Category Archives: Mental Health

When James Martin, a former program facilitator at Whitby Mental Health Centre (now Ontario Shores Centre for Mental Health Sciences) sent a letter to the Minister for Child and Youth Services asking about funding for the hospital’s adolescent programs, the Honourable Laurel Broten sent him a tersely worded letter suggesting he instead contact the Central East Local Health Integration Network.

The funding is linked to plans affecting an adolescent residential rehab program that the hospital has run for more than 40 years. Youth from across the province with three to seven prior hospitalizations are admitted to the program. In the past it has claimed success with teens for which the mental health system was a revolving door.

When Martin did just that, asking for a record of consultations undertaken by the hospital and evidence to support the changes, he received a letter back from James Meloche, a Senior Director at the CE LHIN.

Instead of giving Martin what he asked for, the LHIN told him that Ontario Shores had “engaged in an extensive review of their Adolescent Inpatient Services through a process that included dialogue and input from community healthcare providers, users of Ontario Shores Services, hospitals, community agencies, Ministry of Child and Youth Services, school boards, family services, as well as representatives from the Child and Youth Worker profession at Ontario Shores.”

Meloche also omitted answering his question regarding clinical evidence.

In fact, we had heard this before – from Ontario Shores itself. It’s almost word-for-word from a letter sent by Glenna Raymond in December to Keith Lindsay, President of the Ontario Association of Child and Youth Counsellors.

Our local has asked for the specific consultations and evidence-based practices for weeks. They were told it had to be prepared, even though one would have to wonder why evidence used to make a decision had to be prepared AFTER the decision was made?

This week we tried again to access a detailed record of the consultations and evidence from the Central East LHIN. We were politely told that Ontario Shores would be willing to provide it to us. We still don’t have it.

Remarkably, Ontario Shores told OPSEU’s steward on the unit the delay is because the evidence and consultation list had to be instead given to the communications department to deal with the adverse publicity surrounding changes to the units. Have they never heard of the photocopier?

Meanwhile, time is ticking on the layoffs of 28 Child and Youth workers, who will be finished by mid-April.

When we contacted the American Academy of Child and Adolescent Psychiatry – purportedly the source of this evidence according to a Dr. Wilansky-Traynor – they said they too would like to know what evidence Ontario Shores is using from their organization.

Reviewing the AACAPs guidelines for adolescent residential care, it is hard to make the connection between its recommendations and Ontario Shores’ decision to layoff CYCs, merge the short and long stay programs, and reduce access to the long stay program.  

Even though this program is not covered under the accountability agreement between the LHIN and the hospital, the Meloche letter does acknowledge that the LHIN was “apprised of the service changes.” So why are they so reluctant to share what they know or ask needed questions?

Given the LHINs were created to look at the big picture in regional health care planning, why is it they are so hands-off when it comes to a program that is province-wide in scope? The long stay program is the only one of its kind in Ontario.

Further, why is no one asking why a group of Child and Youth Workers, who are among the list of consulted, are unaware of being consulted? In fact, the workers tell us they cannot find anyone who admits to being consulted on the specific changes to the long stay program. That includes referral hospitals and agencies to the program.

And of course, as we have seen before, consulting does not necessarily involve listening.

In the letter from CEO Glenna Raymond to Keith Lindsay, she says the consultation was about increasing access to specialized assessment, stabilization and treatment services – in other words, making more short stay beds available. That’s very different from consulting on whether to effectively gut a long-stay adolescent residential rehab program that has had success for more than 40 years.

It’s time the Minister of Health and the Minister of Child and Youth Services put a stop to this nonsense and demand some real answers from Ontario Shores.

NDP leader Andrea Horwath has issued a release questioning the decision to layoff 28 highly trained child and youth counsellors at Whitby’s Ontario Shores Centre for Mental Health Sciences.

 “The McGuinty government acknowledges there is a crisis in mental health funding and has promised to fix the problems,” says Horwath. “Why is the government idle while drastic cuts are being made to the very services families need for treating their child’s mental health issues?”

Horwath, who is the NDP’s critic for Children and Youth Services, is calling for cancellation of the layoffs and protection of the existing adolescent residential rehab program.

“It appears as though the stage is being set to reduce and replace longer term residential services with short-term and outpatient programs,” she says. “For the young patients and their families, this marks a return to the ‘revolving door’ of services that experts in the field decry.”

Several prominent child psychiatrists have been critical of Ontario Shores over changes to the program, including replacing the child and youth counsellors with a smaller number of nurses, most of them RPNs. One of them, Dr. Gabrielle Ledger, resigned her post over the changes.

To read Andrea Horwath’s letter to the Minister of Health and Long Term Care, the Minister of Child and Youth Services, and the Chair of the Central East LHIN, click here:

http://www.opseu.org/news/press2010/jan-10-2011-hcrelease-letters.htm

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

Ontario moved another step closer to its much talked-about 10-year mental health strategy when the Minister of Health’s advisory group released its report just prior to Christmas.

