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Central East Local Health Integration Network

Integrated HealtH ServIce Plan

Engaged Communities. Healthy Communities.

november 2006

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Forward

welcome to your Central East LHIN (Local Health Integration Network) and its first Integrated Health Service Plan (IHSP).

This plan represents the first stage in the trans-formation of ontario’s health care system, from centralized to local health care system planning and funding. It is an initial blueprint for change, a three-year plan towards building a better health care system. our ultimate goal is to realize our vision of Engaged Communities. Healthy Communities.

This transformation of health care began with the creation of 14 LHINs across the province through the Local Health Integration Act (2006). Under this legislation, the LHINs were given a mandate to locally plan, co-ordinate, integrate and fund health care services provided by hospitals, long-term care homes, community care access centres, commu-nity support services, community mental health and addiction services and community health centres.

Two things are certain when it comes to people and their health care system. First, people are deeply attached to the system of public health care in ontario. Secondly, they want it to work better for themselves and their loved ones. during our ongoing process of community engagement, community residents often told us of their high satisfaction with the current health care system. we also heard very clearly people’s frustration about the inability to access a well-co-ordinated system of care.

People told us they sometimes experienced inter-mittent care separated by long and costly delays, and anxiety about “where do I go next?” we also heard from health professionals and residents alike about the inability to provide comprehensive “whole person” health care services to people and their families, commonly due to rigid funding and bureaucratic boundaries and a lack of information of what services are available to people.

Foster LoucksChair, Central East LHIN Board of directors

Marilyn Emery CEo, Central East LHIN

Your health care system is made up of tens of thou-sands of dedicated health care professionals, other health care providers and support workers, plus an army of volunteer caregivers who all work to make it a world-class system. But everyone agrees we can do better. To do so requires both a plan and a commitment to deliver on that plan.

Key to the development of a successful plan for the Central East LHIN is community engagement. all too often, health care initiatives have been planned in isolation, and then brought to the public for late reaction. we started our process of commu-nity engagement with two simple premises. First, that local health care system planning and priority setting should begin with the people who use the system. For that reason, we sought out you and your community’s voice before developing any plans.

The second premise was based on the belief that if LHIN initiatives were to be successful, co-operation and shared responsibility throughout our health care community would be required.

we have listened. The core and foundation of this Integrated Health Service Plan was created by the community through grassroots initiatives. Stakeholders, including health care providers and community residents, have been involved as never before in the development of this Plan to identify local needs, local priorities and local actions to make our system more truly people-centred. while we have already begun moving forward, we will continue to listen to your concerns, needs and ideas for improvements.

This Plan has really been a collective community effort. Hundreds of volunteers, community resi-dents and health care providers alike, have provided invaluable contributions to this Plan. The directions contained within this Plan are a testament to their knowledge, commitment and dedication to their patients, clients, residents, colleagues, neighbours, families and friends.

on behalf of our board members and staff, thank you to everyone for helping to create this shared and forward-looking Plan for lasting change. optimism abounds.


For additional copies of this report or for more information, please contact us at 1-866-804-5446 or [email protected]

Central East Local Health Integration NetworkIntegrated Health Service Plan

TaBLE oF CoNTENTS

Forward

Introduction. Health Care is Changing 5A Vision for the Central East Local Health Integration Network 6

What’s in a Plan? The Purpose of the Integrated Health Service Plan 7

It Begins With You!Effective Community Engagement Creates Effective Plans 8Local Planning and Engagement Collaboratives 9LHIN-wide Priority Networks & Task Groups 11Sharing and Validating the Draft Integrated Health Service Plan 12

Environmental Scan. Who We Are and Where We Live 14

A Plan for Change. Priorities for Change 18Enabling Change to Happen: System Enablers 18 E-Health 19 Shared non-clinical services 19 Moving People Through the System 19 Safe Environments of Quality Care 19 Health and Human Resources 20Performance Dimensions 20

Priority for Change: Mental Health and Addictions 22The Impact of Mental Health and Addictions 23What We Know 25What You Told Us 26What We Have Done 27What We Will Do 28

Priority For Change: Seamless Care for Seniors 29Why Seamless Care for Seniors? 30 Impact on the Individual 30 Impact on the Caregiver 31 Impact on Your Community and Health System 31What we know 32 Our Ageing Community 32 Diversity and Ageing 32 Income and Ageing 32 Growth in Dementia 33 Alternate Level of Care 33What You Told Us 35What We Have Done 35What We Will Do 36

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Priority for Change: Chronic Disease Prevention and Management 37Why Chronic Disease Prevention and Management is a Priority 38 Impact on People 38 Impact on Your Community and Health System 38 Chronic Disease Related Risk Factors 38 Social Determinants 38 Hospitalizations for Chronic Conditions 39 Prevalence of Chronic Conditions in Central East 39 Focus on Diabetes and Chronic Kidney Disease 40What We Know 41What You Told Us 43What We Have Done 44What We Will Do 44

Priority for Change: Wait Times and Critical Care 46What We Know 47 Surgical and Diagnostic Wait Times 47 Critical Care 47 Emergency Departments 48How Are We Doing? 49 Surgical and Diagnostic Wait Times 49 Emergency Departments 49 Central East LHIN Critical Care Resources 50What We Have Done 52What We Will Do 53

Integration Begins With Primary Care 54What We Have Done 54

Cultural CompetenceUnderstanding Health within Our Multicultural Fabric 55What We Know 55What You Told Us 57What We Will Do 57

