Category Archives: Mental Health

Drummond report mostly ignores mental health despite the high cost of doing nothing

The McGuinty government says they are committed to implementing about half of the recommendations from the Drummond Commission on the Reform of Public Services.

The other half will be subject to study (read: likely to drift away into the ether).

In health care most of that should be relatively easy given a significant number of Drummond’s 105 recommendations are already in the McGuinty government’s plan, from the implementation of a new funding formula for hospitals (Health-Based Allocation Model) to his endorsement of the government’s sketchy mental health strategy.

Given the recommendations are intended to be implemented over the next four years, it may take some time to ultimately figure out what is really in and out.

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Taxes – Let the mole people pay

Late last year the Vector Poll asked Canadians about whether they supported a 5-cents a drink tax to fund mental health programs.

This is an idea that has floated around for a while. In 2007 Senator Michael Kirby suggested a five cent tax on booze would raise $500 million a year that could help revamp Canada’s woeful mental health services.

To put that in perspective, the provincial initiative to improve mental health services for children and youth is spending about $70 million per year.

The Vector Poll has shown that of all health services, Canadians have the least faith in the present mental health system. If there is anything close to consensus, it is on the necessity for new investment in these services.

The connection between mental health, addictions and alcohol is about as clear as it gets.

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Austerity likely to create more stress-related illness in the workplace

Employers in the public sector may need to think a lot more about the state of mental health as it impacts the workplace.

A new round of restraint is likely to create heightened anxiety among those at risk of losing their jobs, and among those left behind, the threat of work overload and an upset work/life balance.

This is on top of a media environment where public service is being rapidly devalued; raising issues of esteem among those whose career choice is to serve their community.

Mental illness is already the number one cause for disability claims in the workplace.

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Drummond Report: CAMH VP supports more access to gambling?

One has to wonder about what role Susan Pigott played on the Drummond Commission for Public Sector Reform.

Pigott is one of four appointed Commissioners.

Piggott’s day job is Vice-President Communications and Community Engagement at the Centre for Addiction and Mental Health.

You would think, being one in four, her influence would have considerable impact on the final report. We read the Commission report expecting it would come out swinging in favour of good mental health and addictions policies.

And yet the Commission comes out squarely in favour of more access to gambling.

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Drummond Report: Commission relies on unfounded assumptions about hospitals

One of the assumptions of the Drummond Commission report is that if health care services take place in a hospital, it is going to be more expensive.

As Tony Randall once expounded in an episode of television series The Odd Couple, when you “assume,” underlining parts of the word on a blackboard, you end up making an “ass” out of “u” and “me.”

Under such cost assumptions, Drummond recommends anything that isn’t acute care be delivered somewhere else.

The Commissioner does not say what those services would be, but it would be safe to bet it would include rehab, complex continuing care, mental health, palliative care, outpatient clinics and diagnostics, to name but a few. That’s a lot of service to come out of our public hospitals leaving us to wonder what would be left behind?

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Students: $1,000 bursary for best logo design

OPSEU’s Mental Health Division is awarding a bursary with a twist this year. Students intending to go on to post-secondary studies towards a career in mental health will be eligible to apply for a $1,000 bursary. The winner of the bursary will be decided by a logo design competition and an essay. For more details, click here.

Canadian Psychiatric Association gets political on Harper crime bill

We’ve long been used to the Canadian Medical Association politically advocating on behalf of the nearly 60,000 doctors they represent.

It shouldn’t therefore be surprising that the Canadian Psychiatric Association has decided to go public in its criticism of the Harper government crime bill. Some say its about time.

The CPA says the Harper’s “get tough on crime” agenda may impact people with mental illness disproportionately, adding to their present over representation with the criminal justice system.

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Did McGuinty err in his mental heath campaign announcement?

Premier Dalton McGuinty might have found a better venue for his campaign mental health announcement today at the Centre for Mental Health and Addictions (CAMH).

CAMH has experienced significant layoffs over the past two years, yet McGuinty’s announcement really had more to do with support for mental health services delivered mostly elsewhere.

For the first time, however, we have a glimpse of how the Liberals plan to support mental health issues for adults.

After waiting three years for the comprehensive 10-year mental health plan, the McGuinty government instead gave us a three-year plan for child and adolescent mental health this spring. There is no question this is needed – three of four children with mental illness are going without treatment, and waits are frequently more than a year. But what about the adults?

At McGuinty’s announcement he said Ontario would commit $30 million more per year on adult mental health – but not until 2014. This surely must be a mistake on the Premier’s part.

If it’s true, this is insulting on two counts: the first forcing adults with mental illness to wait another three years before their issue can be addressed, the second being the pittance he is offering.

$30 million is a fraction of the cost of the bricks and mortar his government is putting into hard infrastructure at CAMH, North Bay, Windsor, Cambridge and other mental health facilities. If a concrete beam could provide mental health care, this might be a good plan.

