Designing a better mental health care system: Putting patient needs first

Mental health disorders are one of the most common health problems in Canada, affecting 1 in 5 Canadians, and they are the number one cause of workplace disability.

Canada’s mental health care system is fragmented and does not allow for service delivery to easily meet patient care needs. Patients are unable to access simple, clear entry points to mental health care or move through the system in a direct and beneficial manner. Long waiting lists are common, and capacity for specialty mental health services is limited. The current system is a chaotic, disconnected patchwork of services where specialists are often busy delivering lower-level care while primary care providers struggle managing patients in need of greater resources and are often required to work beyond their skill set.

Read this open access paper on the FACETS website.

Existing literature was searched for better ways to organize mental health services, looking at the best models for health care from other areas such as diabetes.

Our findings suggest that a main problem is that the current mental health care system is organized from a structural/institutional perspective. This means the design of services first considers the needs of an institution such as a hospital, followed by the needs of health care providers, while needs of patients or users of the services are considered last.

An original conceptual model was designed that starts with patient and user needs. We borrowed an idea from the world of architecture and applied the Bauhaus Design principle of “form follows function”. Our pyramid-shaped visual framework lays out what a simpler, more rational user-friendly mental health care system would look like. This includes an easier “air traffic control” style single point of entry to three levels of patient care and service needs. Higher patient needs at the top of the pyramid are matched with quicker, more intense and specialized services. We describe what is needed to support services at each level, including funding, physical space, technology, and social supports. Improving our mental health care system is an urgent priority.

Our model can help policy planners and decision-makers as we build a new mental health care system and re-organize existing resources. Our “form follows function” model provides a simple blueprint and organizing principle to improve the quality of mental health care and services.

Fig. 1. Bauhaus mental health system model (concept and figure created by Dr. Thomas Ungar prior to the drafting of this manuscript). This figure illustrates how the form of services within the mental health care system follows patient needs. Patient care pathways begin at intake/triage and flow through to three patient-centred tiers of care: (1) primary care (low needs), (2) acute ambulatory transitional care (moderate needs), and (3) acute hospital and complex care (high needs). Within each tier, various models of care are organized from low to high service intensity. All models of care require enablers to function optimally and must meet certain accountabilities, as further detailed within our paper. FHT, family health team; CHC, community health centres; GP, general practitioner; FP, family physician.

Read the full paper — Applying a Bauhaus design approach to conceptualize an integrated system of mental health care: Lessons from a large urban hospital by Thomas Ungar, Marlene Taube-Schiff and Vicky Stergiopoulos.