The interRAI Mental Health system, or MH, was developed in Canada by the Ontario Joint Policy and Planning Committee (JPPC), a partnership of the Ontario Hospital Association and Ontario Ministry of Health, in collaboration with interRAI. The MH is designed to support care planning, outcome measurement, quality improvement and case mix based funding applications.

Target Population

All adults aged 18 and over in in-patient psychiatric settings, including acute, chronic, forensic and geriatric psychiatry.

Adoption and Use

The MH has been in use in Ontario, Canada since 1999, initially as a research instrument, but increasingly as part of normal clinical practice. In 2005 the Ontario Ministry of Health and Long-Term Care (MOHLTC) mandated the use of the MH as the basis of the Ontario Mental Health Reporting System (OMHRS), for all patients in Ontario hospitals with designated adult in-patient mental health beds. The MH instrument has also been implemented in Galicia, Spain since 2000. In Finland the interRAI MH is being implemented in eight hospital districts for in-patient care since 2007.

• Identification Information
• Intake and Initial History
• Mental State Indicators
• Substance Use or Excessive Behaviour
• Harm to Self and Others
• Behaviour
• Cognition
• Functional Status
• Communication and Vision
• Health Condition
• Stress and Trauma
• Medications
• Service Utilization and Treatments
• Control of Procedures and Observation
• Nutrional Status
• Social Relations
• Employment, Education, and Finances
• Resources for Discharge
• Diagnostic Information
• Discharge
• Assessment Information

Utility

The MH system includes 30 Mental Health Assessment Protocols (MHAPs) for care-planning, 25 draft Quality Indicators for Mental Health (QIMH's) and outcome measures related to depression, aggression, psychotic symptoms, negative symptoms, cognition, disability, addictions and extra-pyramidal symptoms. A case mix study of about 2,000 psychiatric patients in 34 hospitals in Ontario, Manitoba and Alberta was done with the MH between September 2000 and May 2001.

The assessment information was linked to data from a staff time measurement study in order to derive the new System for Classification of In-Patient Psychiatry (SCIPP). Careful attention was paid to exclude service/provider variables and items that may have problems with gaming or poor psychometric properties. The SCIPP case mix algorithm has 47 groups and explains about 27% of per diem resource use in in-patient psychiatry.

Research and Development Team

John Hirdes, University of Waterloo (Canada)
Nancy Curtin-Telegdi, Providence Centre & JPPC (Canada)
Edgardo Perez, Homewood Health Centre (Canada)
Peter Prendergast, Whitby Mental Health Centre (Canada)
Naoki Ikegami, Keio University (Japan)
Brant Fries, University of Michigan (USA)
John Morris, Hebrew Rehabilitation Centre for the Aged (USA)
Charles Phillips, Myers Research Institute (USA)
Terry Rabinowitz, Fletcher Allen Health Care (USA)
Keita Yamauchi, Keio University (Japan) 

Baseline Research Publications

Hirdes JP, Marhaba M, Smith, TF et al. (2001) Development of the Resident Assessment Instrument - Mental Health (RAI-MH), Hospital Quarterly, 4(2), 44-51

Hirdes JP, Smith TF, Rabinowitz T, et al. (2002) The Resident Assessment Instrument - Mental Health (RAI-MH): Inter-Rater Reliability and Convergent Validity, Journal of Behavioral Health Services and Research 29(4): 419-432

Languages Available

• English
• Finnish
• German
• Spanish

For further information please contact:

John P. Hirdes, Ph.D.
Professor, Department of Health Studies and Gerontology, University of Waterloo, & Scientific Director, Homewood Research Institute, Ontario, Canada
Email: hirdes@uwaterloo.ca