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Description
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Percentage of separations (discharges or deaths) for mental illness/addiction out of all general hospital separations by
–Jurisdiction (province/territory)
–Age group
–Sex
–Diagnosis category
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Calculation: Description
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Percentage of total separations in general hospitals involving mental illness/addiction = Total separations in general hospitals involving mental illness/addiction divided by total separations in general hospitals involving both mental illness/addiction and non–mental illness/addiction diagnoses, by grouping (such as age, sex, province/territory or diagnosis category) multiplied by 100
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Calculation: Geographic Assignment
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Place of service

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Calculation: Type of Measurement
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Percentage or proportion

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Calculation: Adjustment Applied
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None

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Calculation: Method of Adjustment
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Not applicable

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Denominator
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Description:
Inpatient separations from general hospitals involving mental illness/addiction and non–mental illness/addiction diagnoses
Inclusions:
1. Admission to a general hospital in Canada

2. Sex recorded as male or female for analyses with breakdown by sex

3. Valid age recorded for analyses with breakdown by age

Exclusions:
1. Newborns

2. Psychiatric hospital separations

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Numerator
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Description:
Inpatient separations from general hospitals involving mental illness/addiction as the primary diagnosis and/or diagnosis category (for data extracted from the Ontario Mental Health Reporting System [OMHRS])
Inclusions:
1. Admission to a general hospital in Canada

2. Sex recorded as male or female for analyses with breakdown by sex

3. Valid age recorded for analyses with breakdown by age

4. Mental illness/addiction as the primary diagnosis and/or diagnosis category (for data extracted from OMHRS)

The following codes were used for inpatient separations involving mental illness/addiction:

For 2011–2012 through 2013–2014

–DSM-IV-TR: 290–319, 607.84, 608.89, 625.0, 625.8 and 780.09
–ICD-9-CM: 290–319 and 648.40–648.44
–ICD-10-CA: F00–F99, G30, R41.0, R41.3 and O99.30As of

For 2014–2015 through 2015–2016

–DSM-IV-TR: 290–319, 607.84, 608.89, 625.0, 625.8 and 780.09
–ICD-9-CM: 290–319 and 648.40–648.44
–ICD-10-CA: F00–F99, G30 and O99.30

As of 2016–2017

–ICD-10-CA codes: F00–F99, G30 and O99.30
–DSM-IV-TR codes: 290–319, 607.84, 608.89, 625.0, 625.8 and 780.09

DSM-IV diagnostic category

a = Disorders of childhood/adolescence
b = Delirium, dementia and amnesic and other cognitive disorders
c = Mental disorders due to general medical condition
d = Substance-related disorders
e = Schizophrenia and other psychotic disorders
f = Mood disorders
g = Anxiety disorders
h = Somatoform disorders
i = Factitious disorders
j = Dissociative disorders
k = Sexual and gender identity disorders
l = Eating disorders
m = Sleep disorders
n = Impulse-control disorders not classified elsewhere
o = Adjustment disorders
p = Personality disorders

DSM-5 diagnostic category

a = Neurodevelopmental disorders
b = Schizophrenia spectrum and other psychotic disorders
c = Bipolar and related disorders
d = Depressive disorders
e = Anxiety disorders
f = Obsessive–compulsive and related disorders
g = Trauma- and stressor-related disorders
h = Dissociative disorders
i = Somatic symptoms and related disorders
j = Feeding and eating disorders
k = Elimination disorders
l = Sleep–wake disorders
m = Sexual dysfunctions
n = Gender dysphoria
o = Disruptive, impulse-control and conduct disorders
p = Substance-related and addictive disorders
q = Neurocognitive disorders
r = Personality disorders
s = Paraphilic disorders
t = Other mental disorders

For information on prior years, please contact the Mental Health and Addictions team at mentalhealth@cihi.ca.

Exclusions:
1. Newborns

2. Psychiatric hospital separations

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Data Sources
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DAD, HMDB, HMHDB, OMHRS

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Available Data Years
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Type of Year:
Fiscal
First Available Year:
2003
Last Available Year:
2015 2017

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Geographic Coverage
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All provinces/territories

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Reporting Level/Disaggregation
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National, Province/Territory

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Update Frequency
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Every year

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Indicator Results
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Web Tool:
Quick Stats
URL: https://apps.cihi.ca/mstrapp/asp/Main.aspx?Server=apmstrextprd_i&project=Quick%20Stats&uid=pce_pub_en&pwd=&evt=2048001&visualizationMode=0&documentID=D901470C442A5B26D6CC89B28B21C75F

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Updates
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2014–2015: Two ICD-10-CA diagnosis codes were removed from the extraction criteria for the Discharge Abstract Database–Hospital Morbidity Database (DAD-HMDB), 2016–2017: For records from the Ontario Mental Health Reporting System (OMHRS) — one of the data sources that populates the Hospital Mental Health Database (HMHDB) . This decreased the volume of separations— broad mental health category in the HMHDB was assigned based on the DSM-5 diagnosis category instead of the specific diagnosis code.

The assignment of diagnosis codes to diagnosis categories was modified. Several ICD-10-CA and DSM-IV-TR diagnosis codes were regrouped into HMHDB broad mental health categories. These changes decreased the volume of separations in the Anxiety Disorders broad mental health category and increased the volume of separations in the Other Disorders category.

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<div role="button" class="expandableTitle" aria-controls="qualityRegion">Quality Statement</div>
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Caveats and Limitations
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As this indicator excludes psychiatric hospitals, it should not be construed to represent all mental health and addiction hospital separations in Canada.

Certain cells were suppressed for confidentiality reasons in accordance with CIHI's privacy policy. Totals exclude suppressed values.

Many factors contribute to the observed variations in the analysis of indicators at the provincial/territorial and regional levels. These include, but are not limited to, geography, population health, provincial and regional health service resources, and health services administration. It is very important to consider these factors and the effect they may have on indicator results when conducting comparative analyses. The variation in results between provinces/territories or between health regions suggests systematic differences in

–Provincial/territorial or regional health policies, practices and resources
–Geography and urban/rural population distribution
–Environmental and socio-economic characteristics
–Types of patients served and acuity of illness
–The range of health services available beyond general and specialty psychiatric hospitals (such as community mental health services)
–Accessibility and awareness of alternative points of entry to the health system

The above list suggests a few of the factors that should be considered when making provincial/territorial and/or regional comparisons.

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Trending Issues
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2011–2012: Additional ICD-10-CA diagnosis codes were added to the extraction criteria for the DAD-HMDB, one of the data sources that populates the HMHDB. This increased the volume of separations.

2014–2015: Two ICD-10-CA diagnosis codes were removed from the extraction criteria for the DAD-HMDB, one of the data sources that populates the HMHDB. This decreased the volume of separations.

2016–2017: For records from the Ontario Mental Health Reporting System (OMHRS) — one of the data sources that populates the Hospital Mental Health Database (HMHDB) — broad mental health category in the HMHDB was assigned based on the DSM-5 diagnosis category instead of the specific diagnosis code.

The assignment of diagnosis codes to diagnosis categories was modified. Several ICD-10-CA and DSM-IV-TR diagnosis codes were regrouped into HMHDB broad mental health categories. These changes decreased the volume of separations in the Anxiety Disorders broad mental health category and increased the volume of separations in the Other Disorders category.

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Comments
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Separations by year are based on the date of discharge, not the date of admission. As such, records with invalid discharge dates are not included.

The HMHDB is an event-based rather than a person-based database; individuals may be represented multiple times in the data.

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