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Tertiary Mental Health Services Definition

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There are some individuals with severe andpersistent mental illnesses who cannot be managed by primary and secondary services and who require tertiary care. Such clients are characterized by aggressiveness, noncompliance with medication, and dangerousness. Tertiary care program elements include psychosocial rehabilitation, sophisticated medication management, and behavioural approaches. Tertiary care may be delivered through assertive community treatment and/or specialized outreach teams, community residential programs, or hospitalbased services. Increasingly, organized systems have been developed to ensure that individuals meet criteriafor tertiary care andreceive the most appropriate level ofcare. Most importantly, the delivery oftertiary care must not be tied toparticularsettings or timeframes, andlevel ofcare must be delinkedfrom model or location ofcare in order to create flexible, efficient, effective mental health services.

The principal objective of efforts to reform mental health services is to improve care for individuals with severe and persistent mental illnesses (SPMI). Approaches involve increased resources for community supports and services and reduced reliance on hospital-based services, particularly services in provincial psychiatric hospitals. Organized systems ofcare characterized by accountability, a heavy reliance on case management, appropriate housing, and medication compliance are able to meet the needs of most people with SPMI, with occasional admission to a general hospital psychiatric unit to provide secondary care. However, there are subgroups who cannot be managed by primary and secondary services and require higher levels ofsupport. The goal oftertiary care services is to treat persons with problems that are complex and refractory to routine community and brief acute inpatient care. Tertiary care can be delivered by a range of specialized interventions designed to achieve change in severe, dysfunctional behaviours.


Tertiary care is defined as specialized interventions delivered by highly trained staff to individuals with problems that are complex and refractory to primary and secondary care. This type ofcare should require referral from secondary care. Criteria for access include the need for higher levels ofmanagement and security, staff expertise, and staff and program resources, as well as more detailed and specialized assessment and treatment. Given these criteria, there is no need to tie tertiary care to particular settings or time frames. In contrast to past reliance on inpatient settings for tertiary care, it is now possible to employ flexible strategies to maximize time in the least restrictive settings. For example, a portable tertiary care model such as assertive community treatment delinks location from level of care. Portable approaches help individuals maintain community tenure, expand the capacity ofthe secondary care system, and efficiently use tertiary care expertise. Portable tertiary care can be delivered to individuals not only in community settings but also in institutional settings such as nursing homes or general hospitals where it can assist staff to serve individuals who require complex care. Long-term care is not synonymous with tertiary care. Many long-term patients who reside in provincial psychiatric hospitals do not need tertiary care services. Provincial hospital patients who have complex but stable conditions can be supported in community settings with access to tertiary services. Level ofstaff expertise is a critical element of tertiary care. While many providers serve individuals with complex conditions, tertiary care providers have advanced training and a commitment to serve the population. Because of these requirements, tertiary care programs often are affiliated with academic health science centres.


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