Mental disorders - hospitals - homeless

Mental disorders account for more than half of hospital stays among the homeless in Canada

New CIHI report offers overview of links between mental health, mental illness and homelessness

August 30, 2007—Mental disorders accounted for 52% of acute care hospitalizations among the homeless in 2005–2006 (outside Quebec), according to a new report released today by the Canadian Institute for Health Information (CIHI). In addition, the report shows that 35% of visits to selected emergency departments (EDs)—mostly in Ontario—by homeless people were related to mental and behavioural disorders, a proportion that is higher than that for other patients (3%).

The Improving the Health of Canadians: Mental Health and Homelessness report provides an overview of the latest research, surveys and policy initiatives related to mental health and homelessness and, for the first time, presents data on hospital use by homeless Canadians.

“Mental illness affects a broad range of Canadians; most people with compromised mental health are not homeless, and many people who are homeless have never been diagnosed with a mental illness,” says Dr. Jennifer Zelmer, Vice President, Research and Analysis at CIHI. “However, studies show that people who are homeless are more likely to suffer from a mental illness or compromised mental health than the general population.”

For example, the leading reasons for hospital use were different for homeless patients and others. Mental disorders were the most common diagnoses among homeless patients admitted to an acute care hospital in 2005–2006 (52% of admissions). The most frequent reasons for hospitalization among other patients were pregnancy and childbirth (13%). Likewise, 35% of visits by homeless persons to selected EDs (mostly in Ontario) were related to mental disorders; injury and poisonings were the most common reasons for ED visits among other patients (25%). Among ED patients recorded as homeless, the most common type of mental disorder was substance abuse, which accounted for 54% of visits (62% for homeless men and 30% for homeless women), followed by other psychotic disorders (20% of visits), such as schizophrenia.
Homelessness linked with stress, coping, low self-esteem, low levels of social support and suicide

The report notes many factors both at the individual and broader social level—such as housing, income and the ability to cope—that have been shown to contribute to the onset or duration of homelessness. Many of these same factors are also linked to compromised mental health.

“This report explores the complex relationship between mental health and homelessness,” says Dr. Elizabeth Votta, Program Lead at the Canadian Population Health Initiative, a program of CIHI. “People with severe mental illness may experience limited housing, employment and income options. On the other hand, people who are homeless tend to report higher stress, lower self-worth, less social support and different coping strategies, factors that are associated with depressive symptoms, substance abuse, suicidal behaviours and poor self-rated health.”

Research cited in the report indicates that the homeless often experience more difficulty coping with stress, experience lower self-esteem and have less social support than people who are not homeless. For example:

· A study in Ottawa revealed that homeless male youth reported stress levels more than twice as high as levels reported by a group of non-homeless youth.

· A study in Kitchener–Waterloo showed that street youth were more likely to engage in substance abuse and self-harm as a means of coping. Non-homeless youth were more likely to cope by talking to someone they trusted or through productive problem-solving.

· A national survey found that 2% of males and 6% of females aged 15 to 24 reported having attempted suicide in Canada. Studies report higher rates among homeless youth. For example, a 2006 British Columbia survey indicates that 15% of males and 30% of females who were street-involved and marginalized reported having attempted suicide at least once in the previous 12 months.

The report also cites many examples of research linking mental illness and homelessness. These studies, conducted across Canada with different methods and over different periods of time, tended to show higher levels of diagnosed mental illness among people who were homeless than among the population as a whole. Several studies also indicate that rates of substance abuse are higher among the homeless than among other Canadians. Research suggests that homeless individuals with both a substance abuse disorder and a mental illness diagnosis are likely to remain homeless longer than others.
Canadian Population Health Initiative

The Canadian Population Health Initiative (CPHI) is part of the Canadian Institute for Health Information (CIHI). CPHI supports research to advance knowledge on the determinants of health in Canada and to develop policy options to improve population health and reduce health inequalities.
About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.

Youth Union Movement Event 1 September 2007 Toronto, ON

An exciting event is coming up.

The Toronto Youth Union Movement has organized an amazing event which is to start of our Labour Day weekend. It is a concert at Nathan Philip Square, on Sept 1st, at 1pm, with local up-and-coming performers and some known ones also. Here and there we will have a short speech, but the focus is on the performances.

We agreed that a cultural event is one of the best ways to reach youth. The goals of the event are to connect labour and community youth, continue to build a youth network in the city, promote Y.U.M., bring labour issues to youth as they will relate to it, and to have an amazing event.

Some of your unions and locals have donated funds to this event. Thank you for the generous support. There will be a program on the day recognizing our sponsors.

