Regional Hospital Mental Health Services Indicator Results
Hospital Separations, Days Stayed, Separation Rate, Days Stayed Rate in General Hospitals Involving Mental Illness/Addiction per 100,000 Population and 30-Day/1-Year Rehospitalization Rate for Mood Disorders, per 100 Patients in Health Region of Residence
Separations, Days Stayed, Average Length of Stay and Median Days Stayed in General Hospitals Involving Mental Illness/Addiction, in Health Region of Residence
Separations, Days Stayed, Percentage of Total Separations and Percentage of Total Days Stayed in General Hospitals Involving Mental Illness/Addiction, in Health Region of Residence (Age)
Separations, Days Stayed, Percentage of Total Separations and Percentage of Total Days Stayed in General Hospitals Involving Mental Illness/Addiction, in Health Region of Residence (Diagnosis Category)
Factors That Affect Indicator Results
Many factors contribute to the observed variations in the analysis of indicators at the provincial/territorial and regional levels. These include, but are not limited to, geography, population health, provincial and regional health service resources, and health services administration, to name a few. It is very important to consider these factors and the effect they may have on indicator results when conducting comparative analyses. The variation in results between provinces/territories or between health regions suggests systematic differences in
- Provincial/territorial or regional health policies, practices and resources;
- Geography and urban/rural population distribution;
- Environmental and socio-economic characteristics;
- Types of patients served and acuity of illness;
- The range of health services available beyond general and specialty psychiatric hospitals (such as community mental health services); and
- Accessibility and awareness of alternative points of entry to the health system.
The above list suggests a few of the factors that should be considered when making provincial/territorial and/or regional comparisons.
- Hospital Mental Health Database (HMHDB), CIHI
- The HMHDB is a pan-Canadian database containing information on separations (discharges and deaths) involving mental illness from Canadian psychiatric and general hospitals. As only a small proportion of those living with mental illness/addiction receives treatment in hospital as inpatients, the HMHDB captures only a fraction of the services delivered for the treatment of mental illness/addiction.
- Discharge Abstract Database (DAD)/Hospital Morbidity Database (HMDB), CIHI
- Ontario Mental Health Reporting System (OMHRS), CIHI
- Hospital Mental Health Survey (HMHS), CIHI
- Population Estimates, Statistics Canada
- As of 2011–2012, the following codes are used for inpatient separations (discharges and deaths) involving mental illness/addiction:
- DSM-IV-TR: 290–319, 607.84, 608.89, 625.0, 625.8 and 780.09;
- ICD-9-CM: 290–319 and 648.40–648.44; and
- ICD-10-CA: F00–F99, G30, R41.0, R41.3 and O99.30.
- For information on prior years, please contact the Mental Health and Addictions team at email@example.com.
- Fiscal years (April 1 to March 31) are used.
- Separations by year are based on the date of discharge, not the date of admission.
- Newborns are excluded.
- The HMHDB is an event-based rather than a person-based database; individuals may be represented multiple times in the data.
- Total Days Stayed may include days stayed that occurred prior to the fiscal year of separation.
- Only cases with a primary diagnosis of mental illness/addiction on separation are included in the analyses.
- Only health regions with populations greater than 75,000 are included in the regional analysis.
- Analysis is based on patients’ region of residence rather than health region of hospitalization. The facility region code was used if the residence region code was blank or invalid.
- The 2006, 2007, 2008, 2009, 2010, 2011 and 2012 population estimates for health regions are based on health region boundaries in effect as of 2005, 2007, 2011 and 2013.
- Percentage of All Separations = Total separations in general hospitals for a primary diagnosis of mental illness/addiction ∕ Total separations in general hospitals for all primary diagnoses, by grouping (e.g., age, sex, province, diagnosis category).
- Percentage of Total Days Stayed = Total days stayed in general hospitals for a primary diagnosis of mental illness/addiction ∕ Total days stayed in general hospitals for all primary diagnoses, by grouping (e.g., age, sex, province, diagnosis category).
- 30-Day/1-Year Rehospitalization Rate is based on patients who had more than 1 episode of hospitalization, with the second episode occurring within 30 days/1 year of the discharge date of the index episode, respectively.
- Patients were included if the discharge date of the index episode was within the previous fiscal year, the most responsible diagnosis was for a mood disorder in a general hospital and the age of the patient was between 15 and 65. An event was deemed a rehospitalization if the patient was rehospitalized for any mental disorder in a general hospital after the index episode within the given period.
- 30-Day/1-Year Rehospitalization Rate per 100 Patients in Health Region of Residence = Total number of patients who were rehospitalized in a general hospital at least once for any mental disorder after the index episode within the given period ∕ Total number of patients whose most responsible diagnosis in the index episode was for a mood disorder in a general hospital × 100. The health region of residence is based on the index episode.
