On Canada’s eastern edge, a CIHI-related tool is supporting a groundbreaking shift in the treatment of mental health patients.
In 2009, in a move to standardize its approach to data collection, staff at the Central Newfoundland Regional Health Centre’s Mental Health Unit started using the RAI–Mental Health (MH) tool to record inpatient assessments. Resident assessment instruments are used around the world to assess patients in various health care settings. Driving this method is a group known as interRAI, which includes clinicians and researchers in more than 30 countries.
In the Mental Health Unit, these tools centralize patient information, supporting better care and better decisions by health care staff. Last year a second tool, the RAI–Community Mental Health (CMH), was introduced so that community mental health workers could reap the same benefits.
The early returns have been so promising that Newfoundland and Labrador has agreed to implement both assessment tools in all regions. This is a first in Canada.
Inside the Inpatient Unit
Dale Gill, the unit’s nursing manager, said the RAI-MH has led to a string of positive developments.
Through the tool, staff send electronic information to CIHI, leading to reports that reveal trends. One of the unit’s first gains was a full-time social worker. Gill said they had been sharing a part-time worker with the rest of the hospital but always felt that they needed more help. The report backed up this assumption with facts. (Ditto for a dietitian.)
And a big step happened in the area of addictions. “The reports showed that addictions were a problem in the unit, so we started doing a lot of education among staff about addiction issues,” Gill said.
Desmond Coombs, Director of Mental Health and Addictions at Central, indicated that this is a critical shift in patient care. Patients with comorbidities have more complex service needs, but until the RAI-MH was introduced, the picture was unclear. Now his staff have a greater understanding and appreciation of addictions issues.
“We’re not shifting because we think this is where our complex patients are coming from,” Coombs said. “We’re shifting because, with this data, we know where they’re coming from.”
The assessment tools help identify not only major issues such as abuse, social issues, caregiver distress and addictive behaviors, but also the smaller details that affect a client’s care. For example: dry mouth. Gill said the tool revealed this common complaint. Was it medication-related? Not always. In fact, it turned out the facility’s air quality was at least partially to blame. This relatively simple fix removed a nagging symptom for clients.
Notably, the RAI-MH helped the unit identify its strengths. For example, it showed that staff rarely use restraints, particularly in the therapeutic quiet room. Gill said they realized this was because de-escalation skills were working well—talk therapy, medication, efforts that didn’t involve restraining clients.
In the Community
The instruments’ impact extends into the community, via the RAI-CMH, which was introduced in Newfoundland and Labrador last spring. The tools are meant to align with each other, so clinical information is shared at different points of care.
“This fosters a continuity of goals and treatment plan for the client,” Coombs said. “A community of practice.”
In the community, case managers now have a standardized assessment instrument. The tools provide a foundation so clinicians can develop and collaborate with clients on a care plan, using built-in outcome scales and mental health assessment protocols. Coombs added that it also saves plenty of time, as clinicians across the continuum of care know exactly where to start with any client, no matter how complex.
The Big Picture
Amid tightening budgets, Coombs said that funding decisions need the support of clear evidence. “The more data you have, the clearer and more standardized it is, then you can present cases for increased services, changes, staffing, education and other issues,” he said.
In mental health, which has many grey areas, it can be more difficult to demonstrate success and change. Coombs said that RAI tools unearth comparable data that demonstrate where and how patients are improving. Instead of offering opinions, those who care for mental health patients can offer facts.
He also believes the sky is the limit for these RAI instruments in mental health that—with embedded tools such as outcome measures, quality indicators and assessment protocols—will help identify areas for intervention in order to deliver top-notch care.
The instruments’ true value lies in staff using the tools right there on the floor while also gaining information at the program, regional and provincial levels . . . and beyond.
“At a national level, we’ll be able to communicate better because of an instrument like this,” Coombs said.