Schizophrenia Care in the Community for Adults Find out why a particular quality standard was created and the data behind it Cover option with no photo

Why a community schizophrenia quality standard is needed Schizophrenia is a severe, chronic mental health condition that usually begins in late adolescence or early adulthood In Canada, about 1 in 100 people have schizophrenia People with schizophrenia face a number of physical health risks related to their condition and die about 15 to 20 years earlier than the general population, often from chronic respiratory or cardiovascular disease This deck includes data that will highlight the burden of schizophrenia in Ontario and where gaps in care may exist Sources: Sources: American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington (VA): The Association; 2013. Health Canada. A report on mental illnesses in Canada: chapter 3, schizophrenia [Internet]. Ottawa (ON): Health Canada; 2002 [modified 2012 Mar 26; cited 2017 Dec]. Wahlbeck K, Westman J, Nordentoft M, Gissler M, Laursen TM. Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. Br J Psychiatry. 2011;199(6):453-8.

People with schizophrenia are often disproportionately affected by homelessness, or are precariously housed Source : Groupe de recherche sur les politiques de santé mentale. « Mental illness and pathways into homelessness: proceedings and recommendations », Toronto (Ontario), 1998.

Nearly 12% of patients revisited the emergency department for a mental health or addictions condition within 30 days of a previous emergency department visit for schizophrenia, and this proportion has not improved since 2006. Percentage of patients who revisited the emergency department for a mental health or addictions condition within 30 days of a previous emergency department visit for schizophrenia, in Ontario, 2006 to 2014 Copy and Paste your Excel graph in. Title at the top is editable as well. No circle detail to allow for clear presentation of graph.

The percentage of patients who revisited the emergency department for a mental health or addictions condition within 30 days of a previous emergency department visit for schizophrenia ranged from 9.3% to 16.6% across LHIN regions. Percentage of patients who revisited the emergency department for a mental health or addictions condition within 30 days of a previous emergency department visit for schizophrenia, in Ontario, by LHIN region, three-year average for 2012 to 2014 Copy and Paste your Excel graph in. Title at the top is editable as well. No circle detail to allow for clear presentation of graph.

The percentage of patients who were readmitted to hospital for a mental health or addictions condition within 30 days of a previous hospital discharge for schizophrenia ranged from 9.1% to 16.2% across LHIN regions. Percentage of patients who were readmitted to hospital for a mental health or addictions condition within 30 days of a previous hospital discharge for schizophrenia, in Ontario, by LHIN region, three-year average for 2012 to 2014 Copy and Paste your Excel graph in. Title at the top is editable as well. No circle detail to allow for clear presentation of graph.

Fewer than 3 out of 10 people hospitalised for schizophrenia in Ontario have a follow-up with a family doctor or psychiatrist within 7 days of discharge

The percentage of patients who had contact with a family doctor or a psychiatrist within seven days of a previous hospital discharge for schizophrenia varied across LHIN regions from 15.0% to 41.3%. Percentage of patients who had contact with a family doctor or a psychiatrist within seven days of a previous hospital discharge for schizophrenia, in Ontario, by LHIN region, three-year average for 2012 to 2014 Copy and Paste your Excel graph in. Title at the top is editable as well. No circle detail to allow for clear presentation of graph.

How will the schizophrenia quality standard address these gaps in care? Together, we can improve the quality of care for people living with schizophrenia in the community. That’s why Health Quality Ontario, in collaboration with health care professionals, people living with schizophrenia, and caregivers, has developed this quality standard outlining what what high-quality health care looks like for aspects of care that have been deemed a priority for quality improvement in the province. While this quality standard addresses care for people who have already been diagnosed with schizophrenia, the importance of having responsive services that ensure all Ontarians with schizophrenia can receive a diagnosis cannot be overstated For a quality standard that addresses care for adults with schizophrenia who present at the emergency department or are admitted to hospital, see the Schizophrenia: Care for Adults in Hospitals quality standard

Schizophrenia community quality standard: quality statements Care Plan and Comprehensive Assessment Treatment With Clozapine Continuation of Antipsychotic Medication Physical Health Assessment Self-Management Cognitive Behavioural Therapy for Psychosis and Other Psychosocial Interventions Family Education, Support, and Intervention Promoting Physical Activity and Healthy Eating Access to Community-Based Intensive Treatment Services Promoting Smoking Cessation Housing Assessing and Treating Substance Use Disorder Antipsychotic Monotherapy Treatment With Long-Acting Injectable Antipsychotic Medication Employment and Occupational Support

How can the success of this standard be measured? How Can Success Be Measured Provincially How Can Success Be Measured Locally Percentage of adults hospitalized for schizophrenia who have had an unplanned hospital readmission for a mental health or addictions condition within 30 days of discharge (See slide 5) Percentage of adults with schizophrenia who report unmet care needs (suggested stratification: type of need) Percentage of adults with schizophrenia who report living in stable housing for the past year Percentage of adults hospitalized for schizophrenia who had contact with a trained mental health physician: Percentage of adults hospitalized for schizophrenia who had contact with a trained mental health professional: Within 7 days of hospital discharge (See slides 6 and 7) Within 7 days of hospital discharge Within 28 days of hospital discharge See the Schizophrenia: Care in the Community for Adults Measurement Guide for more information on how to calculate these indicators

For more information: Website: hqontario.ca/qualitystandards Email: qualitystandards@hqontario.ca Cover option with no photo © Queen’s Printer for Ontario, 2018