Evaluating the Seniors Mental Health Policy Lens Newfoundland and Labrador

Context One of 4 provincial health regions. Merger of 3 former health boards governing health and community services. Large geographical area with a low population density and many small coastal communities. Rural areas are expected to age at faster rate due to out migration, migration to urban centers and lower birth rates.

HEALTH REGIONS

Long Term Care Personal Care Homes: 890 beds in 26 facilities. Facility Based Care: 517 beds in 11 facilities. Admissions coordinated through a “Single Entry Process”.

First Available Options Policy Status: Draft Form Purpose: Facilitates client care in the most appropriate setting Overview: Affects clients who are medically discharged or awaiting discharge and assessed as appropriate for LTC. When a first placement choice is not available an individual is required to “accept an alternative placement until the desired choice becomes available”.

First Available Options Policy Main Benefits: Client: Ensures clients receive the best possible care, in the most appropriate setting, in a timely fashion. System: Ensures efficient and effective utilization of resources and ensures acute care resources are available. P otential Costs: Geographical separation from family and social networks and related adjustment factors. Feelings of having lack of control in process/destiny.

Applying the Lens Exercise Who was involved? - Provincial Mental Health Consultants (2) - Manager of Residential Services Process : - Draft policy and SMHP lens circulated prior to exercise. - Round table review of policy using the lens - Feedback provided which will enable further revisions of the policy and the development accompanying practice guidelines and procedures.

Collaboration between MH consultants and LTC was very helpful. Different perspectives enriched the process. Allowed for a thorough, client centered analysis of the policy. Allowed for reconsideration of policy development process factors. Identified the need to develop accompanying procedures to ensure a client centered and respectful approach. What we learned:

What we learned Importance of involving key stakeholders (i.e. seniors and caregivers) very early in the process of policy development. Semantic presentation has a strong impact on how a policy is interpreted. Need to explain the rationale for the policy and the benefits to the senior (very important as policy statement will be provided to clients, family members &/or substitute decision makers).

What We Learned, con’t: Identified gaps in information and the need to provide more detail (i.e. special considerations, diversity issues). In the case of this policy negative impacts on mental health are possible, however, measures can be taken to address how such impacts can be mitigated and lessened. Overall, a very useful tool!

What happened as a result? Will change the language. Will give more consideration to implementation process and who needs to be involved (consumer, family member and health care team). Will develop accompanying procedures and practice guidelines for implementation of policy (i.e. process for informing patient/family). Will apply the lens to future LTC policy development and use to evaluate the policy over time.