Improving Services for the Central East Francophone Community 58What We Know 58What You Told Us 58 Access, Integration and Innovation 59 Accountability 59 Health Human Resources 59 A Forum to deal with French Language Health Services 59What We Will Do 60

First Nations and Aboriginal HealthPartnerships to Create Better Understanding and Health 61What We Know 61Moving Forward 62

Conclusion: Optimism Abounds 63

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Integrated Health Service Plan 5

INTrodUCTIoN

Health Care is Changing!

recently, the Government brought forward five strategic directions that will form the basis for the development of a 10-year Provincial Health System Strategic Plan. while that plan will be further defined through a province-wide process of citizen engagement, the initial directions are:

Renewed community engagement and partnerships in and about the health care system

Improve the health status of ontarians

ontarians will have equitable access to the care and services they need no matter where they live or their socio/ cultural/economic status

Improve the quality of health out-comes, and

Establish a framework for sustainability of the health system that achieves the best results for consumers and the community.

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The Mandate of a local health integration network is to plan, fund and integrate the local health system to achieve the purpose of the Local Health System Integration Act, 2006.

The advent of LHINs offers the potential to create a true system of coordinated health care. It is also ontario’s acknowl-edgement of what other Canadian prov-inces and international jurisdictions have come to know: To gain full value of the public’s investment, all the parts of current health care system must be inte-grated into a full continuum of care. By eliminating delays between care provided in people’s homes, doctors’ offices, hospi-tals, day programs, and long-term care homes, and of the system – delays which are costly for the people receiving care and ultimately the tax payers – LHINs can help create a new system of health care that focuses on the continuum of care for the “whole person.” By coordinating the path of care, the health system will not only make better use of its resources, but it will provide people with the right care, in the right place at the right time.

The mandate of the Local Health Integration Network is in keeping with the ontario Government’s vision and strategic priori-ties for the provincial health care system. That vision is for a health care system that helps people stay healthy, delivers good care to them when they get sick and will be there for their children and grandchildren.

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6 Central East Local Health Integration Network

a VISIoN For THE CENTraL EaST LoCaL HEaLTH INTEGraTIoN NETworK

To assist in meeting its mandate and achieving local and provincial strategic priorities, the Central East LHIN has devel-oped a vision and supporting values that reflects the nature of our communities and their aspirations.

our vision is “Engaged Communities. Healthy Communities.” and is orientated towards establishing a health system that is responsive to the needs of people and their community for today and tomorrow, as well as improves health care access and navigation for clients and caregivers. This will be achieved, in part, by: promoting shared responsibilities and innovation; recognizing the importance of equity, quality and safety; and making decisions based on performance-based evidence.

The Central East LHIN Board will be guided by the following values in making decisions and upholding its relationships with the community:

Accountability. we will be required or expected to justify actions or decisions. Public funds will be used responsibly.

Responsiveness. we will listen, we will be accessible, and we will respond in a timely manner. we will build sustainable relationships.

Respect. we will show respect to all.

Integrity. we will consistently adhere to principled behaviour and a high standard of ethics.

Innovation. we will be prepared to test new waters; we will be open to a new idea, method, or device.

Equity. we will recognize the diversity of communities and respond reasonably and fairly.

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Engaged Communities Healthy Communities

Values: Accountability. Responsiveness. Respect. Integrity. Innovation. Equity.

People are supported and proactively engaged in

• managing their own health and wellness

• providing direction and solutions for their health care system and their LHIN

• coordinating the delivery of timely health care services

• Supportive and sustainable environments that address the social determinants of health and cultural competency

• Timely and equitable access to care

• The health of the population has improved



wHaT’S IN a PLaN?

The purpose of the Integrated Health Service Plan

sary use of limited and more expensive health care services “downstream.” To achieve these goals, the LHIN will estab-lish working partnerships with physicians, public health units, government-funded children and community programs, munic-ipal programs (such as transportation and social services), the education sector, the private sector and other organizations like the United way.

Most importantly, the strength of LHIN health planning begins with critical contri-butions to the initial design of the system and its priorities. The most notable of those inputs are effective mechanisms of citizen engagement and a comprehensive use of data, both of which provide in-depth knowledge on the local population and its health care needs.

Patient CentredIntegration & Service

Coordination

CommunityEngagement

Funding & Allocation

Local HealthSystemPlanning

Accountability& Performance

Monitoring

Phase One:

System Design

Phase Two:

System Im

plementation

and Monitoring

Planning can be broken into two distinct but related phases: the design and devel-opment phase; and the implementation and monitoring phase.

This initial Integrated Health Service Plan is focused on system design with a focus on key health care priorities for change. The Plan is intended to set the course for health care improvements in the Central East LHIN for the next three years. Each year the Plan will be revised according to advancements, lessons learned, and emerging trends in our community. The Plan does not directly address the second phase of implementation and monitoring. That phase will be accomplished in LHIN work plans, and accountability agreements between the Central East LHIN and health service providers (hospitals, long-term care homes, community care access centres, community support services, community mental health and addiction services, and community health centres).

This Plan also provides “upstream” strat-egies – such as disease prevention and management, housing, cultural compe-tency – which will reduce unneces-

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IT BEGINS wITH YoU!

