The formal recommendations around addressing the challenges of mental health always seem to get it right. So why is it that we never get beyond the nice words from politicians who claim to understand?
This Friday mental health professionals and support staff at Providence Care Mental Health Services – the former Kingston Psychiatric Hospital – will be taking their case public. The staff will be holding an information picket outside their hospital to let Kingston residents know of the volatile situation they face on a daily basis.
Overcrowding, program cuts, and understaffing – mental health services in this province weren’t supposed to be like this.
For all the talk of making things better, decisions still appear to be based on austerity-driven budgets, not on improving care for patients.
A provincial all-party select committee on mental health had unanimously agreed in 2010 that we need to do better so that all Ontarians get the mental health and addictions care they deserve. That includes regional assessments on the availability of a complete basket of mental health services, including acute inpatient treatment.
The all-party committee particularly noted that presenters had told them admission and discharge decisions were becoming motivated not by clinical need, but by the shortage of available beds.
Yet at Providence Care Mental Health Services (the former Kingston Psychiatric Hospital) we have seen continual cuts to services, to the point where very little recreational and vocational programming is left at the hospital. This year an additional 60 beds are expected to be cut along with the services and staff associated with them. This is not addressing a long-standing need, but compounding an already tragic set of circumstances.
The tension created by the cuts has led to a volatile situation inside the hospital. In the absence of programming and appropriate staffing, 142 assaults on staff were reported in 2012 – 85 per cent involving physical violence. That’s one every two or three days. We know that most assaults go unreported. The hospital does not provide us with statistics regarding patient-on-patient assaults, although the detailed staff reports include situations where staff are assaulted while trying to prevent harm to those in their care.
A recent consultants report makes recommendations that will only compound the situation, including a suggestion that the hospital not replace ill staff who normally work evening shifts, raising questions about ongoing safety.
When Kingston’s new privatized hospital is built to replace Providence Care and St. Marys Of The Lake, it will have 270 beds. The present hospitals have a combined 342 beds. Where will the patients that normally occupy 72 disappearing beds go?
The additional challenge of moving lighter care patients into community-based settings is it increases the concentration of patients who are likely to exhibit disruptive behaviours. As this takes place, hospitals need to adjust staffing and take appropriate precautions. There is a partial model for this already — long-term care homes are funded based on the acuity level of residents. The more demanding the resident population, theoretically the higher level of funding (although basing this on comparative averages is flawed — it means nobody gains if acuity rises across the board).
The province has maintained that such cuts to psychiatric hospitals really represent transfers to the community – that was the recommendation of the Health Restructuring Commission of the 1990s.
The Commission set targets for reducing beds under the proviso that community-based services first be established. The beds were cut – meeting the provincial target of 35 beds per 100,000 population in 2008. According to the Queen’s Park all-party committee, the “funding has not followed people from institutions to the communities.” In order to maintain the target for deinstitutionalization, the Ministry determined that 60 per cent of mental health funding would have to be community-based. According to the 2008 provincial auditor’s report, the province spent about $39 on community-based services for every $61 spent on institutional services in the mid-2000s.
Have we seen the province since honour that pledge? Hardly. After working for years on a 10-year strategy for mental health, the province delivered a much more modest three-year strategy for children and youth only. Adults suffering from mental illness were told they would have to wait.
If we already met the provincial target for bed reduction in 2008, why are we still seeing bed cuts in places like Kingston and London? Given these targets were established more than 20 years ago, isn’t it time for a new assessment, as the provincial all-party select committee had recommended?
There have been plenty of warnings about the rising need for mental health services due to a growing and aging population. The Alzheimer’s Society has been telling anyone who will listen that the number of Ontarians with dementia will double in less than 25 years. Studies have linked societies with higher levels of inequality with a greater prevalence of mental illness, and yet we are escalating levels of inequality in this country through wrong-headed decisions made by both Federal and Provincial governments.
Our need will be great. What will these services be like by the time we need them?
If you are in the Kingston area, come out and support these workers on Friday from 11 am to 1 pm in front of the hospital.