A bill to support individuals in their homes and communities with assistive devices for mental health

We appreciate the following contribution from RNAO member Cheryl Forchuk RN PhD O.ONT. FCAHS; Distinguished University Professor; Beryl and Richard Ivey Research Chair in Aging, Mental Health, Rehabilitation and Recovery; Lawson Health Research Institute, Western University. The article explains the importance of a private member’s bill submitted to the Ontario legislature: Bill 277 - Ministry of Health and Long-Term Care Amendment Act: Supporting Individuals in their Homes and Communities with Assistive Devices for Mental Health, 2021. An RNAO action alert is coming on Monday.

If you go to the Ontario Assistive Device program website, the first thing you will see is an overview which states: “Through the Assistive Devices Program (ADP), we help people with long-term physical disabilities pay for customized equipment, like wheelchairs and hearing aids.” Further down you will find many other examples of assistive devices from diabetic equipment to breast prostheses. Indeed, the provincial websites states over 8,000 different pieces of equipment are covered. What you might not realize is missing, are any devices specifically to support someone with a mental disability.

The program has been around for almost three decades. So, it is not surprising that in the last century people did not realize that people with mental disabilities could also be supported with assistive devices. However, in this century the use of smart technologies to support mental health care has flourished. During the pandemic almost all out-patient mental health services have pivoted to virtual care using phones, tablets, and other electronic devices.

Virtual care is the simplest example of mental health support requiring a device. A few years ago, I began work with several researchers from Lawson Health Research Institute (the research arm of the London hospitals) to envision how we could enhance mental health care with newer technologies. One of our early projects used a web-based app for community clients to have various individualized prompts and reminders related to their care, secure communication with their mental health care provider and the ability to set up personalized self-assessment tools among other functions. We had 400 people involved. The results were striking with the decrease in mental health crises. This meant fewer hospitalizations, fewer psychiatric emergency visits, and even fewer arrests. With the emphasis on self monitoring and early intervention, these results were achieved with one third fewer out-patient visits. It was cheaper to provide a phone, data plan and the app to connect the client and care provider, than to provide usual care.

But there was a problem with maintaining these positive results after the study. Although participants kept the phones, they could not afford the data plans. People with mental health diagnoses come from all socioeconomic circumstances. However, once diagnosed there is often a “drift” into poverty such that they are twice as likely as those without a disability to be living in poverty. How then will mental health care be accessed if one does not have a screen device or data plan?  

When we completed this study and tried to figure out how the data plans could be maintained, we were surprised to learn that provincial support for assistive devices excluded people with mental illnesses. My local RNAO chapter, in collaboration with RNAO’s Mental Health Nurses Interest Group put forward a resolution in 2016 to lobby for an amendment to the legislation to ensure that people with mental illnesses could also access devices to support their community living. The resolution passed and initially some fruitful discussions were held. However, the momentum was lost with a change in government.

Since that time, we have had similar research success with different populations of people with mental illnesses and different technologies. For example, we have worked with at risk/street involved youth, to seniors with depression (who used tablet devices). In a recently completed study we looked at people requiring a higher dose of technology due to multiple health concerns, including serious mental illness that impacted functions such as memory and organization. We used the concept of smart homes to pull together several supportive devices. The specific devices were individualized according to the person’s needs. These included a choice of screen devices (phone, tablet or screen on wall) to send and receive messages, prompts and reminders; activity trackers to monitor steps, sleep, heart rate; Bluetooth enabled weigh scales; and an automatic medication dispenser that flashed when a medication was due. All devices were linked securely behind the hospital firewall so that information was available to both the client and their mental health care provider. People were able to reduce their admissions to hospital by avoiding crisis and reduced the number of required outpatient visits. Some people prior to the technology had up to four home visits a day simply to dispense medication. Importantly, participants were able to stay at home and manage their health more autonomously.  During our end of study event for the smart home project, held virtually, a local MPP joined – Terrance Kernaghan. He was surprised, like many before him, to learn that assistive devices were not covered for mental health support. He has since submitted a private member’s bill to address this important issue: Bill 277 - Ministry of Health and Long-Term Care Amendment Act (Supporting Individuals in their Homes and Communities with Assistive Devices for Mental Health, 2021).

The pandemic has reaffirmed that there can be no health without mental health. It was understandable that a program developed in the 20th century would not envision that assistive devices can help people with both mental and physical disabilities. In the 21st century we know new technologies are available to support mental as well as physical health. We need legislation that does not discriminate based on type of disability.