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A lack of province-wide standards, uncertainty over population needs and a shortage of community-based services has resulted in inconsistent access to mental-health and addiction services across B.C., according to a new report by the province's Auditor-General.

The report, released by Carol Bellringer on Tuesday, focuses on access to adult tertiary care, which is the highest level of such services for people who are highly vulnerable and have substantial, complex needs. It can include hospital stays and follow-up treatment in the community. Patients include those with severe mental disorders or substance-abuse problems, or both.

Such services used to be centralized at Riverview Hospital in Coquitlam, but the B.C. government shifted them in recent years to the province's six health authorities.

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While Ms. Bellringer noted "pockets of good practice" across the Ministry of Health and health authorities, she identified numerous deficiencies.

"The health system, as a whole, needs to do more to ensure that people with serious mental health or substance-use problems can access the services they need," she said.

The Ministry of Health, for example, has not clearly articulated a vision, goals or expectations for access to adult tertiary care, the report said. It is only now developing a "province-wide framework with standards, including a definition for adult tertiary care and expectations for managing access."

Health Minister Terry Lake conceded that while regional health authorities are best positioned to serve and design health care for their populations, there is a need for provincial standards.

"What we realized we need to do is set performance standards provincially, accepting that there may be different ways of approaching a problem in Prince George than there is in Surrey, but there still has to be accountability back to the province, based on a framework," Mr. Lake said in an interview.

An example of this would be provincial policies regarding a person's return to the community, he said.

As well, the ministry is developing a standard set of indicators to measure the success of services. This is likely to include some of the indicators suggested in Ms. Bellringer's report: number of referrals received for a specific program, number of admissions, average wait times and occupancy rate.

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Ms. Bellringer also noted that health authorities manage patient access and flow differently. Some flow patients through hospitals "as quickly as possible," while others keep them for extended periods because community support services are not available.

"When health authorities extend a patient's length of stay, it impacts the ability of other patients to be admitted to adult tertiary care," the report said. "But, flowing patients out can lead to pressure points in other parts of the mental health and substance-use system, or be too risky for the patient, if community services or appropriate housing are not available."

As well, Ms. Bellringer found little evaluation of patient outcomes across health authorities, which meant they were "largely unable to show that their adult tertiary care programs have been effective in achieving positive health outcomes."

The report contains 10 recommendations, which include a clarification of regional and provincial roles; improved information-sharing between the ministry and health authorities to facilitate long-term planning; and for health authorities to evaluate the effectiveness of their adult tertiary care programs periodically.

The Ministry of Health has brought several new services online since the auditing period concluded in March, 2015, Mr. Lake said. This includes four teams in the Fraser Health region that will treat people outside of hospital.

According to the Mental Health Commission of Canada, the economic burden of mental health and substance-abuse in Canada is estimated at $51-billion per year in health care costs, lost productivity and reductions in health-related quality of life.

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