Grant: CIHR Fellowship

In many regions, including Ontario, persons with mental health (MH) disorders are high users of emergency department (ED) services, contributing to rising numbers of ED visits and longer wait times. Community MH services include programs such as supportive housing, case management, crisis programs, and physician provided MH services delivered by family physicians and psychiatrists. Although these services are intended to help people manage their health without visiting hospital EDs, little is known about their effectiveness in Ontario or elsewhere. This is because use of community MH services is usually not measured for entire populations. However, a database documenting use of community MH programs for all Ontario residents can now be accessed for research. The proposed study will link this newly accessible database to existing Ontario physician and hospital databases housed at the Institute for Clinical Evaluative Sciences to achieve two study objectives: 1) Describe patterns of use of community MH services, and 2) Assess whether use of community MH services is associated with reduced ED visits. These objectives will be examined, first, for adults with any MH disorders, and second, for three patient subgroups with greater complexity who have more difficulty accessing community care due to: co-occurring substance use disorders; co-occurring developmental disabilities; and serious mental illness (e.g., psychosis/bipolar disorder). This work can flag gaps in community care, and areas to target for improvement to reduce ED use. Findings will be timely for Ontario given that reducing (repeat) ED visits and increasing access to health and social supports for persons with mental illness or addictions is part of the provincial MH strategy. Findings are also relevant to other jurisdictions focused on improving quality of community care and reducing ED use.