Substance Use and Mental Health: Applications of the interrai Mental Health Suite

Transcription

1 Substance Use and Mental Health: Applications of the interrai Mental Health Suite Christopher Perlman, PhD Assistant Professor, University of Waterloo Waterloo, Ontario, Canada Fellow, interrai April 20, 2017

2 Agenda Substance Use Assessment using interrai Patterns of Substance Use Among Inpatient Psychiatry Clinical characteristics Concurrent conditions Informing public health policy: Trends in Cannabis Use New directions for interrai screening and assessment

3 Substance Use Treatment System in Ontario Public-Pay Services Hospital-based and physician services Community-based MH services Community-based addictions services Ontario Drug Treatment Centres (opiod & some nicotine, cocaine, alcohol, marijuana) Some residential services Private-Pay (fee for service/charity) Services Some residential treatment programs Some private counselling and community based services

4 Integrated Substance Use Content Specific Addiction-Related Content: CAGE Screener Patterns of Substance Use, Alcohol, Problem Gambling, Withdrawal Intentional misuse of medications Substance-use diagnoses Substance Use CAP Indirectly-Related Content Social relationships and conflict Employment/Education Criminal involvement Trauma Mental status

5 Substance Use Clinical Assessment Protocol 1. Triggered due to Current Problematic Substance Use This includes persons who have any of the following: used illicit drugs (e.g., inhalants, hallucinogens, cocaine and crack, stimulants, opiates, cannabis) in the last 90 days or used injection drugs in the last 30 days or consumed 5 or more alcoholic beverages in a single sitting in the last 14 days. 2. Triggered due to Prior History of Problematic Substance Use history of substance use, no use in the last 90 days but have the potential to relapse: a history of illicit drug use (but no use in the last 90 days) a history of injection drug use (but no use in the last 30 days) intentional misuse of medication(s) in the last 90 days any one of four behavioural indicators of potential substance-related addiction, based on the interrai-mh addictions screen (CAGE) a social environment that facilitates or encourages drug or alcohol use (which is an additional trigger in the community mental health instrument).

6 Substance Use in Inpatient Psychiatry Proportion of Inpatients Triggering the Substance Use CAP in Ontario, Canada Current Use History of Use Substances Used in 30-days prior to Admission: Inhalants 1% Hallucinogens 3% Stimulants 5% Cocaine/Crack 13% N= 69,295 Opiates 11% Cannabis 39%

7 Substance Use in Inpatient Psychiatry Proportion of Inpatients Triggering the Substance Use CAP in Ontario, Canada Current Use History of Use 3% 28% N= 69,295 33% to 53%

8 DSM-IV Diagnoses among Inpatients with Substance Use Needs Schizophrenia = 19% Mood = 32% Anxiety = 3% Substance Use Disorder Primary = 32% Secondary = 21% Dementia = 2% Other (impulse, adjustment, eating, personality) = 10%

9 Needs among inpatients triggering the Substance Use CAP

10 Pain and Opiate Use 35 Physical Pain among Patients who have Used Opiates or Abused Medication Pain Scale (higher = more frequent and severe) Opiate Use Recent Opiate Use Abuse of Medication

11 Care Planning with the Person

12 Concurrent Substance Use What are the characteristics of inpatients with different types of concurrent substance use and mental health disorders? N = 23, 991 (across 70 hospitals), 2011 Schizophrenia and SUD = 4.7% Mood and SUD = 8.9% Other Concurrent = 2.47%

13 Patterns of Concurrent Diagnosis by Age Schizophrenia and SUD Mood Disorders and SUD Other Concurrent Any DD No None DD

14 Substance Use within 30 days of Admission Among Concurrent Diagnostic Classifications SZ/SUD Mood/SUD Other None None Other Mood/SUD SZ/SUD

15 Mental Health Service Utilization Patients, % Category Non- Concurrent Other MI/ SUD Mood / SUD Schizophrenia / SUD) Number of Psychiatric Admissions (Recent) None to or more Amount of time hospitalized None in last 2yrs days or less days to 1 year More than 1 year Contact with Community Health No contact in the last year days or more days or less