Effective Community Engagement Creates Effective Plans

access, your frustrations and confusion about how to get the information and services you need, and your ideas and aspirations for improvements to the health care system.

wanting to do more than express their concerns, many people expressed a will-ingness to get involved and have since plunged into the hard work of developing this Plan for change.

as a first step, the Central East LHIN met with more than 4,000 citizens through a series of informal and formal community consultations to discuss their ideas for the future of their health care system. Some of these sessions were large public forums and day-long workshops. The LHIN also conducted dozens of engagement oppor-tunities, small and large, with members of our health care community: from physicians to front-line workers, from youth to seniors, from members of our Francophone community to Tamil mothers and from members of our First Nations communities to new immigrants.

as health care service providers and resi-dents of the Central East LHIN, you are a vital part of the health care system and the changes taking place in health services cannot be a success without you.

From the beginning, the goal has not been just to effectively listen to people’s concerns and ideas, but also to empower them in creating solutions that lead to better health and a better health care system. But such a goal cannot be achieved by accident. That is why the first major deliverable of the Central East LHIN was the Framework for Community Engagement and Local Health Planning (available at www.centraleastlhin.on.ca/pdfs/framework.pdf). The “Framework” details the Central East LHIN’s commit-ment and plan for organized, effective and sustainable community involvement.

as a result of meeting the objectives set out in the Framework, people from across the Central East LHIN are actively and inti-mately involved in the planning process. You have told us about the barriers to

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Starting with the premise that “local works better,” the Central East LHIN has divided the region into nine geographic planning and engagement zones, based on several characteristics including size and distribu-tion of the population, travel distances, municipal boundaries and commonly understood patterns of service use by citizens. These zones include Haliburton Highlands, Kawartha Lakes, Peterborough City and County, Northumberland-Havelock, durham East, durham west, durham North/Central, Scarborough agincourt-rouge and Scarborough Cliffs-Scarborough Centre.

“This is the first time ever that planning for health care in this province has been developed at the local level. People I’ve talked to believe it can be done at the local level.”

Stephen Kylie Central East LHIN Board Member

during the public meetings, the LHIN found consensus among the communities across the region on common challenges, common values and common hopes for their public health care system. There was also strong agreement on system priorities and opportunities to achieve real, lasting change. These concerns were heard and this Plan is the initial response.

Local Planning and Engagement Collaboratives

The Central East LHIN is far from being a single uniform community: we are a commu-nity of communities, ranging from the multi-culturally diverse urban cities, ageing rural communities, and isolated remote dwellings. It was no surprise when residents made it clear that change would sometimes require different approaches from one community to the next. There was no support for a “one-size-fits-all” solution.


Community Planning & Engagement Zone(Lower Tier Municipalities – Boundaries)

Population2001 Census

1 Haliburton Highlands Algonquin Highlands, Dysart et al, County of Haliburton,Highlands East, Minden Hills

15,085

2 Kawartha LakesCity of Kawartha Lakes

69,179

3 Peterborough City & CountyGalway-Cavendish-Harvey, North Kawartha, Smith-Ennismore-Lakefield,Douro-Dummer, Cavan-Millbrook-North Monaghan, Otonabee-SouthMonaghan, City of Peterborough, Asphodel-Norwood

121,377

4 Northumberland-Havelock Alnwick/Haldimand, Cobourg, Cramahe, Hamilton,Havelock-Belmont-Methuen, Port Hope, Trent Hills

81,976

5 Durham - EastOshawa, Clarington

208,885

6 Durham - West Whitby, Ajax, Pickering

248,305

7 Durham - North/Central Scugog, Uxbridge, Brock

49,660

8 Scarborough Agincourt – RougeBoundary (Clockwise)from Steeles Avenue and Victoria Park, travel east along Steeles - south along Rouge River to Lake Ontario - west along the lake to Morningside Avenue - north to highway 401 - west along highway 401 to Victoria Park - north to Steeles Avenue.

272,165

9 Scarborough Cliffs – Scarborough CentreBoundary (Clockwise) from Victoria Park and highway 401, travel east on highway 401 to Morningside Avenue - south to Lake Ontario - west along the lake to Victoria Park - north along Victoria Park to highway 401.

321,100


The division of the LHIN into zones and the division of the province into LHINs will have no effect on consumer access to needed health services. The delineation of zones is simply to support local plan-ning and community engage-ment. It is fully expected that consumers and health service providers will move freely among these zones and among LHINs to access the services they need.

Each zone has a local volunteer health Planning and Engagement Collaborative which can be described as a local advisory team made up of a diverse cross section of people in your community. They include doctors, pharmacists, nurses and other health professionals as well as represen-tatives from hospitals, community health centres, community support agencies and mental health and addiction services. These advisory teams also include consumers of health care services and members of the community with an interest in improving the health care system.

More than a hundred volunteers are now participating on these advisory teams, bringing a variety of perspectives to the planning discussions. There is an advi-sory team in your community. You can bring them your ideas for local health care system planning. They will work with you and the LHIN to build understanding and knowledge around local population needs and health care challenges in your community.

LHIN-wide Priority Networks & Task Groups

Through community engagement and consultation, three LHIN-wide Health Interest Networks have been established for three of our priorities for change. Task Groups are also being established for our other key initiatives.

Each of these networks and task groups will be composed of local experts, including citizens, to advise the LHIN directly on its priority initiatives and activities. These individuals are a key resource to the LHIN region as they will assume a good deal of

IHSP Community Contribution

Community volunteers and health care leaders contributed about 8,037 hours or 1,108 working days of direct input into the development of this Plan.

