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Goal: This study aimed to examine provincial differences in patient spending for cancer care and reductions in household spending including decisions to forego care in Canada. Methods: Nine-hundred and one patients with cancer, from twenty cancer centers across Canada, completed a self-administered questionnaire (P-SAFE version 7.2.4) (344 breast, 183 colorectal, 158 lung, and 216 prostate) measuring direct and indirect costs and spending changes. Results: Provincial variations showed a high mean out-of-pocket cost (OOPC) of CAD 938 (Alberta) and a low of CAD 280 (Manitoba). Differences were influenced by age and income. Income loss was highest for Alberta (CAD 2399) and lowest for Manitoba (CAD 1126). Travel costs were highest for Alberta (CAD 294) and lowest for British Columbia (CAD 67). Parking costs were highest for Ontario (CAD 103) and lowest for Manitoba (CAD 53). A total of 41% of patients reported reducing spending, but this increased to 52% for families earning

Background and Aims: Poor substance use‐related health outcomes after release from prison are common. Identifying people at greatest risk of substance use and related harms post‐release would help to target support at those most in need. The Alcohol Smoking and Substance Involvement Screening Test (ASSIST) is a validated substance use screener, but its utility in predicting substance‐related hospitalisation post‐release is unestablished. We measured whether screening for moderate/high‐risk substance use on the ASSIST was associated with increased risk of substance‐related hospitalisation. Design: A prospective cohort study. Setting: Prisons in Queensland and Western Australia. Participants: Participants were incarcerated and within 6 weeks of expected release when recruited. A total of 2585 participants were followed up for a median of 873 days. Measurements: Baseline survey data were combined with linked unit record administrative hospital data. We used the ASSIST to assess participants for moderate/high‐risk cannabis, methamphetamine and heroin use in the 3 months prior to incarceration. We used International Classification of Diseases (ICD) codes to identify substance‐related hospitalisations during follow‐up. We compared rates of substance‐related hospitalisation between those classified as low/no‐risk and moderate/high‐risk on the ASSIST for each substance. We estimated adjusted hazard ratios (aHR) by ASSIST risk group for each substance using Weibull regression survival analysis allowing for multiple failures. Findings During follow‐up, 158 (6%) participants had cannabis‐related, 178 (7%) had opioid‐related and 266 (10%) had methamphetamine‐related hospitalisation. The hazard rates of substance‐related hospitalisation after prison were significantly higher among those who screened moderate/high‐risk compared with those screening low risk on the ASSIST for cannabis (aHR 2.38, 95% confidence interval [CI] 1.74, 3.24), methamphetamine (aHR 2.23, 95%CI 1.75, 2.84) and heroin (aHR 5.79, 95%CI 4.41, 7.60). Conclusions: Incarcerated people with an Alcohol Smoking and Substance Involvement Screening Test (ASSIST) screening of moderate/high‐risk substance use appear to have a significantly higher risk of post‐release substance‐related hospitalisation than those with low risk. Administering the ASSIST during incarceration may inform who has the greatest need for substance use treatment and harm reduction services in prison and after release from prison. [ABSTRACT FROM AUTHOR]

Objectives: Guided by minority stress theory, we explored the association between sexual identity, justice system involvement, self-harm and suicide attempts, among a cohort of incarcerated adults in Australia. Methods: A sample of 2698 adults incarcerated in Queensland and Western Australia were surveyed between 1 August 2008 and 12 August 2016 about their current psychological distress, mental health diagnoses, contact with mental health services, and lifetime and recent self-harm and suicide attempts. We used multivariable logistic regression to explore the relationship between sexual orientation, prior criminal justice system involvement, mental health and demographic factors. Results: Five percent of the sample identified as gay, lesbian or bisexual, with 37% of lesbian, gay, bisexual and other same-sex attracted individuals reporting that they had self-harmed (vs 14% of heterosexual peers; χ2 = 52.4; p < 0.001) and 49% reporting a history of at least one suicide attempt (vs 23%; χ2 = 49.2; p < 0.001). Lesbian, gay, bisexual and other same-sex attracted people were 2.1 times (95% confidence interval: [1.4, 3.3]) and 1.8 times (95% confidence interval: [1.2, 2.8]) more likely to report a history of self-harm and suicide attempt, respectively, than non–lesbian, gay, bisexual and other same-sex attracted respondents. Conclusion: Intersectionality theory suggests that people who are navigating two or more marginalised identities often experience a compounding of internal and external stressors. Consistent with that theory, lesbian, gay, bisexual and other same-sex attracted people who experience incarceration may be at particularly high risk of self-harm and suicidal behaviour. Custodial settings should both improve cultural competency for frontline staff working with lesbian, gay, bisexual and other same-sex attracted individuals and improve access to mental health services during incarceration. [ABSTRACT FROM AUTHOR]

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Objective: The aim of this study was to identify potential model of care approaches and systems processes for people presenting to acute healthcare settings with mental health problems, including mental illnesses. Methods: Five (consensus) nominal group technique sessions were conducted in 2019 with a purposive sample of stakeholders from health, police, ambulance and consumer agencies (n = 21). Sessions were recorded, transcribed and analysed for thematic content. Results: Potential model of care approaches and systems processes for people with mental health problems in the emergency department include: a skilled collaborative approach to care; consumer-focused service; knowledge improvement; early assessment; the development of models, systems and processes; and the built environment. In the broader acute care setting, the themes of formal care, linking of services, enhancing informal and innovative care options, improving information sharing and enhancing training and education were identified. Conclusions: Coherent and multifaceted approaches to the provision of care to people with mental health problems and diagnosed mental illnesses who are requiring emergency care include the linking and sharing of systems and information, changing the built environment and exploring new models of service delivery. What is known about the topic?: There is considerable evidence of interventions used in the emergency department and acute healthcare settings for this vulnerable group of people with mental health problems and diagnosed mental illnesses; however, the evidence for appropriate model of care approaches and systems processes is limited. What does this paper add?: For people with mental health problems in emergency departments and for people with diagnosed mental illnesses in acute care settings, targeted directions to further support treatment include the linking and sharing of systems and information, changing the built environment and exploring new models of service delivery. What are the implications for practitioners?: Planning changes to services for mental health clients with acute problems needs to incorporate clinicians, health service planners, architects and a range of emergency services personnel. [ABSTRACT FROM AUTHOR]