Healthier, wealthier patients treated more frequently, with longer
TORONTO, July 15, 2014 /CNW/ - Major differences in how Ontario
psychiatrists deliver care may explain why some patients have
difficulty in accessing treatment , according to a new study released
today by the Institute for Clinical Evaluative Sciences (ICES) and the Centre for Addiction and Mental Health (CAMH).
There is a long-standing assumption, based on widespread difficulties
with access, that there is a shortage of psychiatrists, which motivated
the researchers to examine the supply and practice patterns of
psychiatrists across Ontario.
"One would assume that in regions with more psychiatrists, patients
would have better access to care, as well as more timely care after
being hospitalized," said Dr. Paul Kurdyak, lead author and Director,
Health Systems Research at CAMH and Lead of the Mental Health and
Addictions Research Program at ICES.
"Instead, we found that in such regions, the opposite was true. A
substantial number of these psychiatrists saw fewer outpatients, while
their colleagues in low-supply, non-urban areas had more patients and
more new patients."
The study which was published today in Open Medicine is the first to investigate the consequences of differing psychiatrist
supply and its influence on practice patterns in Canada.
"These results provide an opportunity to improve the mental health care
system to meet the growing demand for mental health care overall, as
well as the urgent needs of those with the most severe cases of
illness," says Dr. Kurdyak.
Psychiatrist supply ranges from a high of 63 per 100,000 people in
Toronto to seven per 100,000 people in non-urban parts of the province.
But more psychiatrists does not equal more access to psychiatric
In fact, the researchers found that the likelihood of a patient being
seen following a psychiatric hospitalization (the researchers' measure
of need) is only a little higher in the high supply regions than the
lower supply regions.
In Toronto, which has the highest number of psychiatrists per capita, 10
per cent of full-time psychiatrists see fewer than 40 patients a year.
These patients were seen more frequently and for longer visits,
suggesting that these patients were seen for long-term psychotherapy.
"The fee schedule in Ontario does not have limits on frequency or
duration of visits, and does not say anything about the complexity of
patients to be seen, so it may play a role in what we observed," added
The study analyzed practice patterns of full-time psychiatrists and
post-discharge care to hospitalized psychiatric patients, according to
psychiatrist regional supply in 2009 and found:
In regions with higher supply, psychiatrists saw fewer inpatients and
outpatients, they enrolled fewer new outpatients per year, but they saw
their patients much more frequently and for longer visits.
Patients who were seen more frequently were wealthier and less likely to
have had a prior psychiatric hospitalization.
A substantial proportion of full-time Toronto, Champlain, and Southwest
LHIN psychiatrists had practices consisting of less than 100
outpatients per year (Toronto: 40 per cent; Champlain: 28 per cent;
Southwest: 24 per cent compared to 10 per cent in non-urban regions of
The likelihood of being seen following a psychiatric hospitalization is
only slightly higher in the high supply regions than the lower supply
"This research clearly shows that increasing the number of psychiatrists
in Ontario is not the solution," says Dr. Benoit Mulsant, co-author and
Physician-in-Chief at CAMH. "Instead, our study raises questions about
psychiatrists' scope of practice, their practice patterns, and the
reimbursement system, as well as how these issues can be addressed to
improve the mental health care system for all patients."
One solution adopted in the U.K., Australia and the U.S. has been to
shift the psychiatrists' role to serving as a consultant on a
multidisciplinary team, while other mental health professionals such as
psychologists provide evidence-based psychotherapy, at a lower cost to
the system, the researchers note.
The study "Universal coverage without universal access: a study of
psychiatrist supply and practice patterns in Ontario," was published
today in Open Medicine.
Authors: Paul Kurdyak, Thérèse A. Stukel, David Goldbloom, Alexander
Kopp, Brandon Zagorski and Benoit H. Mulsant.
ICES is an independent, non-profit organization that uses
population-based health information to produce knowledge on a broad
range of health care issues. Our unbiased evidence provides measures of
health system performance, a clearer understanding of the shifting
health care needs of Ontarians, and a stimulus for discussion of
practical solutions to optimize scarce resources. ICES knowledge is
highly regarded in Canada and abroad, and is widely used by government,
hospitals, planners, and practitioners to make decisions about care
delivery and to develop policy. For the latest ICES news, follow us on
The Centre for Addiction and Mental Health (CAMH) is Canada's largest
mental health and addiction teaching hospital, as well as one of the
world's leading research centres in its field. CAMH combines clinical
care, research, education, policy development and health promotion to
help transform the lives of people affected by mental health and
addiction issues. CAMH is fully affiliated with
the University of Toronto, and is a Pan American Health
Organization/World Health Organization Collaborating Centre. For
more information, please visit www.camh.ca
SOURCE: Centre for Addiction and Mental Health
For further information:
Media Advisor, ICES
(o) 416-480-4780 or (c) 647-406-5996
Centre for Addiction and Mental Health (CAMH)
416 535-8501 ext. 36015