FACTS AND FIGURES #1


responsibility in not only representing the needs of their priority populations, but they will bring their collective skills and experience to propel our plans to action, and finally, to achievement. These “expert tables,” each at various stages of devel-opment, will be mentioned further within their respective priorities for change.

Members of the nine Collaboratives or advisory teams, the three Health Interest Networks and other task groups - including health providers, caregivers and citizen activists – are working to create a preferred future for your health care system.

These are people you know in the commu-nity, your neighbours and friends. They, like you, want a health care system that provides the right service to the right person at the right time and they want you to join them in building this plan.

Sharing and Validating the draft Integrated Health Service Plan

on September 29th, 2006, the Central East LHIN board approved a draft of this Integrated Health Service Plan to be shared with community residents for comment prior to its final adoption. To successfully get feedback from the general public, the Central East LHIN conducted 8 awareness events in high-traffic, high-exposure areas (such as shopping malls) across the region.

What You SaidResults from IHSP Feedback Survey

92% indicated that the sessions and Plan gave them a better understanding of LHINs

87% said the Plan, if achieved, would make a difference for them and their community. 82% said the Plan would make a difference for their public health system

96% supported the LHIN priorities Seamless Care for Seniors, Chronic Disease Prevention and Management, Mental Health and Addictions. Support for other LHIN initiatives was also strong: Wait Times & Critical Care (87%), and e-Health (84%).


at each event, Central East LHIN board members, staff and, most importantly, volunteers from your community were on hand to distribute materials, listen to residents, and answer questions related to your health system, LHINs and the Integrated Health Service Plan. Hundreds of conversations were held, and 2500 copies of an “IHSP Quick Facts” were distributed to community residents, along with a feedback form that provided an opportunity for residents to comment.


Figure 1 depicts the journey taken to complete and share this Plan. The LHIN will continue to seek your help and provide more opportunities for input as the Plan evolves and further priorities are established. Transforming the system is a journey we all share. we want to hear from you about your hopes and ideas for the future.

Phase 1 COMMUNITY ENGAGEMENT

Phase 2 COMMUNITY PLANNING

Phase 3 DRAFT IHSP FOR PUBLIC COMMENT

YOUR PLAN

4,000 + Participants 2,000 Pages of Community Input

Environmental Scan to validate findings

9 Local Collaboratives + 3 LHIN-wide Networks250 + people contributing 8,100 hours of direct input

Environmental Scan - evidence to support IHSP directions

Presence in 8 public spaces across the Central East.2500 copies of the IHSP Quick Facts distributed.

FIGURE 1: ROAD TO THE IHSP


ENVIroNMENTaL SCaN

Who We Are, and Where We Live

a General overview

The Central East region is both large and diverse, with a total population of about 1.5 million people living within an area of 16,673 square kilometres. This population is spread across a mix of urban, rural and remote communities, from Scarborough to Northumberland and north to the Haliburton Highlands.

demonstrating the diversity within the Central East LHIN, the average popu-lation density of the LHIN is 89 people per square kilometre. Taken alone, this average masks the range of population density among the nine zones, ranging from 3.75 people in Haliburton to 3,545 in Scarborough.

another example of this diversity is found in the age profile of our communities. It is well known that age is perhaps the most important contributing factor of one’s health status and accessibility to health services. age is also a key factor in considering the supply and availability of health human resources. The percentage of people 65 years and older living in the Central East LHIN and all of ontario

To achieve the forward-looking objec-tives of this Plan, there must be a firm understanding of “where we are” today. This understanding requires knowledge of the characteristics and health profile of the people and communities being served, as well as the range of health services provided.

The “data” of our first environmental scan came directly from our engagement of local residents. They told us their experi-ences – good and bad – in interacting with the health system. we heard about chal-lenges in delivering better and coordinated care. and we heard about opportunities that will make a difference. an extensive summary of those findings can be found at www.centraleastlhin.on.ca/researchan-dreports/researchandreports.html.

Throughout this Plan, examples of “what you told us” will be provided. In addition to this qualitative evidence, this Plan also provides information on “what we know” – that is quantitative evidence and related policy directions supporting a plan for action. This data provides comparisons between the Central East LHIN, other LHINs and the province as a whole. More importantly, the data reveals the signifi-cant differences and similarities between the communities of this LHIN.

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is exactly the same - 12.9%. Between the nine planning zones, the percentage of that population differs from a high of 23.4% in the Haliburton Highlands, to a low of 7.6% in durham west (ajax-Pickering-whitby). The stark differences between the current (2001) and estimated future (2016) age profiles across the Central East LHIN are dramati-cally illustrated through a comparison of the population pyramids from durham west and Haliburton Highlands (right).

a theme that runs throughout the envi-ronmental scan is ‘similar but different’. The Community Profile (Facts and Figures #3) on the following page emphasizes this theme in your LHIN. There are clearly many similarities as one compares the Central East LHIN column to ontario. But taken alone, LHIN-level averages can hide significant differences between our neighbourhoods. Planning your health care services effec-tively means understanding these differ-ences. The environmental scan provides the evidence we need to support our plan-ning and activities.

