By Dr. Paul Kurdyak, Director, Health Outcomes for the Medical Psychiatry Alliance (MPA); Medical Director, Performance Improvement at the Centre for Addiction and Mental Health (CAMH).
What does health research mean to you?
Health research is a very broad topic, but to me, it means research aimed at finding ways to improve the health and well-being of individuals suffering from medical conditions, including mental illnesses and addictions. The burden of mental illness is high. Patients who are dealing with a physical health issue on top of their mental illness experience greater impact on their ability to function and on their quality of life. In Ontario, we spend billions of dollars on individuals living with combined mental and physical illness, but are not seeing great quality of care or outcomes. This is the worst case scenario – spending a lot of money to achieve poor health outcomes.
We know what needs to be done based on existing evidence, but we fall short on delivering evidence-based care. For example, we know that getting adequate and timely care for young Ontarians being diagnosed for the first time with schizophrenia is critical to achieve good outcomes. Our research shows that many of these young Ontarians are not receiving adequate physician follow-up. Patients with schizophrenia have double the amount of health care costs compared to those who don’t have this condition – and the costs are related to their physical health care in addition to their mental health. Despite these high health care costs, these patients have a shorter life expectancy – by up to 20 years — compared to individuals who don’t have a severe mental illness. This is unacceptable.
The Medical Psychiatry Alliance (MPA) was established in January 2014 with a six-year mandate, to kick start a transformation in Ontario that will help increase access to quality, integrated mental and physical health care. The MPA is the first of its kind in Canada with this urgent mandate. It is a unique collaboration between The Centre for Addiction and Mental Health, The Hospital for Sick Children, Trillium Health Partners and the University of Toronto. Currently, the MPA is systematically generating evidence for the best models of integrated care in which to treat Ontarians, which we hope will reduce the burden of cost for patients and for the health system overall.
How does health research contribute to a healthier, wealthier, smarter Ontario?
The best health care policy is based on sound evidence. The MPA is leading the analysis of the impact of integrated care on patient outcomes, with an emphasis on rigorous research methods to determine system-level impact using data from the Institute for Clinical Evaluative Sciences. I am the Director of Health Outcomes for this arm of research under the MPA’s mandate.
Recently, our research discovered that treating psychotic illnesses cost the province of Ontario just under $2.1 billion in 2012, which was about four per cent of the total provincial health budget. We already knew costs for treating psychotic illnesses were high, but what our research now shows is how early patients start incurring long-term care and medical care costs. Patients with psychotic illnesses as young as 46 are in long-term care facilities and are generating high medical care costs, which is about 20 years earlier than the general population. The needs of patients with chronic psychotic illnesses change over time, and those needs become more complex as people age.
The MPA’s new models of clinical care, currently rolling out as pilot initiatives at CAMH, SickKids and Trillium Health Partners, hope to better serve the needs of these patients. These new models of care are backed by innovative new education programs spearheaded by U of T, to train learners and healthcare providers and equip them with the training and tools they need to better care for patients with complex needs.
If we are successful in increasing access to integrated health services for those with severe mental illness, we will be helping Ontarians live longer and healthier lives, with improved quality of life. Moreover, we have demonstrated that we are not getting very good outcomes despite very high costs. We hope to show that providing integrated, high quality health care for individuals with mental illnesses and addictions will improve health outcomes, quality of life, and reduce costs.