3):241–8.
Hajizadeh M, Bombay A, Asada Y. Socioeconomic inequalities in psychological distress and suicidal behaviours among indigenous peoples living off-reserve in Canada. CMAJ. 2019;191(12):E325–36. https://doi.org/10.1503/cmaj.181374.
Walker R, Cromarty H, Kelly L, St P-H. Achieving cultural safety in aboriginal health services: implementation of a cross-cultural safety model in a hospital setting. Diversity Health Care. 2009;6(1):11–22.
Canadian Institute for Health Information. National Ambulatory Care Reporting System metadata (NACRS). 2020. Available at: https://www.cihi.ca/en/national-ambulatory-care-reporting-system-metadata-nacrs. Accessed 14 Aug 2020
Canadian Institute for Health Information. Discharge Abstract Database metadata (DAD). 2020. Available at:https://www.cihi.ca/en/discharge-abstract-database-metadata-dad Accessed 14 Aug 2020
Canadian Institute for Health Information. Canadian Coding Standards for Version 2018 ICD-10-CA and CCI. Ottawa, ON: CIHI. 2018. Available at: https://secure.cihi.ca/free_products/CodingStandards_v2018_EN.pdf. Accessed 29 Dec 2020
Government of Province. Mental Health Act: Mental Health Act, R.S.O. 1990, c. M.7 Available at: https://www.province.ca/laws/statute/90m07 Accessed 14 Aug 2020
Province Ministry of Health and Long-Term Care. Classification of Hospitals. 2020. Available at: http://www.health.gov.on.ca/en/common/system/services/hosp/group_c.aspx Accessed 14 Aug 2020
Firestone M, Smylie J, Maracle S, McKnight C, Spiller M, O’Campo P. Mental health and substance abuse in an urban First Nations population in Hamilton, Province. Can J Public Health. 2015;106(6):e375–81.
Kumar M. Lifetime suicidal thoughts among First Nations living off reserve, Metis, and Inuit aged 26–59: prevalence and associated characteristics. Aboriginal Peoples Survey, 2012. Ottawa: Statistics Canada; 2016.
Statistics Canada Health Report. Acute care hospitalizations for mental and behavioural disorders among First Nations people. Ottawa: Statistics Canada; 2018.
Gardiner W, Pajer K, Cloutier P, Currie L, Colman I, Zemek R, Hatcher S, Lima I, Cappelli M. Health outcomes associated with emergency department visits by adolescents for self-harm: a propensity-matched cohort study. CMAJ. 2019;4(191):E1207–16. https://doi.org/10.1503/cmaj.190188.
Statistics Canada (2020) Suicides among First Nations people, Metis, and Inuit (2010–2016). Findings from the Canadian Census Health and Environment Group. Available at: https://www150.statcan.gc.ca/n1/pub/99-011-x/99-011-x2019001-eng.htm Accessed 14 Aug 2020
Canadian Institute for Health Information. Health system resources for mental health and addictions care in Canada, July 2019. Ottawa: CIHI; 2019.
Eggertson L. Aboriginal youth suicide rises in Northern Province. CMAJ. 2015;187(11):E335–6.
VanderBurgh D, Savage D, Dubois S, Binguis N, Maxwell S, Bocking N, Farrell T, Homer T, Ritchie S, Orkin A. Epidemiologic features of medical emergencies in remote First Nations in northern Province: a cross-sectional descriptive study using air ambulance transport data. CMAJ Open. 2020;8(2):e400–6. https://doi.org/10.9778/cmajo.20190186.
Hameed S, Sukhera J, Miller K. Lost together experiences of family physicians with emerging adult mental health K. Can Fam Physician. 2020;66:588–93.
Health Quality Province. Under Pressure: Emergency department performance in Province. Toronto: Queen’s Printer for Province. 2016. Available at: https://www.hqprovince.ca/portals/0/Documents/system-performance/under-pressure-report-en.pdf Accessed 14 Aug 2020
Maar MA, Shawande M. Traditional anishinabe healing in a clinical setting: the development of an aboriginal interdisciplinary approach to community-based aboriginal mental health care. J Aborig Health. 2010;6(1):18–27.
Currie C, Wild T, Schopflocher D, Laing L, Veugelers P. Illicit and prescription dru problems among urban aboriginal adults in Canada: the role of traditional culture in protection and resilience. Soc Sci Med. 2013;88:1–9.
Sioux Lookout First Nations Health Authority. NAN Mental Health Plan. 2020. Available at: https://slfnha.com/search?search_paths%5B%5D=&query=NAN+mental+health. Accessed 16 Aug 2020
Mental Health Commission of Canada. Rural and remote mental health in canada evidence brief on best and promising practices, Ottawa. 2017. Available at: https://www.mentalhealthcommission.ca/sites/default/files/2020-05/Rural_remote_mental_health_evidence_brief_eng.pdf Accessed 28 Apr 2021
Thunderbird Partnership Foundation. First Nations Mental Wellness Continuum Framework. Health Canada, Bothwell, ON. 2015. Available at: https://thunderbirdpf.org/wp-content/plugins/pdfjs-viewer-shortcode/pdfjs/web/viewer.php?file=/wp-content/uploads/2015/01/24-14-1273-FN-Mental-Wellness-SummaryEN03_low.pdf&dButton=true&pButton=true&oButton=false&sButton=true#zoom=auto&pagemode=none Accessed 28 Apr 2021
Acknowledgements
None
Funding
Research was supported by a grant from SLMHC.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Hummelen, R., Lee, H., Russell-Mahoney, B. et al. Demographics of mental healthcare presentations in a northwest Ontario emergency department. Can J Emerg Med 24, 161–166 (2022). https://doi.org/10.1007/s43678-021-00223-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s43678-021-00223-7