85 - 89

6% 4% 2% 0% 2% 4% 6%

0 - 45 - 9

10 - 1415 - 1920 - 2425 - 2930 - 3435 - 3940 - 4445 - 4950 - 5455 - 5960 - 6465 - 6970 - 7475 - 7980 - 84

90+

% OF TOTAL PLANNING ZONE POPULATION

% Male 2001

% Male 2016 % Female 2016

% Female 2001

Haliburton Highlands Planning ZonePOPULATION PYRAMID 2001 VS. 2016

85 - 89

6% 4% 2% 0% 2% 4% 6%

0 - 45 - 9

10 - 1415 - 1920 - 2425 - 2930 - 3435 - 3940 - 4445 - 4950 - 5455 - 5960 - 6465 - 6970 - 7475 - 7980 - 84

90+

% OF TOTAL PLANNING ZONE POPULATION

% Male 2001

% Male 2016 % Female 2016

% Female 2001

Durham West Planning Zone POPULATION PYRAMID 2001 VS. 2016


Community Profile


Central East LHIN Variance Service Province

Average

Central East LHINAverage High Low

% Population 65+

% Lone Parent Families

% non-owned private dwellings

% Unemployment Rate (15yrs +)

% with less than grade 9 education

% non-completed high-school

% completed post-secondary education

% low income

Low birth weight babies (2001-03)

Infant Mortality per 1000 live births (2001-03)

Durham West

Durham North-Central

Durham West

(3 zones)

Durham West

Durham West

Haliburton Highlands

Durham North-Centre

(6 zones)

Scarborough Agincourt Rouge

Complete information for all areas can be found in the IHSP Technical Report. Cultural components can also be found on p.56 of this Executive Summary


Scarborough Cliffs-Centre





Durham West



Kawartha Lakes

13% 13%

23% 24%

32% 27%

6% 7%

9% 8%

26% 26%

49% 46%

14% 15%

6% 6%

5.4 4.5

24%

32%

44%

8%

11%

36%

53%

25%

8 %

6.7%

8%

17%

15%

5%

4%

18%

39%

6%

5%

3.4%


Health Services Provided in the Central East region


Central East LHIN Health Services by TypeMinistry of Health and Long-Term Care Data 2005-2006

Service # of providers Total Budget % of CE

Spending

Mental Health Services

Acquired Brain Injury Agencies

Long Term Care Homes

Community Services

Hospitals

Community Programs

Supportive Housing Sites

Agencies for Drug and Alcohol and Problem Gambling

Speciality Psychiatric Hospital

Psychiatric Out-Patient Medical Services

Long-Term Care Homes

Long-Term Care Beds

Supportive Housing Programs

Community Support Services

Elderly Persons Centres

Community Care Access Centres

Community Health Centres

Hospital Corporations

22

7

3

1

2

2

65

9,000

18

49

9

4

3

9

$37,273,843

$1,345,912

$311,628,145

$32,412,238

$171,454,264

$6,857,976

$1,019,997,566

2%

< 1%

20%

2%

11%

< 1%

65%


a PLaN For CHaNGE

Priorities for Change

our mandate first and foremost is to integrate the many disjointed parts of the current health care mix. Initially we are focusing on a limited, but critical, number of areas.

Priorities for change can be described as topics and/or representative target popu-lations that provide the greatest oppor-tunity for improved health outcomes and overall health system performance and sustainability. The four identified priori-ties for change have been determined through consultation and input from you, the residents of the Central East LHIN, and from consumers, formal and informal health care providers, networks and advisory teams.

They are:

Mental Health and Addiction Services

Seamless Care for Seniors

Chronic Disease Prevention and Management

Wait Times & Critical Care

There are many inter-relationships among these priorities for change that must be explored to truly realize an improved,

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integrated system of care. For example, many seniors live for years with one or more chronic conditions. Mental health and addiction problems affect people living in the community as well as those in long-term care or hospitals.

To capture the synergies between these priorities for change, several enablers have been identified by the LHIN. Enablers are common strategic themes that will be used to achieve our priorities for change.

Enabling Change to Happen: System Enablers

Cutting across the priorities for change are common themes or tools that will allow for better access and integration of services, improved patient outcomes, better use of human and financial resources and enhanced sustainability. These tools or enablers will help you and your health care providers find the right care in the right place at the right time.

Priorities for change are focused on the needs of people who need services (e.g., seniors), whereas Enablers are strategies focusing on better delivering that service.

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action items related to these themes are found in the individual priorities for change in the IHSP technical report. our initial enablers are:

E-Health The ontario Health Quality Council reports that “better, more widespread and integrated use of technology will mean improved decisions about care, more effective diagnosis and treatment, fewer medical errors, greater safety, increased efficiency, better access to services, better research on health care and how to run the system and infor-mation to support continuous health system improvement.”

The LHIN is now working on the devel-opment of a common, fully electronic health record focused on patient needs and the use of technology to support people to access the right care at the right time.

If the patient/client is to be at the centre of the system, the patient/client has to be included in the information network, given the capacity to contribute to and use the electronic health record and to communicate with the care team.

Shared Non-Clinical ServicesThe LHIN will work with providers to achieve back office efficiencies with the aim of making better use of health care dollars, finding ways to integrate services and share resources and infor-mation, reducing waste and duplica-tion. Providers will be encouraged

to share current tools and best prac-tices. By gaining back office efficien-cies, more of our existing financial and human resources can be dedicated to direct provision of health promotion and prevention, care and recovery.

Moving People Through the SystemThe LHIN will work with providers to improve the availability of services and access to transportation to services to eliminate uncertainty and confusion about where to go to get the right service. Gaps in the service will be addressed.

There will be better information for people and their caregivers and no “wrong door” to an integrated health service. we will improve client naviga-tion through the system, case manage-ment and transportation. The LHIN will support interdisciplinary team approaches to care and provide more co-ordinated access. we also aim to better support the person and their caregiver during transition between levels or types of care.

