May 30, 2019 — Canadians now have more information about home care and mental health and addictions services in their province or territory. We released 3 new indicators that show how Canada’s health systems are faring when it comes to how many Canadians
- Are hospitalized because of harm caused by substance use
- Seek frequent emergency room care for help with mental health and/or addictions
- Have their hospital stay extended because the right home care services and supports are not ready
These indicators are the first 3 of 12 chosen by the federal, provincial and territorial (FPT) health ministries, in consultation with Canadians, to measure access to mental health and addictions services and to home and community care.
Common Challenges, Shared Priorities: Measuring Access to Home and Community Care and to Mental Health and Addictions Services in Canada is a companion report that tracks the progress on the overall indicator development plan for the Shared Health Priorities work. It also provides additional context for interpreting the 3 indicators.
CIHI is supporting the performance measurement commitments made by the health ministers in A Common Statement of Principles on Shared Health Priorities. We are working closely with FPT governments to develop a set of common indicators focused on measuring pan-Canadian access to mental health and addictions services and to home and community care.
This first year of results provides a baseline against which to track improvements over time. It will take time for new investments and renewed focus to have an impact on indicator results.
The indicator results are available in the Your Health System: In Brief web tool at the provincial/territorial level.
CIHI moved forward with the development and public reporting of the indicators endorsed by the FPT health ministers to measure access to mental health and addictions services and to home and community care. Over the next 4 years, we will publicly report results for 3 new indicators each year, with the first public release in May 2019. The order in which we will report the indicators reflects jurisdictional readiness and data availability.
CIHI will continue to work with FPT governments to define the methodology for indicator calculation and to identify new data sources to enable comparable reporting. This is a 10-year commitment to public reporting. To provide the best indicators possible, it will be necessary to evolve the work over time as new data sources are established, new methods become available or public needs evolve.
In 2018, the Shared Health Priorities Advisory Council was established to provide strategic guidance on indicator development, to represent jurisdictional interests and to support public messaging and outreach.
The council consolidated the CIHI-FPT work groups from Phase 1 into a single body, with additional participation:
- Council members include representatives from provinces/territories, Health Canada, CIHI and Statistics Canada.
- Council observers include representatives from the Ministère de la Santé et des Services sociaux du Québec, the Canadian Home Care Association, the Mental Health Commission of Canada and the Canadian Centre on Substance Use and Addiction.
All governments recognize the need to make home care more available and mental health care more accessible. In 2017, the FPT governments reached a 10-year agreement that will lead to an $11 billion federal investment. This investment will go toward improving access to mental health and addictions services and to home and community care. By endorsing A Common Statement of Principles on Shared Health Priorities, FPT governments committed to working together to ensure that health care systems continue to respond to the evolving needs of Canadians.
CIHI was asked to work with the FPT governments to select and develop a set of pan-Canadian indicators that focus on measuring access to mental health and addictions services and to home and community care.
What do Canadians have to say about access to mental health and addictions services and to home and community care?
CIHI contracted Santis Health (in partnership with Nanos Research) to conduct public consultations to ensure that public priorities for access to mental health and addictions services and to home and community care were included in the indicator deliberations.
This research was independent of all other activities. It consisted of the following activities:
- 10 focus groups in 5 cities, with a total 80 participants.
The purpose of the qualitative research was to explore participants’ understanding of access to mental health and addictions services and to home and community care.
- Open Link survey.
Over 650 participants self-selected to share their views. The results are not considered generalizable to the general Canadian population, to rural/remote communities or to Indigenous peoples.
- Key informant interviews
In 2018, the FPT health ministers* endorsed a set of indicators for measuring access to mental health and addictions services and to home and community care that had been recommended by CIHI, on behalf of the CIHI-FPT work groups. These recommended indicators were informed by the advice of sector stakeholders, measurement experts and the public, and by published literature on the subject.
The endorsement of these sets of common indicators of access to mental health and addictions services and to home and community care marks a significant step toward improving access to services and support in sectors that are clearly important to Canadians. Over the next 10 years, CIHI will work with FPT governments to report annually to the Canadian public on these indicators.
Important work remains to be done before CIHI can report reliable and comparable indicators on behalf of the provinces and territories. As we continue these efforts, the names of the endorsed indicators may change as the indicator definitions and methodologies are refined.
Recommended indicators for access to mental health and addictions services:
- Wait Times for Community Mental Health Services, Referral/Self-Referral to Services (services provided outside of emergency departments, hospital inpatient programs and psychiatric hospitals)
- Early Identification for Early Intervention in Youth Age 10 to 25 (to be defined)
- Awareness and/or Successful Navigation of Mental Health and Addictions Services (self-reported, to be defined)
- Frequent Emergency Room Visits for Help With Mental Health and/or Addictions
- Hospital Stays for Harm Caused by Substance Use
- Self-Harm, Including Suicide
Recommended indicators for access to home and community care:
- Wait Times for Home Care Services, Referral to Services
- Hospital Stay Extended Until Home Care Services or Supports Ready
- Home Care Services Helped the Recipient Stay at Home (self-reported)
- Caregiver Distress
- Long-Term Care Provided at the Appropriate Time
- Death at Home/Not in Hospital (to be defined)
* The federal government has agreed to an asymmetrical arrangement with Quebec, distinct from the Common Statement of Principles. In addition, given the transition to a new government in Ontario, the province cannot officially endorse the recommendations.
We have long-standing programs of work that measure the performance of health systems. Given our experience, CIHI is well-positioned to facilitate the selection and development of indicators to track progress on the FPT health ministers’ commitments. This work aligns with our mandate to deliver meaningful, comparable information that will accelerate improvement in health care, the performance of health systems and the overall health of the population. The focus on mental health and addictions and on home and community care also aligns with CIHI’s strategic plan.
2 CIHI-FPT work groups were established to consider and recommend to FPT health ministers 2 focused sets of common indicators of access: 1 for mental health and addictions services, and 1 for home and community care.
The CIHI-FPT work groups were made up of 1 representative appointed by each federal, provincial and territorial deputy minister of health and 1 representative each from CIHI. Quebec has observer status, to share information and best practices. Members received the advice of sector stakeholders, measurement experts and the public to support their decisions and recommendations.
Selecting Pan-Canadian Indicators for Access to Mental Health and Addiction Services, and to Home and Community Care: Progress Report (March 2018) explains the indicator selection process, provides the status of the work completed to date and outlines the current state of performance measurement in these 2 sectors. In addition to identifying the state of information standards, infrastructure and measurement in mental health and addictions services and home and community care across Canada, the progress report also outlines how sector stakeholders, measurement experts and the public were engaged to provide advice on where to focus measurement. FPT government representatives will use this information as they work toward selecting meaningful indicators to measure pan-Canadian progress on improving access to mental health and addictions services, and to home and community care.
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