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Repeat Hospital Stays for Mental Health and Substance Use

This indicator measures the risk-adjusted percentage of individuals who had 3 or more episodes of care for mental health and substance use (MHSU) disorders among all those who had at least one episode of care for MHSU disorders in general or psychiatric hospitals within a given year.

Lower rates are desirable.

Data updated:
Data availability: to (fiscal years)
Geographic coverage
All provinces/territories
Reporting level
National, Province/Territory, Region
Calculation

(Total number of individuals who had at least 3 episodes of care for MHSU disorders [repeat hospitalizations] in a 1-year period ÷ Total number of individuals who had at least one episode of care for MHSU disorders in a 1-year period) × 100

The risk-adjusted percentage for each region was calculated by dividing the observed number of individuals with repeat hospitalizations in each region by the expected number of individuals with repeat hospitalizations in the region and multiplying by the Canadian average percentage of individuals with repeat hospitalizations.

Unit of Analysis : Patients

An episode of care refers to all contiguous inpatient hospitalizations in general and psychiatric hospitals and all day surgery visits regardless of diagnoses. To construct an episode of care, a transfer is assumed to have occurred if the following condition is met: 

  • Admission to a general/psychiatric hospital or day surgery facility occurs on the same day as discharge from another general/psychiatric hospital or day surgery facility
Denominator

Total number of individuals who had at least one episode of care for MHSU disorders in a 1-year period. The most recent episode of care in a fiscal year is the index episode of care.

Numerator

Total number of individuals in the denominator who had at least 3 episodes of care for MHSU disorders in a 1-year period. Each individual has a 12-month look-back period prior to their most recent episode of care in a given year. Therefore, data for 2 fiscal years is necessary to obtain the data for the numerator.

An episode of care for an MHSU disorder is identified using the same inclusion and exclusion criteria as for the denominator.

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Both crude rate and risk-adjusted rate are calculated as a percentage. Please refer to the Methodology tab for details.

For significance, the value yes refers to a rate that is statistically different from the average rate (p <0.05).

The dash (—) indicates that no data is available. Select different parameters or reset the chart.

Disparity Rate Ratio and Potential Rate Reduction metrics are available only for Canada and provinces. Potential Rate Reduction (PRR), and the associated confidence levels (UCL, LCL) are expressed as a percentage where available. Please refer to the General Methodology Notes (PDF) for details.

Hospitalization data for 2016–2017, 2019–2020 and 2020–2021 for Qikiqtani General Hospital in Nunavut was incomplete; thus results for Nunavut are not reported.

Results from 2020–2021 onward should be interpreted in the context of the COVID-19 pandemic. To learn more, see the Impact of COVID-19 on Canada’s health care systems.

Sources

Discharge Abstract Database, Hospital Morbidity Database, National Ambulatory Care Reporting System and Ontario Mental Health Reporting System, Canadian Institute for Health Information.

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Notes

Both crude rate and risk-adjusted rate are calculated as a percentage. Please refer to the Methodology tab for details.

For significance, the value yes refers to a rate that is statistically different from the average rate (p <0.05).

The dash (—) indicates that no data is available.

Disparity Rate Ratio and Potential Rate Reduction metrics are available only for Canada and provinces. Potential Rate Reduction (PRR) and the associated confidence levels (UCL, LCL) are expressed as a percentage where available. Please refer to the General Methodology Notes (PDF) for details.

Breakdowns are available only at the Canada and province/territory levels.

Hospitalization data for 2016–2017, 2019–2020 and 2020–2021 for Qikiqtani General Hospital in Nunavut was incomplete; thus results for Nunavut are not reported.

Results from 2020–2021 onward should be interpreted in the context of the COVID-19 pandemic. To learn more, see the Impact of COVID-19 on Canada’s health care systems.

Sources

Discharge Abstract Database, Hospital Morbidity Database, National Ambulatory Care Reporting System and Ontario Mental Health Reporting System, Canadian Institute for Health Information.

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Name

Repeat Hospital Stays for Mental Health and Substance Use

Short/Other Names

Patients With Repeat Hospitalizations for Mental Health and Substance Use

Description

This indicator measures the risk-adjusted percentage of individuals who had 3 or more episodes of care for mental health and substance use (MHSU) disorders among all those who had at least one episode of care for MHSU disorders in general or psychiatric hospitals within a given year.

Note
For further details, please see the General Methodology Notes (PDF)

Rationale

This indicator is considered an indirect measure of appropriateness of care, since the need for repeat admissions to hospital depends on the person and the type of MHSU disorders.

Challenges in getting appropriate care/support in the community and/or the appropriate medication often lead to repeat hospitalizations.

Variations in this indicator across jurisdictions may reflect differences in the services that help individuals with MHSU disorders remain in the community for a longer period of time without the need for hospitalization.