Safe Environments of Quality CarePeople should not be harmed by an accident or mistakes when they receive care. The LHIN will work with providers on improving the quality and effec-tiveness of health care services. The aim is to provide a safe environment, including the home, for health care consumers, health professionals and informal caregivers.


Health and Human ResourcesIn conjunction with provincial initia-tives to improve the supply of health care professionals, the LHIN will bring together health providers to improve local capacity for recruitment, training and retention of health care profes-sionals including doctors and nurse practitioners. In addition, barriers that limit the flexibility of health profes-sionals to provide services in the most appropriate place will be dismantled.

Performance dimensions

with your input, future priorities for change will change as required. what is less likely to change are the vision and objec-tives for your public health care system. while this Plan advances the immediate strategic directions of both the Province and the Central East LHIN community, it also contributes to the creation of a high-performing health care system. The Ontario Health Quality Council (www.ohqc.ca) described the features of such a health care system as:

PerformanceDimension

Ontario Health Quality CouncilDescription

Safe

Effective

Person-centred

Accessible

Efficient

Equitable

Integrated

Appropriately Resourced

Focused on Population Health

People should not be harmed by the care that is intended to help them.

People should receive care that works and is based on the best available scientific information.

Healthcare providers should offer services in a way that is sensitive to an individual’s needs and preferences.

People should be able to get the right care at the right time in the right setting by the right healthcare provider.

The health system should continually look for ways to reduce waste, including waste of supplies, equipment, time and information.

People should get the same quality of care regardless of who they are and where they live.

All parts of the health system should be organized, connected and work with one another to provide high quality care.

The health system should have enough qualified providers, funding, information, equipment, supplies and facilities to look after people’s health needs.

The health system should work to prevent sickness and improve the health of the people of Ontario.


The LHINs, in partnership with community residents, health service providers, and other provincial and municipal agencies and programs, will be a leading force in achieving these broad system goals. The strategy map (Figure 2, above) illustrates the process from priority for change to

Priorities for ChangeOur initial focus for system change

Mental Health and Addictions


Chronic Disease Prevention & Management

Wait Times & Critical Care

System OutcomesHow we will evaluate our strategies

Accessible

Effective

Efficient

Safe

People Centred

Integrated


EnablersCommon ways in whichwe will achieve our goals

Moving People Through the System

e-Health

Safe Environments of Quality Care

Health Human Resources

Back Office Transformation

Equitable


Tools & Actions

Community Engagement & Partnerships

Enhanced Cultural Competency

New Resources to Improve Capacity

Funding and Accountability Agreements

FIGURE 2: STRATEGY MAP

enabler to outcomes. Throughout this Plan, we will demonstrate how actions stemming from our identified priorities for change and enablers are making a direct contribution to the performance dimensions of a high-performing health care system.


There is also a need for more community services for people with addictive behav-iours, from eating disorders to alcohol, drug and gambling addictions, she says. “There should be a transitional place, a safe environment where people can spend a couple of months getting interim care, learning job skills and how to cope in the community.

PrIorITY For CHaNGE

Mental Health and Addictions

Mental Illness in the LHINPrevalence Rate. Physician Access.

The prevalence rate for a serious mental illness is 2.5 – 3% of the population, or approximately 43,700 people in the Central East LHIN.

According to the Ontario Health Insurance Plan, (OHIP) billings for 2004, 18% of the population over the age of 15 accessed a physician for mental health concerns in the Central East LHIN.

That adds up to 216,872 people.


Cheryl McCarthy of Courtice has concluded that the health care system is “broken” after her experiences in attempting to get help for her daughter who has anorexia, an eating disorder.

When her daughter first became ill at the age of 12, “we could not find anywhere to go for help,” she says. “There is no connection between agencies, no flow of information, and that has to change.”

When her daughter first developed the illness, there was not much media interest in eating disorders but they are the third most diagnosed illnesses among children, she says.

While the Hospital for Sick Children has an excellent program for children with eating disorders, it took a crisis situation before her daughter was assessed and treated, she says. There are long waits to get into such programs.

Her daughter has been in inpatient hospital programs five or six times over the past 10 years but still had to go through a reassessment to get into an outpatient program, she says. “The whole system is choked down with paperwork and dupli-cation and it doesn’t work.”

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The Impact of Mental Illness and addictions

Mental health and a positive sense of emotional and social wellbeing are funda-mental to the health of individuals, fami-lies, communities and society as a whole. Mental Health and addictions needs to be addressed from a population health approach that takes into account all of the physiological, psychological and social factors that impact health and illness. Such basics as safe and affordable housing, an adequate income, employment, education and a supportive network of family and friends are essential factors in facilitating wellness and promoting recovery from mental illness or substance use. The reality is that people with mental illness or addic-tions often face discrimination, poverty, homelessness and social isolation. These life situations exacerbate the mental illness or substance dependency and often cause serious physical health problems. Mental health and addictions problems (including problem gambling) affect a significant portion of the population.

