1. cihi.ca@cihi_icis Canadian Institute for Health Information Care for Children and Youth with Mental Disorders healthreports@cihi.ca 1 Michelle Parker CAHSPR – May 12 th, 2016

2. Better data. Better decisions. Healthier Canadians. Our Vision

3. 3 Key Activities Data −28 data holdings comprising hospital, community, specialized services, pharmaceuticals, health workforce, spending Standards −ICD-10-CA, CCI, CMG, CACS, RAI, MIS Analysis −Annual reports, analytical reports, series Understanding and Use −Knowledge transfer/exchange About CIHI

4. 4 Context and Background 70% of mental disorders emerge in childhood.  Early intervention is key to reducing the impact later in life. Services provided to children and youth with mental disorders sometimes lack integration.  2 or more ministries involved Some question whether the current system has the capacity to meet the needs of these children and youth. The hospital is one important segment of youth mental health services.

5. 5 Using CIHI data to report on mental disorders This study examines: Inpatient Hospitalizations Emergency Department (ED) Visits Psychotropic Medication Use Significant data gaps in mental health remain at a comparable, national level, including: - Long term outcomes - Utilization of community-based services - Diagnoses associated with prescribed medications - Complete coverage across Canada for ED and medication data

6. 6 Jurisdictional variation in the use of inpatient care for children and youth age 5-24 with a mental disorder Note: Based on MRDX Source: Discharge Abstract Database and Hospital Morbidity Database, CIHI, 2014-2015; Ontario Mental Health Reporting System, CIHI, 2014-2015 Population estimates: Statistics Canada, Demography Division

7. 7 7 Significant growth in both emergency and inpatient hospital use

8. 8 ED Visits Of children and youth who visited the ED for mental disorders: 39% had 3 or more ED visits in one year vs only 16% of patients who visited the ED for other reasons. Girls more likely to go to ED with anxiety disorders Boys more likely to go to ED for substance use disorders They were admitted to inpatient care significantly more often than children presenting at the ED for other reasons

9. 9 Wide range in ED visit rate by Local Health Integration Network (LHIN) Ontario had a 53% increase in ED visits per 100,000 population (2006-07 to 2013-14)

10. 10 Inpatient Hospitalizations Of children and youth with an inpatient stay: - 11% had 3 or more inpatient stays in one year vs only 4% of patients with a stay for other reasons. - Boys more often in hospital with schizophrenia and psychotic disorders - Girls more often in hospital for mood disorders

11. 11 Less variability in inpatient hospitalizations by Local Health Integration Network (LHIN) Ontario had a 58% increase in inpatient hospitalizations per 100,000 population (2006-07 to 2013-14)

12. 12 Hospital use more common among 15-24 year olds compared to 5-14 year olds Source: Discharge Abstract Database and Hospital Morbidity Database, CIHI, 2006-2007 to 2014-2015; Ontario Mental Health Reporting System, CIHI, 2014-2015; Hospital Mental Health Database, CIHI, 2006-2007 to 2013-2014. National Ambulatory Care Reporting System, CIHI, 2015 Population estimates: Statistics Canada, Demography Division Note: ED Visit Data includes Ontario and Alberta Based on Main Problem and MRDX

13. 13 Hospital use more common among rural as compared to urban residents Source: Discharge Abstract Database and Hospital Morbidity Database, CIHI, 2006-2007 to 2014-2015; Ontario Mental Health Reporting System, CIHI, 2014-2015; Hospital Mental Health Database, CIHI, 2006-2007 to 2013-2014. National Ambulatory Care Reporting System, CIHI, 2015 Population estimates: Statistics Canada, Demography Division Note: ED Visit Data includes Ontario and Alberta Based on Main Problem and MRDX

14. 14 Interpretation of increase in hospital service use No evidence of an increase in prevalence of mental disorders Increase in utilization could be due to: - Challenges accessing community-based services Parents identified significant issues in this area - Improvements in identification of mental disorders in children and youth - Reduction in stigma associated with mental disorders, and thus a greater willingness to seek help

15. 15 7.0% of youth dispensed a medication to treat mood/anxiety disorders 1.6% of youth dispensed an antipsychotic medication These percentages increased significantly between 2007-08 and 2014-15 Dispensing of psychotropic medication common and growing

16. 16 Dispensing of psychotropic medication common and growing Without diagnostic information in the data, we cannot be sure of the intended use.

17. 17 Help to address data gaps Outcomes of mental health care Community-based data Integration with community sectors Discharge planning: Coordination of care between hospital settings and primary care providers post-discharge to ensure proper follow-up occurs. Capacity Building: Programs, resources and coordination in order to integrate and support pathways. Consider staffing in ED: On-staff social worker or psychiatric nurse? Continue the conversation! National and provincial organizations continue to work together on this important topic What can we do?

18. 18 The Difference Data Makes. Policy : Allows for evidence based conversations that inform policy development. Informed Discussions : Mental Health Symposium, Conferences, Program Development. Value for Money : Data allows for estimates on cost to system and forecast economic demand based on rising trend. Recommendations : Mental Health Commission of Canada, Provincial and Territories Recommendations, Agencies, Ministry of Education.

19. cihi.ca @cihi_icis HealthReports@cihi.ca #CYMH #mentalhealth