Mental ��ϱ� and Substance Use Disorder Discharges

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Neurocognitive disorders are conditions that are caused by decreased functioning of the brain due to disease, trauma or injury. Included in this category, for example, are various forms of dementia. This category may be included or excluded by selecting Yes or No from the Include Neurocognitive Disorders drop-down list.

Both crude and age-standardized rates are calculated as rate per 100,000 population. Please refer to the Methodology tab for details.

Certain metric values were suppressed or modified for confidentiality reasons in accordance with CIHI’s privacy policy. These values are identified with the text “Suppressed” in the data tables and hover-over tool tip.

In data tables, the dash (—) indicates that the metric was not calculated because the discharge volume was too low or was 0.

Results from 2020–2021 onward should be interpreted in the context of the COVID-19 pandemic.

To learn more, refer to Impact of COVID-19 on Canada’s health care systems.

Sources

Discharge Abstract Database, Hospital Morbidity Database, Hospital Mental ��ϱ� Survey and Ontario Mental ��ϱ� Reporting System, Canadian Institute for ��ϱ� Information.

Statistics Canada, Centre for Demography. Population estimates, July 1 (based on 2021 census), by age group and gender for Canada, provinces, territories, health regions and peer groups.

Data

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Notes

Both crude and age-standardized rates are calculated as rate per 100,000 population. Please refer to the Methodology tab for details.

In data tables, the dash (—) indicates that the metric was not calculated because the discharge volume was too low or was 0.

Results from 2020–2021 onward should be interpreted in the context of the COVID-19 pandemic. To learn more, refer to Impact of COVID-19 on Canada’s health care systems.

Sources

Discharge Abstract Database, Hospital Morbidity Database, Hospital Mental ��ϱ� Survey and Ontario Mental ��ϱ� Reporting System, Canadian Institute for ��ϱ� Information.

Statistics Canada, Centre for Demography. Population estimates, July 1 (based on 2021 census), by age group and gender for Canada, provinces, territories, health regions and peer groups.

Methodology

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Identifying Information

Name

Mental ��ϱ� and Substance Use Disorder Discharges

Short/Other Names

Not applicable

Description

Number, percentage, and crude and age-standardized rate of discharges for mental health and substance use disorder hospitalizations, by Canada and province/territory, with the following available breakdowns:

Age group (not provided for age-standardized rates)
Recorded sex or gender
Hospital type
Diagnosis category and selected subcategory

Note that some breakdown combinations are available only at the national level.

Background, Interpretation and Benchmarks

Rationale

Having a solid picture of the proportions of discharges and the trends over time provides health system planners and other decision-makers with information to plan care and evaluate the performance of their health care system.

Interpretation

This group of measures provides information about hospital utilization and may reflect differences in the health of the population and mental health service delivery models as well as variations in the availability and accessibility of specialized, residential and/or ambulatory and community-based health services.

See related Days Stayed indicator

HSP Framework Dimension

��ϱ� system inputs and characteristics: ��ϱ� system resources

Areas of Need

Not applicable

Targets/Benchmarks

Not applicable

Availability of Results

Available Data Years

2019 to 2023 (fiscal years)

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National
Province/Territory

Result Updates

Update Frequency

Every year

Latest Results Update Date

March 2025

Updates

Categorization of episodes of care to broad mental health category is based on the DSM-5/DSM-5-TR diagnosis category (not the specific diagnosis code).

From 2016–2017 to 2021–2022, the Ontario Mental ��ϱ� Reporting System (OMHRS) used the DSM-5 diagnostic classification system.
In March 2022, the American Psychiatric Association (APA) released the DSM-5-TR. Subsequently, from April 2022 to September 2022, OMHRS used both DSM-5 and DSM-5-TR diagnostic classification systems. As of October 2022, OMHRS uses the DSM-5-TR diagnostic classification system only.

Indicator Calculation

Description

Counts = Total discharges involving mental health and substance use disorders

Percentages = (Count of discharges for breakdown value ÷ Count of discharges across all breakdown values) × 100

Crude rate = (Number of discharges for mental health and substance use disorders ÷ Population estimate) × 100,000

Age-standardized rate = Number of discharges based on the crude rates for each age group and the application of population weights for each age group

Unit of analysis: Mental health and substance use disorder discharges

Discharges by year are based on the date of discharge, not the date of admission. Each discharge represents an episode of care. The data is event-based rather than person-based; individuals may be represented multiple times in the data.

