If ever there were evidence to suggest its time the government abandon the mental health bed targets set out in the 1990s Health Restructuring Commission, it is the skyrocketing encounters between police and Ontarians with mental illness.
According to the Toronto Star this weekend, Mental Health Act apprehensions have skyrocketed in the Ontario capital from 520 in 1997 to 8,441 in 2013.
Police can apprehend someone with mental illness if they pose a threat to themselves or others or are unable to care for themselves.
The Star notes that mental health funding has declined since the 1970s when it represented 11.3 per cent of total public health care spending. Today Ontario sits at 7 per cent – slightly below the national average of 7.2 per cent and a great distance from the goal of the Mental Health Commission of Canada to increase the share to 9 per cent. Even that recommendation is presently below what many developed countries are spending.
It’s clear from the numbers that we didn’t substitute community care for institutional care – we mostly just eliminated mental health care.
Now the results are there for everyone to see.
Last August the Canadian Association of Chiefs of Police told the media that lack of funding for mental illness was putting too many people on the streets and in contact with their officers.
“We went from the agency of last resort to the mental-health service agency of first resort,” Association President Jim Chu told the Globe and Mail. “And that’s wrong. That’s failing those who are mentally ill and who deserve better care.”
We’ve noted that plans for new psychiatric hospitals in both Kingston and London have been based on a reduced number of beds even though the existing funded beds are constantly full.*
The South West Centre for Forensic Mental Health announced May 22 that they were able to secure funding to open four additional inpatient beds. That’s four of nine beds that were planned to absorb population growth and increased need over time. Instead all those beds could be filled now. Almost half of the future capacity is now gone even though the Centre has been open barely a year.
In Kingston the Wynne government signed a 30-year $901 million agreement with a private consortium to finance, build and maintain a new 270 bed psychiatric and rehab hospital. The new hospital will have 40 fewer mental health beds than the present facility had as recently as last year. That’s the last of an ongoing legacy of bed cuts in Kingston. In 1984 there were 467 beds at Providence Care Mental Health. The new hospital will open with 120.
We reported last year that while Kingston was losing inpatient mental health beds, base funding for Frontenac Community Mental Health Services was also down slightly.
All three parties have steered away from discussion of mental health care in this election. In the May budget the Wynne government passed on a $65 million increase in mental health funding – that’s about $15 million below what it has been for the past three years. Sounding like an afterthought, the PCs say they will make mental health a priority, but offer no funding proposals or explanation of what they would do. The NDP platform has been silent on the issue and it is not among their $220 million in new investments for health care for 2014-15 and beyond.
It wasn’t that long ago the three parties were singing a very different tune. The 2010 all-party Select Committee on Mental Health and Addictions had remarkable consensus on what needed to be done.
“We have been changed by what we have heard, and are now convinced that a radical transformation of mental health and addictions care is necessary if Ontarians are to get the care they need and deserve,” the MPPs wrote in the introduction.
The select committee had recommended an agency similar to Cancer Care Ontario to ensure a single body would be responsible for designing, managing and coordinating the mental health and addictions system.
They recommended that a core basket of institutional, resident and community mental health services be available in every region.
Clients and families would have access to system navigators.
They called for more 24/7 mobile crisis intervention teams, expanding the capacity of TeleHealth to deal with mental health issues, review ER protocols, build more supportive housing, create new employment strategies, provide a full basket of mental health services to those who are incarcerated and dozens more recommendations.
As for the inpatient beds? They recommended there be a new assessment of the need for acute care psychiatric beds for both children and adults by region.
So why is it we are still building mental health facilities based on the recommendations of the Health Restructuring Commission’s 1997 report? That, coincidentally, was the year the Toronto Police acknowledged there were just 520 Mental Health Act apprehensions. Times change, so why can’t planning?
* When we suggested in February 2013 that there was overcrowding at Providence Care, Dr. Roumen Milev called it ridiculous given the hospital was built to accommodate 600-700 patients. What Milev conveniently overlooked is that the majority of those beds were not funded, limiting patients to funded wards only. Hence why we now talk about “funded beds,” as unfunded beds in empty wards are not terribly useful to patients or their caregivers.