OSOT 
  A Monthly Message from the OSOT Board of Directors                              March 2017
Laura Hayos, Director

Back to the basics: A reminder of the importance of addressing the 
co-existing   mental AND physical health care  needs  of our clients. 

I have been fortunate enough in my new role to gain exposure to the Medical Psychiatry Alliance  (MPA) whose primary goal is to transform the delivery of health care services for individuals living with co-occurring mental and physical health care issues( 1) . I say fortunate because in learning more about the MPA, it has brought to front of mind the importance of integrated health care. The MPA highlights a few facts( 1)  that have really stuck with me in recent weeks, in particular the 3rd one below:
  • "In Ontario, 1.3 million people suffer from co-morbid mental and physical health illness." 
  • "...it is estimated that Ontario spends $2.75 billion on individuals with combined illness." 
  • "The lives of people with serious mental illness are 20 years shorter than those without mental illness."
The Report from the Canadian Chronic Disease Surveillance System: Mental Illness in Canada 2015  ( 2 ) also highlights the prevalence of co-occurring mental and physical health care issues more broadly in Canada.

The notion of providing holistic, integrated health care is not new, and was certainly not new to me as an occupational therapist (OT). In fact it is often what I highlight to others as unique about our profession. We are trained to explore mental, physical, cognitive and spiritual aspects of a person in our assessment and treatment. Yet in practice, I think that this is not always the case. 

We are trained to explore mental, physical, cognitive and spiritual aspects of a person in our assessment and treatment. Yet in practice, I think that this is not always the case. 

I think we often lack an integrated approach to care in part because we work within a health care system which is largely designed to focus on either mental OR physical health issues rather than both simultaneously, as the MPA highlights (1). I saw an example of this in an OT job posting for working with clients with a spinal cord injury (SCI). Nowhere in the job posting did they indicate that the applicant should have skills to support the psychological adjustment associated with an SCI despite the research  that indicates the increased risk of co-occurring psychological issues among people with an SCI ( 3 ).  Furthermore, it can be challenging as a clinician to develop and maintain a skill set in assessing and treating both mental and physical health issues.

Fortunately, awareness of the need to address complex co-occurring mental and physical illnesses is becoming more prominent which is why I think it is timely as OTs to go back to the basics of our OT training (addressing mental, physical, cognitive and spiritual client needs) to find ways to change our current practice so that we employ a more integrated approach.

Consider the client who suffered a stroke who is now expressing thoughts of suicide. This shifts the priority of treatment focus. Or, the client with the brain injury, who had a pre-existing addiction, and as a result is not participating in treatment because they are struggling with being on an abstinence-based rehab unit. Or, consider the client with schizophrenia who has stopped taking their medication due to significant weight gain, which has resulted in their current inability to remain in the community independently.

These are all examples where the client requires support for both their mental and physical health to meet their current needs.

As previously mentioned, I recognize that for many (myself included) this can be a challenge because of the pressures of the system, your program's mandate and because of the challenges of gaining the knowledge and skills to address mental and physical health care issues simultaneously.

We cannot realistically become experts in assessing and treating all health conditions. However, we can become advocates for our clients so that their mental and/or physical health care needs aren't left unaddressed as is often the case (1). A first step to achieve this is to bring awareness to the existence of co-occurring mental and physical illnesses. A second step is to equip ourselves with basic assessment skills to at least be able to identify these issues. Then, we need to acquire knowledge about appropriate referrals that we can make for our clients acknowledging the limitations in our scope of practice in any given practice context.

Since time and money can be a barrier to accessing information as health care providers, below are few FREE resources and suggestions to get you started to enhance your current knowledge to begin to provide more integrated care:

Brush up on the basics with easily accessible web-based resources:
  1. CAMH's Mental Health and Addictions 101 Series 
     
  2. CAMH's Portico Network which contains educational videos and clinical toolkits among other resources. 
     
  3. Websites of Canadian advocacy organizations promote information on various diseases, injuries, disabilities, etc.  Check this CharityVillage listing of advocacy organizations.
     
  4. Ontario's Electronic Health Library accessible to all registered OTs is a great resource to find journals, articles, best practices for any condition.  Make sure you've created your FREE account!
     
  5. DynaMed Plus is a new resource that contains thousands of evidence based clinical topics.You can find information on virtually any condition.  Find overviews of diseases, conditions, treatment, etc. You can sign up for remote access so you can check resources anywhere or even download a mobile app!  Tied to your Electronic Health Library account this is another resource government has provided for registered OTs.
     
  6. Cognitive Assessment Tool Inventory 
     
  7. OSOT Sector Practice Resources - consider exploring resources outside of your current sector.
     
  8. OSOT's Archived webinars - many of which are complimentary to members (link: )
Leverage each other's knowledge. Start an educational partnership with another site whose focus is on a different but complimentary practice area.
 
The OTs at my mental health hospital have partnered with OTs from a physical rehabilitation hospital to provide quarterly webinars. This has been a great opportunity to share knowledge and resources, while developing relationships and partnerships with other OTs. So far the mental health OTs presented on " Substance Use, Harm Reduction and Cognitive Impairment." And the phys-med OTs presented on "Cognitive Assessments - Approaches and Considerations."

I hope this BoardTalk has provided you with an opportunity to reflect on your own practice and the importance of supporting an integrated health care system. With a solid foundation of skills in providing holistic care, I think we are well positioned as OTs to be leaders in improving the care of clients with co-occurring mental and physical heath care needs. 

Hope you do too!

Laura

References:
  1. The Medical Psychiatry Alliance. (2016). Retrieved from http://www.medpsychalliance.ca/Pages/default.aspx
     
  2. Government of Canada (2015). The Report from the Canadian Chronic Disease Surveillance System: Mental Illness in Canada 2015. Retrieved from https://www.canada.ca/en/public-health/services/publications/diseases-conditions/report-canadian-chronic-disease-surveillance-system-mental-illness-canada-2015.html#s4a 
     
  3. Craig, A. Tran, Y. & Middleton, J. (2009). Psychological morbidity and spinal cord injury: a systematic review. Spinal Cord, 47, 108-114. 
2016-2017 BOARD OF DIRECTORS
Beth Linkewich - President
Diane McLaughlin - Vice-President/Secretary  
Lesya Dyk - Treasurer 
Sylvia Davidson - President-Elect
Donna Dennis - Director
Catherine Donnelly - Director
Laura Hayos - Director
Teri Shackleton - Director
Lynn Stewart - Director 


Through this monthly newsletter, BoardTalk, your OSOT Board Directors will share their thoughts, insights and perspectives about issues affecting our members, our profession and our shared community, OSOT. We encourage you to share your responses, feedback and suggestions regarding the topics that we discuss in this newsletter. Always feel comfortable to contact us at osot@osot.on.ca.