2012–2013 Diagnostic Groupings
|Diagnosis Category||Subcategory||DSM-IV-TR Code||ICD-9-CM Code||ICD-10-CA Code|
|Organic Disorders||Senile and pre-senile psychotic conditions||290.40–290.43||290.0, 290.10–290.13, 290.20–290.21, 290.3, 290.40–290.43, 290.8–290.9||F00–F09, F53.1, G30, R41.3|
|Transient organic psychotic conditions||293.0, 293.9||293.0, 293.1, 293.81–293.84, 293.89, 293.9|
|Other organic psychotic conditions||294.0, 294.8, 294.10, 294.11, 294.9, 310.1, 780.09||294.0, 294.1, 294.8, 294.9|
|Substance-Related Disorders||Alcoholic psychoses||291.0–291.9||291.0–291.5, 291.81, 291.89, 291.9||F10–F19, F55|
|Drug psychoses||292.0, 292.11, 292.12, 292.81, 292.82–292.84, 292.85, 292.89, 292.9||292.0, 292.11–292.12, 292.2, 292.81–292.84, 292.89, 292.9|
|Alcohol dependence||303.00, 303.90||303.00–303.03, 303.90–303.93|
|Drug dependence||304.00, 304.10, 304.20, 304.30, 304.40, 304.50, 304.60, 304.80, 304.90, 305.1||304.00–304.03, 304.10–304.13, 304.20–304.23, 304.30–304.33, 304.40–304.43, 304.50–304.53, 304.60–304.63, 304.70–304.73, 304.80–304.83, 304.90–304.93|
|Nondependent abuse of drugs||305.00, 305.20, 305.30, 305.40, 305.50, 305.60, 305.70, 305.90||305.00–305.03, 305.1, 305.20–305.23, 305.30–305.33, 305.40–305.43, 305.50–305.53, 305.60–305.63, 305.70–305.73, 305.80–305.83, 305.90–305.93|
|Schizophrenic and Psychotic Disorders||Schizophrenia||295.10, 295.20, 295.30, 295.40, 295.60, 295.70, 295.90||295.00–295.05, 295.10–295.15, 295.20–295.25, 295.30–295.35, 295.40–295.45, 295.50–295.55, 295.60–295.65, 295.70–295.75, 295.80–295.85, 295.90–295.95||F20–F29, R41.0|
|Psychotic||298.8, 298.9||298.8, 298.9|
|Paranoia, delusional disorders, other psychoses||297.1, 297.3, 293.81, 293.82||297.0–297.3, 297.8, 297.9, 298.0–298.4|
|Mood Disorders||Bipolar||296.00–296.06, 296.40–296.46, 296.50–296.56, 296.60–296.66, 296.7, 296.80, 296.89, 301.13||296.00–296.06, 296.10–296.16, 296.40–296.46, 296.50–296.56, 296.60–296.66, 296.7, 296.80–296.82, 296.89||F30–F31|
|Depression||296.20–296.26, 296.30–296.36, 300.4, 311||296.20–296.26, 296.30–296.36, 300.4, 311||F32–F33, F34.1, F53.0|
|Other||293.83, 296.90||296.90, 296.99||F34.0, F34.8, F34.9, F38, F39|
|Anxiety Disorders||Anxiety||300.00–300.02, 300.21–300.23, 300.29, 300.3, 309.21||300.00–300.02, 300.09, 300.20–300.23, 300.29, 300.3, 309.81||F40–F42, F93.0–F93.2|
|Acute stress||293.84, 293.89, 308.3, 309.81||308.0–308.4, 308.9||F43.0, F43.1, F43.8, F43.9|
|Personality Disorders||Personality disorders||301.0, 301.20, 301.22, 301.4, 301.50, 301.6, 301.7, 301.81–301.83, 301.9||301.0, 301.10–301.13, 301.20–301.22, 301.3, 301.4, 301.50–301.51, 301.59, 301.6, 301.7, 301.81–301.84, 301.89, 301.9||F60–F62, F68–F69|
|Other Disorders||Adjustment disorders||309.0, 309.24, 309.28, 309.3, 309.4, 309.9||309.0–309.1, 309.21–309.24, 309.28–309.29, 309.3–309.4, 309.82–309.83, 309.89, 309.9||F43.2, F99|
|Physiological malfunction arising from mental factors||307.80, 307.89||306.0–306.4, 306.50–306.53, 306.59, 306.6–306.9||F59|
|Sexual disorders||302.2–302.4, 302.70–302.76, 302.79, 302.81–302.85, 302.89, 302.9, 306.51, 607.84, 608.89, 625.0, 625.8||302.0–302.4, 302.50–302.53, 302.6, 302.70–302.76, 302.79, 302.81–302.85, 302.89, 302.9||F52, F64, F65, F66|
|Dissociative and factitious disorders||300.12–300.16, 300.19, 300.6||300.10–300.16, 300.19, 300.6||F44, F48.1|
|Somatoform disorders||300.11, 300.7, 300.81, 300.82||300.7, 300.81–300.82, 300.89, 300.9, 307.80–307.81, 307.89||F45|
|Eating disorders||307.1, 307.50, 307.51||307.1, 307.50–307.54, 307.59||F50|
|Disorders of infancy, childhood, adolescence, and developmental disorders||299.00, 299.10, 299.80, 302.6, 307.0, 307.20–307.23, 307.3, 307.52, 307.53, 307.59, 307.6, 307.7, 307.9, 309.21, 312.81, 312.82, 312.89, 312.9, 313.23, 313.81, 313.82, 313.89, 313.9, 314.00, 314.01, 314.9, 315.00, 315.1, 315.2, 315.31, 315.32, 315.39, 315.4, 315.9, 317, 318.0–318.2, 319||299.00–299.01, 299.10–299.11, 299.80–299.81, 299.90–299.91, 307.20–307.23, 307.0, 307.3, 307.6, 307.7, 307.9, 309.21–309.22, 312.00–312.03, 312.10–312.13, 312.20–312.23, 312.4, 312.81, 312.82, 312.89, 312.9, 313.0, 313.1, 313.21–313.23, 313.3, 313.81–313.83, 313.89, 313.9, 314.00–314.01, 314.1–314.2, 314.8–314.9, 315.00–315.02, 315.09, 315.1, 315.2, 315.31–315.32, 315.39, 315.4, 315.5, 315.8, 315.9, 317, 318.0–318.2, 319||F70–F73, F78–F79, F80–F89, F90, F91–F92, F93.0, F93.3, F93.8–F93.9, F94, F95, F98|
