Research Pillar: Health Services

Job tenure of people with severe mental illness registered in supported employment programs

Although many people with severe mental health problems are ready and available to integrate into the competitive workplace, more than 80 per cent of this group are unemployed. For those who obtain employment, job tenure is typically brief, lasting an average of 3 to 7 months. Supported Employment (SE) programs have been developed to help people with mental problems obtain and maintain employment. Though these SE initiatives fare better than other vocational programs, they still encounter difficulties regarding implementation issues and individual differences in job tenure. Dr. Marc Corbière is evaluating the programmatic and individual components of SE initiatives in the Greater Vancouver area. He is interviewing SE program directors and employment specialists, and asking participants (300-400 people) to fill out questionnaires and tests. From these results, Dr. Corbière will create and evaluate a novel and integrated model of job tenure for people with mental illness, including the ‘best’ program services and individual components. Results of his research will bring a new understanding to the vocational rehabilitation field by determining the key factors for maintaining employment for people with severe mental illness.

Understanding community capacity in mental health reform through an examination of the gendered dimensions of the Riverview redevelopment process in British Columbia

Recent mental health reforms in British Columbia have resulted in a shift in the way services are delivered to people with serious and chronic mental health problems. Specifically, the main source of care for people has shifted from the provincial psychiatric hospital (Riverview Hospital) to smaller care facilities located in various regions throughout the province. Dr. Marina Morrow is studying the impact of these service changes on various groups affected by deinstitutionalization by examining the experiences and needs of recipients of mental health services, family members of people with mental illness, mental health care providers, administrators, advocates, and community members. Dr. Morrow is particularly focussing on issues relating to gender, and how the needs of women and men leaving Riverview Hospital might differ. Dr. Morrow is also examining the capacity of the current mental health system to respond to individuals, that have been newly discharged from Riverview, to ensure their successful integration into communities, and how the system can provide community-based support to individuals who become ill in the future. Dr. Morrow hopes the results from her research will contribute to improving the mental health care system’s response to people with serious and chronic mental health problems so that they can live full and productive lives in their communities.

Gender and ethnic differences in treatment seeking for acute coronary syndromes

Important advances in the diagnosis and treatment of heart attacks have resulted in a growing majority of people recovering and resuming healthy, active lives following a heart attack. In spite of these medical advances, however, little progress has been made in reducing the time it takes for individuals to seek medical assistance after they first experience symptoms of a heart attack. Many people still arrive at a hospital too late to receive the full benefit of clot-busting therapy and other drugs. Patient-related delays result in a significant number of poor health outcomes and deaths. To achieve better clinical outcomes following a heart attack, people must be able to recognize heart attack symptoms and be willing to seek treatment immediately. Dr. Pamela Ratner is examining the many factors that shape people’s understanding of their risk of heart attack, the symptoms that occur, and the course of action that should be taken. She is focusing specifically on gender and ethnicity, together with other socio-demographic, clinical, psychological, and social factors. Dr. Ratner’s research aims to clarify the roles that gender and ethnicity play in modifying these factors, and to develop a theory of treatment seeking for cardiac symptoms. Results from her research will contribute to designing effective interventions that improve responses and decrease patient-related delays.

Access to care at the end of life: encounters between home care nurses and family caregivers

An important social change of the last quarter century has been a shift in the setting for health care delivery away from institutions — the move from facility-based care to home-based care. In particular, access to palliative home care services has become a major health policy issue in Canada. With an aging population, a growing number of Canadians diagnosed with terminal illness, and almost 90 per cent of Canadians reporting a preference to spend their final days at home, current government policy is pressing for more and better care of the terminally ill in the community. While several conditions are needed to effectively support palliative care at home, two of the most important are the availability of family caregivers (FCGs) and access to services by home care nurses (HCNs). Dr. Kelli Stajduhar is studying the decision-making factors that HCNs take into account when providing specific levels and types of palliative home care nursing services and exploring how the relationships between HCNs and FCGs shape access to care for dying patients. She is interviewing FCGs providing palliative care at home, HCNs and expert clinicians and administrators. Dr. Stajduhar is also observing relationships between HCNs and FCGs to better understand how these interactions affect access to care. Ultimately, results from this research will inform the development of health services, policies and HCNs’ decision making in order to improve access to care for families in palliative care.