Would you be so kind as to share it with your contacts and networks, and asking them to share it with their contacts and networks? Also please encourage any youth and really anyone to come out to the event. Thank you. We need all the help we can get in promoting this event. It is a first and getting youth to come out is an exciting challenge; but I am hopeful. We have a great line-up of performers.

New CIHI analysis shows varying rates of adverse events in Canada

August 14, 2007

A new analysis on adverse events released today by the Canadian Institute for Health Information (CIHI) examines the risk of birth trauma in hospital and a range of other adverse events, including medication errors, in-hospital hip fractures and problems related to blood transfusions. Focusing on results from recent surveys, as well as several patient safety indicators, Patient Safety in Canada, shows that some adverse events are comparatively rare, but others occur more frequently. For example, in 2005, 1 in 10 adults with health problems reported receiving the wrong medication or wrong dose in the previous year. Adverse blood transfusion events are reported much less often. They occurred in about 1 in 4,100 cases in 2003.

“While we do not know how to prevent all adverse events, tracking how often they occur and understanding the factors that contribute to them is an important step in improving patient safety,” says Dr. Jennifer Zelmer, CIHI’s Vice-President of Research and Analysis.

One in 141 babies experience birth trauma each year; one in 21 women experience obstetric trauma

There are over one quarter of a million babies born in Canadian hospitals each year (outside of Quebec), one of the leading reasons for hospitalization in Canada. While most deliveries proceed smoothly, adverse events do occur in some cases. For example, the analysis found that between April 2003 and March 2006, on average, one in 141 babies born in hospitals outside of Quebec experienced birth trauma, such as injuries to a baby’s scalp and nervous system or skull fractures. This represents more than 1700 cases yearly.

Likewise, 1 out of 21 mothers giving birth by vaginal delivery (almost 5%) experience obstetrical traumas, such as lacerations of the cervix, vaginal wall or sulcus, or injury to the bladder or urethra. Between April 2003 and March 2006, there were, on average, more than 9,100 reported obstetric traumas in Canadian hospitals outside of Quebec each year. Previous research suggests that risk factors for obstetric trauma include newborns weighing more than 4 kg, long labour, instrumental delivery and a woman’s position during birth.

Risk of post-admission pulmonary embolisms measured for the first time

CIHI’s analysis found that 3.6 out of every 1,000 patients in Canadian hospitals (outside of Quebec and parts of Manitoba) experience a pulmonary embolism (PE), which occurs when
a blood clot or globule of fat or tissue travels through the veins and into the lung. It usually originates in a vein in the leg, when it is known as deep vein thrombosis (DVT).

The risk of post-admission PE or DVT generally increases with age, with patients 60 and over at higher risk than younger patients. However, the rate among children 4 and under is statistically significantly higher compared to that for older children up to 17 years of age.

Reducing the risk of foreign objects left in after surgery

Foreign objects left in after a procedure are less common than many other adverse events, affecting about 1 in 3,000 inpatients in Canadian hospitals outside of Quebec and parts of Manitoba, resulting in more than 200 cases per year between 2003–2004 and 2005–2006.

Previous studies show that obese patients are at higher risk of having a foreign object left behind after surgery. Other higher risk groups include patients who undergo emergency operations, have an unexpected change in operation or have a change in nursing or surgical staff during a procedure. Patients aged 17 and under are at lower risk than adults.

“The consequences of leaving a sponge or other foreign object in after surgery can be significant, but experts suggest that targeted strategies can reduce the risk,” says Dr. Indra Pulcins, CIHI’s Director of Health Reports and Analysis. “Documented prevention strategies include following a strict practice of sponge and instrument counts, as well as vigilant inspection of body cavities when the surgery is complete.”

Improving patient safety

“Health professionals always give their best efforts yet the fact remains that problems or adverse events happen during care delivery,” said Phil Hassen, CEO of the Canadian Patient Safety Institute. “By being vigilant in our focus on patient safety, we hope to see changes in practice that will significantly reduce needless injuries and deaths that result from adverse events.”

For example, many health care providers are focused on reducing the risk of medication errors. In a survey conducted in 2006, 8% of primary care doctors reported that patients had received the wrong drug or dose in the last 12 months. In 2005, 18% of nurses surveyed reported that patients in their care had occasionally or frequently received the wrong medication or dose in the previous year.

Experts have suggested a number of strategies to reduce the risk, including medication reconciliation—the process designed to prevent medication errors at patient transition points—(recently made an accreditation requirement for Canadian health care facilities) and automated drug alerts. In 2006, 10% of Canadian primary care physicians reported routinely receiving computerized alerts about potential drug interactions or dose problems. (Another 31% said that they received this information using a manual system.) Canada’s 10% compares with 23% in the United States, 40% in Germany and 80% or more in Australia, New Zealand, the Netherlands and the United Kingdom.

About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.