Psychiatrist quits job, calls changes at Ontario Shores 30 years out-of-date

WHITBY – Changes to Ontario Shores’ adolescent program are 30 years out-of-date says Dr. Gabrielle Ledger, a Bowmanville psychiatrist who quit her job last month at the Whitby psychiatric hospital.

In a public letter, Ledger says she quit her job at Ontario Shores Centre for Mental Health Sciences as a direct result of changes being implemented there.

In December Ontario Shores issued layoff notices to about half of its child and youth workers as part of a merger of the short and long-stay adolescent programs. The long-stay adolescent residential rehab (ARR) program has successfully worked with youth from across the province that have had between three and seven prior hospitalizations.

“In my opinion, this proposed change reflects the hospital’s attempt to apply an adult model of mental health services to a non-adult population,” she writes. “This is a significant step backwards towards a model that is thirty years out of date.”

Ontario Shores plans on replacing about 28 child and youth workers with nursing staff providing a very different model of care.

Ledger says the adolescent programs at Ontario Shores are staffed by an experienced team of professionals who have collaborated for more than 25 years.

“Unfortunately the recent decision made by the administrators of this newly divested hospital suggests that they may be unaware of the history of the programs and the careful evolution that occurred before their tenure at Ontario Shores.”

Ledger is not the first health professional to speak about the move.

Dr. Krista Lemke, Medical Director of Child and Adolescent Mental Health Services a the Toronto East General Hospital, stated in a December letter that while nursing staff are equally essential team members and contribute their own unique skills, they often require additional training in child and adolescent mental health.

Lemke writes: “From a human resources perspective, this was a well-functioning team, capable of providing high quality care to a particularly vulnerable population of adolescents. It saddens me greatly to hear that this unique team no longer seems to be valued and may be largely disbanded.”

The complete text of the letters is available at http://www.opseu.org/news/press2010/jan-10-2011-hcrelease-letters.htm.

The Full text of Dr. Ledger’s Letter:

 Dec 26, 2010

To whom it may concern:

I am writing to outline my significant concerns regarding the changes underway in the Adolescent Program at the Ontario Shores Centre for Mental Health Sciences. I was previously the staff psychiatrist on the adolescent Assessment, Stabilization, Treatment and Transition (ASTT) program from September 2009 until December 2010. I resigned from my position as a direct result of the changes currently being implemented in this program.

My colleague, Dr. Krista Lemke, Medical Director of Child and Adolescent Mental Health Services at Toronto East General Hospital has recently written a letter outlining her concern that the impact of the changes underway in the Adolescent Program at Ontario Shores will be felt throughout the continuum of children’s mental health services in the province. I share her concerns and hope to expand on them in this letter.

As of December 13, 2010, the administrators of Ontario Shores have declared their intention to replace two thirds of the current frontline staff, Child and Youth Counsellors, with nurses. As a specialist in the field of children’s mental health, I am keenly aware of the differences in training and expertise of these two groups of professionals. They serve unique but complimentary roles in delivering high quality health care for our provinces most vulnerable youth. Their roles, however, do not overlap to the extent that one group can be replaced by the other. I fear that those proposing this exchange are insufficiently aware of the specifics involved in caring for mentally ill children. In my opinion, this proposed change reflects the hospital’s attempt to apply an adult model of mental health services to a non-adult population. This is a significant step backwards towards a model that is thirty years out of date; the child and youth counsellor representatives in inpatient children’s mental health programs are the product of a long, healthy evolution.

Another significant change already implemented in the adolescent inpatient programs at Ontario Shores concerns the elimination of half of the social work positions. This occurred in early 2010 and was the first decision that shook my confidence in the decision-makers at Ontario Shores. Inpatient adolescent mental health programs utilize social workers intensively. The most unwell young people admitted to psychiatric hospitals in Ontario deserve expert assessments of the family dynamics affecting their illness and their recovery. Once again, applying an adult mental health social work staffing model to youth is inappropriate.

Finally, the decision to eliminate the longer term Adolescent Residential Rehabilitation (ARR) program at Ontario Shores further reflects a lack of understanding of the unique function of this highly specialized program within the province. The program offers young people diagnosed with illnesses such as schizophrenia an opportunity to attempt a gradual reintegration to life outside the hospital setting by building a bridge to the rest of the world. Programming in ARR (designed by the child and youth counsellors) facilitated a progressive and successful return to social, family and academic functioning outside of the institution, but within the safety of the hospital and prevented repeated “bounce-backs” when young people return to crisis and require readmission. Sadly, one gradual but successful attempt at reintegration is less financially rewarding to institutions reliant on “results-based funding” wherein the revolving door pays.

The adolescent programs at Ontario shores are staffed by highly skilled, extremely experienced teams of professionals, some of whom have collaborated for over 25 years to carefully craft the best treatment for the most marginalized and most vulnerable youth. Unfortunately, the recent decisions made by the administrators of this newly divested hospital suggests that they may be unaware of the history of the programs and the careful evolution that occurred before their tenure at Ontario Shores. It saddens and concerns me that the transformation of the adolescent programs at Ontario Shores may be taking place without benefitting from a sophisticated understanding of the past, present and future of adolescent mental health.

Sincerely, Gabrielle Ledger, MD, FRCPC

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