New standards to improve mental health care

(Montreal) Less than a week after the filing of the Coroner’s Office report in the public inquiry into the topic of suicide, two new Canadian standards have been unveiled in the areas of mental health and addiction as well as suicide prevention.

These rules developed by the Health Standards Organization (HSO) are adopted by Accreditation Canada. They must therefore de facto be deployed in all Quebec health and social services establishments since they are required to hold certification from Accreditation Canada.

In addition, in the case of the new suicide prevention standard, certain criteria will be used as “required organizational practices”, that is, elements analyzed during conformity assessments.

This standard outlines the key elements that should be included in a comprehensive suicide prevention program. It covers systematic screening for suicide risk, risk assessment, safety, care, and post-event treatment and intervention.

“It will require that the teams, in all the facilities in Quebec, be made aware of suicide prevention programs and use a validated tool to detect the risk, assess this risk and come up with a safety plan”, describes Executive Director of Clinical Partnerships at HSO, Dr.^D Louise Clement.

In the case of the standard dealing with mental health and addictions, the importance of dealing with these two issues as a whole and no longer separately is emphasized. This is precisely in line with one of the concerns raised by coroner M^e Julie-Kim Godin in her report entitled “FOR the protection of human LIFE”. She described in detail the extent of the phenomenon of concurrent disorders, that is to say the combination of mental health and substance use problems.

In turn, HSO specifically names the need for a “paradigm shift towards a more integrated and comprehensive approach to mental health and addictions services”.

It is explained that this shift must take place within the intervention teams in “response to the evolution of the landscape” where one “recognizes the complexity and the interconnectedness of these problems”. It adds that “research and clinical observations have clearly demonstrated that these health problems frequently occur together and share common underlying factors”.

Concretely, the D^D Clément explains that mental health care and services must be decompartmentalised. “It starts with mental health teams capable of detecting addictive disorders and vice versa,” she says, adding that workers must have a minimum of training in both areas.

Depending on the composition of the teams in each health establishment, this basic dual competency requirement could apply to doctors, psychologists, social workers or occupational therapists, lists the doctor who has the mandate to make the content of the standards accessible to clinical teams. , managers and users.

Another aspect addressed by coroner Godin and integrated into the new standards: the support of loved ones. According to the experts commissioned by HSO, the immediate entourage of the patients must be part of the team for the intervention to be a success.

In the enumeration of the patient’s rights, we include his prerogative to “participate in all aspects of [ses] care and to make personal choices”. This includes “the right to choose one or more caregivers” who can participate in his care in the way he wishes.

However, in the context of mental health and addictions intervention, it can be complex to obtain informed consent from the patient to the participation of a loved one, recognizes the D^D Clement. However, she maintains that the decision must come from the patient.

“It depends on the person receiving the care, if they have the competence and the ability to decide. It’s human rights, she says. Professionals have to accept that. »

It happens in certain cases that professionals take the decision to inform relatives without the patient’s consent, but these are exceptional cases if the information proves to be essential and the patient is unable to consent.

Long construction site

During a briefing by videoconference, the general manager of global programs at HSO, Kaye Phillips, explained that the development of these standards began in 2017.

A technical committee of 18 members was tasked with carrying out a review of the scientific literature with the aim of gathering best practices and identifying innovative approaches. Subsequently, working groups were formed to hear the concerns and recommendations of various groups, including experts, patients and representatives of various communities.

Kaye Phillips noted that special attention has been paid to adopting a “high quality empathetic care” approach that takes into account the principle of cultural safety.

For the co-chair of the technical committee, Rita Notarandrea, the unveiling of these new standards is only the first step towards better services to the population.

“It’s not an end in itself. These standards are tools, but they must be put in place. They must be adopted by institutions and healthcare professionals. These practices need to be deployed and promoted for them to become mainstream,” commented the former CEO of the Canadian Center on Substance Use and Addiction during the virtual presentation.

Both of these standards will officially come into effect during the Accreditation Canada assessment process in 2024.

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