Denominator

Description:

Counts and percentages: Discharges in Canada involving mental health and substance use disorders as the primary diagnosis and/or diagnosis category

Crude rates: Total mid-year population

Inclusions:

Crude rates: Total mid-year population

Only cases with a primary diagnosis of mental health or substance use disorder on discharge are included in the analyses.

Discharges were assigned to diagnosis groups based on the primary diagnosis or the diagnosis that contributed most to the patient’s length of stay during that hospitalization period.

Recorded sex or gender is male or female

Valid age recorded

Valid discharge date recorded

Exclusions:

Records pertaining to newborns, stillbirths and cadaveric donors

The inclusion criteria result in the exclusion of <1% of discharges annually, as the following records are excluded:

Records from OMHRS and from specialty psychiatric facilities that submit to the Discharge Abstract Database (DAD) that are classified as non–mental health disorders and that are not otherwise classified
Records with age = missing from all contributing data sources
Records with recorded sex or gender = other or missing from all contributing data sources

Numerator

Description:

Discharges in Canada involving mental health and substance use disorders as the primary diagnosis and/or diagnosis category

Inclusions:

Discharge from hospitalization in Canada with a primary diagnosis of mental health or substance use disorder

Discharges were assigned to diagnosis groups based on the primary diagnosis or the diagnosis that contributed most to the patient’s length of stay during that hospitalization period.

Recorded sex or gender is male or female

Valid age recorded

Valid admission and discharge date recorded

For information on grouping diagnosis codes and categories to broad mental health and substance use categories, please refer to the ��ϱ�Mental ��ϱ� and Substance Use Diagnosis Code Groupings for Selected Indicators (XLSX)

Exclusions:

Records pertaining to newborns, stillbirths and cadaveric donors

The inclusion criteria result in the exclusion of <1% of discharges annually, as the following records are excluded:

Records from OMHRS and from specialty psychiatric facilities that submit to the DAD that are classified as non–mental health disorders and that are not otherwise classified
Records with age = missing from all contributing data sources
Records with recorded sex or gender = other or missing from all contributing data sources

Method of Adjustment

Age-standardized rates: Direct standardization (standard population = Canada 2011)

Adjustment Applied

Age-standardized rates: Age-adjusted

Geographic Assignment

Place of residence

Data Sources

DAD
HMDB
OMHRS

HMHS
Statistics Canada, Centre for Demography. Population estimates, July 1 (based on 2021 census), by age group and gender for Canada, provinces, territories, health regions and peer groups.

Quality Statement

Caveats and Limitations

Substance-related disorders presented in these measures are mental and behavioural disorders. Users are cautioned to not compare the results with those of other indicators (e.g., Hospital Stays for Harm Caused by Substance Use), which may include a broader or narrower set of conditions, including poisonings.

Certain cells were suppressed or modified for confidentiality reasons in accordance with CIHI’s privacy policy.

Neurocognitive disorders are conditions that are caused by decreased functioning of the brain due to disease, trauma or injury. Included in this category, for example, are various forms of dementia. This category may be included or excluded by selecting yes or no, respectively, from the Include neurocognitive disorders drop-down, where available.

Where selected subcategories are made available, users are advised that the totals displayed represent the overall total at a higher level for context (e.g., rate for Canada for all mental health and substance use disorder categories combined rather than rate for Canada for selected subcategories combined).

Many factors contribute to the observed variations in the analysis of indicators at the provincial/territorial level. These include geography, population health, provincial and regional health service resources, and health services administration, among others. It is 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 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 comparisons.

Comments

The basic unit of observation is the discharge abstract or the record of an inpatient’s stay in a psychiatric or general hospital. The discharge abstract is completed at discharge, which includes, for example, cases where the individual was transferred to another hospital or care setting (e.g., long-term care), left against medical advice or died. Records are grouped into fiscal years based on the individual’s date of discharge from the hospital. If an individual was hospitalized more than once in the same fiscal year, a separate record for each stay was submitted. Hence the basic units of observation are events, not unique patients. If an individual was admitted prior to the beginning of a fiscal year, the days stayed prior to the year of discharge are included in the total days stayed for that event.

In Canada, there is no standard definition of a psychiatric hospital. For the purposes of these measures, psychiatric hospitals are medical hospitals that provide psychiatric services on an inpatient and/or outpatient basis and that have been identified by the provinces or CIHI. Also for the purposes of these measures, a general hospital is a publicly funded hospital that provides primarily for the diagnosis and treatment of hospitalized individuals with a wide range of diseases or injuries. The services of a general hospital are not restricted to a specific age group or a specific recorded sex or gender.

References

Not applicable