This is $30 million on what by then will be a health budget of at least $53 billion (quite literally by Conservative standards). That’s .006 per cent.

Ontario lags far behind other provinces on mental health spending and it’s not even close to reaching the World Health Organization standard, which suggests eight per cent of health care spending should be committed to mental health. Ontario is a little over five per cent.

Ironically CAMH is part of the Ontario Mental Health and Addictions Alliance, which is calling for a comprehensive basket of services in every community, complaining of “wildly uneven” access.

The Alliance states: “In communities across the province, there are shortfalls in service across the many parts of the continuum including access to psychiatric assessments, hospital beds, residential addiction treatment and peer support, to name but a few.”

After a three-year plan that delivered little, the Alliance is calling for “a number of critical policy, planning, and funding capacities” at the provincial level to meet broader system reforms.

They say the needed reforms include clearly articulated goals and objectives, the capacity to plan and fund based on population need, and the ability to monitor and report on the functioning of the system. Wasn’t this all supposed to be in the 10-year plan?

The cost of inaction on this file is huge – the Alliance estimates the economic cost of mental health to be $39 billion annually in Ontario.

There is also a further question about support for mental health issues that fall outside the Ministry of Health and the Ministry of Children and Youth Services. The PC campaign shows programs outside the health and education envelopes being frozen until at least 2017, which raises questions about where the money will come from to address the social determinants of health, including supportive housing. Clearly there is some silo thinking going on in the Tory camp.

Unless Dalton misfired, the Liberal commitment appears to be a smoke screen to a public that is unaware of the scale of this problem. The NDP tell us they still support the all-party plan, which is far from being implemented. To date they have not addressed the issue publicly. The Tories say people have been lost in the mental health system, but offer no remedies in Changebook.

A year ago the three parties were all fired up about addressing the injustices in mental health. A year later nobody appears to want to talk about it.

Royal Ottawa: Is the private operator trying to push costs onto the public payroll?

Approaching its five-year anniversary, a new wrinkle has developed between the private developer and the public tenant over the cost of dieticians at the Royal Ottawa Health Centre.

The hospital has twice tried to advertise a position that should, under its contract, belong to Carillion, the P3 operator.

The blurring between public and private has been a continual problem at the mental health hospital.

Now the private consortium is trying to offload one of its costs – for an administrative dietician – on to the hospital payroll. The question is, if Carillion is supposed to be providing this service, why is the hospital being asked to essentially pay twice for the same service?

Having originally listed the position as an administrative dietician, the hospital corrected the situation by re-advertising for a charge dietician — a position that works directly with patients to recommend appropriate diets. However, the job description is still mostly that of an administrative dietician, which is responsible for working with food services in preparing the diets.

It appears the hospital and Carillion have simply changed the title to duck responsibility for the costs.

The Royal Ottawa has had continual food services problems since moving into the privatized facility in 2006. Part of the problem has been the lack of appropriately credentialed staff in food services, which is the responsibility of Carillion.

It is not the first time there has been a dispute over costs at the hospital, managers claiming after the first year that the lack of access to the services contract means they are continually asked to pay for costs our of their clinical budgets.

The Royal Ottawa Mental Health Centre opened October 27, 2006 claiming to be on time and on budget. However, staff quickly complained to the Ministry of Labour that they had been moved into the building prematurely and faced significant safety risks as construction continued around them.

After delays with the other P3 – Brampton’s William Osler Hospital – there was a significant push to validate the privatized option by showcasing the Royal Ottawa. There was also one other incentive to move in early – the private consortium would not be paid until the premises were occupied.

The ROMHC was originally designed to hold 284 beds at a cost of $95 million. It opened as a 188 bed hospital costing $146 million under the P3 arrangement.

In 2010 Carillion’s international operations posted almost $300 million Canadian in reported profit, an increase of 24 per cent over the previous year.

Long-awaited mental health strategy missing cash or timelines

It was almost three years in the making. It totals 28 pages, including pictures, cover, a few case studies and a couple of blank pages.

Open Minds, Healthy Minds is the long awaited provincial mental health strategy. Whether it ever gets implemented will depend on a fall election and a government’s willingness to expand services in a new era of fiscal austerity.

Ambitious in scope, it comes up short on specifics or even on timelines for implementation of many of the strategies. This was supposed to be a 10-year blueprint. Beyond $257 million over three years for mental health initiatives aimed at children and youth, there is no costing or financial commitment for the rest. In fact, new reporting requirements without administrative support will likely mean some mental health providers will have to divert resources to keep everyone posted on the progress of their unfunded quality improvement plans. OPSEU’s child treatment sector reports “we are already drowning in ‘justifying’ our work with limited support staff.”

