Mental Health: No easy answers, but there are still answers

Nancy Casselman, TEGH’s Director of Human Resources and Organizational Quality, Safety and Wellness.

There are no easy answers, but that doesn’t mean there aren’t answers.

We’ve been meeting in downtown Toronto to try and tackle the issues behind the injuries front line professional and support staff are sustaining by simply going to work to help others recover from or cope with a mental illness.

We know that individuals with a mental illness are no more likely to physically and verbally strike out than anyone else.

The evidence is clear — this is not even a debate.

Queen’s University professor Dr. Heather Stuart pointed out that only three per cent of violent crimes are committed by individuals with a serious mental illness. There’s another seven per cent committed by those with addictions.

Yet in popular culture that perception is much greater. Stuart points out that in the world of popular fiction that rate is closer to 20 per cent. When one in five violent crimes are committed on TV by fictional mentally ill people, what does that tell us? How does that shape our view?

Academics, clinicians, and other experts – including our own members – have been spending the past day trying to solve the riddle poised by the very real injuries these front line workers are sustaining. On paper this is not supposed to happen – at least not to this extent.

Nor is it exclusive to this one corner of health care.

Speaking about violence and mental health in the same sentence is likely to raise the spectre of stigma, yet stigma itself is likely a big part of why mental health receives so little attention and funding which in turn fosters these kinds of system breakdowns.

There is, after all, a direct proven correlation between the level of staffing and likelihood of patient’s striking out. Under the circumstances many of us would be provoked into a fight or flight response.

Clearly the system is not working as it should.

Several managers from The Toronto East General Hospital showed up in the morning to talk about the incredible work they are doing to reduce workplace violence.

There are positive models out there – theirs is but one. They would gladly take the calls of any hospital that would like to learn from them. The entire room wanted Nancy Casselman’s business card. Casselman is the hospital’s Director, Human Resources and Organizational Quality, Safety and Wellness.

They are making progress in part because they have serious buy-in from the top. At one point the CEO actually sat on the joint occupational health and safety committee. How many other CEOs see health and safety as that kind of priority? Maybe they should given the high price of WSIB premiums from injured workers. How many joint occupational health and safety committees even have participation from managers who have significant clout within the hospital or agency structure?

Instead of discouraging workers from reporting incidents, TEGH encourages it. If you can’t measure it, you can’t expect decision-makers to sit up and take notice. That’s a lesson for everyone.

Workers could see the results of their reporting in the policies that were jointly developed at TEGH, including a unique flagging system for patients who pose serious risk to themselves and others. Results prompt more diligent reporting because workers knew it wouldn’t just get lost in the void.

Workload also is a factor. If an incident derails a worker’s day, they might think twice about taking the time to fill out the forms and report it to their supervisor.

TEGH says the results are there – they have only had one related lost time injury in three years. Imagine that?

We also heard from front line staff in other psychiatric hospitals and mental health agencies who talked about the blame game that goes on when an incident is reported. How the heck do health providers expect to work towards change when the first words from a manager are, “what did you do to provoke this?”

That’s a sure fire way to ensure accurate reporting never takes place.

Every hospital likes to talk about best practices, but in this field there are too few that are supported by evidence. The reality is stigma also keeps funding away from researchers who could be building evidence towards such best practices.

We heard that least restraint, when implemented whole, can actually make a difference in reducing workplace violence. The bad news is that when implemented piecemeal, it tends to have the opposite effect.

That doesn’t mean that no patient should ever be placed under physical, chemical or environmental restraint (seclusion). We heard how considerable confusion exists between the policy of least restraint and no restraint. Much of it depends on the individual – the best decision remains the one that is patient-centered.

That’s why there is such complexity in addressing this issue. Those with mental illness hate being described by their illness. They are right to resent such labelling. Why do we think one size fits all when it comes to mental health care?

We also heard about training and competencies. How many hospitals even have a list of competencies for front line staff? This is skilled work and its time those who do it well earn some respect and assistance.

The work of our mental health agencies and institutions also deserves respect.

It is real work that gets real results when done competently. It’s hard to convince government to increase funding if the perception is there is no value in it.

Mental illness is not something you can physically see. Dr. Stuart spoke of her experience in a run-down hospital where bugs were crawling out of the ceiling. Management’s first reaction was to make a joke of it, asking if the bugs were real or in the heads of the patients. When they caught the bugs and sent a container of them to the CEO, she was no longer laughing.

What do those run-down surroundings even say about how we view mental health care?

The Chief Physician for the Ministry of Labour spoke early in the proceedings and then stuck around to hear what everyone else had to say. We appreciate that.

The Minister of Labour was originally supposed to open our meeting, but then an election happened.

They have a clear role to play and need to show some courage in applying laws meant to protect workers.

We had a lot of people in and out of our little room today.

Some connections got made. Some new doors were opened.

We’ve been banging around like a bull in a China shop over this for too long.

It’s time to turn the page and do some real politics for ourselves and the patients we serve.

Change starts now.

One of three break-out groups speak about their experiences and search for best practices.