relationship of policy aims and implementation

Description

Background: Ontario’s Ministry of Health and Long Term Care (MOHLTC) claims people with mental illnesses/addictions need improved care/overuse emergency departments. MOHLTC expects Coordinated Care Planning (CCP, teams of mental/physical health professionals, social workers and informal caregivers) to improve care and lower emergency department returns/healthcare costs. CCPs are directed by policies, Smith’s “problematics,” or Deleuze’s “expressions,” supposedly reflecting “contents”/“everyday worlds.”
Research Question: How do Ontario health/allied professionals come together with a person with mental illness/addictions and informal caregiver(s) to address health needs through a CCP?
Method: 1) Analyzed CCP policies; generated questions about creation/implementation. 2) Interviewed eight professionals about interpreting/enacting policies. 3) Connected interview data to policies.
Findings: Opportunities for fragmentation exist in gaining consent; determining eligibility; persons in care, informal caregivers and professionals’ participation; person-centeredness; “shame-free” environments; health literacy; records of medications.
Conclusion: CCP participants need to minimize fragmentations which takes time, space, money; creates contradictions in lowering costs/improving care.
Author Keywords: Addiction, Dual Diagnosis, Health Care Policy, Institutional Ethnography, Integrated Health Care, Mental Illness