Do Mental Health Patients Fall Through the Cracks?

The Canadian Mental Health Association says 20% of Canadians will experience a mental health illness at least once in their lifetime.  Eight percent of Canadians will have major depression.  When necessary, we hope that patients with depression and other psychiatric illnesses receive good care while they’re hospitalized. However, according to a new study, once they’re discharged from hospital, it’s a different story.

Researchers at the Centre for Addiction and Mental Health looked at more than 13,000 Ontario patients who were admitted to hospital for treatment of depression and then discharged from hospital when they no longer needed to be admitted.  Within 30 days of discharge, one in four patients hospitalized for depression had either visited an ER or was readmitted to hospital for depression.

The study found that men, older patients, and those who live in rural communities (where there’s a chronic lack of mental health services) were more likely to need readmission to hospital or treatment in the ER.

More important, it turns out that the overwhelming majority of the patients who required further treatment in the ER or hospital readmission were those who did not receive appropriate follow up care from a mental health professional or family doctor.

You might be amazed just how many patients with depression do not get follow up care.  Of the 13,000 patients studied by researchers at the Centre for Addiction and Mental Health, nearly 5,000 did not receive appropriate follow up care with a family doctor, psychiatrist or community worker.

For context, the researchers also looked at patients from Ontario who had been hospitalized for a heart attack or heart failure.  The study found that 99% – in other words, virtually every patient with heart attack or heart failure – had a follow-up visit to a doctor within 30 days of leaving the hospital. That compares to just 62% of the patients admitted with depression.  That tells me there’s a yawning gap in the care received by mental health patients.

It’s a gap I see in the ER.  Just about every shift, I see patients recently discharged from hospital for depression who need to be readmitted.  As well, I see lots of patients with other mental health diseases who also tend to fall through the cracks.  In particular, patients with borderline personality disorder tend to go through phases when they’re in and out of hospital.  I would also put people who have both depression and alcohol and drug abuse in that category too.  Patients who are both homeless and have mental health issues are also at high risk of needed to be readmitted.  So too are patients with schizophrenia and other forms of psychosis.

The mental health patients I see from the vantage point of a big city teaching hospital have a fair number of outpatient community resources that can provide some level of after care.  Patients with mental health problems who are discharged from rural hospitals have it much worse.

Hospital readmission is not simply the price of doing business.  It’s a benchmark of failure that is expensive for a health care system trying to save its pennies.  It’s also quite deleterious to the health and wellbeing of patients.

The take home message is that hospitals, family doctors and others who provide community health services need to communicate better with one another so that community services can step in the moment a patient is discharged.  Electronic health records would help with that.

More than that, a generation ago, when ‘deinstitutionalization’ of psychiatric services was in vogue, mental health treatment was supposed to move from hospitals to the community.  Beds were closed.  Community mental health services were supposed to be built up, but in many cases, they weren’t.  Some have suggested that deinstitutionalization has been a failure.  And now, we’re paying the price.

I say it’s time for governments to pony up with increased services and better coordination of available resources – especially in rural and other underserviced areas.  Meanwhile, mental health patients need to be watched carefully in the hours and days following discharge because that’s when they’re at high risk of relapse and suicide attempts.

And, while we’re at it, how about putting a bit of accountability into psychiatric hospitals that discharge patients without adequate follow up?  It would be easy to track and penalize hospitals with high readmission rates.  In the ER, I have to see and take care of patients within a prescribed period of time or we get penalized.  The people who work in psychiatric hospitals should be accountable too.

Original article can be found at


3 thoughts on “Do Mental Health Patients Fall Through the Cracks?

  1. Yes, I am a good example of someone who suffered from major depression and undiagnosed, untreated Post Traumatic Stress Disorder for 29 years before I FINALLY was sent to the Homewood Health Centre at age 44. My depression and Post Traumatic Stress disorder resulted from genetics and my home environment which was upper middle class but both of my parents were not in the best of health..mother with Type 1 Diabetes, father with a rare neurological disorder.
    I had been seeking help since I was 15 years old more times than I can count. I was repeatedly told that I was “fine”, even though I openly reported being suicidal every time I asked for help. I become disabled from employment at age 30, again sought professional help and was told again that it was “all in my mind” and that there was no help available for me. Finally I snapped at age 41, due to being sexually, psychologically, and emotionally abused by a counsellor I saw for “help with early childhood abuse” I attempted suicide. I was sent from the hospital to a physically and emotionally unsafe shelter, with NO MEDICATIONS and no resources. Out of desperation I returned to the abusive counsellor. I was then cleaned out financially by this counsellor, and too broke to even go bankrupt, ended up in the hands of a doctor who wisely sent me to the Homewood Health Centre…where I received treatment for PTSD. Sadly, I was informed by my treatment team that I was responsible for putting my life back together! This was a very hard pill to swallow…I had already been abused, exploited, robbed, reduced to having no family or friends left, to living below the poverty line, and barely able to take care of myself due to chronic illness resulting from years of neglect by the mental health and general health care system.
    Here I am 10 years later..54 years old. I am sad to say that my kind of experience is VERY COMMON among people I have met who have needed mental health services.
    This was ALL very needless. I was once a young very motivated and strong person who was prepared to give my life fully to society, to have a family of my own…etc. This is forever gone.
    I now try to make the most of the bits that are left – i.e the people I have met who have had similar struggles. I also am blessed to have some basic intelligence which has allowed me to learn intellectually how to deal with my situation. I do not like to be pitied, abandoned or made to feel “less than” due to my circumstances in life…But this is what a large part of society does..or worse, I am “invisible”. People generally do not like to know what the truth of our mental health services and realities are.
    If more people opened up their minds to realize that people with some kind of mental illness/condition are first and foremost individual people with many talents and abilities, and intelligence…through real contact without prejudice…maybe their could be real improvements made to our mental health system. Guelph-Welllington is the only place I have ever encountered some competent mental health services. Even here, there are people employed in the mental health system who abuse their power, or neglect those who are supposed to be under their care.
    I wish this all was not true..but sadly it is.

    What has saved me from suicide and the death of my spirit has been a combination of the Homewood Health Centre’s programs, my current psychiatrist, peers in recovery and my ongoing commitment to make the most out of what I have received in this community.

  2. After spending most of my summer at the Homewood Health Centre, I arrived home on September 2 to my apartment, determined to feel better and cope with all life has to throw at me. However, it has been difficult, and I still struggle with day to day activities, such as getting up the incentive to brush my teeth and shower. Therefore I must agree with your article, many of us with mental health disorders do “fall through the cracks” and end up feeling as though we ought to go back for further treatment.
    After a stay in a mental health institution, friends and family have a tendancy to treat a person as though they are stupid or incapable of normal living. My own family assume that I am just looking for attention and/or lazy. But there is nothing I would like more than to have a decent job and earn my own way. My disability has meant giving up my jobs, and spending each day wondering if I will ever get back to work!

  3. Thank you for your very touching comments. You have both inspired us to open a forum for people to discuss and support others living with mental health issues and their family, friends and supportive allies. You may find the forum here – and continue on with this discussion there and also find a variety of other topics. Thank you. Be well and take excellent care.

    Spark of Brilliance

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