Specific and funded commitments include expanding mental health supports in the school system, increased funding for community-based agencies to reduce wait times for children, expansion of telepsychiatry (video counselling) to remote and underserviced areas, and more mental health workers in aboriginal communities, the courts and post-secondary education.

The government also promises to develop performance measures for public reporting of wait times, client experiences and health outcomes – all new administrative work without any matching resources.

The government claims these initiatives will mean more than 50,000 kids and their families will immediately benefit from this strategy even though the funding is supposed to roll out over the next three years. (Curiously when they factor how many children will be supported by each initiative, it only adds up to 47,000.)

Nowhere in the report does it even mention the role of tertiary care mental health facilities, leading one to question why these facilities issued their own press release praising a plan that doesn’t include them. Given these institutions take up 60 per cent of current mental health funding, it is a notable absence.

The question of funding is central to the ambitions in the plan, especially when both the Tories and Liberals have committed to reducing health care spending increases to three per cent per year despite a growing and aging population.

The document makes note of the fact that mental health disability claims have overtaken cardiovascular disease as the fastest growing category of disability costs in Canada. The plan says workplaces should be key partners in the mental wellness strategy – adopting policies and programs that help employees enhance their mental health.

The report gleefully states: “Happier workers, higher productivity and less absenteeism – we all gain from improvements in mental health.” It is interesting the plan suggests the government work with communities and the private sector to deliver education and awareness programs and to develop best practices. Whatever happened to the public sector in this scenario?

It is not clear under a Hudak government how “happy” public sector workers will be as he tries to scale back their incomes, cut the size of the public sector by two per cent per year, make workers insecure in their employment through competitions for their jobs, or interfere in the arbitration process. This flies in the face of the plan’s recommendation to create “attractive career choices and pathways for people who work in mental health and addictions.”

As part of their effort to “create healthy, resilient, inclusive communities,” the plan calls for harmonizing policies to improve housing and employment supports, but nowhere does it actually call for an increase to supportive housing for mental health clients. It does suggest that Ontario “develop policy, guidelines and tools to match health, housing and employment resources to the needs of people with mental health and addictions problems.”

While OPSEU’s own mental health survey indicated a widespread need for workplace training in mental health both for employee wellness and to help respond to clients with mental illness, there is very little beyond a call for training to support family health care providers, teachers and first responders, including police who will receive “sensitivity training.”

The government has also put mental health workers on notice that it intends to develop a competency-based mental health and addictions workforce with standardized roles and responsibilities and scope of practice. There is no detail as to how this would function or affect existing workers in the system, including whether the government intends to provide workplace training.

No McGuinty-era health care report would be complete without the usual tools of accountability agreements, wait time targets, targeted funding increases (unspecified) and integration between providers.

There is no question that transition between providers has been lacking in the mental health system. The report speaks to the need for a client-centered approach, one that “engages the person with mental health addiction needs and includes health services, housing, employment and education, social services and the justice system, if needed.”

Let’s not forget the fragmentation that does exist is largely due to the rush to get services out of hospitals where many of the supports had already been integrated.

The plan does call for a “directory of services” to help families navigate the system as well as a plan to “identify core institutional, residential and community services at the regional and local level.” The government and Children’s Mental Health Ontario just completed a lengthy provincial mapping exercise, raising the question of whether the plan is intended to repeat this work.

In the section “building on our progress” the government admits it has only provided two base funding increases to child and youth mental health in over a decade to “support and expand core services.” Any service that gets only two funding increases in a decade is not expanding core services – it is losing ground.

In terms of leading the strategy, the government clearly sees no role for workers who toil on the front lines of mental health service delivery. Workers are not invited to sit on the Mental Health and Addictions Advisory Council.

While the report puts all the emphasis on community-based care, they acknowledge that St. Joseph’s Health Centre, a West-end Toronto hospital, has been so successful in reducing wait times for mental health visits that it now has the second highest volume of mental health visits in the city. There is no mention in the report as to whether the government is funding these additional volumes, or whether quality is being affected. At the same time, the report sets an objective of reducing “unnecessary use” of emergency departments.

The World Health Organization says governments should aim to spend 8 cents per health-care dollar on mental health. New Zealand spends 10 cents. Britain spends 8 cents. Ontario manages just 5.4 cents. While the $257 million is welcome towards addressing a long standing shortfall in children’s mental health, the money is being spread around to the extent that it may limit its overall effectiveness on any particular agency. Let’s not forget that over the three years the funding starts at $76 million and will rise in year three to $93 million. On a $47 billion health budget, this is not exactly a game changer.

For those looking for supports for the adult population coping with mental illness, Open Minds, Healthy Minds is absent of any actionable items within the next three years. Given the length of time it has taken to come up with this document, it is a bitter pill for adults seeking better to have to wait that much longer.