The road to Ontario’s 10-year mental health strategy has been a lengthy one. In October 2008 then Health Minister David Caplan established the advisory group to recommend how the province could improve mental health and addiction services. It released a discussion paper, Every Door is the Right Door, in July 2009. An all-party select committee of MPPs also worked on its own recommendations, released in August 2010 as Navigating the Journey to Wellness: The Comprehensive Mental Health and Addictions Action Plan for Ontarians.

December 20 the final recommendations of the original advisory group were released in a slim 45-page report: Respect, Recovery, Resilience: Recommendations for Ontario’s Mental Health and Addictions Strategy. The government’s final plan is expected in the spring of 2011 – two and a half years to establish a 10-year strategy.

Work on the 10-year strategy was also contracted to a private consultancy firm and subject to comment last fall by the office of the Auditor General of Ontario. The auditor noted the first two phases were contracted without competition. The third phase was put out to competition and awarded to the same company despite the fact that it was the highest bidder at $819,000. The scope of the work was reduced to bring the bid price to $495,000, still well above the budget of $375,000.

How much of the advisory group’s recommendations will be used in the final plan is an open question given it differs substantially from the MPPs recommendations.

The slim 45-page document gives little detail despite some very significant recommendations.

Unlike the MPPs report, which calls for a centralized administrative model similar to Cancer Care Ontario, the Minister’s working group is recommending the creation of a much more limited Mental Health and Addictions Council which would have “clear authority and resources” to set the pace of implementation, develop guidelines and standards that reflect all “human services,” and promote quality improvement. This Council would report to the Ministry of Health and Long Term Care. It would include representation from a broad base of sectors, including children’s and youth services, justice, municipalities, school boards, Local Health Integration Networks (LHINs), hospitals, physicians, and community mental health and addiction services.

The Advisory Group is also silent on many of the recommendations made by the MPPs, from the need for system navigators to increasing the number of mobile intervention teams. Whereas the MPPs recommended the need to do an assessment on the need for acute care psychiatric beds for both children and adults by region, the Advisory Group totally ignores any question of beds or tertiary care hospitals. In its diagram of how the new system will work, there is no specific reference to tertiary care hospitals.

The report is also silent on the issue of moving children’s and youth mental health to the Ministry of Health and Long Term Care.

What is striking about the report is the lack of evidence to support the changes they are recommending, or any indication that other options were examined.

Given the low key release at a time of year usually used to bury embarrassing details – such as the Ombudsman’s mini-report on long-term care – it is possible the government may be working on a different track altogether.

The advisory group does make a number of recommendations around human resources planning, including a review of current remuneration levels with the sector along with an implementation strategy to address inequities. While the report doesn’t indicate what those inequities are, there is no question that many small non-union agencies have difficulty attracting and retaining skilled workers at low levels of pay.

They also are calling for a more culturally diverse workforce, hiring more peers support workers, and for an increase in training aimed at existing workers, particularly around early identification and intervention and concurrent disorders.

The one profession it specifically calls for more of is mental health youth court workers.

The report acknowledges that Ontario spends less than “most other G8 nations.” Given the present period of restraint, the group suggests we may not be spending what we have “in the right way.” While it makes many sweeping and expensive recommendations – such as increased OHIP compensations for family doctors, widespread anti-stigma programs covering everyone from front-line health care workers to employers and landlords – it never addresses what any of this will cost. 

The working group also recommends a new Assistant Deputy Minister (MOHLTC) who is dedicated to implementation of the 10-year strategy.

There is clear emphasis on fulfilling the promise of funding community-based mental health services, a promise that has met much scepticism given the recent track record in Ontario. Recommendations include extending the hours of community-based agency work from 7 am to 11 pm.

The report calls for more standardization, particularly around intake and assessment, more measuring of outcomes, and the establishment of wait-time targets for mental health services.

The report puts considerable emphasis on this being an all-government initiative. There is strong buy-in on social determinants, which would touch on such issues as poverty, housing, and education.

To view the full report, go to:

http://www.health.gov.on.ca/en/public/publications/ministry_reports/mental_health/mentalhealth_rep.pdf

WHITBY – Twenty-eight full and part-time child and youth workers are facing layoff at Ontario Shores (formerly Whitby Mental Health Centre) despite four decades of success with some of the province’s most difficult to place youth.

The Ontario Shores Adolescent Residential Rehab program has turned around the lives of youth who had previously found the province’s mental health system a revolving door. The program provides therapy to youth for periods of up to six months in a residential setting. Most of the youth in the program have had three to seven prior hospitalizations. Last year there was an average wait of 44 days to get into the program.

While the hospital has told patient family members that the program is merging with the shorter stay transition program, the large layoff suggests the staff mix is being altered away from highly trained child and youth workers to more general health care nursing staff.

“These workers graduate from a three year accredited program that looks at everything from child-protection legislation and children’s rights to therapeutic recreational programming and advanced therapeutic interventions,” says Warren (Smokey) Thomas, President of the 130,000-member Ontario Public Service Employees Union. “They will be soon replaced by general nursing staff who have been given very little of this specific training. How does that improve quality?”

