Raising flags to improve care for mental health clients

Raising flags to improve care for mental health clients

Much like a flag waving, new tools launched by CIHI earlier this month will improve the quality of care and life for mental health clients by identifying potential problems to their care providers before they start or escalate.

The new Clinical Assessment Protocols (CAPs) were developed by interRAI, an international research collaborative, with the support of CIHI and other clinicians and researchers. The 21 protocols look at a client’s safety, social life, economic issues, autonomy and health promotion, covering everything from self-harm and harm to others to criminal activity, falls and traumatic life events.

The CAPs will replace the previous Mental Health Assessment Protocols (MHAPs), which were developed in 1999. The redevelopment started with a review of international best practice guidelines. Then, with the help of partner organizations like CIHI, extensive consultations were done with subject-matter experts around the world, including direct evaluations of the CAPs by clinicians.

Analyzing interRAI mental health data was also part of the process. This included data in CIHI’s Ontario Mental Health Reporting System, as well as data gleaned from assessments in Newfoundland and Labrador.

"This was truly an international effort," says John Hirdes, interRAI’s senior Canadian fellow and board member. "We had experts from nine countries participate in research to create the new CAPs."

So how do they work?

In Ontario, for instance, every adult admitted to a mental health facility or a hospital mental health unit is assessed. The protocols draw on this information and, based on a person’s answers, a CAP may be triggered—essentially, a flag is waved. Considerations and evidence-based guidelines are then presented to help care providers enhance care planning.

"CAPs identify the people with a greater likelihood of a bad or good thing happening," Hirdes says. "They help you identify people who are expected to have a different clinical outcome."

The information is real-time, which allows for monitoring of outcomes. As the CAPs put great emphasis on a person’s recovery and interventions to support that, it’s also important to note the protocols that aren’t triggered, says Chris Perlman, Associate Director of Homewood Research Institute, who also worked on their development.

"Flags not waving could be potential strengths," he says. "That’s important in mental health care, as it identifies areas where someone doesn’t have a problem."

The CAPs were designed to be more specific and sensitive than the MHAPs.

"We’re now triggering care plans on people who really need them," Hirdes says.

"The other major advance is that they’re designed to work in inpatient and community mental health, so that will improve the continuity of care."