Mental health: Death should prompt MOHLTC to look upstream at root causes

It’s time for the Ministry of Health to look at the root causes behind the violence and injuries that are taking place in the province’s hospitals that provide mental health care.

Given persons who are mentally ill are no more statistically inclined to be violent than anyone else, clearly something is changing in these settings to push reports of violent incidents upwards.

While the union is privy to statistics around injuries experienced by its own members, we do not see the parallel data around patient-on-patient violence.  Why is it one can go on-line and look at the record of critical incidents at a long-term care home but not at a psychiatric hospital?

Sadly, workers being injured in such incidents barely make the news. Some believe that getting punched, spit at or slammed against a wall is part of the job (it shouldn’t be). Hospital managers and Ministry of Labour officials have shown little sympathy for workers suffering from post-traumatic stress disorder — surprising given where this is taking place.

Workers at these hospitals tell us repeatedly it’s just a matter of time before someone dies.

In fact, that time came this spring.

A 30-year-old schizophrenic patient at Hamilton St. Joseph’s Health Care was tragically beaten to death in May. Another patient subsequently pleaded guilty to manslaughter and was given an eight-year sentence.

Instead of prompting change, St. Joseph’s said they conducted a thorough assessment and concluded the event was unpredictable and therefore couldn’t have been prevented. That is at odds with the fact that the same review produced 11 recommendations from the incident, including a review of security.

This denial of responsibility may have more to do with the fact that the family of the deceased are now initiating their own legal action against the hospital.

Workers at St. Joseph’s had been warning of such an incident after a registered practical nurse at the hospital had been beaten beyond recognition two years earlier. CUPE issued a press release stating that the death was linked to overcrowding, understaffing and lack of security. They are now asking for a Coroner’s investigation.

At Ontario Shores Centre for Mental Health Sciences OPSEU’s complaints last year led to a lengthy investigation by the Ministry of Labour. In May, the labour ministry handed the hospital a lengthy list of orders intended to prevent workplace violence. Despite persistently high numbers of reported violent incidents and injuries, the Ministry of Labour decided not to prosecute the hospital under the Occupational Health and Safety Act.

If this was a factory and not a psychiatric hospital, the decision would have likely been very different.

Despite proceeding through a lengthy work plan resulting from these orders, some front line workers still feel betrayed. Many took time to speak to the Ministry investigator and were assured change would come.

Little appears to have changed on the units despite the orders. Incidents continued to pile up over the summer and look similar to last year’s terrible results. The Durham police also went public on the issue – noting earlier this month calls to Ontario Shores had added up to 438 hours of police time so far this year.

A member of the police services board has openly asked “who is running this place?”

If there is any hope, it is around the arrival of health and safety consultant Tim Savage to Ontario Shores. Savage has almost 30 years’ experience dealing with health and safety issues and is well-known within the sector. However, Savage’s scope to bring about change will be limited.

When the Ministry of Labour began its investigation at Ontario Shores we said the Ministry of Health should do the same. We heard of circumstances that may be adding fuel to the situation, including the loss of recreational and programming support at the hospital.

This year we heard similar stories coming out of Providence Care in Kingston. Like CUPE’s St. Joseph’s members, we were told that overcrowding and understaffing is creating a volatile situation inside. Late this summer we learned the hospital plans to lay off even more staff and cut beds that are badly needed. Nearly one in five workers will soon lose their jobs at the former Kingston Psychiatric Hospital.

Hospitals providing mental health services are under the same level of restraint as everyone else. That’s zero-base funding. While the major psychiatric hospitals finished last year fiscally in the black, that may not be the case at the end of March 2014. That will likely lead to more bed cuts.

Similarly, OPSEU members who work in the province’s long-term care homes are saying their facilities are not prepared for the downloading of patients from the psychiatric hospitals. They are experiencing similar levels of rising violence as a result.

The Ministry of Health needs to take a hard look at this situation. The focus on reduced use of physical and chemical restraints is laudable, but they also require alternative measures to keep staff and patients safe. Austerity may be also a contributing factor as fewer workers and cuts to programming can lead to a more volatile workplace. As fewer beds are made available, psychiatric hospitals may also be facing a concentration of much more acutely ill patients who simply cannot be cared for in the community.

There may be other factors at play.

That’s where the Ministry of Health should play a role. We know that looking upstream can yield tremendous benefits to the system. Instead the Ministry appears to accept the cost of the injuries, the lost time, the stress, and in at least one case now, the death of a patient.

Clearly we could be doing better for both patients and staff in these settings.