People of all ages, cultures, education, and income levels experience mental illnesses. according to the Canadian Psychiatric association, “at least 20% of Canadians will experience some degree of mental illness during their lifetime that is serious enough to impair their daily functioning, and the remaining 80% will be affected by an illness in family members, friends or colleagues.” The Canadian Community Health Survey found that nearly 12% of the people between the ages of 15 and 64 suffer from a mental disorder or substance dependence in any one year (CIHI, 2002).

as many as 20% of people age 65+ suffer mild to severe depression, ranging from 5-10% of seniors in the community to as many as 30-40% of those in institutions.1

People with mental illness spend more days in hospital than for the treatment of cancer or heart disease combined.2 Mental Illness accounts for one in seven hospital-izations and one third of all days in hospital (CIHI, 2003; 2005).

Mental health is as important as physical health. and mental health factors can increase the risk of developing physical problems such as diabetes, heart disease, serious weight loss or gain and reductions in immune system efficiency. For example:

People with bipolar disorders have obesity rates two times higher than the general population.

People with physical health problems often experience anxiety or depression that affects their recovery.

Clinical depression occurs in 30% of people who suffer a stroke.

Health Canada reports that more than 30% of users of illicit drugs other than cannabis report harm to their physical health.

30% of people with a mental illness will also have a substance use challenge in their lifetime (termed a concurrent disorder). 37% of people with an alcohol use disorder (up to 53% if it is a drug disorder) will also have a mental illness (Kirby, 2006).

1 National advisory Council on aging-dealing with depression at http://www.nada-ccnta.ca/expression/13-32 Joint Paper of CaMH, oFCMHaP, CMHa-ont, 2001.

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Most mental health and addictions prob-lems remain untreated because of the stigma associated with admitting to these problems. The consequences of not receiving help can be tragic. More than 4,000 Canadians commit suicide every year and more than 90 per cent of suicide victims have a diagnosable psychiatric illness or substance abuse disorder.


Central East LHIN Mental Health & Addictions Access to Primary Care, Ambulatory ER Visits, and Hospital Inpatient Visits (2004-2005)

Service

An

xiet

y D

iso

rder

, S

om

ato

form

, an

d

Dis

soci

ativ

e D

iso

rder

s

Su

bst

ance

-Rel

ated

D

iso

rder

s

Mo

od

dis

ord

ers

Per

son

ality

dis

ord

er

Oth

er C

on

diti

on

s

Primary Care Access forMH&A Services* 49% 12% 10% 8% 9% 2% 1% 9%

The percentage of primary care diagnoses in the Central East LHIN is consistent with the Ontario percentage of 8% for substance-related issues and with a slightly higher percentage of people with anxiety disorders (49% versus 43%).

Ambulatory Emergency Room Visits** 33% 3% 11% 21% 27% 2% 2% 1%

For hospital ambulatory care and Emergency Room visits, the data for Central East LHIN is very similar to the Ontario data, with anxiety disorders accounting for the highest percentage of the visits (33%),followed by mood disorders (27%) and substance-related issues (21%). Together, these three disorders account for 81% of the total visits.

Hospital Inpatient Visits*** 10% 7% 23% 14% 39% 3% 3% 1%

For in-patient hospitalizations, when comparing Central East LHIN data with the Ontario average, the data is almost identical, with mood disorders accounting for 39% of admissions, and schizophrenic and other psychotic disorders 23%.

*Data from one year medical tables, MOHLTC, Population Health Planning Database, excluding institutional patients, percent total visits by diagnostic codes 290 to 319

**Data from MOHLTC, Population Health Planning Database, NACRS Table percent total visits by DSM IV Chapter 5 Block Codes

***Data from MOHLTC, Population Health Planning Database, DAD Table, percentage total visits by DSM IV Chapter 5 Block Codes

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along with profound costs to quality of life, the economic costs of mental illness and addictions are estimated as amongst the most costly of all health problems.


what we Know

Mental health and addictions services have been engaged in a process of reform in ontario and across Canada for the past several years. Based on the Ministry of Health and Long-Term Care policy framework as well as the recommen-dations of the provincial Mental Health Implementation Task Force reports, there is a clearly articulated vision and opera-tional framework for a client-centred/client-driven mental health and addictions service delivery system in ontario and in the Central East LHIN.

Most recently, the Final report of The Standing Senate Committee on Social affairs, Science and Technology: Out of the Shadows at Last, Transforming Mental Health, Mental Illness and Addiction Services in Canada (Kirby report) was released in May 2006. after two and a half years of pubic hearings held across Canada, the Standing Senate Committee has made a total of 118 recommenda-tions, including key recommendations that affect the mental health and addic-tions “system” as a whole.

after countless hours of planning, the consumers, family members, health providers, community leaders and govern-ment policy-makers that were engaged in the Task Forces and Kirby reports have created a strong foundation to build upon in guiding the transformation of the mental health and addictions system.

recently, the MoHLTC has made signifi-cant investments in community-based mental health services, in particular for the seriously mentally ill population. Funding has been made available to expand crisis response services to operate 24/7, to provide crisis mobile outreach and crisis residential beds; to implement more aCT Teams and increase intensive case management services; to expand court support and diversion services; to imple-ment early intervention first episode psychosis services; to increase supportive housing; and to provide services to specialty populations (e.g. psychogeriatric, forensic, dual diagnosis, concurrent disor-ders, transitional age youth). Some recent investments in addictions services include community and day withdrawal manage-ment services.


what You Told Us

Mental health and addictions have long been “orphans” within the health care system. during our consultations, you told us people need mental health and addictions services that are fully inte-grated into the overall health care system that include health promotion and preven-tion of illness, acute care and community-based provision of proper services and supports. You also told us to improve navigation through the system with coor-dinated points of entry.

with the leadership of local health providers, a series of focus groups with members of various cultural and linguistic communities was held across Scarborough in June 2006. Participants spoke highly about hospitals and their family and wellness-centred programs, crisis teams, family physicians, commu-nity-based programs including case management and self-help, consumer and family programs and services offered in their same language and culture.

