Many home care clients with psychiatric diagnoses who could have benefitted from psychiatrist visits did not receive them, especially in Nova Scotia.
In our recent publication, we compared psychiatry service utilization among older home care clients (people enrolled in a publicly funded home care program) in the Winnipeg Regional Health Authority (WHRA) compared to Nova Scotia Health (NSH) jurisdictions. We were surprised to find that both jurisdictions had similar proportions (53 per cent) of older adults with at least one psychiatric diagnoses, including depression, anxiety, schizophrenia, or substance abuse disorders, among others. However, when we look at visits to a psychiatrist, this is where the two provinces show stark differences. We observed over 10 times the volume of psychiatry visits in the WRHA cohort (8,246 visits versus 792 visits in NSH); this translated into a four-fold increased likelihood of receiving psychiatry visits and 2.5 times more visits on average in the WRHA compared to NSH. In Winnipeg, 27.4 per cent of home care clients with at least one psychiatric diagnosis saw a psychiatrist. In Nova Scotia, only 7.4 per cent of home care clients with a psychiatric diagnosis saw a psychiatrist. More clients in the WRHA saw a psychiatrist in hospital than in NSH.
The information gap
Older adults who receive diagnoses and treatment for psychiatric conditions have better health outcomes and quality of life than those who have psychiatric conditions but do not receive diagnoses. Unfortunately, mental health services have been neglected in Canada, especially for older adults. And while this neglect is well known, what had not been previously documented was the magnitude of difference between need of psychiatry services and receipt of these services; therefore, our findings fill this knowledge gap.
How to use this information
The Canadian federal and provincial governments are trying support to support ageing in the community rather than in institutions (i.e. long-term care homes). If the goal is to keep older adults living safely at home, then publicly-funded home care in Canada provides personal support and home health services to meet that goal. However, we must acknowledge the increasing prevalence of mental health illnesses in home care clients will be an impediment to keeping older adults at home. These results raise important questions about the overall lack of psychiatric access, and differential access to psychiatry by site of care (hospital versus community) and by geographical location. These results also have implications for creating mental health strategies within public home care services.
Want to learn more?
There are more findings! For example, there were significant differences between psychiatry service use in rural compared to urban locations. Furthermore, we looked at the characteristics of home care clients who were more likely to see a psychiatrist. Read the full publication and consider following similar projects being researched at the Nova Scotia Centre on Aging.