The union is also concerned that fewer long term beds will be available for youth in need.

Two-thirds of youth in the program come from outside the boundaries of the Local Health Integration Network, suggesting how unique it is within the province’s mental health continuum.

The union is concerned that lives are being endangered by a short-sighted move that will likely not save money.

“For these youth, this program ended the revolving door,” says Thomas. “Instead any minimal savings from this action will likely be multiplied many times over as costs to elsewhere in the system.”

OPSEU has written to the Minister of Health and Long Term Care asking that the program be left intact and expanded to meet need. It has also asked the Minister to assure families that quality of care will not be jeopardized by replacing these skilled workers with staff who do not possess similar skill sets.

Coverage from CHEX-TV:

OPSEU recently called upon the provincial government to ensure timely access to mental health and youth services following a series of suicides in the Sarnia community.

OPSEU joined community members in calling for change following statistics showing higher-than-normal suicide deaths this year at a November 10 press conference in Sarna. Fourteen youths have taken their lives in that community.

“We’re drowning,” says Deb Gordon, Chair of OPSEU’s Child Treatment Sector. “In the past six months, St. Clair Child and Youth Services have received 34 crisis referrals from youth who had suicidal ideations or who have planned or attempted suicide. That is more crisis referrals than we received in an entire year from March 2009 to April 2010.”

Teen bullying and suicide have been in the media spotlight recently as several Hollywood celebrities have drawn attention to a topic often overlooked. Although the reasons can vary, homophobia and bullying are major contributors to teen suicide.

“I believe there is a direct relationship between the funding crisis and the crisis with children and youth in this community.” said OPSEU President Warren (Smokey) Thomas. “There has been no increase to core funding for children and youth mental health services in 14 out of 17 years.  What that translates to is a 35% reduction in capacity to be responsive.”

Ontario government has neglected youth mental illness leaving Ontario families to cope on their own. 

One in five children and youth meeting the criteria for mental health diagnosis but the majority of children will go untreated.

The press conference included OPSEU President, Warren (Smokey) Thomas; Sahar Nasr, President, Board of Directors, St. Clair Child and Youth Services; Peter Smith, Chair, Children’s Mental Health Advocacy Committee of Sarnia-Lambton and Deb Gordon, OPSEU Child Treatment Sector Chair and staff member at St. Clair Child and Youth Services.

By the numbers:

– The average wait time for youth mental health services in Ontario is five months.
– More than 90 per cent of suicide victims have a diagnosable psychiatric illness.
– Someone in the world commits suicide every 40 seconds, according to the World Health Organization.
– Canada suicide is the second leading cause of death in the 10 to 24 age group. The aboriginal youth suicide rate is four to six times that of non-natives.
– Ontario there are about 1,000 suicides every year. The Ontario Association for Suicide Prevention believes the real number is much higher.

September 22nd the South West LHIN approved transfer of 50 mental health beds from Regional Mental Health – London to Kitchener’s Grand River Hospital. Staff are expected to transfer through the month of October, the patients at the end of next month.

The so-called “integration” was expected to go through, and after a botched summer of negotiations between the sending and receiving hospitals, OPSEU did not want to oppose the transfer and leave 56 members further dangling between Kitchener and London.

The workers were originally told they would transfer to Kitchener September 1st, however, St. Joseph’s Health Care was premature in sending letters to staff before an agreement had actually been reached between the hospitals.

During the LHIN Board meeting, Dr. Michael Bryant raised a key point that OPSEU had made in its “No Place To Go” report distributed the day before. The pivotal underpinnings of the redistribution proposal go back to the Health Service Restructuring Commission. While the recommendations emerged in 1997, the actual data it was based on came from 1993.

Given it is 2010, Bryant suggested that best practices have changed considerably in the intervening time, casting doubt on the effectiveness of continuing to follow such dated recommendations.

He also took on the hospital’s assertion that the region will meet the target of 35 mental health beds per 100,000 residents. Bryant pointed out that taking such a blanket approach to planning failed to take into consideration the demographic profile of cities and towns within the LHIN. Bryant said that communities with higher levels of poverty, for example, would have a greater need for beds than a wealthier community.

Bryant is no dilettante when it comes to health services planning. According the LHIN website, Bryant is a professor at The Ivey Business School at the University of Western Ontario, where he conducts research in the area of health care management. He has held academic leadership positions at The Ivey Business School and The Rotman School of Management at the University of Toronto.

OPSEU’s report “No Place To Go” was distributed the day before to the LHIN Board. SW LHIN Senior Director Kelly Gillis invited the board to read the report, suggesting OPSEU had done a good job of framing the outstanding issues.

Now that the transfer to Kitchener is out of the way, it is hoped the SW LHIN will take a fresh look at the rest of the plan, which presently includes a considerable loss of mental health beds to the region.