16 Evaluating Policy: Trends in Cannabis Use

17 Cannabis Use Among Adults in Inpatient Psychiatry, Ontario, Canada: 2006 to 2015 Inpatient admissions in Ontario, Canada N = 147,550 Recent Cannabis Use = reported use within 30 days prior to admission 18.3% (25% had any cannabis use in prior year)

18 Percent Recent Cannabis Use 25 Trends in Cannabis Use Within 30-days of Admission to Inpatinet Psychiatry( ) Year

19 Percent Recent Cannabis Trends in Cannabis Use Among All Age Groups ( ) Age=65+ Age=55-64 Age=45-54 Age=35-44 Age=25-34 Age =18-24 Age = < Year

20 Percent Recent Cannabis Trends in Cannabis Use Among All Age Groups ( ) Age=65+ Age=55-64 Age=45-54 Age=35-44 Age=25-34 Age =18-24 Age = < Year

21 Percent Recent Cannabis Trends in Cannabis Use Among All Age Groups ( ) Age=65+ Age=55-64 Age=45-54 Age=35-44 Age=25-34 Age =18-24 Age = < Year

22 Percent Recent Cannabis Use Trends in Cannabis Use among Patients by Selected Primary Diagnoses and Concurrent Substance Use Substance-Related Disorders (Q1d) Mood Disorders (Q1f) Concurrent Schizophrenia (Q1e) Anxiety Disorders (Q1g) 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Year

23 Percent Recent Cannabis Use Trends in Cannabis Use among Patients by Selected Primary Diagnoses and Concurrent Substance Use Substance-Related Disorders (Q1d) Mood Disorders (Q1f) Concurrent Schizophrenia (Q1e) Anxiety Disorders (Q1g) 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Year

24 Percent Using Concurrent Substance What other drugs are used by those using cannabis? % of Cannabis Users had no concurrent substance use Concurrent Substance

25 Implications of interrai for Cannabis Policy Prescribed vs. Recreation Use? Mechanism for evaluating trends and impact of policy Do age limits and restrictions on potency impact admissions to inpatient psychiatry? Increase in first-episode psychosis? Opportunity to monitor longitudinal trends for youth into adulthood interrai Children & Youth Mental Health interrai MH/CMH

26 Improving assessment and screening: The interrai Addictions Supplement Canada: Chris Perlman: interrai & University of Waterloo Nancy Curtin-Telegdi: interrai & University of Waterloo John Hirdes: interrai & University of Waterloo Shannon Stewart: interrai & Western University Carol Anne Wight: Director, Western Health, Newfoundlan Nawaf Madi: Canadian Institute for Health Information Jennifer Berger: Canadian Institute for Health Information Chile Bert Kempfe: Psychologist, Santiago, Chile South Africa Duncan Laurenson: Physician, Cape Town, SA

27 interrai Content vs. Other Addictions Screens RAI-MH/CMH vs. Addictions Severity Index (396 items) RAI-CMH items directly or indirectly about 46% of ASI items E.g., 22 CMH questions related to the 106 ASI questions on Alcohol and Drugs ASI missing bout 50% of CMH item content RAI-MH/CMH vs. GAIN 41% of Full GAIN items not on RAI-MH 59% of RAI-MH/CMH items not on the Full GAIN

28 Addictions Supplement v pages (18 items) History of addictions issues/services Expanded oral and physical health status Video gaming and internet use Expanded sections on patterns and risk associated with use Readiness, need, and support for change Additional page on subjective usability ratings (for Pilot Study) Subjective rating of severity Content ratings for clinical utility Suggestions for missing content Time to complete

29 Current Pilot Canada Integrated into 1 of 14 health regions in Ontario for use in all hospital and community-based mental health services Hospital-based services in Manitoba Community-based services in Western Newfoundland Chile Integrated into use with interrai Community Mental Health Assessment U.S. Integrated into interrai Community Mental Health Assessment for New York State

30 Applications Full range of clinical, psychosocial, and health services information to support: Advanced care planning Levels of care decision support Outcome monitoring Quality indicators

31 Holistic assessment of the person, not just the addiction!

32 Dank je wel - Merci - Thank you Christopher Perlman Chris.Perlman@uwaterloo.ca