Answering a 'Grand Challenge' for the Mental Health Care Sector

The bar is being raised for mental health care providers in terms of the quality of care received by people living with mental illness.

At its annual Health Quality Transformation Conference last month in Toronto, Health Quality Ontario (HQO) unveiled its first three Quality Standards in an effort to advance mental health care in Ontario.

These Quality Standards address key opportunities for improvement in the care of major depression, schizophrenia and behavioural symptoms of dementia based on the identified need for improvement in these three areas; each identified need is expressed as a quality statement, with a target of 100% compliance with the statement.

Ontario Shores had already addressed numerous quality statements through our work in implementing Clinical Practice Guidelines;  given this experience, we were asked to provide leadership in the development of these Quality Standards. A Corporate Action Plan will close the remaining gaps between our previous Clinical Practice Guideline work and the new Quality Standards.

Each Quality Standard consists of 10-15 quality statements that are actionable, measurable and grounded in the best available evidence. 

Examples of some of the key changes that have now been launched as a result of this work include the following:

• Introduction of a quick standardized tool (PHQ-9) that will now be used at the time of referral for service for depression, to assess severity level and direct time frames, and modalities, for/of treatment;
• New depression treatment and follow-up notes in MEDITECH for clinicians and psychiatrists to facilitate key components of the Depression Quality Standard and support recording of these items in the patient’s record;
• Individualized cognitive behavioural therapy for psychosis offered to patients who are screened as candidates for this intervention;
• New depression decision aides, available in multiple languages, to facilitate shared decision making with patients on treatment options;
• New schizophrenia treatment planning note for psychiatrists to facilitate key components of the Schizophrenia Quality Standard;
• Additional assessment tools for patients with dementia, including a modified dementia communication screen and an order for re-assessment to determine readiness for discharge;
• Development of a specialized Conference Report-Dementia to review target symptoms specific to dementia and medication review section that is specific to monitoring psychotropic medications used for managing agitation or aggression in dementia;
• Coordinated approach to reducing mechanical restraint use for managing agitation or aggression in dementia which includes case-based education, enhanced SMG training for specialized elder care techniques, and implementation of a conflict message for orders of mechanical restraints in patients with a primary diagnosis of dementia.

Further information about these Quality Standards is available through HQO.

I encourage clinicians to engage patients and families in conversations around the Quality Standards.  Patients and caregivers were involved in the development of these standards, including several patients and families of our organization.  Complimentary Patient Reference Guides can empower service users and families by ensuring a clear understanding about what to expect at various points in care. Active and engaged service users, and families/carers, will help ensure good adherence to the Standards, given that now they should know exactly what to ask for, for a given condition or diagnosis. 

These conversations will help provide guidance and direction as we continue our work to incorporate the best available evidence in our standard care practices.  They will also help as we expand our discussions regionally and provincially as leaders in implementing these Quality Standards.