Healthcare Management Forum

There is limited research on suicide risk in Canadian home care. Older adults have the highest rates of death by suicide worldwide. This article examines characteristics of rural and urban home care recipients with a hospital or emergency department visit for suicide attempts in Ontario, Canada. Factors that increase or decrease risk for emergent care are identified. This research builds on a growing need for health leadership to ensure that home care providers have appropriate training and resources to assess and respond to potential risk of suicide among frail elders.

Healthcare organizations are increasingly tasked with implementing change initiatives that improve the patient experience and target priorities such as Emergency Department (ED) volumes. This article describes the development, implementation, and outcomes of a collaborative protocol between the Niagara Health System and the Niagara Regional Police Service that resulted in a 57% reduction in police wait times in the ED. Six critical success factors contributed to the outcomes that were achieved and are detailed for those organizations interested in engaging in a similar change initiative.

This study examined the prevalence of Control Intervention (CI) use in adult in-patient psychiatric units/hospitals in Ontario and developed a profile of those patients who had CI use during their admission between April 2006 and March 2010. Control intervention types included mechanical/physical, chair prevents rising, acute control medications, and seclusion. The profiles of patients with control intervention use included an examination of sociodemographic, mental health service use, and mental health clinical characteristics.

This article examines the characteristics associated with Alternate Level of Care (ALC) status in mental health in-patient units across Ontario. Using assessment information from the Resident Assessment Instrument–Mental Health, the prevalence of ALC episodes, resource utilization associated with ALC, and demographic and diagnostic characteristics of ALC patients are examined. The effective management of ALC patients should be an important priority for all stakeholders involved in mental health services delivery in Canada.

This study demonstrates the use of the interRAI assessment instruments to examine mental health symptoms in children and adults within residential and in-patient care settings. Regardless of service setting, children exhibited more harm to self and others than adults. Children in adult in-patient beds were more likely to exhibit suicide and self-harm and less likely to exhibit harm to others compared to children in child-specific service settings. Implications related to service system improvements are discussed.

Gender can have separate and interacting effects on mental health. Gender-based analysis provides insight into these effects on mental health, and it can provide evidence to inform policy and practice to meet these gender-specific needs among persons in forensic mental health settings. Both individual and facility-level characteristics play a role in restriction to room as a form of control intervention in forensic mental health. Understanding the gender differences associated with the factors that increase a person’s risk of restriction to room can allow for more targeted interventions and provide insight into policies that will help reduce these types of control interventions.

Persons with mental illness often struggle to meaningfully participate in decisions about their services. This study engaged persons with mental illness to understand how health information could empower them. Participants reported wanting information on diagnoses, medications, symptoms, and strengths as well as clinician notes and rationale. The Resident Assessment Instrument for Mental Health contains this information and is mandated in in-patient psychiatry. Its findings could be summarized and shared with individuals to promote and facilitate shared decision-making.

There has been a limited amount of research suggesting that cultural and linguistic variables may affect access to health services, but no study has examined the access of French-speaking Canadians to psychiatrists. The present study used data from the Ontario Mental Health Reporting System to examine patterns of daily contact with psychiatrists in the first 3 days of admission to mental health facilities in Ontario. The results showed that after controlling for a broad range of covariates, French-speaking Ontarians were about one-third as likely to have daily contact with psychiatrists in that time period compared to English-speaking patients. These results were not explained by regional differences. Instead, they point to the possibility that language poses an important barrier to specific and highly specialized mental health services in this province.

This article discusses the scientific and ethical implications of random drug testing in the workplace. Random drug testing, particularly in safety-sensitive sectors, is a common practice, yet it has received little critical analysis. My conclusion is that there are important ethical challenges with these programs. Employers must ensure that every aspect of their policies are rooted in scientific evidence, linked rationally to the goal of workplace safety, and are ethically justifiable.

Le présent article traite des répercussions scientifiques et éthiques des tests aléatoires de dépistage des drogues en milieu de travail. Ces tests sont pratique courante, particulièrement dans les secteurs constituant un risque pour la sécurité, mais s’appuient sur peu d’analyses critiques. J’en conclus que ces programmes s’associent à des défis éthiques importants. Les employeurs doivent s’assurer que chaque aspect de leurs politiques repose sur des données scientifiques, est lié rationnellement à l’objectif de la sécurité en milieu de travail et est justifié sur le plan éthique.