The groups, as well as the nine zone advi-sory teams made up of members of your community, reported on common issues across the LHIN and recommended that the health care system must address the stigma of mental health and addic-tions related illness and increase public awareness.

Mental illness and addictions prevention and early intervention, diagnosis and treatment are crucial. There is a lack of information on available resources and then, once these are found, there are long waiting lists for treatment services. Many people would have avoided hospitaliza-tion if they had known of, and received support services sooner.

They called for increased access to primary health care, the need for supported, affordable housing and employment opportunities and the lack of equitable access to culturally competent services by clients and families of ethnic cultural groups. Concerns expressed also included the high cost of public transportation, the stigma attached to mental health and addictions, lack of family support, and a lack of compassion or respect by some health professionals.


what we Have done

The Central East LHIN Integration Priority report (February 2005) called for the creation of a Mental Health and Addictions Network of service leaders to work with and inform the then-to-be-established Central East LHIN with respect to issues, needs and opportunities in mental health and addictions within the LHIN bound-aries. although the Central East LHIN didn’t formally open its doors until the fall of 2005, the Network held its first meeting in May 2005. Every organization that is directly funded by the MoHLTC (and even-tually the LHIN) and mandated to provide mental health or addictions services is considered a member of the Network. The membership currently represents 25 direct service community agencies, six hospitals and eight associate members.

The Network is able to provide advice using the perspectives of health care providers from their experience “in the field” and their ability to collaborate and consult at the front-line where the challenges to service provision and the opportunities for moving forward are most pronounced. The key purpose of the Network is to support the development and provision of high quality and leading edge mental health and

addiction services that are integrated with each other, with other sectors of the health care system and with their communities throughout the Central East LHIN by:

Providing a collaborative forum for information sharing, linking and innovation

working with and informing the Central East LHIN with respect to issues, needs and opportunities within the mental health and addictions systems

advising on strategies to facilitate system integration and growth

Linking with mental health and addictions networks in other LHIN areas

Preparing a mental health and addictions systems service development plan

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The Central East Mental Health and Addictions Network is advising the LHIN and working on integration, collaboration and partnerships.


what we will do

Here are some of the action steps for this priority for change. Further actions and details are available in the technical report.

PerformanceDimension

Sample Action Steps

Safe

Effective

Person-centred

Accessible

Efficient

Equitable

Integrated



Develop a health resources recruitment, retention and training strategy for the mental health and addictions field.

Promote knowledge exchange focused on excellent program standards and learnings from CQI initiatives.

Develop an interdisciplinary team approach to care across agencies and across sectors (e.g. mental health and seniors, addiction and chronic disease prevention and management.)

Determine what core services should exist in different areas of the LHIN including what elements of service must be locally based and what elements can be regionally based in order to improve access to a continuum of services and supports.

Maintain an up-to-date publicly accessible inventory of agencies, programs and services.

Community mental health and addictions agencies to find ways to share resources and coordinate services.

Develop consistent data collection methodology and outcome measures for success to inform planning processes and funding decisions.

Develop a regional strategy to enhance cultural competency in service provision.

Develop formal partnerships with newly created primary care Family Health Teams and Community Health Centres to ensure inclusion of mental health professionals and addiction specialists in their interdisciplinary teams.

Develop in partnership with other government agencies a youth early intervention strategy that includes prevention education, early intervention and mechanisms to help people move from children’s through the youth and into the adult mental health system if necessary.

Work with the Mental Health and Addictions Network, health providers, consumer groups and family groups to reduce the stigma of mental illness and addictions and the discrimination against those experiencing them.

Promote health and prevent illness by influencing the broader determinants of health such as employment, housing, income and social support.


PrIorITY For CHaNGE


People of her father’s generation grew up at a time when there were no supports and people were taught not to ask for help, she says. It is now important to educate people as they approach senior age on what help is available, she says. “If they will accept help, they can have a better quality of life.”

She is concerned that too many seniors who don’t have family support fall through the cracks because they don’t qualify for Access to Care. “I worry about seniors without family support. With children now moving far from home, more seniors find themselves alone as they age.”

“The whole system relies on the help of the caregiver.”

Helen Edwards Lakefield, caregiver for her mother

“It is kind of mind-boggling a bit. At times I get tired.”

Bev Skinner Ennismore, caregiver for her husband

Judy Nemis is part of the growing “sand-wich generation,” squeezed between providing care for her 95-year-old father so that he can stay in his home and helping her 22-year-old son to estab-lish himself in his own home while she continues working as a registered nurse.

“It helps to have a good sense of humour,” Nemis says when asked how she copes with juggling the demands of caregiver, parent, grandparent, wife and nurse. Caregiver burnout is a problem for those looking after an ageing family member, Nemis who lives in Durham Region admits. “We have our frustrating days and we would all love to have respite,” she says.

Support groups for caregivers are impor-tant, she says. “You learn that you are not alone, you can throw ideas around and there is the opportunity of introducing your senior to others for possible relationships.”

In her case, she says, it helps to have a supportive husband and supportive group of friends.

She visits her father at least once a day to help out around the house, go grocery shopping and run errands such as picking up prescriptions. He receives Meals on Wheels service three times a week and regular Community Care phone calls.

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