|Sleep disorders||307.42, 307.44–307.47||307.40–307.49||F51|
|Impulse control disorders||312.30–312.34, 312.39||312.30–312.35, 312.39||F63|
|Mental disorders due to a general medical condition not elsewhere classified||290.40–290.43, 316||290.40–290.43, 310.0–310.2, 310.8, 310.9, 316||F54
|All other psychiatric disorders||300.9||300.5, 648.40–648.44||F48.0, F48.8, F48.9, F53.8, F53.9, O99.3|
The following codes may be found in more that one category in the above grouping table: DSM-IV-TR—290.40, 290.41, 290.42, 290.43, 309.21; ICD-9-CM—290.40, 290.41, 290.42, 290.43, 309.21, 309.22; ICD-10-CA—F93.0. To avoid double-couting separations, these codes have been grouped to only one broad mental health category within the Hospital Mental Health Database (HMHDB). The volume of separations for these codes is very low (ranging from 0 to 35 nationally for the 2011–2012 data year); consequently, the impact on categorization to one category versus another is minimal.
Diagnostic groupings correspond to 2012–2013 data. For information on diagnostic groupings for prior years, please contact the Mental Health and Addictions team at firstname.lastname@example.org.
Crude/Standardized Rate Calculations
- For 2006–2007, 2007–2008, 2008–2009, 2009–2010, 2011–2012 and 2012–2013, crude rate calculations at the provincial/territorial level are based on population estimates from Statistics Canada as of July 1, 2006, 2007, 2008, 2009, 2011 and 2012, respectively.
- For 2010–2011, crude rate calculations at the provincial/territorial level are based on population estimates from Statistics Canada as of October 1, 2010.
- For 2006–2007, 2007–2008, 2008–2009, 2009–2010, 2011–2012 and 2012–2013, crude rate calculations at the regional level are based on population estimates from Statistics Canada as of July 1, 2006, 2007, 2008, 2009, 2011 and 2012, respectively.
- For 2010–2011, crude rate calculations at the regional level are based on population estimates from Statistics Canada as of October 1, 2010.
- Standardized rates are age-adjusted using a direct method of standardization based on the July 1, 1991, Canadian population.
- Additional information regarding population estimates is available on Statistics Canada’s website.
Interpretation of Data
The basic unit of observation is the discharge abstract or the record of an inpatient’s stay in a psychiatric(i) or general(ii) hospital. The discharge abstract is completed at separation (discharge or death). Records are grouped into fiscal years based on the inpatient’s date of separation from the hospital. If an individual was hospitalized more than once in the same fiscal year, a separate record for each stay was submitted. Hence the basic units of observation are events, not unique patients. If an inpatient was admitted prior to the beginning of a fiscal year, the days stayed prior to the year of separation are included in the total days stayed for that event.
Figures are based on the primary diagnosis or the diagnosis that contributed most to the patient’s length of stay during that hospitalization period.
- For more information about the Hospital Mental Health Database, please send an email to email@example.com.
- For assistance using interactive CIHI data, please send an email to firstname.lastname@example.org.
- All other inquiries can be directed to:
Canadian Institute for Health Information
495 Richmond Road, Suite 600
Ottawa, Ontario K2A 4H6
Last Updated: October 23, 2014
(i) In Canada, there is no standard definition of a psychiatric hospital. For the purposes of this report, psychiatric hospitals are medical hospitals that provide psychiatric services on an inpatient and/or outpatient basis and that have been identified by the provinces or CIHI.
(ii) For the purposes of this report, a general hospital is a publicly funded hospital that provides primarily for the diagnosis and treatment of inpatients and clients with a wide range of diseases or injuries. The services of a general hospital are not restricted to a specific age group or sex. Within the HMHDB frame, facility types such as non-teaching general hospitals with or without long-term care units, pediatric hospitals, teaching general hospitals and specialty institutions (cancer, cardiology, maternity, extended and chronic care, rehabilitation, neurological, orthopedic, etc.) are included. Contact CIHI for more information about the facilities included in the HMHDB frame.