CRITICAL THINKING PAPER

CRITICAL THINKING PAPER

CRITICAL THINKING PAPER

Introduction

The origin of continuity of mental health care in Canada? Ontario as a service delivery principle can be traced to the early 1960s. Since that time many theoretical and conceptual definitions have arisen in the literature. The first attempt to operationalize continuity of mental health care was reported in 1967. (Chien 2000) The mental health care context resulted in a definition focused on readmissions to and transfers between psychiatric facilities. Subsequent operational work has also reflected the service delivery context. During deinstitutionalization the concept shifted to include follow-through on community contacts after referral or discharge and aspects of community-based mental health care—client movement in response to need? stability of the client-caregiver relationship? communication among providers? and efforts to retrieve clients lost to treatment. This paper discusses contemporary care of mental health clients and how it differs from the early 1900's and What factors have contributed to the change in the Canadian health care system.

Discussion

In the late 1970s the rise of case management approaches such as assertive community treatment had enormous influence on ideas about continuity of mental health care. Such interventions were designed fundamentally to improve continuity of mental health care. As a result? the continuity-of-care concept of that period is almost indistinguishable from the interventions themselves? (Millar 2001) and evidence of the effectiveness of assertive community treatment continues to be taken? tautologically? as evidence of the effectiveness of continuity of mental health care rather than as a phenomenon that can be measured and tested independent of a particular program model. (Austin & Mary 2008)

Despite the growth of general hospital psychiatry and the service continuum in the 1980s? there was little further development of continuity-of-care measures. Operationalization was still considered to be difficult? although some indicators were tested and calls were made for research on the effects of continuity of mental health care. The theory of continuity of mental health care as a multidimensional concept was also advanced during that period by Bachrach and others? with a shift in emphasis toward team rather than individual provider-based mental health care as well as inclusion of the perspective of the patient on continuity of care.

The 1990s heralded major restructuring of mental health care systems in most developed countries through regionalization and integration of services. In this context? continuity of mental health care was seen as a potential measure of system-level reform. Thus the idea of ...