Understanding this population can aid in developing/enhancing programs that may prevent the need for repeat hospitalizations.

Interpretation

Lower rates are desirable.

HSP Framework Dimension

Health system outputs: Person-centred

Areas of Need

Living With Illness, Disability or Reduced Function

Targets/Benchmarks

Not applicable

Available Data Years

to (fiscal years)

Geographic Coverage

  • All provinces/territories

Reporting Level/Disaggregation

  • National
  • Province/Territory
  • Region
  • Age group
  • Recorded sex or gender
  • Neighbourhood income quintile
  • Urban versus rural/remote
  • Mental health category.

For more information, please refer to CIHI’s Equity stratifiers web page.

Indicator Results

Web Tool:
Your Health System: In Depth
PDF:
Accessing Indicator Results on Your Health System: In Depth (PDF)

Update Frequency

Every year

Latest Results Update Date

Updates

Not applicable

Description

(Total number of individuals who had at least 3 episodes of care for MHSU disorders [repeat hospitalizations] in a 1-year period ÷ Total number of individuals who had at least one episode of care for MHSU disorders in a 1-year period) × 100

The risk-adjusted percentage for each region was calculated by dividing the observed number of individuals with repeat hospitalizations in each region by the expected number of individuals with repeat hospitalizations in the region and multiplying by the Canadian average percentage of individuals with repeat hospitalizations.

Unit of Analysis : Patients

An episode of care refers to all contiguous inpatient hospitalizations in general and psychiatric hospitals and all day surgery visits regardless of diagnoses. To construct an episode of care, a transfer is assumed to have occurred if the following condition is met: 

  • Admission to a general/psychiatric hospital or day surgery facility occurs on the same day as discharge from another general/psychiatric hospital or day surgery facility

Type of Measurement

Percentage or proportion

Denominator

Description:

Total number of individuals who had at least one episode of care for MHSU disorders in a 1-year period. The most recent episode of care in a fiscal year is the index episode of care.

Inclusions:

  1. An MHSU disorder is identified by DSM-IV/DSM-5 diagnostic category in Ontario Mental Health Reporting System (OMHRS) data or by the most responsible diagnosis (MRDx) ICD-10-CA codes in Discharge Abstract Database (DAD)/Hospital Morbidity Database (HMDB) data
  2. The following MHSU disorders are included (see CIHI Mental Health and Substance Use Diagnosis Code Groupings for Selected Indicators (XLSX)): 
    1. Substance-related and addictive disorders
    2. Schizophrenia and other psychotic disorders
    3. Mood disorders
    4. Anxiety disorders
    5. Selected disorders of personality and behaviour
    6. Other disorders
  3. Recorded sex or gender coded as male or female
  4. Admission to a general or psychiatric hospital 

Exclusions:

  1. Records with an invalid health card number
  2. Records with an invalid code for province issuing health card number
  3. Records with a missing age
  4. Records with an invalid admission date
  5. Records with an invalid discharge date
  6. Cadaveric donor or stillbirth records (Admission Category Code = R or S)
  7. Records with a discharge status of dead on arrival (Discharge Disposition = 11, 71* for NACRS)
  8. 2018–2019 data onward: Medical assistance in dying (MAID) (Discharge Disposition Code = 73)

Note
*2018–2019 data onward.

Numerator

Description:

Total number of individuals in the denominator who had at least 3 episodes of care for MHSU disorders in a 1-year period. Each individual has a 12-month look-back period prior to their most recent episode of care in a given year. Therefore, data for 2 fiscal years is necessary to obtain the data for the numerator.

An episode of care for an MHSU disorder is identified using the same inclusion and exclusion criteria as for the denominator.

Method of Adjustment

Logistic regression

Adjustment Applied

Covariates used in risk adjustment:

For a detailed list of covariates used in the model, please refer to the Model Specification (PDF) document.

Geographic Assignment

Place of residence

Data Sources

  • DAD
  • HMDB
  • NACRS
  • OMHRS

Caveats and Limitations

Not applicable

Trending Issues

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was implemented in the Ontario Mental Health Reporting System as of 2016-2017. Prior to 2016-2017, the fourth edition (DSM-IV-TR) was used. Due to the fact that the DSM-IV-TR and DSM-5 diagnostic categories are not fully comparable, there may be some shift in the distribution of cases across categories. Therefore, trending of 2015-2016 and 2016-2017 rates for Ontario may potentially be affected.

Comments

Indicator results are also available in

References

Lin E, Durbin J, Zaslavska N, et al. Hospital Report 2007: Mental Health (PDF). 2008.

How to cite:

Canadian Institute for Health Information. Repeat Hospital Stays for Mental Health and Substance Use. Accessed April 25, 2025.